WILMA BUCCI,  Ph . D.https://docs.google.com/drawings/u/3/d/sPNXg3QviG-XdrB3asjsjiQ/image?w=226&h=1&rev=1&ac=1&parent=1oc687wp7v_2yc0uhWEgkrSCr4ETwKe6-

DISSOCIATION FROM THE PERSPECTIVE OF MULTIPLE CODE THEORY

Part I

PSYCHOLOGICAL ROOTS AND IMPLICATIONS FOR PSYCHOANALYTIC TREATMENT ‘*

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Abstract: The multiple code theory, based on current work in cognitive science and neuroscience, provides a new context for examining the psychological and biological bases of dissociative processes. As I elaborate here,  we  need  to broaden our understanding of dissociative processes as encompassing not only means of protection against anxiety and stress, but also a broad range of positive functions that underlie courage, productivity, exploration and joy; we also need to broaden the definition of trauma to encompass a wide range of chronic as  well  as  acute events. In this paper, I outline the spectrum of dissociative processes, as these apply in psychic sickness and health, from the perspective of multiple code theory; then examine new views on trauma and its regulation; then discuss briefly the implications of these changes in perspective for treatment of the various types of dissociative processes that clinicians encounter—and experience.

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Keyword: dissociation, symbolic, sub-symbolic, trauma, referential

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•An earlier version of this paper was presented November 2005, in Palermo, Italy, at an international congress on the assessment  and  treatment  of  traumatic  experiences.  Portions  of the paper were also presented in April 2006 at an all-day seminar on “The Dissociative Mind: Psychological Roots and Psychoanalytic Processes in  Action,  “ The International  Society  for the Study of Trauma and Dissociation, at Adelphi University, Garden City, Long Island. The collaborative research and clinical  perspective  presented  in  this  paper  has  roots  in  a  panel on “Trauma, Dissociation and Conflict: The Space Where  Neuroscience,  Cognitive  Science, and Psychoanalysis Overlap," at the April 2002 meeting of the Division of Psychoanalysis

  1. of the American Psychological Association.

' This is the first of two papers presenting a new and broader understanding of dissociative processes as they operate in adaptive functioning, in pathology, and in psychoanalytic treatment, viewed from the perspective of multiple code theory.

Contemporary Psychoanalysis, Vol. 43, No. 2. ISSN 0010-7530

02007 William Hanson White Institute, New York, NO. All rights reserved.

165

HUMANS HAVE EVOLVED as complex organisms, with multiple states, multiple functions, multiple ways of processing information,https://docs.google.com/drawings/u/3/d/sat8JbfQzIrgWfLfIkZYaVg/image?w=31&h=45&rev=1&ac=1&parent=1oc687wp7v_2yc0uhWEgkrSCr4ETwKe6-

and substantial but limited integration of systems. We are all more dissociated than not. The dissociation among systems is the basis for our vulnerability and also, in some respects, our strength in negotiating our worlds. The adaptive human capacity for encompassing multiple and shitting states is what makes possible the absorption of a scientist in his creative thought; the phase of maternal preoccupation in late pregnancy and during the infancy period; the capacity of an athlete to enter the zone in which "everything seems to work" and he can “play incredible," as Fed erer said following his winning the U.S. Tennis Open; the altered state of romantic love; the “place” that jazz musicians describe that they “go to,” in which improvisation somehow flows. Sometimes the same person can be mother, athlete, jazz musician, lover, and even scientist, at different times and in different states.

There is a theoretical tension, we may say dissociation, that pervades the field, and that needs to be explicitly acknowledged, between our modern recognition of the inherently complex nature of human psychic organization, and the time-honored view of dissociative processes as hav ing their roots in the response to trauma, stress, and anxiety. With all the changes in theory from Janet, to Freud, to Fairbairn, Ferenczi, and Sullivan, beautifully summarized by Howell (2005), the assumption remains that dissociative processes emerge as the organism (human or otherwise) attempts to protect its own stability in response to trauma; with the corollary assumption that somehow, if there were no stress, we would all be whole.

To understand dissociative processes as they occur in response to par-

Ticular events that may be characterized as traumatic, we need first to understand the more general and ubiquitous operation of these processes in  a normative psychological sense; we also need to examine the nature of traumatic experience and its impact in the context of the inherently complex and multifaceted nature of human psychological and biological organization.

