An Introduction to "Prisoners of Childhood" by Alice Miller (1981)

Prisoners of Childhood, published by Basic Books,(republished under it's German name Drama of the Gifted Child in 1997) is ironically a basic, but essential book that focuses on the the loss of the self (and its origins) and on the traumatic consequences of this loss. Prisoners of Childhood is divided into three short chapters rich in psychoanalytic insights (especially in the first two chapters).

First, a little bit about the two editions of the book. The original edition centered around the psychoanalytic concept of narcissism. In the ensuing years, Miller had a complete falling out with the psychoanalytic community and even turned away from the concept of psychoanalysis itself, which is a bit confounding given what a gifted psychoanalyst she was. Thus in the 2nd edition she stripped the work of any and all psychoanalytic "jargon". I believe something was lost in the process, so I have chosen to review the original.

Like my review (March 17, 2011) of Gaslighting... (Dorpat), I will quote this book extensively for it is rich in deep insights spoken so eloquently they hardly need explanation.

In the foreword Miller focuses on the ways many children are taught to behave at a very early age. With this focus on behavior, the child, who cannot risk losing his parents' love, complies, behaving before he can possibly understand what the behavior means. Miller than goes on to show how this leads to the development of a "false self" in gifted children (by "gifted" Miller is referring to those children that are very good at modifying their behavior to secure the parents' love, i.e. surviving).

On the lack of "respect for others" found in the narcissist, Miller has this to say:

If a mother respects both herself and her child from the first day onward, she will never need to teach him respect for others. (viii)

How lost this is on so many parents! I see it all around me, the commandment "Thou shall Honor thy mother and thy father" is drilled into a child's head on the one hand, but that honor is never practiced in the parent-child relationship. Children learn through observation and experience, what better way to teach a child respect than to respect yourself as well as the child? This commandment ought to be "Honor thyself and thy child". The original is a poisonous commandment that has misguided countless parents and poisoned society.

Miller continues:

... a mother who [was not respected as a child] will crave this respect from her child as a substitute; and she will try to get it by training him to give it to her. The tragic fate of such training and such "respect" is described in this book, (viii)

Miller makes some poignant observations about this early focus on behavior:

[it is inconceivable to love others] ...if one cannot love oneself as one really is. And how could a person do that if, from the very beginning, he has had no chance to experience his true feelings and to learn to know himself? For the majority of sensitive people, the true self remains deeply and thoroughly hidden. (viii-ix)

Miller's point is that the 'gifted' child, the child who most successfully conforms to her parents' wishes of behaving a certain way (and thus being something the child is not) most thoroughly loses any notion of love and respect for who she really is.

Miller poignantly concludes:

Such people are enamored of an idealized, conforming, false self. They will shun their hidden and lost true self, unless depression makes them aware of its loss or psychoses confronts them harshly with that true self... (ix)

On page ix we get the origin of the books title, where Miller speaks of the "true self's 'solitary confinement' within the prison of the false self." (ix) For Miller then, the ultimate goal of therapy is to help the patient experience his true feelings which will allow him to face repressed instinctual conflicts, which he will experience intensely. (x)

I could justifiably end this review with the opening sentence, one which could not be more insightful or informative to the therapist and patient:

Experience has taught us that we have only one enduring weapon in our struggle against mental illness: the emotional discovery and emotional acceptance of the truth in the individual and the unique history of our childhood. (3)

but continuing,

for many people the truth is so essential that they must pay dearly for its loss with grave illness. (4)

I have born deeply personal witness to the veracity of this statement! "The truth hurts, but lies kill" I often say.
Miller goes on to say

Sometimes I ask myself whether it will ever be possible for us to grasp the extent of the loneliness and desertion to which we were exposed as children and hence intrapsychically are exposed as adults." (5)

by Tim LaDuca

(To be continued...)

Review of "Gaslighting, the Double Whammy, Interrogation, and other Methods of Covert Control in Psychotherapy and Analysis" by Theo Dorpat (1996).

