DISSOLVING SHAME AND THE METAPHYSICS OF
PSYCHOANALYSIS
March 06, 2017
To be with the mind of another person is a truly beautiful
thing. This paper will attempt to
demonstrate the need for psychoanalysts to proactively explore the primary
affect of shame with patients as the first focus of therapeutic
intervention. I am proposing areas where
we will need to adjust the philosophical foundations of our theories of
practice. According to Heinz Kohut: “It
is easily observed that the narcissistically vulnerable individual responds to
actual (or anticipated) narcissistic injury either with shamefaced withdrawal
(flight) or with narcissistic rage (fight).”
[1] It requires careful self-observation to
approach this type of investigation from a stance of effort toward
equality.
We need to remember the patient’s shame and embarrassment
hide what Dr. Kohut goes on to say is “the need for revenge, for righting a
wrong, for undoing a hurt by whatever means, …these are features which are
characteristic for the phenomenon of narcissistic rage in all its forms.”2 Narcissistic injury underlies all forms of
shame. We are looking for effective ways
to lessen its influences. Simple
didactic and investigatory processes can provide touchstones through the course
of therapy for the patient to see how the patterns from her childhood continue
to create rigidity and preclude spontaneity,
allowing moments of a new type of self-awareness.
An authentic self-story may begin to
emerge in this awareness in moments of dyadic resonance. This self-story is
instantly embedded in an historical narrative.
Intuition and empathy take place outside of
the time frame of history. They happen
within an instant; with either an internal resonance with many systems within
us, and/or a resonance with an outside being.
I learned about the mind/body processes of these moments in my
undergraduate studies of Robert Ornstein’s work in the early 1970’s. He quotes William James (1950) “Our normal
waking consciousness, rational consciousness as we may call it, is but one
special type of consciousness…there lie potential forms of consciousness
entirely different…for they are so discontinuous with ordinary
consciousness. Yet they may determine
attitudes though they cannot furnish formulas, and open a region though they
cannot give a map. At any rate, they
forbid a premature closing of our accounts of reality.” (cited in Ornstein, R.
1972)
[2] This, I believe, is the essence of our work
as psychoanalysts; to sit in mutual recognition of unresolvable internal
conflicts.
I will endeavor to synthesis, and build upon the theories
of Heinz Kohut, Jessica Benjamin, Jaak Panksepp, Donald Winnicott, Mark Solms,
Donna Orange and others in order to propose a dialogic approach to analytic
processes for explorations of lived moments in therapy. These vitalized moments
need feelings of equality to be recognized between patient and analyst. To help our patients, we must become ever
more sensitive to our own known and non-known overly structuralized
biases.
We must embrace the uncertainty of our beautiful art. The deepest, most hidden patterns of distress
are the most important to investigate.
Jaak Pankseep seemed to illuminate this idea: “The deepest and most
ancient nuclei of the cerebellum, the
fastigial
and the
interpositus nuclei, can
generate aggressive behaviors when they are electrically stimulated.”
[3] One of our goals in psychoanalysis is to
sooth these aggressive tendencies. We do not need to bring these powerful
forces into conscious awareness. We must
remain uncertain of the exact effects of these deep patterns; however we can
practice exploring their influences.
We can best help our patients by
being alerted when our own areas of shame and disgust are activated. This is actually the dual-unfolding process,
patient/analyst, of tracking the balance between the intrapsychic (subjectivity)
and the intersubjective
(social subjectivity), without exclusivity
to either. In Jessica Benjamin’s terms: “This is important, as it allows the
fascination with and love of what is outside, therefore appreciation of
difference and novelty.”5 Separation can now contain love of the
world rather than simply using hostility to distance from mother. According to Sartre this is transcendence of
both independence and dependence; subjectivity and social subjectivity through
projection. We must embrace and explore
this transcendence.
This is the patient both loving and hating us. Her subjectivity needs to know her hostility
toward us in order for her to move toward completion of her therapeutic
work. Her subjectivity (individual
survival) and her social subjectivity (fitting in in her surround) need a hand to hold in the darkness of her
deepest fears. The patient will need
touchstones through the course of therapy to see how the patterns from her
childhood continue to block innovations in her self-image. We embrace uncertainty by holding lightly our
theories of practice in order for our patient to effectively use her
projections without recreating the drama and shame patterns of her childhood.
Patients are always aware, at some level, of the searing
nature of the psychic pain which accompanies shame. Adults may have a difficult time attending to
this shame because of denial, disavowal and other defensive structures. Patients can, on the other hand, easily tell
you about shame experiences from their youth.