The first major point that I emphasize throughout this paper is that dissociation does not emerge first or necessarily from negative roots. A person without an adequate capacity for multiple states and functions will lead a limited life. People call on a pool of dissociative and integrative processes to manage the wide range of challenges and problems of life; these may involve positive explorations or retreat from experience. Some-

times the solutions that are adaptive in one context will turn out to be maladaptive in others; treatment may also involve further dissociation as well as new integration.

My second major point concerns our understanding of the nature of traumatic experience, its challenge to personality organization, and the various ways that people use the tools of adaptation that they possess to respond to this challenge. Just as we see a theoretical tension in the definition of dissociative processes, so we must also recognize a similar kind of tension in the definition of trauma and traumatic events.

The specific nature of trauma is a psychic injury that remains unhealed. The process begins as an adaptive response to danger; the human organism, like all organisms, mobilizes its defenses against a threat, with immediate responses of fight or flight, in their many variations. In adaptive functioning, the emergency response is regulated when the external danger is past. In some cases however, the regulation, resetting the response system to non emergency mode, does not occur or occurs only partially. The person appears unable to register changes in his situation and continues to respond as if danger were present or imminent; thus the initial response patterns of avoidance or attack are replayed in a broadening range of simations, rather than modulated in the context of the person’s current circumstances and current powers. The expectations of danger and the protective responses may become dangers in themselves, preventing the healing of the psychic wound that might occur naturally over time. Treatment may activate the threat of danger and elicit further defense; this is the “vicious circle” of the treatment of traumatic disorders. Before I address the mechanisms underlying this vicious circle of treatment, however, I would like to make a general point about the circularity of diagnosis that complicates the problem further, but also provides a potential escape.

The Logical Quagmire of Diagnosing Stress and Trauma-Related Disorders

Posttraumatic Stress Disorder (PTSD) is the only psychiatric entity for which an external event is one of the necessary criteria for diagnosis. According to DSM IV (American Psychiatric Association, 2000), the first criterion for PTSD is exposure to a serious stressor as defined within the system. It is also true, however, that the inclusion criteria for the stressors identified as trauma are so broad as to render the criterion essentially meaningless. According to a national survey published  in the Archives of

General Psychiatry, 61% of men and 51% of women reported experiencing at least one major trauma in their lifetimes, and in most cases more than one event (Kessler et a1., 1995). In a study using the Traumatic Experiences Checklist (TEC) a self-report questionnaire developed by Nijen huis et al. (1999), over 90% of a sample of general psychiatric outpatients reported one or more traumas, and the mean number of traumas reported was 6. Yet the prevalence of PTSD in the general population has been estimated at 3% to 6%. Clearly what is necessary for the diagnosis is not sufficient; what is trauma for one is not trauma for all.

We also recognize that long-term, chronic situations, such as childhood sexual and physical abuse, produce symptoms with features of PTSD. In some classifications, psychological abuse has been added to the categories of chronic abuse; thus the set of potentially traumatic events may now be seen as encompassing the human  condition—a  view  that  may be accurate in our times, but does not help very much for psychiatric diagnosis.

From a converse perspective, we also know that the events that people do not remember, that are severely dissociated or warded off, may have at least as much impact as those they report. If a patient shows the symptom picture of PTSD, but lacks an explicit memory of exposure to a stressor, will we not suspect a traumatic event for which the person is amnesic and proceed to treat the patient accordingly?

We are left with a definition of a traumatic stressor as an event to which a person has a posttraumatic response, and an assumption that occurrence of a posttraumatic response must imply some prior exposure to a traumatic event. If we do not know this event as yet, we seek to help the patient to remember it—with all the dangers of this directed recollection.

Further confounding the issues of diagnosis are questions concerning the large proportion of people who show apparent  resilience  in the face of known and documented trauma and who appear to  be  functioning well: survivors of concentration camps, survivors of known sexual or physical abuse in childhood; people who were present at catastrophic events. There is now some indication that these well-functioning survivors may be paying a complex psychological price for their resilience— holding components of themselves hostage to maintain their psychic balance. Thus the name of possible response to trauma is in danger of becoming as broad as the definition of traumatic events.