As a layperson I found Gaslighting... by Theo L. Dorpat a true gift. Through it I learned that the psychoanalytic process could be a useful and trustworthy tool in the treatment of mental illness. Before I read Gaslighting..., I harbored a great distrust for psychoanalysis and psychotherapy in general. Gaslighting... taught me it is not these great institutions that matter, but the individual persons who populate them and their kindness*.

It is hard to get across the impact this book has had without quoting it extensively, which I shall do. It has a very high signal-to-noise ratio. By that I mean it is jam packed with facts and truths, and I would recommend it for that alone.

Gaslighting... is a book about "covert methods of interpersonal control" both inside and outside of the therapeutic framework. It's not just about covert abuse in psychoanalysis but the role of covert abuse in the genesis of mental illness. This dual framework is what makes the book so amazing. Hopefully the first three sentences will peak the readers interest:

It has been said that fish don't know they swim in water until they are out of the water. Similarly, most people do not know about the subtle and covert types of interpersonal control, domination, and abuse they are exposed to all of their lives in their families, at their schools, or in their workplace. Not until they have experienced relationships that are more caring, respectful, and nonmanipulative are they able to recognize how much they have been covertly manipulated, controlled, and abused by others. (1)

Aptly covered is the concept of "projective identification", Dorpat's definition:

In projective identification, the subject first unconsciously projects unwanted aspects of themselves onto another person and pressures the object to contain, as it were, the subject's disavowed affects and contents. (6)

This is a primary form of gaslighting, which I assert, is unfortunately used quite commonly on children unwittingly by their parents becoming the source of many, in Dorpat's words, "pathogenic beliefs" often seen by clinicians.

Dorpat covers many covert methods of interpersonal control in the therapeutic situation including the aforementioned projective identification, a form of gaslighting which "...is an attempt to impair or destroy an individual's confidence in his or her psychic abilities". (7) Also covered are questioning, "defense interpretation", confrontations, interrupting or overlapping communication, and abrupt change of topic all which can lead to a "fragmenting [of] the patient's experience" (11).

I want to emphasize that although this book emphasizes the therapeutic framework, it also recognizes the covert methods that are endemic in society.

Dorpat wastes no time with a brief, simple but scathing critique of behavioral therapy and it's use of rewards and punishment, noting that "Humans have used rewards and punishment as effective means of training and attaining social control over others... for millions of years" (22), concluding that behavioral therapy is merely a means of getting patients to "act normal"(23). [In the interest of revealing my own bias, I would add that CBT is even more insidious with the "C" merely a proxy for brainwashing.]

Dorpat includes numerous, rich case studies to explore the dynamics of psychoanalysis. By studying where psychoanalysis goes wrong he manages to show its immense worth by saving the baby from the bathwater. He discusses a patient's reaction to attacks on the patient's judgements and perceptions noting the patient's "self-esteem fell as his confidence in his reality-testing and mental functions was markedly lowered." (36)

Dorpat skillfully portrays the use of questioning (quite simply, asking questions) as a method of control. In a vignette he reaches a beautiful conclusion of what a patient tries to communicate about the author's use of questioning: "Don't worry about not immediately knowing something about me. Your questions are pushing me away!" (54) Dorpat takes a very hard line on questioning, stating that it is only useful "in situations where the therapist is uncertain about the meaning of something said by the patient...". (71)

Gaslighting... shows some ways psychoanalysis can be counter-productive and the meat of this book illustrates in great detail, through vignettes, the disastrous results of covert interpersonal control in therapy. I fast-forward to the beautiful conclusions of this book. Extensively paraphrasing Wiess et al. (1986) Dorpat agrees:

Psychopathology stems from unconscious pathogenic beliefs of dangers if the patient were to pursue certain important goals. Unconscious pathogenic beliefs are irrational and they involve feelings of guilt, shame and anxiety. These are mainly formed in childhood out of traumatic relationships with parents and others... Patients are powerfully motivated to disconfirm these beliefs because they are maladaptive and grim, and they produce much mental pain. (238)

This is pure gold. Other conclusions are: to avoid the use of stereotyped psychoanalytic approaches (226); to recognize the importance of the nature of the analyst's interaction with the patient (231); and the importance of evaluating patient's responses to interventions by the analyst (247).

