Monday, July 20, 2015

Resources

RESOURCES


C:\Users\Bill\Documents\Current Writings\References.docx
References:
Winnicott, D. (1982)  The Maturational Processes and the Facilitating Environment.
                                                 London:  The Hogarth Press.
Morrison, A. (1997)  Shame: The Underside of Narcissism.
                                                   New York, NY: W.W. Norton
Panksepp, J. (2012)   The Archaeology of Mind.
                                                    New York, NY: W.W. Norton

Winnicott, D. (1963)   Fear of Breakdown.
                                                  London: The Hogarth Press.
Schore, A. (2012)    The Science in the Art of Psychotherapy.
                                                   New York, NY: W.W. Norton
Benjamin, J (1995)  Like Subjects, Love Objects.
                                                   New York, NY: W.W. Norton
McWilliams, N. (2011)  Psychoanalytic Diagnosis.
                                                   New York, NY: The Guilford Press
American Psychoanalytic Assoc. (2006)  Psychodynamic Diagnostic Manual.
                                                   Silver Spring, MD: Alliance of Psychoanalytic Organizations
Hirsch, I. (2008)  Coasting in the Countertransference.
                                                  New York, NY: The Analytic Press

Nhat Hanh, T  (2002)  No fear, no death.
                                                  New York, NY: Riverhead Books

Heineman, T (2006)  Building a Home Within.
                                                  Baltimore, MD: Brookes Publishing Co.

Dupont, J (1985)  The Clinical Diary of Sandor Ferenczi.
                                                  Cambridge. Mass: Havard University Press


Schore, A. (1994)    Affective Regulation and the Origin of the Soul.
                                                   New York, NY: W.W. Norton

Schore, A. (2003))    Affective DysRegulation and Disorders of the Self.
                                                   New York, NY: W.W. Norton

Schore, A. (1994)    Affective Regulation and the Repair of the Self.
                                                   New York, NY: W.W. Norton

Orange, D. (1997)  Working Intersubjectively.
                                                  Mahwah, NJ: The Analytic Press

Benjamin, J. (1988)  Bonds of Love.
                                                   New York, NY: W.W. Pantheon
Damasio, A. (2003)  Looking for Spinoza.
                                                 New York, NY: A Harvest Book

Damasio, A. (1994)  Descartes Error.
                                                 New York, NY: Penguin Group

Damasio, A. (2010)  Self Comes to Mind.
                                                 New York, NY: Vintage Books

Atwood, G.  (1979)  Faces in the Cloud.
                                                Lanham, Md: Rowan & Linfield Publishers

Atwood, G.  (1984)  Structures of Subjectivity.
                                                Hillsdale, NJ: Rowan & The Analytic Press

Ornstein, R. (1972)  The Psychology of Consciousness.

                                                 New York, NY:  W.H. Freedman and Company

Non-formulaic, Intersubjective Process---The insufficiency of Technique—

“From the intersubjective point of view, there is no ‘right answer’ to the questions about self-disclosure or other matters of what many call ‘technique.’ There are two people together, an analyst and a patient, trying to find understanding that will permit a reorganization of experience or perhaps a developmental second chance.´ Orange, D. (2001) Working Intersubjectively p. 34



In the early 1970's I studied Pierre Tielhard de Chardin, William Blake, Paul and Anna Ornstien, and many others to understand the organization of our body/brain/mind.

Saturday, June 20, 2015

-CHAPTER FOUR-

-THE SCIENCE OF SHAME-

Simple Science of Shame

" This state (Shame) occurs in helpless and hopeless stressful situations in which the individual becomes inhibited and strives to avoid attention in order to become 'unseen' (Powles, 1992). Mahler's observations have been corroborated by Beebe and Lachman (1986b), who describe a stress-induced 'inhibition of responsivity in which a sudden total cessation of in infant movement accompanies a limp, motionless headhang". (Schore, A. 1994, p. 204)
Shame Recovery
I have asked several hundred people to tell me about their most embarrassing childhood experience.  The strategies they used to cope with childhood shame has always related to their current life feelings of inadequacy, failure, being bad, worthless or hopeless.  It is my belief each patient’s story of childhood shame needs to inform the beginning stages of psychotherapy. 

As therapists we are working to allow a ‘felt sense of attunement’ with our patients, affect synchrony.  Any deep seated, pervasive feelings of predictable misattunement will require the patient to develop defensive structures, which Winnicott called the “False Self”.  Our job is to make familiar these defensive structures, so the patient can develop new options.  Affect synchrony is missing when a child (or adult) is experiencing shame.  Therapy is a developmental second chance to practice affect syncrony.

Healthy Attachment

Here is a quote from
Schore, A. (2003)    Affect Dysregulation and the Disorders of the Self.
                                                   New York, NY: W.W. Norton, pp.273-4
 “Within mutual gaze episodes of affect synchrony (Feldman, et al., 1999) parents engage in intuitive, nonconscious, facial, vocal, and gestural preverbal communication...provide young infants with a large amount of episodes—often around 20 per minute during parent-infant interactions—in which parents make themselves contingent, easily predictable, and manipulatable by the infant”. (Papousek et al., 1991)