Our job, once a patient has shared a shame based story, is to slowly and
respectfully allow these disclosures to illuminate her early childhood patterns
of narcissistic rage and current, rigid patterns of negative opinions about
herself. Mark Solms says:
Above all, the phenomenal
states of the body-as-subject are experienced affectively. Affects do not emanate from the external
sense modalities. They are the states of
the subject. These states are thought to represent the biological value of
changing internal conditions (e.g. hunger, sexual arousal). When internal conditions favor survival and
reproductive successes, they feel ‘good’, when not, they feel ‘bad’.
[4]
Shame results from an early-on strategy of
picking the lesser of destructive options.
We pick practiced patterns of believing we are ‘bad’ because we know how
to survive with that amount of shame.
As the highly defended patient begins to feel observed in
her ‘bad’ states while she is in my office, she learns to perturbate them by
evolving a new internal condition, which includes me knowing her hidden
shame. As this patient then goes out
from therapy she comes up against the world outside the surround of the
therapeutic milieu. As she feels a
misattunement with the world, she will automatically repeat early-formed
patterns for coping with misattunement.
Being so fresh from seeing these patterns with me, she may also utilize
her inventive self to color her projection.
If so, what is it she transported from the therapy room? Was she remembering some pithy comment of
mine, or was she remembering the sound of the gurgling water of the fountain in
my office while she is imagining her mother’s misattunement? Either way she may treat the world in a
different manner.
In as much as her old patterns were based on feelings of
shame, any new pattern is likely to be less destructive. Jean Paul Sartre
[5]
would say her subjectivity appears as a repetitive being, an inventive being
and projection. I want to help her be
familiar with her repetitive being, empowered in her inventive being and move
toward more ability to sophisticate her projection.
Jean-Paul Sartre’s critic of the
metaphysics of psychoanalysis
Analysis,
psychoanalysis, is a method often used by charlatans, and its underlying
metaphysics isn’t a good one. But as a
technique for putting oneself in perspective by relation to an onlooker,
there is something truly excellent about it, in the sense that it is a moment
where we open up our thinking about what we are, and we see things that we did not
know.
[6]
I want to call into question several
philosophical concepts underpinning psychoanalytic theory. The following is the thread of my
understanding of the deconstruction of the metaphysic of psychoanalysis
outlined by Orange, Atwood and
Stolorow (1997)
[7]
in their critique of the
Metaphysics
of Neutrality in
Working Intersubjectively. They identified four conceptions of
neutrality that need to be reexamined, which are prominent in psychoanalytic
literature.
One; is Sigmund Freud’s 1915 dictum (cited in ibid), that
“treatment must be carried out in abstinence”, typically interpreted to mean
that the analyst must not offer patients any instinctual satisfactions.
Abstinence is the expression of deeply held belief systems for conducting
analytic work, which include basic assumptions about human nature. This is not a neutral stance. Two; is Freud’s 1912 recommendation that the
analyst ‘should be opaque to his patients and, like a mirror, should show them
nothing but what is shown to him” (cited in ibid). “Opaqueness” denies the essential interactive
nature of the analytic process. Three; is Anna Freud’s 1936 statement that the
analyst’s stance be one of “clear objectivity” and an “absence of bias” (cited
in ibid). Rather than being neutral, we
are asking the patient to adopt and believe our beliefs about our own
objectivity. Four; is Dr. Kohut’s own
statements about the idea of “expectable responsiveness” (cited in ibid). Although this is a highly useful analytic
stance, it does not describe a neutral one.
Instead, Working Intersubjectively
recommends that we strive in our self-reflective efforts toward our own
personal organizing principles, including those enshrined in our theories. They
recommend we take a stance of empathicintrospective inquiry, similar to Dr.
Kohut’s “vicarious introspection”.
Knowing we are uncertain about our patients’ habits and patterns of
experiencing shame and disgust is the only true starting place for mutual
recognition to occur. Allan
Schore quoting Krystal (1988), “proposed
that all later-developing affects evolve out of a neonatal state of contentment
and a state of distress that differentiate into two developmental lines, an
infantile nonverbal affect system and an adult verbalized, desomatised system.”
[8] Shame, a verbalized, desomatised system, is
more available in talking cure processes. While disgust is typically utilized in the
last stages of therapy. It is a
nonverbal affect system and takes more maturity to transmute.
In the talking-cure, when we are inquiring about affective
processes, which include shame and disgust, we are getting at some of the
earliest forming and most influential patterns of our own and of our patient’s
distress. The lived moments of these
explorations provide the opportunity for a second chance to transmute her
developmental biases. Shame patterns are
the easiest to see and talk about because they develop along pathways shared
with the occipital cortex. These areas
also underlie our language abilities.
