Thursday, March 30, 2017

Dissociation as the hallmark of trauma

Because Adrienne Harris so eloquently discussed intergenerational transmission of trauma on March 18, 2017 at the Tampa Bay Psychoanalytic Society [see 3-21-2017 post], I thought I might share a bit of what Bruce Bradfield’s wrote on the subject:

“[P]sychic trauma...attempts to make meaning out of a phenomenon that resists knowing. … [D]issociation [i]s a primarily relational process, which keeps traumatic experience
unformulated and ambiguously signified in both the mother and her child. … [It is] a defense against intolerably painful affective states,which manifests in the mother’s intrapsychic experience, and in the relationship between mother and child…[T]rauma [is] experience that overwhelms the individual with inassimilable affects.

“[E]lements of parental traumatic experience are passed on to their children …and… subsequent generations. …[D]issociation is a consequence of a disruption of the parent’s caregiving capacity. [The parent’s] disrupted capacity to be emotionally attuned to the child ...[and] may impact on the child’s expectations[.]... [W]hat may be dissociated are not only the emotions associated with the parent’s trauma, but also the child’s need for relationship with the parent. …[T]rauma [is] communicated through patterns of relationship. … [C]hildhood interpersonal trauma has implications for the development of a particular disruption in lived experience [going on being], affecting attachment relationships directly. [There is] a relation between attachment style and posttraumatic responses.

“[A]ttunement within the relationship between mother and child facilitates the development of a capacity to integrate and contain painful emotions. … [D]issociation [is] an experience of disruption of the... capacity to integrate painful affective experiences. [D]issociation [is] manifest in future interpersonal relationships. …[and] reflects the incommunicability of traumatic histories, with trauma being held in familial and individual narratives as something unformulated and nameless.”

Thursday, March 23, 2017

Survival, Destruction, Attachment and Going on Being, and Sexuality

Winnicott wrote of the importance of the mother’s survival (neither retaliating nor withdrawing) [see post of 2-28-12] of the the infant’s aggression, but, lest we forget that the mother does not survive unscathed, Harris [see post of 3-21-17] referred us to Ogden’s Destruction Reconceived (1) in which Ogden states that the destruction must succeed in part, that is, the infant must know he has an impact. Referring to Winnicott’s ‘The Use of an Object and Relating through Identifications’ Ogden writes:

.... In my reading/writing of the paper, the mother becomes real for the infant in the process of his actually destroying her as an external object (destroying her sense of herself as an adequate mother), and his perceiving that destruction. She also becomes a real external object for the infant in the process of his experiencing the psychological work involved in surviving destruction, a form of work that does not occur in the world of fantasied objects. The analyst or mother may not be able to survive destruction. It is essential that the analyst be able to acknowledge to himself his inability to survive and, if necessary, to end the analysis because of the very damaging effects for both patient and analyst of prolonged experience of this sort.

In discussing Winnicott on bisexuality (2), Harris considered - for Winnicott’s patient-  the conditions for going on being, to feel continuous in time. She considered that Winnicott’s patient’s mother’s “madness,” intergenerationally transmitted to the patient, might include a break in her going on being-ness. Then I had what I thought to be an exciting thought about attachment. Schore writes that attachment is affect regulation (or, conversely, that affect regulation engenders attachment) but what if attachment is also the capacity to be sufficiently present (hold in mind the infant) such that the infant experience a continuous going on being? Failure of the mother to go on being vitiates, maybe momentarily annihilates, her ability to facilitate her infant’s going on being, leading to disorganized attachment.

Another exciting thought of the day came from Peter Rudnytsky. Harris was discussing the “excess” of sexuality which Ruth Stein wrote was “essentially traumatic” for the infant and Peter mused: shouldn’t a ‘good enough’ mother be able to help the infant regulate this ‘excess’? [just as she does for other excesses, such as hunger. That is, what makes sexuality so unique that it cannot be contained and managed within a good enough relationship? Have we really returned to essentialism to give sex such a boogeyman status?]

2. Winnicott, D.W. (1971). Playing and Reality. London: Tavistock Publications. The Split-Off Male and Female Elements to be Found in Men and Women p.72

Tuesday, March 21, 2017

The Analyst's Self-care; Ghosts, and Witnessing

The local (Tampa Bay) psychoanalytic society had the pleasure of hosting, on March 18, 2017,  Adrienne Harris, renowned psychoanalyst and author, known for her work on gender and, more recently, on the analyst’s ‘ghosts,’ that is, what ‘haunts’ the analyst and makes her or him less able to see the patient’s ghosts. Ghosts are a sign of blocked mourning of what has been lost or never was, but also, pointedly, about the confrontation with the limits of our immortality/omnipotence by the knowledge of the finality of death.  