This means Mom and Dad have to know their child is relating to them.  They must do repetitive behaviors with which the child is familiar.  The young infant must know they can influence their parents.  This is especially true in play states of high arousal. In all high arousal states of interest-excitement or enjoyment-joy the child is the most prepared to establish new attachment organizations throughout their body/brain.  The right orbital frontal lobe, the right side of the amygdala and the brain stem are key players in learning new patterns of interacting with others.
The preceding is all the good news.  So how is it we become emotional basket cases?  Many times during healthy development humans can feel quite distressed about themselves and others; adolescence and the terrible twos are major examples.  The two earliest forming and most disruptive feelings or affects are shame and disgust.  Shame is the easier of the two to explain because it develops along-with and through our occipital lobe which also contains the low brain underpinnings of our language abilities.  This allows us to connect words to our deflated feelings.
The well-known effects of shame on during high energy, developmentally mandatory moments are explained below with some quotes from:
Schore, A., 1994,    Affect Regulation and the Origin of the Self.
                                                 Hillsdale, NJ: Lawrence Erlbaum Publishers
“The optimal ‘good enough’ mother (Winnicott, 1971) of the late practicing period is thus one who can tolerate inducing stressful socialization transactions in her infant.” (p. 209)
Shame will only occur when the individual is in a state of interest-excitement or enjoyment-joy; and there is a failure of fulfillment of expectation that the attachment need will be fulfilled. (p.203)
"Shame is originally grounded in the experience of being looked at by the Other and in the realization that the Other can see things about oneself that are not available to one's vision. (Wright, 1991, p.30) (p. 208)
“Tomkins (1962, 1963) notes that shame is activated when one expects another to be familiar but suddenly the other appears unfamiliar”. (p. 244)

Babies are full of high arousal affective states of excitement-interest and joy.  Their behavior cannot always meet the approval of Mom.  When Mom looks disapproving babies demonstrate that they feel ashamed.


--CONSCIOUSNESS IS GENERATED IN THE BRAINSTEM--

This chapter is written to clarify the modern understanding of the relationship between primary affects, such as shame and disgust: and consciousness.  We have now turned neuroscience on its head.  Consciousness is not generated in the cortex and is not inherently perceptual, it is first recognizable affectively.  Our felt sense of being “us” has less to do with cognition, more to do with our feelings and much more to do with our instincts.

I will use and explain many quotes from: Solms, M, 2013, The Conscious Id: Neuropsychoanalysis: London, England. http://www.tandfonline.com/loi/rnpa20.  He concludes this paper by challenging us to determine if this new information will help us better understand the facts we observe.

Black= Solms, M
Red= Maier, B

Ego is defined as ‘external self’.  It is an ideational concept of the individual as the center of the universe.  I will substitute ‘external self, or ‘omnipotent self’ in order to be slightly less vague .

 Id is defined as: “the bodily ‘self’ as an idea, albeit an everyday one.  It is a learnt representation of the self” (p. 15) Therefore I will substitute; ‘the bodily self as an idea, a learnt representation of self’ or ‘internal self’, for Solms’ use of ‘Id’.

Definitions:
Cathexis= concentration of physic energy on some particular person, thing, idea, or an aspect of the self.
Dint=force: exertion.
Biological Valence=wished-for, feared, etc.


“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”(p. 7).  There is a mysterious, innate sense in us of our identity.  Solms’ article will help us know it is not knowable.  We can know things about our consciousness which may help us understand our distress and our health.
Affect is an intrinsic property of the brain….vital needs (represented as deviations from homeostatic set-points) can only be satisfied through interactions with the external world……affects, although inherently subjective, are typically directed toward objects: ‘I feel like this about that’ (cf. the philosophical concept of intentionality or aboutness’)” (p. 7).  We are constantly scanning from our innermost out toward our surround.  Our instinctive survival scans are at some level of balance every instant.  As data comes down to this level we may change this state of a ‘good’ or ‘bad’ sense.  Bodily input arrives; such as hunger and thirst, our internal sense of self automatically can change.
        “The keynote of affective consciousness is provided by the pleasure-unpleasure series, the motor expression of which is approach-withdrawal behavior. Feelings of pleasure-unpleasure—and the associated peremptory actions—are readily generated by stimulating the periaqueductal grey (PAG).  This ancient brain structure is found in all verebrates….ascending from the PAG and into the limbic forebrain, which reciprocally provides descending controls, are various instinctual motivational circuits that prepare mammalian organisms for situations of fixed biological value.  These are known as the circuits for ‘basic emotions” (p. 7). If something attracts us we tend to approach it.  When no pleasure is derived or imagined we pull away and move on.  When the situation matches situations which have benefitted us in the past we approach it.  This emotional sense of pleasure/nonpleasure is coordinated between the limbic system and our brainstem.  In its simplest form, a ‘good’ or ‘bad‘ valence is associated with the situation.

“the basic emotions enumerated  above do not exhaust the range of human affectivity.  What distinguishes them is their instinctual nature. There are whole classes of simpler affects, such as homeostatic affects, which give expression to vegetative drives (e.g. hunger and thrust), and sensory affects, which respond automatically to certain stimuli (e.g. surprise and disgust), not to mention the infinite hybrid forms generated when any of these affects blends with cognition (see Panksepp, 1988)” (p. 7).

       There are two ways in which the body is represented in the brain. One is equal to the ideational concept of the individual as the center of the universe.  Freud would call this the “ego”.  
“The second aspect of the body is its internal milieu. The autonomic body. This aspect is barely represented on the cortical surface.  It is represented deeper and lower in the brain. The structures that represent this aspect of the body pivot around the hypothalamus……..these introceptive structures, too, not only monitor but also regulate the state of the body (homeostasis).  We call this aspect of the body representation the internal body, for short.” (p. 8)  This is Freud’s “id”.

“Recent research demonstrates unequivocally that the corticalcentric view of consciousness (as the seat of the sentient self) is mistaken” (p. 10).  Just because we can think about being conscious with our cortex doesn’t locate consciousness there.  In fact because we can observe that we are conscious helps to prove we are see something with the observing part of our being which is not the thing being observed.