Much of my admiration for this book is due to the fact that it is very extensively sourced (a quality with which it shares in common the Pulitzer Prize winning "Denial of Death", Becker (1972)), drawing on works from A-Z including Hienz Kohut, Robert Langs, Joe Weiss, DW Winnicott, Eric Fromm, Bob Stolorow, and more than 100 others.


Gaslighting... is a great starting point for anyone interested in covert abuse, mental illness, psychoanalysis, and how power is unconsciously communicated in American society. I'll end with the books cogent epigraph:

For those who stubbornly seek freedom, there can be no more urgent task than to come to understand the mechanisms and practices of indoctrination. These are easy to perceive in the totalitarian ocieties, much less so in the system of "brainwashing under freedom" to which we are subjected and which we all too often serve as willing or unwitting instruments. Noam Chomsky, 1987


* Dorpat's kindness and caring is unconsciously woven though every page of the book.


Tim LaDuca
Wednesday, March 16, 2011

Is Stolorow's Intersubjectivity Intersubjective? Philip Ringstrom in Tampa Bay

Philip Ringstrom delighted the intimate group -- particularly students in attendance from the Tampa Bay Institute of Psychoanalytic Studies, Inc (T-BIPS) who are learning to think critically-- with his critique of Stolorow, Atwood, and Orange’s Worlds of Experience (2002) on Sunday, March 21, 2010 at the Tampa Bay Psychoanalytic Society, Inc. (TBPS). An interesting juxtaposition for Tampa Bay, as Stolorow had recently (Jan 2010) discussed his work in Tampa, this book was currently being read at T-BIPS. Ringstrom also contrasted these authors, who write as if with one voice, to Relational authors who, celebrating difference, write in separate voices.

Stolorow, et al had a theory of intersubjectivity which posited that it was not trauma per se which proved traumatic but instead the absence of attuned responsiveness, along with feeling shamed for one’s reactions to trauma, which proved traumatic. Ringstrom claims that Stolorow, as a result of experiencing his own personal trauma and finding no comfort in the attuned responses from others, had a crisis of theory: Stolorow distinguished attunement not supplied with attunement not felt. Ringstrom thinks Stolorow has a hidden moral agenda, when, after turning to philosophy, particularly Heidegger, Trauma and Human Existence(2007) splits the world into those who have been traumatized, their absolutisms shattered (brothers and sisters in darkness) and therefore, consequently, the only ones awakened to authenticity, and those who have not been traumatized and therefore continue to live in delusion. Stolorow finds the two incommensurable.

Ringstrom finds this incommensurability at odds with intersubjectivity, for intersubjectivity, per Stolorow et al, says all is contextualized. Likewise, if Stolorow et al had previously seen as normal delusions which are protective after the shattering of absolutisms, how now, when these delusions are shattered, do traumatized people become the only ones who are normal/authentic? And if only those who are traumatized can supply, in a kind of twinship, attunement to other victims of trauma, Relational theorists might ask how then does Stolorow’s intersubjectivity confront difference? While Stolorow sees twinship as a consequence of trauma, Ringstrom asks what becomes of Kohut’s idea that there exists an innate longing for twinship? (He refers us to Ilene Philipson’s Pathologizing Twinship.) Ringstrom adds that twinship is also a cult dynamic, splitting ‘us’ and ‘them,’ and sees the us/them mentality as a failure (see Benjamin’s work) of intersubjectivity.

