Individual and Couple Therapy
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parke@parkeburgess.com



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MUSINGS BLOG

Monday
Sep022013

One Post Everyone Should Read

If forced to say one and only one thing that would be most helpful to most people struggling with the vicissitudes of emotion and mood--in other words, to most people--this post is what I would choose to say.

Sometimes we feel bad. No one really likes this. In fact, our whole nervous system is set up to get out of bad feeling as quickly as possible and restore a sense of feeling good. But, as it turns out, feeling bad is part of what it is to be human. If we can orient ourselves to this crucial fact and its many implications, we can avoid a lot of unnecessary and fruitless suffering.

The nervous system is designed by evolution to maintain homeostasis--that is, to keep the body in the range of conditions wherein it can continue to live. A simple homeostatic mechanism is the common household thermostat. Its function is to keep the interior temperature within a certain range. The thermostat will monitor room temperature and turn on the furnace if the temperature falls below a certain point, turn off the furnace when the temperature gets to a certain point; or turn on the cooling system when the temperature goes above a certain point, and turn off the cooling system when the tempterature falls to a certain point. All of this produces the following cycle:

At the top of the cycle, the temperature is in the ideal range. Gradually, the temperature moves one way or the other, in the direction of too hot or too cold, until, at the bottom of the cycle, the thermostat is triggered to activate the mechanism to restore the desired temperature (furnace or cooling system). Gradually, the temperature returns to the desired range, at which point the corrective mechanism is switched off. The cycle repeats.

The human central nervous system does the same thing on many different levels at the same time. It monitors our blood oxygen and C02 levels, our body temperature, our blood sugar levels, hormonal levels, and so on. At an aggregate level, all of these factors and many more contribute to our overall state. We experience well-being when all these systems are in their optimal ranges, and some kind of discontent when one or more of these systems are sufficiently out of whack. Because the total system is much more complex than the thermostat example given earlier, there is often a lag time between when we experience discontent and when we start to feel better. This is the time when our central nervous system (CNS) is re-organizing itself on various levels to coordinate a re-regulation of the total system. Thus:

 

This cycle operates continuously virtually from the moment of conception until some time after we exhale our last breath. It never stops. At any given moment we are somewhere, as a total system, in this cycle. This is true for every one of us, all the time. As sentient beings capable of self-consciousness, we experience this cycle profoundly. It first impresses itself upon us early in infancy, if not before, and never releases its grip. We are thus always involved in the following drama:

Because our CNS is oriented always to restoring a good feeling, most of this cycle can be experienced as a problem, even as it is a perfectly inevitable part of any homeostatic system. Tragically, we can become so concerned with not wanting to feel bad that we become stuck in the lower regions of the cycle. Various psychological mechanisms can develop that, in effect, block our ability to round the corner and move back toward feeling good. Shame, a topic of special interest to me and much discussed in this blog, is one of those mechanisms that keeps us locked into perpetual states of feeling bad.

Therapy is especially effective in helping us see how we get stuck in feeling bad, and how we can unblock ourselves and keep this cycle flowing in an optimal way. Part of it, an important part, is recognizing that feeling bad is not a problem so long as we have some confidence that feeling good is just around the next bend.

Of course, I don't mean to minimize how profoundly difficult it can be to work through the impediments to a smoothly flowing homeostatic cycle. There are many thorny issues that can be involved, including trauma, organic (genetic) predispositions, and attachment dynamics of all kinds. But, as I say, if I could impart but one idea that is potentially most helpful to the largest number of people, it would be the idea of this dynamic cycle as a basic rhythm of human life.

Monday
Aug122013

Review: Helen Block Lewis on Shame and Guilt

Lewis, H. B. (1971). Shame and guilt in neurosis. New York: International Universities Press.

This work seems to be regarded as Lewis' crowning achievement, and is best known for its emphasis on the power of unacknowledged shame in psychotherapy to impact the client in negative ways in the course of therapy. Lewis operates squarely within the psychoanalytic tradition as it had evolved by the middle of the last century. Both because of its age (more than 40 years) and its theoretical affiliation, the book has an exotic, antique feel to this reader. Three of its chapters (Chapters 3, 4, and 5) are of strictly historical interest, reporting a kind of proto-attachment research that the author fails to integrate into the much more compelling general approach to shame and guilt offered elsewhere in the book.