“The state of consciousness as a whole is generated in the upper brainstem…..is generated in a part of the upper brainstem then called the ‘reticular activating system.’  Total destruction of the exteroceptive structures had no impact on the intrinsic consciousness-generating properties of the brainstem system…all consciousness ultimately derives from the upper-brainstem sources” (p. 11-12). Visa-versa damage to the upper brainstem obliterates consciousness.

“{Cortical removal did not interrupt the presence of the sentient self, or of being conscious, it merely deprived the patient of ‘certain forms of information’ (Merker 2007, p. 65).  Lesions in the upper brain stem, by contrast, totally and rapidly destroy consciousness” (p. 12).

       The cortex contributes representational memory space to consciousness. This enables cortex to stabilize the objects of perception, which in turn creates potential for detailed and synchronized processing of perceptual images.  This contribution derives from the unrivalled capacity of the cortex for representational forms of memory (in all its variety, both short- and long-term).  Based on this capacity, cortex transforms the fleeting, wavelike states of the brainstem activation into ‘mental solids.’  It generates objects” (p. 12).  These ‘objects’ include somewhat static representations of our early care givers and other significant people in our lives.  Judith Herman stated in 2007: “Shame is one’s own vicarious experience of the other’s scorn”. If we feel we are not living up to how we think our parents wanted us to live, we see their scorn inside us. Re-viewing these ‘mental solids’ can help soften the look on their faces.

“To be clear: the cortical representations are unconscious in themselves; however, when consciousness is extended onto them (by attention), they are transformed into something both conscious and stable, something that can be thought in working memory…
      If such encounters are to issue in more than stereotyped instinctual responses, they also require thinking.  And thinking necessarily entails delay.  This (delay) function is rooted first and foremost in the stability of cortical representations, which enables them to be ‘held in mind’.  The prototype for this in Freud’s metapsychology was ‘wish cathexis’, which entails a representation of the wished-for object being used to guide to ongoing behavior…In other words, biologically valenced (wished-for, feared, etc.) objects of past experience are rendered conscious by dint of their ‘instinctive salience’ (which is ultimately determine by their biological meaning in the pleasure-unpleasure series—the very basis of consciousness)” (p.13).  We want to ‘issue in’ more accurate cortical representations of our thoughts about parents.  If they could not take a scowl off their face in real life, we must learn to see the hurt and pain they were feeling which caused them to scowl.  Our ‘guide to ongoing behavior’ becomes our modified images of our caregivers when observed through the rich tapestry of people we respect and trust.  I would call this making meaning in an authentic way.

“biologically valenced (wished-for, feared, etc.) objects of past experience are rendered conscious by the dint of their ‘instinctive salience’ (which is ultimately determine by their biological meaning in the pleasure—unpleasure series---the very basis of consciousness).”(p. 13)
      “Hence the evolutionary and developmental pressure to constrain incentive salience in perception through prediction-error coding (this is Freud’s ‘reality principle), which places constraints on motor discharge. Such error-coding must be regulated at bottom by the homeostatic function of affective consciousness, which determines the biological value of all objects of attention (p. 13). This is a great blessing or a horrible curse.  We inhibit actions as we check in with our mental representations.  If the error we predicted has us being mistreated by people (or dogs) we tend draw people looking to mistreat someone.  Then, we get more and more constrained.  On the other hand, the ‘delay’ allows us time check-in with our realistic self-objects and predict more useful outcomes.  Failing to achieve an imagined useful outcome is far superior to holding yourself back from acting because of shame.

“Freud’s earliest conceptions of the ego (external self) defined it as a network of ‘constantly cathected’ neurons that exert collateral inhibitory effects on each other (Freud, 1895) (p. 14).

“In short, words enable us to think about relations between things both in space and in time.  This greatly enhances the delay-response mechanism and surely defines the essence of what Freud called ‘secondary-process’ thinking (p. 15).  This intermingling of inhibitory effects gives us even more time to process in a healthy way, information that would have in the past fallen into rigid predictable patterns.  We can now be uncertain and curious about judging ourselves, rather than safely prejudged as flawed.

“self unfolds over several levels of experience”(p. 16).

“the internal self…is the fount of all consciousness; the external self…is a learnt representation that is unconscious in itself, but can be consciously ‘thought with’ when cathected by the...abstracted (internal) self, which provides the reflexive scaffolding for the (observing ability of the external self), is likewise unconscious, but can consciously ‘think about’ the (external self)”.
Parentheses are mine to substitute for id, ego & superego. (p. 16)


“the goal of all learning is automatization of mental processes—that is, increased predictability and reduced surprise.  It is the biological salience of prediction errors—mediated by attention—that requires the affective ‘presence’ of the internal self.  As soon as the external self has mastered a mental task, therefore, the relevant associative algorithm is automatized.  This could be the mechanism of repression: it could consist in a premature withdrawal of reflexive awareness (of episodic ‘presence’), premature automatization of a behavioral algorithm, before it fits the bill.  In this context, fitting the bill implies obeying the reality principle.  Premature automatization therefore results in constant prediction-error, with associated release of free energy (affect), and the ongoing risk of repressed cognitive material reawakening attention” (p. 17).  Shame structures become ‘automatized’ early in life before we have enough data to optimally determine their salience.  An outcome of therapy (and also healthy friendships) is to set up behavioral algorithms that obey our reality principles, our beliefs and values.  Shame is experienced when we deviate from our own values. 