Instead, Ringstrom considers a part of what is traumatic to include the unimaginable. In Heidegger’s being toward death, there is an awareness of death, and the question is whether, at the end of one’s life, one has lived an authentic life or not. Ringstrom referred to the paradox eloquently described by Irwin Hoffmann: that death is both a necessary boundary to ascribe meaning to life and renders life meaningless. Ringstrom cautions against confusing this death anxiety with death trauma. The audience, too, noted the difficulty of taking personal experience and generalizing it to a theory.

On therapeutic action - From emotional availability to psychoanalytic compassion.

In addition to Orange’s (1995) initial view of empathy as emotional availability, Lachmann’s discourse on empathy (February 13th, Tampa) also brought to mind this treasure she gave us in 2006: an elaboration of emotional availability as psychoanalytic compassion. Although it is best to study this essay in its entirety, for brevity I will review here only the section on ‘Compassion as Emotional Understanding’. In footnote 4, Orange explains: “I think of empathy as a larger capacity to understand another's emotional experience from within an intersubjective field (Orange, 1995). Compassion, in my view, is that part of empathy that makes me willing and able to descend into and to explore the Dantean realms of suffering with the other.” Deriving from the Latin patior (to suffer, undergo), patient, as a designation, is not pejorative, for “a patient is one who suffers, one who bears what feels unbearable. Compassion, then, is a suffering with, a bearing together.”

Orange notes that the capacity to share the suffering of another “can gradually restore the shattered, alien-feeling, frozen, lost, dehumanized other a sense of belonging to the human community,” and therefore, along with others, Orange “would restore the concept [of compassion] itself to a central role in the “therapeutic action” discourse. In this paper, however, she focuses “on the attitude and capacity that the analyst brings to the psychoanalytic engagement.”

Not technique, and even less a rule of technique, compassion is, instead, both process and attitude. As process, compassion approximates Gadamer’s (1975) dialogic process of “undergoing the situation with the other” and arriving at an understanding, which is something Orange (1995) elucidates as emotional understanding. “Together we make sense of the patient's emotional predicament within the relational system that we experience together, and gradually this shared world changes by means of a personal reorganization of experience (of both participants)” (emphasis added).

Something that, at times, may not seem gentle or nice, and may occasionally even challenge, contradict, or introduce alternative perspectives, “[a] compassionate attitude... enables hitherto unknown and impossible forms of experiencing. Implicit and explicit forms of participation in the patient’s suffering create a world of compassion that introduces new experiential possibilities” (emphasis added). Ah, therapeutic action, how analysis cures, rendered less elusive, less mysterious!

But that is not all. “This participation, however, is a way of being-with, not a formula for doing psychoanalysis. Where there was indifference, humiliation, rejection, shattering loss, and the like, compassionate psychoanalytic understanding does not simply replace or heal by intentionally providing new experience. Instead, when the analyst treats a person as endlessly worth understanding and his or her suffering as worth feeling-together, this attitude of compassion implicitly affirms the human worth of the patient. Instead of being preoccupied with the question of the patient's recognition of the analyst as a subject, the psychoanalytic relationship accords to the patient, often for the first time, the dignity of being treated as the subject of one's own experience (the reciprocity may come later).”

And what about interpretation? “Because of their previous experience in life and in treatment, patients most often come to us expecting to be classified, judged, treated with rigidity, or exploited. If, however, we are not too intent on naming pathologies and defenses or with being right, but instead relentlessly seek to understand and accompany the sufferer, an implicitly interpretive system emerges. For me, close and compassionate listening is itself an important form of interpretation, dissolving the interpretation-gratification duality, and fully deserves to be considered psychoanalytic. It says to the analysand: "You are worth hearing and understanding." ” (emphasis added).