The early chapters (1 and 2), on the other hand, provide the best and most richly elaborated discussion of shame and guilt I have yet seen anywhere. In Chapter 2, Lewis makes a reasonably thorough study of all the terms in the dictionary associated with shame and guilt and attempts to map out their relations--a fascinating endeavor that bears abundant fruits, though I think she might have gone even further. I highly recommend that all students of the phenomena of shame and guilt acquaint themselves with these chapters.

Chapters 6-10 provide a much more detailed and technical discussion of shame and guilt as they arise in psychotherapy. These chapters may be of interest only to therapists and theorists, but offer a plentitude of examples of shame and guilt as described by real world clients, both directly and indirectly. These chapters prove somewhat problematic, too, because Lewis' analytic interpretive approach requires one to have drunk the Freudian Kool-Aid in a way that few readers these days will have done--certainly, I have not. (For example, it seems that a disprorportionate amount of shame relates to masturbation in these anecdotes, whether the client knows it or not. Can't we be ashamed of anything else?)

My main issue with Lewis' presentation of shame and guilt concerns her strong theoretical commitment to distinguishing between them as if they are two entirely distinct phenomena. I both agree and disagree with this: it's true we can make a distinction between shame and guilt (and Lewis helps enormously to clarify this distinction); but fundamentally they represent a single movement of the psyche. Shame and guilt, in my view, are two facets of the same phenomenon. Lewis too strongly compartmentalizes the two, missing their underlying psychological unity.

Lewis distinguishes between shame and guilt as follows (p. 81):

Shame is an affective state; guilt may or may not be affective.

Shame is about the self; guilt is about something objective that may or may not involve the experiencing self.

Shame may be evoked by a moral or non-moral stimulus; guilt...is evoked...by the acceptance or acknowledgment of moral transgression.

Shame and guilt, in my view, represent different phases of a single psychic gesture. Shame is the affective core of that gesture. Accordingly, it makes no sense to speak of guilt as lacking an affective component. Shame is what it's like to perceive (real or imagined) rejection from an attachment figure. It's a terrible feeling. (It is also a neurobiological process involving basic emotion circuits, and an action tendency, and so forth.) In adaptive cases, guilt sometimes flows out of this feeling and ultimately motivates the making of amends. By this understanding, shame is the feeling that underlies guilt and motivates guilt-based thoughts and action tendencies. Lewis tacitly, and presumably unintentionally, illustrates this point over and over again in the later chapters as she identifies unacknowledged shame beneath many instances of guilt responses.

Lewis' second point refers to the by-now-venerable idea that shame is about the self and guilt is about actions performed by the self. This suggests that when we feel that we are fundamentally flawed we feel shame, but when we feel that we have done something wrong we merely feel guilt. This distinction has merit, but it overlooks a basic existential problem. How can we possibly separate our actions from our being? Parents are taught to discipline children for what they do, not who they are (so as not to shame them). But how can a child make sense of the idea that "I am a good girl who does bad things"? This is, at best, an adult concept; at worst, it's a pure fiction.

A better distinction might be: I can be a good person who sometimes makes mistakes which require correction. But this still doesn't avoid the trap of shame because we are left to ask: Why do I make such mistakes? What's wrong with me? And the next question: Other people don't seem to make the same mistakes, or as many of them, as I do, so how come I don't measure up? Moreover, the reliance on mistakes leaves aside the whole domain of human motivation that is not mistaken but anxious, selfish, hostile, and so on--all legitimate and unavoidable parts of the human psyche.

All this illustrates a fundamental principle of human psychology, I believe, that one can rarely feel guilt without feeling shame. Guilt is rooted in shame. Not all shame will eventuate in a guilt process, but the great majority (if not all) of guilt processes proceed from a basic shame experience.

Once this is accepted, Lewis' third distinction fades into irrelevance. Any perception of (real or imagined) rejection, whether it be connected to ideas that are defined as moral or not moral by the prevailing culture, evokes shame and may result in a guilt process. It's probably true that the guilt process involves cognitions that we may define as moral: "What I did was wrong, so I should make amends." But these are just cognitions that accompany the real drama of shame and guilt: the drama of feeling, of needing to belong, and trying or failing to recover from the painful experience of rejection.