Sunday, May 31, 2015

CHAPTER SEVEN - DISGUST



Disgust
I will now look at the data we currently have on how we organize ourselves around feelings of disgust.  I have discussed shame as an organizing principle of development of human beings early primitive processes and later intrapsychic processes, When these processes become structuralized they can be imagined as being in a desublimated state. Sublimation, in the psychological sense, is the process of transmuting our urges into acceptable thoughts, feelings and behaviors.


A sense of coherence, congruence and compatibility requires us to construct easily followed internal guidelines for behaviors related to our most primitive instincts. This becomes problematic when we need to develop habits to survive which conflict with our sense of values and beliefs.  Imagine a healthy baby using distress vocalizations enough times for her caregivers to recognize her primary concern.  Caregivers have been doing this guessing/intuitive game for ever.  If the infant cannot get across this felt threat to their going-on-being they eventually act more panicked or become indifferent (dissociation).


The pivot point of healthy sublimation is processing the affect of disgust.  Left desublimated, disgust has us rapidly categorizing input as to its possible poisonous effect on us.  At the worst, we portray rage or “non-doing”.  Better to be safe-than-sorry from a “going-on-being” perspective.  All of us, emotionally healthy, and emotionally unhealthy, constantly scan for scenarios resembling previous threats to our safety.  Healthy parent/caregiver’s help us separate real threats from imagined by responding to our distress vocalization and facial expressions of disgust.  Therefore we learn to sophisticate our distress expressions in socially appropriate ways.
If our caregivers cannot help us differentiate safe from unsafe data we build patterns of reactions to supposedly ensure our safety.  These defensive/fear reactions tend to draw us toward situations within which we can utilize these exaggerated skills.  Our defenses also tend to provoke those around us to feel a deep sense of danger, thus drawing aggression or withdrawal from them.  The patient and therapist who can hold onto a realistic image of one another, while observing heightened defensive states, can do much toward learning together novel behaviors when feeling threatened.

Healthy Disgust and the Death Instinct
DEW EVAPORATES
     AND ALL OUR WORLD
    IS DEW…SO DEAR,
SO FRESH, SO FLEETING
                                         Issa


Nourishing, mourning and social play are moments of acting at the dew point or the freezing point of feeling disgust and/or the death instinct.  Our 'Death Wish' seems like an answer to all our deep fears.  Murder will also feel like an ultimate solution to a lack of wish fulfillment. The Death/Murder instincts can healthfully remain flexibly sublimated by a desire to 'fit in' and to make sense or meaning of our impulses.  Sublimation has us imagining the future of these moments.  Unhealthy desublimation keeps us in the solid patterns of our history of coping with our fears.  Fluid responses can emerge naturally much like dew forming on a frosty leaf.  Containing these moments in low arousal in the therapeutic environment allows even riskier exploration in our jointly sublimated future.


Sublimation is always moving forward and backward from the present moment.  When psychological sublimation takes place interpretation is impossible, and not desirable.  Our job is to imagine the observed (our patient), a coherent being in past and future states having grown from; and growing into organizations around primal urges. This produces an affective resonance necessary to all mammals.  Cues of many types are used in the processes.

Affective resonance is necessary for mammals to grow.  Growth happens around primal urges.  A different type of resonance takes places when an observer imagines an infant’s strategies for “feeling safe-in-the-body and seeking meaning making.  Mother’s exuberant responses to Baby’s squawks are great examples that require sublimation.  When she gets the message, their eye contact and his joy at sharing his skills verifies the accuracy of her imaginings. She could be holding two images of her son: one, staring at a blank wall and obediently falling asleep; and two, imagining a healthy form of his uniqueness acting in the world.  He has a deep sense of seeing her seeing him in earlier moments of his enlivenment in his agency in the world.

REFERENCES


(Schore, A. 2012, p. 99-100) “In my 1994 book I also discussed the developmental origins of another parasympathetic affect that is perhaps even more overlooked than shame: disgust, an affect associated with olfactory processing.  Disgust, a basic emotion (Darwin, 1872/1965), is expressed early in infants as distaste (Rozin & Fallon, 1987, and in rejection and avoidance behaviors (Izard, 1991)……..At later points in the life span, disgust is a central threat emotion associated with distress and avoidance behavior in reaction to psychological contamination and violation.  It is triggered by body odors and rotting, death, offensive and contaminating body products, inappropriate sexual behaviors, and body envelope violations (e.g. blood, injuries, gore, mutilation)………Krusemark and Li (2011) assert that parasympathetic disgust states, like sympathetic fear states, are associated with threats to survival, yet they incite divergent autonomic mechanisms in the human defense systems.  Their research demonstrates that disgust at the autonomic physiological level increases parasympathetic responses, reducing heart rate (bradycardia), respiration and blood pressure, thus suppressing activity and initiating a state of inhibition and passive coping……….disgust provokes immediate suppression of visual attention and sensory rejection…….modulating visual and olfactory sensors with widen versus narrowed eyes and nostrils, increasing sensory intake of fear and dampening in disgust. (Krusemark and Li, p. 3434)….. Using visual event-related potential indexes, they show a rapid discrimination between fear and disgust as early as 96 milliseconds after presentation of a threat stimulus……..Rusch et al. (2010) note that pathological (dysregulated) disgust is associated with eating disorders, phobic and obsessive disorders, schizophrenia, sexually traumatized individuals, post-traumatic stress disorders (PTSD), and borderline personality disorder (BPD)……..their study reports women with BPD and/or PTSD exhibit heightened disgust sensitivity, and more disgust-prone implicit self-concept.”
The conscious transcendence of an alienating existence-“a higher level” or mediated alienation.