Distressing categorizations, or disgust, require the mysterious process
of sublimation to healthfully influence thoughts, feelings and behaviors.
Disgust, a sensory affect, has us ‘spitting out’ or
recoiling from our environment. Dr.
Schore also clarified that “implicit, nonconscious processing of nonverbal
affective cues in infancy ‘is repetitive, automatic, provides quick
categorization and decisionmaking, and operates outside the realm of focal
attention and verbalized experience.’”(Lyons-Ruth, 1999, as cited in Schore, A.
2012)
[9] In so much as we seem to have an endogenous
sense of our being, our habits of disgust and rapid categorization also contain
highly useful influences. They are our
unique responses to our feelings of danger about our environment. Our patient need to learn to use these
powerful forces through sublimation when she feels an immediate threat
physically or emotionally.
The desublimation of our fantasies of destruction into our
projections allows us to hold our boundaries gracefully. Sandor Ferenczi explained sublimation as “a
special investigation and observation of the conversion of passion into logic
and ethical selfcontrol, then converted into positive pleasure taken in growth
and development.”
[10] Our patient now has a new ability to see
herself in the future having utilized her instincts in line with her values and
beliefs. Therapy can be considered
satisfactorily completed when our patient can utilize influences from sensory
affects around rapid categorization.
We are truly Sartre’s “onlooker” when our
patient feels we are attuned to her innocent viciousness, or she and I know we
are misattuned. When patient and analyst can reregulate after moments of
dysregulation in the counseling room both people can carry a new sense of
coping with challenging situations. Our
cognitions about her pain are of little value.
The only time the patient sees us as an “onlooker” is when
we are sharing a sense of uncertainty about her narcissistic pain. Jessica Benjamin explains that our job is
that of “reintegrating the excluded, negative moment to create a sustained
tension rather than an opposition.”
[11] Our task, as therapists, is then to
recognize the subtle, ever deeper thoughts/feelings of our own distress,
trusting our patient to find and express her new found tensions. We, therapist
and patient, now have a history of illuminating ever deeper layers of our most
feared states of organization.
Our aggressions are patterned early, then later socially
modified. Jaak Pankseep explains: “RAGE
is normally quelled by understanding of social consequences and by arousal of
positive social relationships.”
[12] We want this positive arousal to occur for
our patient as we observe. A “working
through” in Benjamin’s terms takes place as the patient experiences a felt
sense of attunement with us, the onlookers.
What cannot be worked
through and dissolved with the outside other is
transposed into a drama of internal objects, shifting from the domain of
the intersubjective into the domain of
the intrapsychic. In real life, even
when the other’s response dissipates
aggression, there is no perfect process of
destruction and survival; there is always also internalization. 15
We meet our patients when they are asking
us to help them change the drama of their internal objects. We must capture
within therapeutic ambiance a shared sense of change of status. The perceived change, though embody in our
patient, requires her to feel an attuned recognition of the onlooker. Now the patient, in Sartre’s terms, is able to
transcend both her internalized sense of herself as subjectivity; and at the
same instant hold us in mind as resonating with her from our external position
as a part of her social subjectivity.
Her innovative self then contains a projection in which she has
introjected us.
An Example from a
Once-Weekly Analytic Process
We need to be searching for what Sartre calls, “the
not-known.”
[13] When distressed, our patient has “clearly
marked off a domain within the real world,”
17 which feels uniquely
her own, as Sartre was translated to say.
She makes herself a being that is constructed of her deep-held
prejudices about herself and others. We
are helping patients see the distress they create for themselves with their
deep felt biases and stereotypes which have been habituated in their affects; such
as disgust and shame.
Once a therapeutic alliance is established I always read
and explain with the patient the following set of ideas from Andrew Morrison in
Shame: The Underside of Narcissism.
I believe that the ego ideal
- and particularly the ideal self- provides a framework for understanding shame
from an internal perspective. The values, idealizations, and parental expectations of perfection,
which form the content of the ego ideal,
have been structuralized and no longer require the presence of external object as guide… The shape of this ideal self is determined by
this internal perspective. It is failure
to live up to this ideal self –
experienced as a sense of
inferiority, defeat, flaw, or weakness – that results in the feeling of shame…it is the affective
response to that failure, the
searing shame, that is experienced
clinically… and that therefore should be the first focus of therapeutic intervention.
[14]
Even eight year old patients are able to
tell me how they hold internal images of their parents wanting them to be
perfect.
After discussing these theories with a 30 year old male
patient during his 3rd weekly session, I asked him to tell me the earliest
embarrassing memory he had from grade school.