Thursday
Jul182013

Review: Alexis Johnson on Healing Shame (2006)

Johnson, A. (2006). Healing Shame. The Humanistic Psychologist, 34(3), 223-242.

Johnson offers a lovely description of shame and an account of its treatment using a case study, a client she calls Maria. The article provides a thoughtful introduction to the issues of shame aimed at clinicians. As such, it does not propose a new or comprehensive theory of shame, but rather a working understanding of shame processes for use by therapists. This has value, of course, in its own right, but it also has value as a representation of how shame is understood by clinicians. Johnson does an excellent job of making use of the available theoretical models for her purposes. I read this article to see how sense is being made of shame in the trenches, as it were. The remarks that follow are intended to underline a few key areas where I think the resulting sense being made of shame is not quite right, even as so much of it seems good and true.

1. Johnson proposes an "identifiable sequence" to shame that has four phases (p. 225): 1) action tendency (including dropping our gaze, lowering our head, sloughing our shoulders); 2) reduction in clarity of perception; 3) cognitive confusion; 4) "interruption" of emotional processing and communication. But is this a sequence or a confluence of phenomena? If it is intended to be a sequence (that is, a string of events across time), it appears to be out of order and over-simple.

The following strikes me as more accurate: The perception of social rejection is the signal that reliably results in shame, following such perception the first response is emotional dysregulation which, in turn, inspires distortions in perception and cognitive processing (more or less simultaneously), and which also inspires, in parallel, the action tendencies of shame. This model suggests that appraisal of significant rejection (or threat of such) is first registered in the limbic system, generating a cascade of emotional responses that are dysregulating of the entire nervous system. This dyregulation floods the executive functioning parts of the brain (the prefrontal cortext), reducing their effectiveness both at processing further external stimuli and processing the flow of information through the brain. At the same time, the limbic response immediately triggers the associated action tendencies of bodily withdrawal from social contact.

So, rather than one "identifiable sequence," I think we see at least three parallel processes (limbic, cortical, and motor) that unfold more or less simultaneously and at somewhat different speeds. Though complex, this falls more into the general category of a confluence of events than a single sequence of events. (All of this reasoning goes to how I have structured my understanding of emotion, discussed in an earlier post.)

2. Johnson summarizes a key tenet of recent shame theory as follows, "the baby-as-body falls into the shame affect with any kind of generated failure (reaching for something and not getting it) or interpersonal failure (displeasure on the mother's face)" (p. 226). I find I cannot accept this; it seems to me that these are two very different kinds of event in the baby's world, only the latter of which falls under the purview of shame. When a baby reaches for an object and fails to get it, she experiences frustration, of course. There is, following Tomkins, interest and a bad feeling in relation to the object of interest, but in this case I think it does not register as shame. Rather, I would propose it registers as dismay.

Shame is a subset of dismay. Dismay comes from the Old French, "to trouble, disturb," from an even older Germanic word meaning "to divest of power or ability." In the baby's case, she is reaching with hopes that she has the power and ability to attain the desired object which, when frustrated, troubles and disturbs her. Compared to her aspirations, she does not have adequate power and ability; in this sense she has been divested of them. I want to say that shame only occurs, by definition, when our power or ability is divested by another (or, at a later stage of development, when we have internalized the divesting other and thereby divest ourselves). But in this case, it is an impersonal universe that denies the baby her prize. Shame does not enter into it until or unless it becomes relational.

Similarly, when Johnson asserts (again following Tomkins) that, "pride affect involves the pleasure of competence plus excitement" (p. 227), I think this fails the test of being relational. I want to say that a sense of mastery is the flip side of the sense of dismay, a subset of which is pride, which requires a relational component. I'll say more about this, no doubt, when I review Donald Nathanson's book Shame and Pride.

3. Allow me one further quibble. Johnson builds a developmental model to understand shame, beginning with the assertion that a baby's sense of worthiness depends on such mechanisms as experiencing the movement "from discomfort (hunger) to comfort (full)" (p. 228). This formulation misses a key distinction, I think, that lies at the core of how shame works and how it develops in childhood.

Prior to the formation of attachment bonds, which occurs no earlier than the fourth to sixth month of life, I would argue that the sense of worthiness does not, indeed cannot, arise. Worthiness is a relational element, based on acceptance by and belonging to the attachment figure. Prior to attachment, I would hypothesize, the baby experiences the discontent of hunger followed by the well-being of fullness as a movement from feeling bad to feeling good. This is an important event, when consistently patterned, that bodes well for the formation of a secure attachment bond later on, but it is not yet relational.