CHAPTER EIGHT- CUE RECOGNITION

facial muscle and prosody recognition during sublimation


As we make the choice between independence and dependence a tension develops in us that can only be resolved by imagining the destruction of the object of our dependence.  On both side of this tug-of-war is a resulting sense of emptiness.  The emptiness of being alone; or the emptiness of being subsumed by the ‘other’. As humans, we must delude ourselves to believe we have overcome our emptiness.  The vacuum at the core of our being is intolerable to us.  We find or create signifiers of support.  Our going-on-being depends upon a reflected sense of ourselves, accomplished in a felt sense of attunement.


The hole of the feeling of emptiness needs to be seeking an existing and desirable 'love object', which is unreachable (and therefore experienced as something missing).  All of this is dependent on our subjectivity's expectation to re-find the lost object in the mistaken belief it will continue to satisfy us.  The urge to destroy becomes an assertion of autonomy. Seeing the deep brain/body patterns of this assertion of autonomy is nearly impossible. The fact it is nearly impossible does not change the level of the importance of its exploration.

An example of health would be the imagined, relational meaning-making of a four month-old girl by her easy and varying facial muscle expressions. “Her gaze has an objective quality, which she transforms to a broad array of interactive expressions after settling on me, Mom or her cousin.  Today’s gazes were by far the most numerous and the least intense.  We had had a few low meaning visual and auditory connections in the past, however today was full of them.” Maier (2014).  I have observed this baby once a week for an hour since two weeks old.

In relation to facial muscle recognition, sublimation has many intriguing aspects.  The prefrontal cortex is exquisitely attuned to minor fluctuations in facial muscles of people around us and our own.  Patient’s is looking to see if the therapist will wound them in the way their parents did.  It is likely some facial twitch can be interpreted as seeing them as flawed.  Healthy sublimation will always include both a sense of fear and an awareness of the developing sense of connection.


What of the child/mother who has trouble with latching during breastfeeding?  The defensive patterns needed to cope with the fear of the day-to-day survival struggles can quickly form into rigid patterns. Fear of starvation is related to our death wish or killing desire. This fear, and the tension it creates, can exacerbate any physical challenges of the baby and mother. Helping train the muscle of the baby’s tongue to press toward the roof of the mouth is facilitated by relaxing the muscles around the mouth and head. Helping the mother to learn to relax and enliven her face, and to establish eye contact, are a highly worthwhile exercises even if they do not lead to nursing.  I see infant/mother dyad, and the facilitator, as sublimating the multiple, complex urges in a manner which can lead to a rhythm and timing conducive to the dyad.

CHAPTER SIX - SUBLIMATION OF SHAME













Enhancing Sublimation When Working With Distress from Shame

We want to utilize moments when the analyst and patient can recognize they are both seeing an adult behavior pattern that is distressing for the patient. Our goal is to notice any discordant temporal and rhythmic patterning.  Progress can be made if they can draw a connection to the patient’s earlier strategies for dealing with challenging aspects of their caregiver environments. Together, patient and therapist, desublimate the unnecessary, destructive coping strategies. Sublimation, in the psychological sense, is the process of transmuting our urges into acceptable thoughts, feelings and behaviors. A sense of coherence, congruence and compatibility requires us to construct easily followed internal guidelines for behaviors related to our most primitive instincts.

A transformation, or dynamic reorganization, takes place as a patient sees and releases the restrictions of their early childhood thoughts and feelings of shame. This catharsis, and resulting feelings of relief or freedom, need to be a center of organization for the rest of analysis.  Shame structures need to be explored early in therapy because they are mutable, and also indelible.  As analysis continues, later forming distressing self-states will need dynamic reorganization.  The words in this paper are chosen to be accurate in chemistry, neuroscience and attachment theory. The objective of this explanation is to help therapists provide a developmental second chance for their patients. In general, softening up of defensive structures is this developmental second chance. The end product sought after in primary affect centered analysis is an enlivened use of sublimation by both therapist and patient.

Sublimation might be thought of as an ability to imagine. The way the patient and the therapist imagine the future will influence their self-images in the present.  A major portion of their deeply felt self-images were formed before they were six years-old. Sublimation always appears dualistic.  At a deep, mysterious level it contains the death/murder instinct and the wish to belong.  We emerge self-concepts that allow the tension between this independence and dependence to coexist.  When the child senses they have not lived up to their parent’s expectations of them (shame) they defend themselves at deep levels.  They protect their desire to go-on-being. The defense of sublimation can provide flexible options to keep alive their vitality affects as they move into new social environments, or it can create pain, as with shame.  The therapist can blindly collude with the patient in disjunction or conjunction around these deep seeded feelings.  Our plan is to identify and soften these periods of false resonance, or dissonance, and allow understanding to deepen and expand.  We are seeking what Stern (1995) calls ‘present moments’.  He postulates that ‘present moments’ are infused with vitality affects, that they are the smallest molar unit of psychologically meaningful relational experience that exhibit temporal and rhythmic patterning, and that they operate at an implicit/procedural ‘core’ level of consciousness.

All parent/caregivers of our patients, and us, have areas they are unable to participate in the above-mentioned rhythmic give-and-take. The more unaware these parents are to their deficits the more rigid and powerful the defense which develop to cope with them.  Part of the current self-images of the therapist and patient will include how they began to think and feel about themselves when their caregivers could not provide “good enough” care.  In these situations, when the child expresses an instinctive/primal need that is not satisfied, he/she develops a strategy of internal attempts at regulation.  This can be a moment of unhealthy sublimation which happens over and over again as the caregiver environment fails to tend the baby’s basic need. Thus creating a deficit in implicitly generating and integrating of another way Stern defines ‘a present moment’; “the basic fabric of lived experience created in continuous small packages of interactions with others”.   That “basic fabric” becomes a self-story of inadequacy

We want to utilize moments when the analysts and patient can recognize they are both seeing an adult behavior pattern that is distressing for the patient. Our goal is to notice any discordant temporal and rhythmic patterning.  Progress can be made if they can draw a connection to the patient’s earlier strategies for dealing with challenging aspects of their caregiver environments. Together, patient and therapist, desublimate the unnecessary, destructive coping strategies. Sublimation, in the psychological sense, is the process of transmuting our urges into acceptable thoughts, feelings and behaviors. A sense of coherence, congruence and compatibility requires us to construct easily followed internal guidelines for behaviors related to our most primitive instincts.