My main point in putting a foot in the logical quicksand of diagnosis of PTSD is not so much to address the many problems of the DSM-IV or ICC

criteria as to underscore my claim that in order to understand and treat these disorders, we need to go beyond psychiatric categories and try to understand the psychological processes that intervene between  purported precipitating events and observed symptomatic (or asymptomatic) responses. Freud (1926) made this point three quarters of a century ago, when he wrote that the psychic effects of any danger depend on the per son's “estimation of his own strength compared to the magnitude of the danger and his admission of helplessness in the face of it” (p. 166). From the perspective of mental health, it remains true that it is psychic reality, not material reality, that is the important kind. What we define as trauma or stress is an internal psychic condition, determined not only by a particular environmental situation, but by how an organism reacts to this, as his own powers and capacities allow.

The focus on basic psychological mechanisms has several major implications: 1) we can see these mechanisms as operating on a continuum  with varying degrees of severity in all disorders; and 2) we can see the processes of treatment also as operating on a continuum and by  this means work toward our escape from the vicious circle of definition and treatment of trauma related disorders.

Current work in cognitive science and neuropsychology provides a new basis for understanding the psychological mechanisms underlying adaptive and maladaptive patterns of response to stressful events. The multiple code theory (Bucci, 1997) provides an account of these mechanisms and their variation in response to stressful events that is compatible with psychoanalytic views and that provides a basis for treatment. Once we examine these general mechanisms, we can then also attempt to distinguish particular features that may vary with the severity and quality of the precipitating events. I’ll assume some familiarity with the theory and review it only briefly here, focusing on the application to the understanding and treatment of severe disorders associated with traumatic events.

Brief Review of Multiple Code Theory

The human organism is a multi-code, multi-system emotional information processor, with substantial but limited integration of systems (Bucci, 1997). The systems are characterized as subsymbolic, symbolic nonverbal, and symbolic verbal codes. Symbols—in the sense used here, not the psychoanalytic sense—are discrete entities that refer to other entities and can be combined to make an essentially infinite variety of forms. Words are the quintessential symbolic forms. Symbols also include imagery in any sense modality, although the visual modality may dominate.

The subsymbolic system is less familiar conceptually and difficult to describe technically, but most familiar to us in our daily lives. Subsymbolic processing may be characterized as continuous or "analogic", in contrast to the discrete representational entities of the symbolic mode. Thus computations on continuous dimensions are required for a vast array of functions, from skiing to musical performance and creative cooking; "analogic" processes are used in the characterizations of wines and perfumes and teas, where dimensions of continuous experience that cannot be broken into discrete elements are seen to correspond.

The phenomenon of affective attunement described by Daniel Stern (1985) is basically a type of ana-logic and continuous emotional communication. In the following example, the mother provides a nonverbal anal ogy in continuous format to her 10 month old girl’s emotional expression:

The girl opens up her face (her mouth opens, her eyes widen, her eyebrows rise) and then closes it back, in a series of changes whose contour can be represented by a smooth  arch. Mother  responds  by intoning “Yeah” with a pitch line that rises and falls as the volume crescendos and  decrescendos:

The mother's  prosodic  contour  has  matched  the child's facial-kinetic

contour [ p. 140]

Subsymbolic processes occur in motoric, visceral, and sensory forms, and in all sense modalities. They are organized, systematic, rational forms of thought that continue to grow in complexity and scope throughout life. Unlike the primary process as characterized in psychoanalytic theory, subsymbolic processes are not chaotic; not driven by wish fulfillment or divorced from reality. Subsymbolic processing is modeled in cognitive science by connectionist or parallel distributed processing (PDP) systems (McClelland, Rumelhart, and Hinton, 1989), with the features of dynamical systems (Bucci, 1997). (I should emphasize that this is a psychological model, not a neuropsychological one; although it is fully compatible with neuropsychological findings.)

In such dynamical systems, memory and learning are determined by connections among the elements of the network; knowledge is distributed over the interconnected nodes of the network; retrieval of memories, including emotional memories, is understood in terms of changing patterns of activation, continually reforming, rather than as retrieval of fixed

and stable contents. The model accounts in a systematic way for organized processing in the subsymbolic system, functioning with its own rules, outside of the symbolic mode; such processing is dominant in emotional information processing and emotional communication. We are not accustomed to thinking of processes, including somatic and sensory processes, that cannot be verbalized or symbolized as systematic and organized thought; the new understanding of subsymbolic processing opens the door to this reformulation. It changes our entire perspective of pathology and treatment when we are able to make this shift.