This sequence teaches the child, "I can feel bad and then feel good again" which carries the existential message that "the world is a safe place for me." When feeding is inconsistently provided, the child may learn that "I can feel bad and it may go on forever," which further means, "the world is not a safe place for me." From a developmental perspective, these are crucial messages that likely influence all that follows through the course of development. Not least, these messages will get mapped onto the attachment relationships that develop in later months--at which point, but not before, worthiness becomes part of the meaning the child may make of her experience.

Though my objections to Johnson's description of shame and its onset may seem minor, in fact I think they underline a state of affairs in the field wherein shame is known in its broad strokes but not understood very well at the fine-grained level. But when we have clarity about the details--where, famously, the devil of a thing resides--a very different larger idea of shame emerges. It is my hope to sketch that larger view in future posts and, eventually, in book form.

Thursday
Jul042013

Review: Silvan Tomkins on Shame and Affect Theory (1995)

Tomkins, S. (1995). Shame and its sisters: A Silvan Tomkins reader. E. K. Sedgwick & A. Frank (Eds.). Durham, N.C.: Duke University Press.

Silvan Tomkins (1911-1991) was certainly some kind of genius, father of what calls itself affect theory. He produced a sprawling 4-volume work, his magnum opus, called Affect, Imagery, Consciousness over a period of decades. He took a special interest in shame, which he regarded as a central feature of his grand theory of affect. The book under review here, a selection of chapters drawn from this larger work, offers a chance to dip one’s toe somewhat intelligently into the vast ocean of Tomkins’ thought.

It’s a strange little collection, not least because of the editors’ stated agenda—some sort of historical demonstration of postmodern literary criticism. Their introductory essay baffled me as a reader interested, perversely, in affect theory as opposed to what they evidently regard as “theory”—you know, literary theory. Early on, I was given to know that I have not even entered “theory kindergarten,” much less been “long out” of it (p. 2). What a fascinating way to begin a book about shame!

Tomkins himself reads much like John Bowlby, his nearly exact contemporary. Both have a freshness about them, an intellectual rigor and commonsensical thorough-goingness that enjoyed its heyday prior to the crisis of quantum mechanics in mid-century, wherein science became less sure of itself and began to take cover in ever more elaborate and obscure technical detail (not unlike postmodern critical theory, come to think of it). But Tomkins has a whimsy about him one doesn’t find in the more sober writings of Bowlby. Both were mavericks, but Tomkins is more the purveyor of crazy wisdom and Bowlby the solemn prophet.

Tomkins’ crazy wisdom, however, contains a radical paradox I rather love. He aims at deep understanding of the human condition through a severe reductionism, a profoundly mechanistic worldview. He wants to conceptualize the richness of our affective life, and in no way diminish it—if anything, to call our attention to its dizzying variety—using a series of binaries. On-off switches, yes-no choice points, ones and zeros. Can all the glory of human consciousness be thus reduced? Tomkins seems to think, yes. I do too. Exhibit A: in every one of our billions of neurons, that neuron either sends an action potential down its axon or it doesn’t. All of our mental life comes down to that. (And it’s much more complex than this, of course. But the fact remains. This is only Exhibit A, after all.)

That said, I find myself unmoved by Tomkins’ actual proposal. He attempts to reduce all affective responses to the patterns of “density of neural firing.” If, for example, the brain’s density of neural firing suddenly increases, we experience that as startle (which Tomkins controversially identifies as an affective state). Laughter, on the other hand, is what occurs when the density of neural firing quickly diminishes from an elevated state to a lower one.

In current affective neuroscience, Tomkins’ view takes the form of the circumplex model of affect. The most common form of this model suggests that emotions can be mapped onto two dimensions, arousal and valence. Broadly speaking, arousal refers to how energetic we feel, and valence refers to a spectrum of positive to negative feeling associated with the emotion. All distinct emotions have some unique position in the circular space demarcated by these twin dimensions of affect. The current model and Tomkins’ proposal share the belief that any given emotion or affective response corresponds to the global state of the central nervous system.

