"Delicate' Cutting

On November 18, 2017, the Tampa Bay Psychoanalytic Society, Inc hosted Shelly Doctors, PhD  who read a paper titled Advances in Understanding and Treating Self-Cutting in Adolescence. Doctors sees “delicate” (careful, superficial) cutting as a strategy for coping with overwhelming affects. With the lack of a reliable partner in mutual regulation, a child with insecure attachments learns from experience that others cannot be counted on to soothe and regulate painful feelings, so the child relies instead on strategies of self soothing.

Cutting can serve to both down regulate and up regulate extreme ends of arousal of the autonomic nervous system. This is how I understand it: The hyperarousal of the sympathetic (fight/flight) nervous system is calmed by the release, upon cutting, of endogenous opioids. The parasympathetic (freeze) nervous system’s numbing and deadness are up-regulated when it is likewise dampened by the brain’s opioid release.

Doctors notes that this kind of self “management” does not necessarily include suicidal ideation. What others see as problematic, the cutter sees as problem solving, a way of attending to an unbearable affect state or self state which, Doctors says, heralds self loss. This fragmentation of the sense of self is frightening, experienced as an assault on the self, and cutting, paradoxically, restores the self [by regulating overwhelming, that is, fragmenting, affect]. Cutting may be a response to separation, rejection, or loss, when the patient feels utterly alone, tense, or angry. Self-cutting increases when other means of self-regulation are blocked (for example, in prison, when drunk, etc).

Relational but not intersubjective?

Shelly Doctors, PhD, promoter of Self Psychology and of one of its daughters, Intersubjective Systems Theory, wrote a brief paper on Self Psychology’s “Earning a Seat at the Table (Again),”  which reminds us how Kohut’s paradigm shift from intrapsychic conflict to the importance of environmental surround was rejected by mainstream psychoanalysis of its day. Now Doctors notes a second struggle for Self Psychology: being accepted at the relational table. [She does not mention how earlier relational theorists, such as Ferenczi or Bowlby -- with his ideas on attachment and the importance of the environmental surround-- were also denied for decades ‘a seat at the table.’  Winnicott, also an early relational theorist, is likewise not mentioned (perhaps following in Kohut’s footsteps of not mentioning earlier theorists upon whom Kohut may have built his ideas), though Winnicott, wisely using classical language for his revolutionary ideas, was more palatable to his traditional peers.] Doctors also notes the irony of Self Psychology, having once been too relational, is now seemingly not relational enough.

Championing Kohut’s ‘selfobject’ as a unique contribution to psychoanalytic thought and as evidence of Self Psychology’s relationality, Doctors does not go further to discuss how ‘selfobject’ is not intersubjective. The selfobject experience is to the subject any person, thing, or idea which leads to an increased sense of self as cohesive, coherent,and continuous. The trouble is that it sees the other as a function and not as a subject in her or his own right. So while Self Psychology is relational in that it recognizes the importance of the human surround, it is not necessarily intersubjective when it emphasizes one of its greatest achievements to be the ‘selfobject’ concept.

Benjamin, on the other hand, sees intersubjectivity as a goal, if you will, or outcome of the psychoanalytic process, the precariously held capacity to both be a subject oneself and recognize the subjectivity of the other. Not only is this tension of subject-to-subject relating hard to sustain for any length of time, but may only be achieved in a particular self state and not other self states (or affective states), and only by that self state in a particular moment. Go figure.

Poetry

Happy Birthday, G!

From PBS NewsHour’s ‘Brief But Spectacular Series’ aired on August 10, 2017

G Yamazawa, Poet & Rapper, and teacher, said of the following piece, “I wanted to acknowledge this place in my life that i felt Iike I was proud of myself and all the things I’ve done up to this point”:

I think I’m starting

To rhyme more

‘Cause I want my life

To start connecting

‘Cause, see, I’ve learned

How to learn, so

Now I’m learning

How to teach

‘Cause I done learn how

To practice

Whatever I preach

Boy, I grew from a grain

Into a beach

And I knew

For the game

I’m playing for keeps

So whatever I say I say

What I mean

So whatever I speak

I’m able to reach

A place that bleeds

And a place that burns

And a place that knows

I got a lot

More to learn.

G Yamazawa

Shouts to Durham

Diversity

Marking the 50th anniversary of the 1967 Supreme Court landmark civil rights decision in Loving v. Virginia -- which struck down the 1660s  (300 years old!) anti-miscegenation law (prohibition against interracial marriage) in Virginia -- PBS NewsHour interviewed, on June 15, 2017, Sheryll Cashin, Georgetown University Law Professor and the author of Loving: Interracial Intimacy in America and the Threat to White Supremacy. The case was brought to the Supreme Court by the  Virginia couple, married in 1958, Richard and Mildred Loving, about whom the 2016 movie, Loving, was made. 

Cashin said some things in that interview that I thought very apropos of our work. For example, she defined “Cultural dexterity” as “the ability to enter a situation where you are outnumbered by a different group and experience that with comfort, even wonder. An enhanced capacity for dealing with people of a different group. It is the opposite of colorblindness, it is the ability to see and understand difference and accept it rather than demanding that someone else assimilate to your cultural norm.” 

Isn’t this also demanded of us therapists, that we see, with wonder, and accept difference, and not expect patients to acquiesce to our agendas?

Cashin hopes that a critical mass, of particularly white people, will accept the loss of centrality of whiteness and join with growing populations of people of color to fight together for the common good. Cashin believes racists today are a minority and that there is a growing population of people who embrace diversity.

Listening Stance

Analysts listen. But in what ways?

Fosshage delineates, adding jargon to the lexicon, two modes: an empathic mode of perception which he calls “the subject-centered listening perspective;” and one from the vantage point of the other who listens, and who also experiences the patient as the other, called “the other-centered listening perspective.” What is required of the analyst by the patient is an ongoing (repetitive) experience of the analyst as empathically attuned. The analyst’s empathic listening implicitly affirms her/his interest in the patient; lends validation to the patient’s experience; regulates affects, thus creating a safe attachment and space; and conveys understanding of the patient’s experiences.

Fosshage, J.L. (1997). Chapter 4 Listening/Experiencing Perspectives and the Quest for a Facilitating Responsiveness. Progress in Self Psychology, 13:33-55.

One problem with jargon is its inherent ‘narrowing-by-naming.’ For example, in ‘subject-centered’ listening, Fosshage means the patient as the ‘subject,’ as if this subject can be delineated from the relationship between the patient and analyst, and, moreover, from the co-created third, the shared unconscious that emerges as something bigger than either of the two separately. Of course, the patient is separate from the analyst, but the process is separate from neither.

Attunement and empathy, listening and perception, bring me to the major paradigm shifts in psychoanalysis from left brain (cognition, interpretation, insight) to right brain (affect and its regulation); from content to context; and from ‘how to’ (technique) to a way of being in relationship. More than Freud’s one-person “evenly hovering attention” to the patient’s narrative content is a shared affective state, shared dissociation and enactment in which attunement now speaks to a “contextualized perceptual experience.” (Bromberg) We 'listen' with more than our ears. We are hard-wired with the added capacity to perceive meaning in micro-expressions, in tone and prosody, and more.

Bromberg, P (2011) The Shadow of the Tsunami. Ch.6. Routledge, New York.

Listening, it turns out, includes who we are--- and who we are emerges uniquely with each unique patient.

HB! JA