Orange then adds detail. “This listening involves attention to the ways the patient's experiential world has created suffering for the patient as well as for others in the patient's life. Without leaving the patient's side or becoming judgmental, we can understand how one could come to be so hurtful to oneself and to others. We can understand the simultaneous two-sided experience, so often dissociated, of being both hurt and hurtful. Recognizing context and complexity [the two preceding sections of the essay] prevents reduction and judgmental attitudes and enables compassionate understanding. ”

To make the concept of psychoanalytic compassion more complete, Orange offers the notion of accompanying the other. “In recent years I have become more aware of the importance of simple accompanying that some would contrast with proper "analytic" work and might disparage as "supportive" psychotherapy. Whether my patient suffers from an incurable, painful, and debilitating disease or from terminal cancer or lost a family member in the World Trade Center tragedy, I must not look for ways to see my patient as causing or even contributing to her own suffering; if I did so, I would be joining those who tell her just to accept it or get over it. There is no way to fix the situation or to "cure" the patient, so I must accept my own powerlessness to help. I must simply stay close to her experience, sorrowing and grieving and raging with my patient, even if this means that my practice feels very heavy to me. Even when the story is very complex -and it always is - a willingness to walk together into the deepest circles of the patient's experiential hell characterizes the attitude of compassion ... that the process of psychoanalytic compassion requires.”

Orange summarizes this way: “The interpretive gesture of reaching out to embrace the patient in a sustained, even relentless, struggle to find an understanding is what I mean by psychoanalytic compassion...[it is] an implicitly interpretive process of giving lived meaning and dignity to a shattered person's life by enabling integration of the pain as opposed to dissociation or fragmentation. A compassionate attitude says to every patient: your suffering is human suffering, and when the bell tolls for you, it also tolls for me.”

Orange, D. (1995), Emotional Understanding: Studies in Psychoanalytic Epistemology. New York: Guilford Press.
Orange, D. (2006), For Whom the Bell Tolls-Context, Complexity, and Compassion in Psychoanalysis. International Journal of Psychoanalytic Self Psychology, 1 (1):5-21.
Gadamer, H. (1975), Truth and Method. New York: Crossroads, 1991.

Ernesto Vasquez, MD
February 17, 2010.

[Donna Orange will speak in Tampa April, 2011]

"The Temple Guardian"

Because the subject matter is about Post Traumatic Stress Disorder (and the Tampa Bay Institute for Psychoanalytic Studies, T-BIPS, supports a network of low fee - pro bono therapy for family members of Afghani and Iraqi soldiers and veterans, called The Veterans Family Initiative, VFI) and because it was written by Charles Larsen, a long time colleague of mine at the Tampa Bay Psychoanalytic Society, and perhaps because it is set in FLorida, a mutual colleague of mine and the author's sent me a description of the novel "The Temple Guardian." Here is our mutual colleague's description:

The Temple Guardian, by Charles Larsen, is an action packed literary novel available from Amazon.com.

“The Temple Guardian,” delves into the consequences, including ripple effects, of warring upon several people. A Haiku precedes each chapter.

The male protagonist is Michael Stark, age 55, a Vietnam combat veteran who has struggled with his demons for many years. His female opposite is Norma Jennings, a nurse who has been impacted upon by her former husband’s service in the First Gulf War.

Almost all of the contemporary action takes place in South Florida, and in a small fictional town near Steinhatchee. Explosive action and sensual explorations are juxtaposed with philosophical, tranquil, and lyrical experiences. Dreams, flashbacks, and reflections provide insight into the way events, past and present, weave themselves into our lives.

It is a novel about the process of emerging from the crippling effects of post traumatic stress, a struggle that most of us engage in while attempting to build our lives into meaningful wholes. There are apparent movements toward acceptance and resolution, then setbacks in the current world, which threaten to reverse any apparent progress. There are near Platonic dialogues between Michael Stark and a Catholic priest (also a Vietnam veteran), as well as between Michael and a Vietnamese man who once held him captive under horrific conditions. There is vivid action in the flashbacks and memories of both Michael and Norma Jennings. Contemporary action takes place in North Florida, the Everglades (where Michael’s 17 year old daughter is assaulted by drug dealing Vietnam veterans), and in the Florida Keys.

“The Temple Guardian” is a tale of struggle, of overcoming, and also failing. In the end there is a resolution of sorts to the angst felt by Michael and Norma, namely a sense of hope.