This countertransferential problem of ghosts may be aggravated by the analyst’s overlooking the importance of self-care. Therapists get so interested in taking care of others that they often ignore their own self-care. Citing Lyons-Ruth, Harris reminded us that children with disorganized attachment can cope by becoming disorganized, and, later, our patients, or they organize the best they can and become caretakers of their parents (what Lyons-Ruth called “tend/befriend”) in a “precocious maturity” and, later become therapists and other caregiving professionals.

Rey noted that many of his psychotic patients sought not to change themselves but, instead,  to repair damaged internal objects from their childhoods. Apprey called this the “pluperfect errand,” an impossible task to go back and fix the other of the past. Harris said, therapists, too, may have an unconscious hope in our mission as analysts, which is “organized around our omnipotence,” to help others. “Some therapists have masochistic levels of commitment” to their patients, where they will try to do anything to intervene or help their patients. This penchant also may come with an increased capacity to be attuned to others. Harris mused about one version of the Greek myth of Philoctetes: that he could only be a perfect archer if his wound remained unhealed.

Unfortunately, self-care may be circumvented by the shame felt over needing, neediness, the shame of disappointed or unfulfilled need, as if all are not entitled to self-care.

Harris also talked about “Ghosts and Demons in the 21st Century.” She asked, “How do cultures come to terms with impossible betrayals?” and noted that “ghosts proliferate when there is no witness” to trauma. Ferenczi had also pointed out in Confusion of Tongues that the lack of a witness is as catastrophic as the traumatic event itself. Harris cited Ireland’s great famine. When catastrophe goes unwitnessed, it reveals itself in symptoms (e.g. alcoholism), sometimes generations later. “Melancholia is a hallmark of ghosts.” These “ghosts are lived through enactments, carrying and reproducing historical trauma.”

Another unwitnessed or insufficiently witnessed historical catastrophe is US slavery, its unfaceable and unspeakable horrors more recently coming to light. Stalinism, too, went long unwitnessed, with its subsequent flourishing of “the grotesque,” the admixture of horror and comedy, in art and literature.

Tuesday, March 14, 2017

Where is the pre-oedipal father in psychoanalyic theory?

Freeman advocates for increased conceptualizing of the pre-Oedipal father in psychoanalytic theory. Freudian psychoanalysis placed the Oedipus complex at the foundation of neurosis: “from its inception, psychoanalytic theory has been thoroughly imbued with allusions to the symbolic power of father…[m]ost the formation of the individual psyche [the Oedipus complex] and of civilization itself” [the superego], yet requires the relative absence of the  pre-Oedipal father for its theory, an assumption now questioned, as well as found to be constraining on men, and unnecessarily gendered. Freeman finds a “curious tension between the symbolic presence and substantive absence of fathers… embedded at the heart of psychoanalytic theory.” (Yet psychoanalytic theory represented this pre-Oedipally absent paternal authority in the so-called phallic mother.) 

The paradox: father, the “absent authority”, is relatively absent in psychoanalytic discourse, yet the “symbolic weight” of the father in psychoanalytic theory overlooks the “exclusive presence of the the lynchpin of early childhood development.” (Klein first turned our attention to the mother-infant dyad, but its importance was previously overshadowed by the Freudian idea of the Oedipus complex where the child must repress earlier fantasies, developed in the relative absence of the pre-Oedipal father, and “ the moral order represented by the father” which will then give rise to the child’s separate identity and morality. The disembodied father was also emphasized by Lacan: the “real father” distinguished from the “symbolic father” or “the-name-of-the-father.”)

In the Oedipus complex, “the child’s initial confrontation with the father is marked by aggressive resentment and fear”. This pejorative take means the boy reveres and resents the father. Freud ignored or denied the early paternal-infant interaction. For the boy, father arrives on the scene and severs the mother-infant engulfment (and risk of incest). The boy "turns... toward culture” as if the father  psychologically birthed the child [just as Zeus, from his head, birthed Athena]. (Western religion, too, emphasizes the symbolic role of the Father (God) as procreator.) The girl, however, disavows her mother for bringing her into the world without a penis. In actuality, father’s role is not merely as authority, but also includes “containers, protectors, facilitators, models, challengers, initiators, sanctioners, and mentors.” including “a prenatal role (father as “mother-facilitator”), and pre-oedipal roles (e.g., “identification” and “gender identity”).”