A case example of healthy growth of sublimation is a 26 year old single female who has a new way of envisioning her mother. Between her 41st and 42nd session of therapy she talked with her mother on the phone.  She told her Mom she has been attending therapy.  Her mother became defensive and distracted.  Her mother immediately presented her with an example of why she could not connect with her. When patient was an infant finished nursing she would cry until her mother laid her down.  She then would become calm and content. As my patient said this to me she admitted to feeling this was an example of something being wrong with her at birth.  Mom and daughter had colluded in this deep view my patient had of herself.  She left the session connecting her mother’s current distractibility with her likely inability to attend to her daughter.  This new way to imagine her baby/mother system allows her a different sense of her baby self.  Her deepest feeling of early childhood shame occurred setting on the curb outside of grade school long after all the other children had been picked up, waiting for her mother or maternal grandmother to pick her up.  Her mother’s mother and the patient’s mother had more important things to think about than her.  It is easy to imagine both mothers being distracted nursing their babies. Understandably this young woman developed a highly distressing anxiety disorder, with a strong desire for perfect union followed by, ”breaking down” , when she felt unattended to. “Is not anxiety therefore in the last analysis a feeling of the power of the death drive, a beginning of death (starvation)?” The Clinical Diary of Sandor Ferenczi on June 3, 1932

  
Relational psychoanalytic treatment can be especially successful in areas of adult verbalized, desomatised systems. These systems easily become structuralized, starting with pre-verbal affect and identity reactions, then later forming around internally verbalized patterns of shame.  The high volatility of primary affect states can be an advantage or a disadvantage.  My therapy process is designed to utilize this volatility to allow rigid, distressing patterns to precipitate out (become conscious); new behaviors and more flexible patterns to emerge.  “A developmental second chance”, or change in our disposition. Our shame structures are among the earliest patterns to precipitate out. They are among the most dominate, repetitive and painful affective states.  In the heat of observation these shame patterns have little or no value, except to have allowed us to have survived the deficits in our caregiver environments. 

The occurrence in the therapy room of the dyad identifying a break in attunement caused by their shame structures is the most profound moment in the early analysis. It announces the end of the first stage of treatment.  Noticing discord in analyst and/or patient, around moments of awareness of shame, becomes the bedrock for discovering deeper layers of organizational distress.  A new, felt sense of attunement and ability to re-regulate occurs when the patient utilizes awareness of shame to not repeat problematic behavior patterns with the analyst. This allows the emergence of different choices.  It is the necessary foundation for exploring Winnicott’s Authentic Self, Jung’s Shadow or Nietzsche’s source of human dignity.

Subliming a Tear of Shame
Subliming Shame


To move fantasy into action

In the physical sense sublimation is the transition of a substance directly from the solid to the gas phase without passing through an intermediate liquid phase. Sublimation in the psychological sense is the process of transmuting our urges into acceptable thoughts, feelings and behaviors.  The reverse process of sublimation is desublimation, or deposition. The act of solidifying and habituating some of our urges from our innermost self through desublimation is necessary for us to interact with the world around us.  The depository of these solidified organizations of our character, become our dispositions.  At the core of our disposition are our primary affect states. These primitive states have patterned themselves into our later forming dispositions with ever increasing complexities and many overlapping influences as we developed as humans.  Disposition is most changeable (volatile) in the latest developing cognitive realm.  Shame is the simplest of the primitive affect states to identify and the most searingly distressing.  The components organized inside us around ideas that we are inadequate, flawed or bad can be desublimated out to purify our access to our sovereignty.


The thoughts, feelings and behaviors our dispositions permit are the solid and liquid form.


Deposition, also known as desublimation, is a thermodynamic process, a phase transition in which gas transforms into solid. This is what early forming patterns of shame or inadequacy do to us.  These feelings desublimate from our phantisizes, to become rigid, repeatable and eventually habituated.


One example of deposition is the process by which, in sub-freezing air, water vapor changes directly to ice without first becoming a liquid. This is how snow forms in clouds, as well as frost and hoar frost on the ground. Another example is when frost forms on a leaf. For deposition to occur, thermal energy must be removed from a gas. When the leaf becomes cold enough, water vapor in the air surrounding the leaf loses enough thermal energy to change into a solid. Deposition in water vapor occurs due to the pureness of the water vapor. The water molecules containing only Hydrogen and Oxygen; are therefore, able to lose large amounts of energy before forming around something. When the leaf is introduced, the supercooled water vapor immediately begins to condensate, but by this point is already past the freezing point. This causes the water vapor to change directly into a solid. Psychologically this is what William Blake calls “Experience”.  We cannot go back to “Innocence”.


Now let us see what we know about the development of shame and how that development is involved with language.


