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.






Saturday, May 23, 2015

CHAPTER ONE - WHY EXPLORE SHAME?

CHAPTER ONE

WHY EXPLORE SHAME IN RECOVERY?

It is constantly becoming clearer that all ­models of mental health intervention and support must explore the patient’s feelings of disgust/shame early in therapy.  Symptom reduction, while important, can mask the desperate need to feel less ashamed.  Because shame, as opposed to disgust, develops in a verbalized, non-body-based system it runs around in your patients mind in thoughts and words.  It is embarrassing to talk about embarrassing things.  Colluding with your patient to not investigate early patterns of feeling inadequate or flawed allows them to go on thinking there is something wrong deep inside them.

If you don’t have a practiced model for identifying these dynamics, there will be more and more questions about the long-term efficacy of your work.  Symptom reduction, with documented results from Evidence Based approaches, have gained deserving validation.  They are becoming the expectation. Neuroscience will also soon be pressuring us to document recordable development in our patient’s abilities to recognize, tolerate and soothe feelings of disgust and shame.

Psychoanalytically informed work is rapidly moving in the direction of sensitivity to patient’s primary affects.  There is an evolving body of neuroscience data proving primary affects of shame and disgust underpin many later developing distressing self-states.  This affective neuroscience data is confirming long-held understandings in Attachment Theory and Family Systems.  The neural pathways that are later associated with feelings of shame begin to take recognizable form early in life.  Shame will be discussed in the early chapters of my writing because it is observable and mutable in adults and youth through talking.  Shame illumination is useful to clients in many therapeutic milieus; further clarification will be done in Chapter 3.

Disgust and shame emerge in two different and overlapping pathways.  Krystal "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" .  (Krystal, H. 1988 What cannot be remembered or forgotten., p. 219 New York: Psychology Press).  Two of the states of distress mentioned above are disgust and shame.  Shame is a neonatal affective state of distress which is cognitive and not based predominantly in bodily sensations.  Blushing systems, emerging in infants at 10-12 months, include the same circuitry  evident when an adult tells us they are feeling embarrassment or shame.

The nonverbal affect state of disgust includes touch and smell and is not as interconnected to verbal development. Disgust needs to be explored in the latest stages of therapy the patient can tolerate exploring concepts such as Jung’s “Shadow” and not feel ashamed for harboring its dark influences.  Within sublimated shame, disgust can be useful for becoming aware of the patient’s “Healthy Grandiosity”.  A solid footing of soothing shame feelings is necessary prior to the exploration of  "Shadow" and disgust.  Therapeutic sensitivity to utilizing disgust will be explain in later chapters of this manual. 

The “adult verbalized, desomatised system” mentioned above is included in later (socialized) developing shame states.  Shame grows along with language based cognitions.  Our talk therapy approaches can give us access to these volatile primitive organizations. Feelings of inadequacy, being flawed, inferior or ashamed can, and should, be illuminated early in therapy.  Many groundbreaking analysts have professed this same belief about the requirement of exploring shame.  Sandor Ferenczi stated this very firmly: “Analysis must make possible for the patient, morally and physically, the utmost regression, without shame.”  (Dupont, J. 1995  The Clinical Diary of Sandor Ferenczi), entry dated June  1932 . To have dissolved shame in the heat of observation allows the courage to feel the dread of annihilation. 

"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)  These early embarrassment pathways emerge out of the patient’s earlier attachment processes. “Face-to-face interactions, 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, The Science of the Art of Psychotherapy, p.231).  Discussing early childhood feelings of embarrassment or shame allows the analyst and patient to synchronize the intensity of their affective behavior within lags of split seconds.  The process of two brains resonating in low and high arousal states allows a new strategy for modulating these states with each holding the other in mind.

For 20 years I have used a model of illuminating my patient’s childhood patterns of feeling shame to inform my work with their distress from symptoms of anxiety, depression and/or undue concern with the thoughts and feelings of others.  Although my process with these hundreds of people is not at all formulaic, it is amazingly similar with patients across the board, from six to 80 years old. We need to be near the client in utter regression for them to know they can experience their worst feelings about themselves, at the same moment as having a feeling of belonging with another human-being.

Several quotes will follow from (Morrison. A., 1995, SHAME, The Underside of Narcissism, New York: Norton Press). In this book Morrison did a review of the existing literature about a type of guilt which is about the subject’s internal feelings about themselves.  He differentiates this from research about feelings of guilt about specific behaviors.   As I read this book on a weekend in 1995 imagined helping my 11:00 AM Tuesday patient exploring his early feelings of embarrassment.  I felt confident he would understand Morrison’s ideas and benefit from clarification of his life-long feeling of not being good enough. He was well educated and had worked hard in therapy for two years.  To my surprise halfway through my 9:00 AM Monday patient I realized he would easily understand and benefit from these ideas. He had a vocational high school education and worked at a plywood mill.  The value of these two explorations seemed obvious; however it was their reports of the utility of their new awareness presented in their next weekly session which solidified my new sensitivity. 