It is the quality of parenting and not the gender or sexuality of the parent which is important. Freeman questions psychoanalytic theory’s gendered Oedipal theory which serves to suppress female sexuality and to deny male “access to the psychological vocabulary of love and emotional connectedness that define the maternal sphere.” She notes the male dilemma: “the expression of involved forms of fatherhood ... would at once provide emotional relief from the inevitable “discontents” of civilization while presenting a painful threat to masculine identity within a patriarchal culture. … Rather, parenting is identified as a form of compensatory pleasure for mothers alone”.  Freeman makes a point for the benefits of both parents participating in child-rearing.

Thursday, March 9, 2017

Envy Revisited: From intrapsychic to relationally co-created intersubjective envy

Envy was originally conceived as a derivative of the death instinct (Ego psychology, drives). Eventually environmental failures were posited as causes of envy (Object relations, Self psychology), and envy is now seen as coming out of the intersubjective matrix (Relational). Segal posited that need (in neediness envy) might be met in relationships, or it might be denied, with deadening effect. The authors conversely note that denial of need might not be deadening, but an attempt at self preservation in the face of environmental (relational) failure, as noted by WInnicott. [Chronic denial of need (and desire) can lead to an existential emptiness, deadness.]

In the clinical situation, an area for envy is when the patient envies traits, imagined or real, of the therapist (patience, or equanimity, or friends, or a family life) which the patient does not possess, or vice versa. Sometimes envy, whose neediness is shaming by revealing the imperfect or incomplete self, makes it hard for one to accept something from the other, except perhaps to grab and steal it. The acceptance and containment by the self of envy allows one to feel sadness and loss for what one does not have. Some people feel chronically deprived.They may wonder why others have love or friends or accolades, and ‘Why not me?” They may hold no hope for their future, for getting what they want, except sometimes when they are demanding. When envy is present in patients, they may criticize others and the therapist; they may accuse the therapist of withholding help and care. [Because of the unpleasantness of their chronic criticism, patients may be accurate about the therapist’s withholding.] A patient’s deprivation and envy may leave the therapist feeling guilty,frustrated, incompetent and helpless. Fees are also fraught with envy dynamics, for either party. The patient can have much more income than the therapist, or much less.

“Envy attacks the links of relationships” rejecting what is given to avoid admitting need, eschewing mutuality and reciprocity because separateness seems unbearable. Narcissistic envy destroys meaning and creativity, because, say the authors, progress means moving toward death. [Perhaps, it destroys creativity because it is an injury not to be born, like Venus on the halfshell, fully formed.] They conclude, “The capacity to contains the pains of envy serves to reconstruct or create a link in which the pathological envy that destroys the linkis transformed into an awareness and a recognition that subjects are immersed in the endless dialectic of sameness and difference. They therefore constantly compete, desire, and attack each other in the intersubjective encounter. This awareness becomes synthesized into a synthetic whole  of love and hate, enriching and destroying, recognizing and separating and knowing.”

Shoshani, M., Shoshani, B., Kella, R., Becker, M. (2012). Green Eyes, Crows, and Scorpions: Envy in the Contexts of Neediness, Separateness, and Narcissism. Psychoanal. Psychol., 29:440-458.

Three Forms of Envy

Shoshani, et al delineate three forms of envy: neediness, separation, and narcissistic. They illustrate their ideas with clinical cases illustrating how dissociated parts are regained and how the therapeutic dyad can help contain envy. The authors conceive of envy both as a drive and an intersubjective co-creation, “as both an object and a relation,...coexisting without being mutually exclusive.” They see these two as a dialectic, that is, “each creates, destroys, and re-creates the other...”

In citing Klein and Segal, the authors note that both Klein and Segal saw envy as partly constitutional deriving from aggression and the death instinct and is the wish to take away and/or destroy something desired that another person possesses. Envy, said Segal, is derived from both need and admiration of that which is desired. They see Spillius as adding a more relational aspect, noting that no one is comfortable with envy.

The authors find it “clinically useful to conceive of malignant envy as one of the leading anxieties,”  a “disintegrating feeling” that  humans are “desperate” to avoid and thus “evoke hatred, cruelty, blindness, narrow-mindedness, self destruction, and destruction of the other
both as expressions of envy and as a means of counteracting its devastating influence.”