What seems to be missing from these models that the thinking of Panksepp, among others, provides is localized circuitry within the brain that would account for the very phenomenological qualia specific to distinct emotional states. For example, anger feels a very particular way. It is not just that it is highly energetic (arousal) and unpleasant (valence), but that it involves a certain quality of energy, and a precise type of unpleasantness. While there are many different experiences of anger a single person might have across her lifespan, I think it reasonable to say they all share a certain family resemblance that is more specific than the dimensions of arousal and valence alone can account for.

So, Tomkins’ conceptualization of shame is already in trouble even before he advances it. “Density of neural firing” simply cannot provide a sufficient basis for a meaningful understanding of shame, in my view. Nevertheless, Tomkins defines shame as that which is organically and innately evoked when there is an “incomplete reduction of interest or joy.” On the one hand, this definition seems so generic and bland as to be almost meaningless. It is certainly devoid of the kind of sharpness and richness of affective flavor we associate with shame. On the other hand, Tomkins identifies something really foundational to the shame experience that, to my knowledge, no one else before had identified at such depth. Tomkins shows his mavericky genius here. He captures the sense in which shame causes us to want to hide ourselves and isolate ourselves not because of disinterest in the other, but precisely because of our interest in the other.

There is much more to say here than this post could possibly handle, but perhaps I have done enough to suggest one of the rich veins Tomkins finds in his formulation of shame. My own sense is that he offers a revealing and powerful lens into the dynamics of shame, but he has in no way defined it, nor has he offered what could hope to be an adequate or complete theory of shame.

Even so, time spent with Tomkins is never time wasted. His keen sensitivity to the nuances of human experience and his razor-sharp mind have proven to be a source of continual surprise and fascination for me. While I think we could have a perfectly sufficient grasp of shame without taking Tomkins into account, why would we want to?

Thursday
Jun202013

Emotion Defined

In recent weeks, in order to try to tackle the question of whether shame is an emotion or, as I have earlier suggested, some kind of complex of emotions, I have been scouring the scientific literature (both in psychology and neuroscience) for a definition of emotion that draws a substantial consensus of opinion. It appears that no such definition yet exists. I will, therefore, propose my own definition below.

I will also propose a definition of mood below, as distinct from emotion. It has become clear to me recently that these are two separate, though interwoven, phenomena (that is, emotion and mood). But what exactly constitutes the difference remains unclear--indeed, the two terms are often used interchangably in conventional usage. I am quite excited about (and somewhat daunted by) my proposal for mood. If I'm right about it, my proposal carries profound significance for how we think about the relation between human health and psychological well-being.

Emotion

General description: Emotion is a discrete, short-lived subjective phenomenon linked with a specific menu of neurobiological circuitry and a specific behavioral repertoire.

Definition: Emotion is a discrete feeling that involves all of the following: 1) a more or less consciously registered felt sense concerning what it's like to be experiencing a given moment; 2) the activation of one or more of the basic emotion circuits of the limbic system; 3) the conscious or unconscious performance of action tendencies directly associated with those basic emotions.

Mood

General description: Mood is a lasting, pervasive subjective phenomenon linked with a general appraisal of bodily homeostasis that influences the valence and intensity of emotional responses.

Definition: Mood is a lasting, pervasive feeling that involves all of the following: 1) or more or less consciously registered felt sense of what it's like in general to exist (across a period of hours or days); 2) signals from the autonomic nervous system regarding homeostatic balance; 3) the conscious or unconscious performance of action tendencies directly associated with the maintenance of bodily homeostasis.

Both definitions just offered consist of three parts, an a, b, and c. The relation between these parts is not causal or contingent, but rather identical. In other words, I am not saying that emotion or mood is of the type where if a is true and b is true and c is true (as opposed to one or more of these conditions not being true) then we have an emotion or mood. I am saying, rather, that emotion or mood is the sort of thing where a, b, and c are three different ways of saying the same thing. An emotion, for instance, is any one of those things and all three of those things. The items a, b, and c are three different but entirely mutually consistent ways of describing the same state. Emotion is, by definition, that which satisfies all three of these equivalent descriptions. I am not defining emotion as Emotion equals a + b + c. Rather,

Emotion is that wherein a = b = c

Clearly, I have left far more unsaid here than said. I will provide more background about what is intended here in future posts. In the meantime, I welcome--no, implore!--you to leave comments about these rather innovative and risky efforts to define these elusive concepts. Thanks!