He said: “At Show-and-Tell in first grade the kids laughed at me because
I showed my Barney stuffed toy.” He was
harboring a fear they would find out how terrified he was of the bear in the
Barney video. The other kids were seeing
him as immature for still being attached to his Barney, while he was presenting
it as a way to cover the way he knew his parents felt about him for being
afraid of a cartoon bear. This reinforced his feelings of being awkward around
his peers. As he left this therapy
session I asked him to carry the awareness of us both knowing he suffers from
fearing of being spontaneous in social situations because people will find out
about all his fears of being immature.
He originally came into to see me because his social world
was shrinking as his symptoms of anxiety increased. His few friends were getting jobs and
starting families while moving away from video games and partying. There was a woman at work he wanted to get to
know. His first week after disclosing
his embarrassment, he reported the self-narrative which kept him from talking
to her. “I will say something to her
that she thinks is immature and she will laugh at my advances.” Rather than feeding into his obsession about
coming up with the perfect thing to say, we brain-stormed a body posture for
him. He had demonstrated good
spontaneous social skills, both in his sessions and when I had seen him in the
halls of my office building. Our
therapeutic work is based on the hypothesis that his embarrassed, afraid stance
was related to his inability to see his parents as satisfied with his social
maturity. In subsequent sessions he
communicated a new sense of identity, which included an ability to talk with
this attractive co-worker. Knowing the
reality of his early strategies sets the two of us in a novel stance in
relation in our investigatory processes.
We perceive his current distress from a changed state, a state of
knowing, which is a felt sense. This is
not about having cognitions related to the factors of his distress. His developmental second chance is a felt
sense we know we share.
Development, which would have been better timed at two
months old, can be vitalized at 30 years old to transmute the overly rigid
self-narrative of him being immature. He
must pause in real life to allow a new self-concept to inform his choices. The
great, deeply irresolvable tension of creating a pause in the process of
going-onbeing, is Sartre’s: “to know oneself is to change oneself, and most
importantly, it is to pass from one status to another…we are all, from this
point of view, subjectivities transcending ourselves towards objects. But I remind you that what I said, most
importantly, is that there is a change of status.”
[15] We must capture within therapeutic ambiance
a shared sense of change of status. This
happens as we pause and can only happen from a position of equality. The perceived change, though embody in our
patient, requires attuned recognition of the onlooker. Remember, also that Sartre said “I am working
entirely on the basis that the two notions—of subject and object—are senseless
when taken in separation from one another.”
20
Conclusion
Our distressed patients are
attempting to get along in a world full of people who seem to have no distress
from deep internal tensions. Suffering
people come to see us when the pain of being so different from those around
them has become unbearable. Our job is
to help them take ownership of the value of the suffering which led them to
us. As quickly, effectively and
respectful as we can we must relieve them of shame based strategies for coping
with their lives. As stated by Andrew
Morrison:
I
am also convinced that, so long as shame or its manifestations are fundamental and experienced strongly, it is
fruitless to proceed with dogged
interpretations or clarifications of conflictual or genetic
factors. That is, any attempt to bypass shame in favor of
underlying explanatory factors will be
unsuccessful and counterproductive and will cause patients to feel misunderstood or criticized and attacked. As Lewis 1977, (cited in
Morrison 1989) noted, “the
continued bypassing of shame represents one of the major sources of negative therapeutic
reaction”.
[16]
Our joint
investigation only starts when there is a feeling of mutual respect. If our patient can embrace her relationship
with us, she has a better chance to modulate the tendencies to push people away
or smother them with dependence. Once
she consistently transmutes the stance of her self-judgements, she can begin to
recognize the healthy and unhealthy process of disgust she has toward people,
places and things. The power of her
healthy disgust is then able to fuel her intuition when she needs to stand up
for herself. Transmutation, and the
ability transport it into ever more challenging environments, allows the
simultaneous transcendent awareness of interiorisation and
exteriorization. To complete therapy the
patient needs to know how and with whom she can continue this
transmutation. The patient’s stance as a
subject among objects needs perpetual innovation of her projection.
Distressed people cling disparately to a need to predict,
lest they re-experience the dreadful feelings in their history. Healthy people move through new environments
with the same need to predict in a natural, obvious development: using
defenses, such as; of sublimation, humor and altruism. My patient arrives at my door holding tightly
to her defenses. She leaves the last
time with those same defenses held within her ability to imagine her future,
while laughing at her painful self-talk and, now, able to see that her
emotional burdens are resources for others who suffer as she does.
Morrison, A. (1997) p. 180.