Neediness envy, “results from the realization that the other has something we need but do not have” and the wish to be connected to the other includes the wish to secretly posses the coveted possession. In Othello, envy, “the green-eyed monster,” is directed at the nurturing other and includes the wish to devalue/destroy the other. “[T]he most  consuming aspect of envy is the one directed against the person who gives us what we so desperately need but feel helpless to provide ourselves with.” (The authors consider jealousy triadic, and envy dyadic, thus interpreting Shakespeare’s ‘jealousy’ to really be envy.) Neediness envy arises from recognition by child that I am small and needy.

Separateness envy results from the “dependency on the other who is separate from me, has a mind of his or her own, and who is not in my possession” [under my control]. Here the wish to be connected includes eliminating separateness through merger. The author’s use Tolstoy’s The Kreutzer Sonata and its protagonist’s envy and hatred toward his wife as an example of “imprisoning and objectifying the other.” He finds his wife’s subjectivity (separateness) so unbearable that he murders her.

According to the authors, separateness is the precondition for envy, as when when the child discovers it cannot control its mother, and gives rise to all three forms of envy, including invidious comparison of self to the separate other. They agree with Symington that “shame, [then] is the progenitor  of envy.” For the infant who maintains the grandiose self (fails to move, in Winnicott’s terms, from object relating to object usage), there still exists the awareness of the self as deficient, separate,  and needy.

Narcissistic envy “arises from the painful realization of one’s own limitations...vis-a-vis fantas[ies] of all-inclusive omnipotence and immortality” and entails, not the relationship between self and other (object), but between self and unconscious fantasy. Agnon’s short story, The Doctor’s Divorce, shows a man unable to accept that he did not exist for his wife before they met, that is, “he did not always exist” for her and so is not eternal, death being the deepest narcissistic injury. Narcissistic envy can also arise when a parent who is competent explicitly or implicitly belittles the less competent child by, for example, failing to allow twinship or idealizing transferences.

Shoshani, M., Shoshani, B., Kella, R., Becker, M. (2012). Green Eyes, Crows, and Scorpions: Envy in the Contexts of Neediness, Separateness, and Narcissism. Psychoanal. Psychol., 29:440-458.

Sunday, March 5, 2017

The Analyst's Shame

We may go into this helping profession with fantasies of being all knowing, all powerful (to change others), and, especially, all loving. Our ambitions to change, help, or fix our patients collide with the reality that patients have symptoms and behaviors that sometimes must remain if the patient is to feel safe and unfragmented. Not discerning the purposes served by these necessary symptoms, our ambitions can fail and we feel helpless, incompetent, unseen, and useless. Thus, we may become angry with patients, as if they are incorrigible or recalcitrant. We may resent them for rebuffing our overtures to be helpful. We may become ashamed of our failure and of our negative feelings, as if  good therapists don’t get angry, good therapists don’t resent their patients.

Therapists can feel shame when talking about fees as if accusations of being greedy, uncaring, or sadistic hits too close to home. Therapists can feel shame about bodily infirmities such as when hearing loss, urinary urgency, gastrointestinal upset and other uncontrollable bodily changes are present. They can feel shame asking for referrals from more successful colleagues, or when litigation or completed suicide stigmatizes their practices.

If our expectations of ourselves are unrealistic and our assessment of ourselves harsh, we may respond to our mistakes with shame despite knowing that mistakes are inevitable, are useful learning opportunities, and can reveal heretofore unrecognized dynamics within and between patients and ourselves. Part of our shame can be resonating with our patients’ shame (e.g. projective identification) and thereby help us empathize with our patients’ experience. Owning up to our mistakes with our patients models survival of our own humiliation and may lead to more authenticity in the therapeutic relationship. Our patients’ forgiveness through repaired or continued trust can mitigate our sense of failure and shame.

Patients can experience a lessening of their shame in therapy when they find acceptance and empathy from therapists upon revealing what was once thought unspeakable, but when the therapists’ shame remains unrevealed, where do they find relief? Supervision with a nurturing and accepting, experienced colleague may help the therapist transform a grandiose ideal self into a more realistic expectation of one’s role as the therapist. Supervisors can remind us that patients value our dependability, our empathy, our trustworthiness, our ability to provide a safe space more than insight and perfection.

Weber.R.L. & Gans, J.S. (2003) The Group Therapist’s Shame: A Much Undiscussed Topic, International Journal of Group Psychotherapy, 53:4, 395-416.