"Shame, or blushing, is evident in infants at 10-12 months old.  The neural-circuitry we utilize for blush develops with the occipital cortex, which is the seat of our language development".(Feldman, Greenbaum, & Yirmiya, 1999, p. 223) “Face-to-face interaction, emerging at approximately two months of age,  are highly arousing, affect-laden, short interpersonal events that expose infants to high levels of cognitive and social information.  To regulate the high positive arousal, mothers and infants…..synchronize the intensity of their affective behavior within lags of split seconds.”  Schore, A 2012, p.231 “developmental neuroscientists have observed that a milestone for normal development of an infant brain occurs at about 8 weeks.  This is the onset of a critical period during which the following take place: Synaptic connections in the occipital cortex are modified by visual experience (Yamada et al., 2000); infants as young as 2 months show right hemispheric activation when exposed to a woman’s face; and particular areas of the right hemisphere are timed to be in a plastic and receptive state at the very time when polysensory information that emanates from faces is being attended to most intensely by the infant" (Tzourio-Mazoyer et al., 2002). (Schore, A, 2003, p. 152) quote from (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".  Especially the "adult verbalized, desomatised system is easily structuralized, starting with pre-verbal affect and identity reactions, then later forming around internally verbalized patterns of shame.  The volatility of primary affect states can be an advantage or a disadvantage.  Therapy is designed to utilize volatility to allow rigid, distressing patterns to precipitate out and new behavior to emerge. A developmental second chance.


Desublimation is going from harmonized, integrated internal environments (phantasies) to fixed dispositions. The sublime, we are looking for in therapy, is bringing the dyadic, ambience pressure of investigation of our two dispositions to the point of allowing phantasy to be re-materialized and to be communicated.  Under the heat of the benign investigation of the therapeutic alliance, our disposition can volatilize.  Sublimation has the dual appearing aspect in the spiritualization of the body and the corporatizing of the spirit.


As humans, we must delude ourselves to believe we have overcome our emptiness.  The vacuum at the core of our being is intolerable to us.  We find or create signifiers of support.  Our going-on-being depends upon a reflected sense of ourselves, accomplished in a felt sense of attunement. The hole of the feeling of emptiness needs to be seeking an existing and desirable 'love object', which is unreachable (and therefore experienced as something missing).  All of this is dependent on our subjectivity's expectation to re-find the lost object in the mistaken belief it will continue to satisfy us.


Are those of us who gave up on finding our mothers before we could habituate the desire to "re-find" that filler of emptiness (our phantasized Mother), more realistic? My mother had severe post-partum depression.  She often sat staring out the kitchen window for hours.  I developed a flattened lumbar curve from arching my back to get away from her non-responsive face. Two years later my brother was born and she became nearly catatonic. Solid reality began taking the place of phantasy. Robin Williams seems like another example of this.  Super real.  Exquisite awareness of the unattainability of transcendence.  Playfully holding the terror of almost touching.  Painfully aware of a deep sense of where other people know to laugh at themselves and him.  Lenny Bruce might have been closer to this flame.  


Sublimation is a technique used by chemists to purify compounds. A solid is typically placed in a sublimation apparatus and heated under vacuum. Under this reduced pressure, the solid volatilizes and condenses as a purified compound on a cooled surface (cold finger), leaving a non-volatile residue of impurities behind. Once heating ceases and the vacuum is removed, the purified compound may be collected from the cooling surface.[3][4] For even higher purification efficiencies a temperature gradient is applied, which also allows for the separation of different fractions. Typical setups use an evacuated glass tube that is gradually heated in a controlled manner. The material flow is from the hot end, where the initial material is placed, to the cold end that is connected to a pump stand. By controlling temperatures along the length of the tube the operator can control the zones of recondensation, with very volatile compounds being pumped out of the system completely (or caught by a separate cold trap), moderately volatile compounds recondensing along the tube according to their different volatilities, and non-volatile compounds remaining in the hot end. Vacuum sublimation of this type is also the method of choice for purification of organic compounds for the use in the organic electronics industry, where very high purities (often > 99.99%) are needed to satisfy the standards for consumer electronics and other applications.



































The Epistemology of Sublimation in Medicine

Modern psychoanalytic therapy is beginning to utilize understanding of treatment of primary affects in order to help people understand their distress.  We help them identify and regulate the defenses they use around their primary affects of shame. Our treatment processes need to effectively include work to visualize patients’ early forming self-concept; such feeling flawed, bad or inadequate.  I see sublimation as resting point in psychoanalytic search for relief from suffering from primary affects, such as, shame and disgust.

Sublimation, in a relativistic sense, eats at the core of Western medicine, and Freud's narrow, mechanicalized ideas about it.  Hippocrates and the early Greek ideas of medicine in 400 B.C. understood medicine through the use of Vital Force and would embrace a more inclusive, mysterious view of sublimation. Claudis Galen, who in the second century A.D. became the greatest authority in medicine for the next five hundred years, is more accurately called "The Father of Western Medicine". He introduced "The Treatment of Opposites", the idea of fighting off pathogens with substances that competed with them. Freud's ideas grew out of allopathic understanding of medicine. The ancient Greeks viewed disease as disharmony, with healing aimed at restoring balance. Relativistic sublimation would have been obvious to them.

One reason that sublimation is a key notion in psychoanalysis is that from a therapeutic point of view, successful psychoanalytic treatment ideally aims at sublimation, inasmuch as sublimation is seen as a necessary condition for full psychic health. By bringing to conscious light hitherto repressed drives, desires, and wishes, energy that has previously displayed itself in unpleasurable symptoms may be harnessed and directed to more productive and felicitous ends. And indeed, at first glance, sublimation might seem a clear enough concept. It can involve the redirecting of a repressed sexual drives toward a nonsexual aims.