In general you want to start the process of Shame illumination during the Psych/Social questioning, after therapeutic rapport is established.  I ask the patient to tell me about the earliest memory of shame and/or embarrassment they have.  The Shame question usually happens during the third, fourth or fifth session.  At the end of the session of their disclosure I ask the patient to notice during the week if they feel any of that embarrassment.  Any type of distressing affect the patient experiences is likely to contain some similarity to how they coped in childhood. If it isn’t an obvious match to current life feelings of distress we look for some other, more representative memory of shame.  My patient and I then refer to this memory throughout the therapy process. “I am convinced of the central importance and significance of shame as an affective experience- for each of us, as for our patients.” (p180)  Being able to cope with our imagined flawed-ness in areas our early caregivers had deficits, is part of the glue that holds our self-narrative together. The view of us as inadequate is a central organizing principle of our narcissism. “The authors cited demonstrate, I believe, that shame earns its place at the center of narcissistic experience.” (p62)

The neurological substrata of later developed shame structures can be detected in the first few months of life.  Looking from the direction of adult structures which create distress for the patient, it is relatively easy to hypothesize earlier coping strategies which may have generated unhealthy habits in development.  It is difficult to guess what adult defensive patterns are going to become rigidified into what type of distress by looking at an infant.   Winnicott want us to know about the patterns we were seeing in infants which are easier diagnosed in adult stages of life. “In seeking the etiology of the False Self we are examining the stage of their first object-relationships. At this stage the infant is most of the time unintegrated, never fully integrated; cohesion of the various sensori-motor elements belongs to the fact that the mother holds the infant, sometimes physically, and all the time figuratively.  Periodically the infant’s gesture gives expression to a spontaneous impulse; the source of the gesture is the True Self,…….We need to examine the way the mother meets this infantile omnipotence revealed in a gesture (or a sensori-motor grouping).  I have here linked the idea of the True Self with the spontaneous gesture.  Fusion of the motility and erotic elements is in the process of becoming a fact at this point of development of the individual.” (Winnicott, 1960, Ego Distortions in Terms of True and Falsae Self).  False Self holds off use of spontaneous gestures because of the futility of their use.

When the mother “repeatedly fails to meet the infant’s gesture; instead substitutes her own gesture which is to be given sense by the compliance of the infant.  This compliance is the earliest stage of the False Self, and belongs to the mother’s inability to sense her infant’s needs.” (Winnicott, 1960)

As therapists we are modelling the necessary “client-lead-therapist-follows” view of their life, to allow low energy reorganization of the patient’s reflected sense of self.  Childhood shame will carry a feeling of being unseen, or un-seeable. When we remember this episode in the following weeks, the patient feels carried-in-mind. They now feel seen in a moment in their history of feeling unseen in the world.  A matrix of attachment processes are active in feeling the self being carried-in-mind.  The areas of attachment related to the neocortex are highly useful for inhibiting impulses from the brain stem and above.  To imagine telling a therapist how you acted when you feel angry or afraid, will provide a different set of options for a patient.

Parents, who as children survived threats to their survival, such as abuse or neglect, developed coping-strategies to tolerate their caregiver's behaviors.  In the most extreme these habits develop into personality constructs and persist into adulthood. Healthy friends in childhood don't like being around people who use defensive coping-strategies, so the healthier abused or neglected children begin to soften up these patterns.  In the stress of experiencing repeated high threatening situations, these individuals may find their less complex, more primal strategies for survival more useful because of the speed and clarity knowing how to act. Those reactions are processed in the primitive brain/body in rapid, low energy organizations that can dominate later developing levels. The patient may have little awareness of the similarities between his/ her action patterns in high stress environments and the pattern they used for navigating in his/her family of origin.

When the mother “repeatedly fails to meet the infant’s gesture; instead substitutes her own gesture which is to be given sense by the compliance of the infant.  This compliance is the earliest stage of the False Self, and belongs to the mother’s inability to sense her infant’s needs.” (Winnicott, 1960)

Much to my delight I found a couple of my heroes in thinking about PTSD treatment had already written about the importance of exploring shame with our patients.  Judith Herman in her 2007 paper Shattered Shame States and their Repair (p. 7), presented at The John Bowlby Memorial Lecture stated: “Separations, which evoke fear and protest in normal toddlers, do not evoke shame; rather, shame can be seen in reunion interactions, when the toddler’s excitement is met with indifference or disapproval.  To a certain extent, such experiences are inevitable and normal, since no caregiver can be empathically attuned to her child at all times, and sometimes the caregiver must chastise the child.”   She concludes her paper with two ideas I am professing here “future research is needed to develop a fuller understanding of the neurophysiology of shame,……and to explore the potentially therapeutic effects of addressing shame as a central issue in the treatment of trauma survivors.”


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 searing.  The components organized inside us around ideas that we are inadequate, flawed or bad can be desublimated out to further purify the sovereignty our innermost self.  The behaviors that result from accurate sensing of our dispositions become the bedrock of our Authentic Self.