As Nietzsche himself nicely puts the point: “The multitude and disaggregation of impulses and the lack of any systematic order among them results in a ‘weak will’; their coordination under a single predominant impulse results in a ‘strong’ will: in the first case it is the oscillation and lack of gravity; in the later, the precision and clarity of direction” (KSA 13:14[219]). Sublimation, for Nietzsche, is the key means to such concerted expression and, hence, to overcoming resentment.





Sublimation according to Ferenczi ==
“It is not easy to conceive how the same being who is determined by passions from without should also be determined by reason from within….Can passions be annihilated or can they be spiritualized?
“Freud tried to define all sublimation and all striving for perfection as unfulfillable wish impulses, which must remain forever unsatisfied, as though they were compensatory and consoling fantasies and actions.  A special investigation and observation of the conversion of passion into logic and ethical self-control, then into positive pleasure taken in growth and development [Gedeihen] everywhere (this means in oneself, as well as in the environment) led to the assumption that there are possibly two distinct processes involved in sublimation, that is to say, in the pleasure taken in well-being and development; mutual kindness and tenderness

 Sublimation according to Jung ==
C. G. Jung believed sublimation to be mystical in nature, thus differing fundamentally from Freud's view of the concept. For Freud, sublimation helped explain the plasticity of the sexual instincts (and their convertibility to non-sexual ends). The concept also underpinned his psychoanalytical theories which showed the human psyche at the mercy of conflicting impulses (such as the super-ego and the Id, ego and super-ego|id). Jung criticized Freud for obscuring the alchemical origins of sublimation and for attempting instead to make the concept appear scientifically credible:
 “Sublimation is part of the royal art where the true gold is made. Of this Freud knows nothing, worse still, he barricades all the paths that could lead to true sublimation. This is just about the opposite of what Freud understands by sublimation. It is not a voluntary and forcible channeling of instinct into a spurious field of application, but an alchemical transformation for which fire and prima materia are needed. Sublimation is a great mystery. Freud has appropriated this concept and usurped it for the sphere of the will and the bourgeois, rationalistic ethos.”Carl Jung, Letters, ed. By G. Adler and A. JaffĂ© (Princeton University Press; Princeton, 1974), vol. 1, 171
This criticism extends from the private sphere of his correspondence (as above) to specific papers he published on psychoanalysis:
“Freud invented the idea of sublimation to save us from the imaginary claws of the unconscious. But what is real, what actually exists, cannot be alchemically sublimated, and if anything is apparently sublimated it never was what a false interpretation took it to be.” C. G. Jung, Dreams: (From Volumes 4, 8, 12, and 16 of the Collected Works of C. G. Jung),(Princeton University Press, 2012), p.100

Sublimation as  resting point in the psychoanalytic search for relief of suffering from primary affects, such as, shame.

All sublimations involve an expression of a pent-up quota of affect.
In the case of sublimation reached through psychoanalytic treatments, typically, the ideational component becomes available for conscious apprehension. However, in all sublimations, therapeutically achieved or otherwise, the force component is expressed in behavior.

One reason that sublimation is a key notion in psychoanalysis is that from a therapeutic point of view, successful psychoanalytic treatment ideally aims at sublimation, inasmuch as sublimation is seen as a necessary condition for full psychic health. By bringing to conscious light hitherto repressed drives, desires, and wishes, energy that has previously displayed itself in unpleasurable symptoms may be harnessed and directed to more productive and felicitous ends. And indeed, at first glance, sublimation might seem a clear enough concept. It involves the redirecting of a repressed sexual drive toward a nonsexual aim.1
As Nietzsche himself nicely puts the point: “The multitude and disgregation of impulses and the lack of any systematic order among them results in a ‘weak will’; their coordination under a single predominant impulse results in a ‘strong’ will: in the first case it is the oscillation and lack of gravity; in the later, the precision and clarity of direction” (KSA 13:14[219]). Sublimation is for Nietzsche the key means to such concerted expression and, hence, to overcoming ressentiment.22
Treating people who have concerns around feelings of shame is effectively done by working with sublimation

“Freud invented the idea of sublimation to save us from the imaginary claws of the unconscious. But what is real, what actually exists, cannot be alchemically sublimated, and if anything is apparently sublimated it never was what a false interpretation took it to be.” C. G. Jung, Dreams: (From Volumes 4, 8, 12, and 16 of the Collected Works of C. G. Jung),(Princeton University Press, 2012), p.100

Shame needs to be an early focus of therapy processes.  Our early development is organized around our primary affects. An understanding of sublimation is required to soften the defensive structures around feelings of shame and disgust. Ferenczi (1932) explained sublimation as “A special investigation and observation of the conversion of passion into logic and ethical self-control. Then into positive pleasure taken in growth and development [Gedeihen] everywhere (this means in oneself, as well as in the environment) led to the assumption that there are possibly two distinct processes involved in sublimation, that is to say, in the pleasure taken in well-being, development, mutual kindness, and tenderness.”



Sublimation, in a relativistic sense, eats at the core of Western medicine, and Freud's narrow mechanicalized ideas about it.  Hippocrates and the early Greek ideas of medicine in 400 B.C. understood medicine through the use of Vital Force and would embrace a more inclusive, mysterious view of sublimation. Claudis Galen, who in the second century A.D. became the greatest authority in medicine for the next five hundred years, is more accurately called "The Father of Western Medicine". He introduced "The Treatment of Opposites", the idea of fighting off pathogens with substances that competed with them. Freud's ideas grew out of Galen's allopathic understanding of medicine. The ancient Greeks viewed disease as disharmony, with healing aimed at restoring balance. Relativistic sublimation would have been obvious to them.

Nietzsche provides us with the idea that sublimation serves to qualify the effects of our own naturalistic critique by revealing how and why our animal bodies and drives can now be practically affirmed as a new source of human dignity.