We know this processing as intuition, the wisdom of the body, and in other related ways. The crucial information concerning our bodily states comes to us primarily in subsymbolic form, and emotional communication between people occurs primarily in this mode. Reik’s (1948) concept of "listening with the third ear" relies largely on sub symbolic communication (see Bucci, 2001, for a detailed discussion).

My claim is that the disjunction between subsymbolic and symbolic processing formats is inherent in human emotional and mental functioning, not restricted to pathology. The "theoretically perfect person whose development had been optimum," referred to by Fairbairn (1952, p. 7), would necessarily share the same organization based on multiple processing systems and inherent dissociations among them. In emotional disorders, these inherent dissociations are exacerbated and transformed in particular ways, as I will discuss.

The  Referential Process

Connecting the Multiple Systems.

The continuous and "analogic" formats of the subsymbolic system can be mapped only partially onto the discrete elements of the symbolic  code. On the simplest level, the limitations of the connecting process become apparent when one attempts to verbalize an experience that has not previously been formulated, describe a taste or smell, or teach an athletic or motoric skill, or when one struggles to express an emotion and can’t "find the words."

The referential process is the integrating function of the multiple code system; imagery, which is symbolic and nonverbal, plays the pivotal role in this integration. Images of the episodes of our lives, which incorporate all sense modalities, connect in their sensory aspects to the "analogic" sensory contents of the subsymbolic code. As discrete representational

elements, they are also capable of mapping onto the discrete elements of language; thus images provide the necessary link between the subsym bolic nonverbal and symbolic verbal codes.

27ie Emotion Schemas and the Referential Process

Adaptive functioning requires some degree of coordination (we may say “good-enough“) between subsymbolic and symbolic systems in the service of a person’s general functioning and overall goals. We need to bring together information from our bodies and emotions, with information from past and present experience,  to make decisions about  how to act at any given time, and to express how we feel.

The fundamental organizing structures of human emotional life—and probably of other species—are emotion schemas. Like all memory schemas, emotion schemas include components of all three processing systems—subsymbolic processes, imagery, and, later, language—but emotion schemas are more strongly dominated by sensory and bodily representations and processes than other knowledge schemas. The sub symbolic sensory, somatic, and motoric representations constitute the effective core of an emotion schema, the basis on which the organization of the schema is initially built. The objects and settings of time and place constitute the specific contexts and contents of the emotion schemas, which continue to be elaborated throughout life.

Emotion schemas are built through registration in memory of specific episodes of one’s life. They represent the characteristic form of one’s interactions with other people from the beginning of life. Interactions with caretakers play the central role in these constructions. The interactive events bring together sensory, somatic, and motoric processes with images of people, in a specific time and place, and build emotional memory by this means. Emotion schemas, like all memory schemas, are active and constructive processes, not passive storage receptacles. They determine how we experience all the interactions of life and are themselves changed by each new interaction. We see all things through the lens of memory schemas; there is no other way, no view of reality outside of this lens.

This formulation of emotions as schemas built and rebuilt through representation of the episodes of one’s life is compatible with current views of emotions. According to Lang (1994),

a memory of an emotional episode can be seen as an information network that includes units representing emotional stimuli, somatic or visceral re-

spouses, and related semantic (interpretive) knowledge. The memory is activated by input that matches some of its representations. Because of the implicit connectivity, the other representations in the structure are also automatically engaged, and as the circuit is associative, any of the units might initiate or subsequently contribute to this process Up.218L

The schemas of emotional memory are organized and reorganized throughout life in many dimensions. They may be connected by a common object, as in the multiple schemas of mother. Schemas that we characterize as fear or love or control or rage will involve complex circuitry based on episodes that are connected through a common core of somatic and sensory experience and motoric response, with some  shared  and some unique contextual information. Emotion schemas are also organized in autobiographical memory on dimensions of time and place to develop the multiple schemas of the self.

The basic concept of internalized object representations, or object relations, is essentially a form of emotion schema, as is Stern’s (1985) concept of Representations of Interactions that have been Generalized (RIGs) or Bowlby’s (1969) working models, and many others. Damasio’s (1994, 1999) notion of dispositional representations provides a neurological basis for the construct of the emotion schema, and supports and extends this concept: dispositional representations exist as potential patterns of neuronal activity distributed throughout the nervous system, connecting sensory and association cortices with limbic structures and structures sub serving motoric and visceral response. The structure of the schema provides the conceptual basis for the processes of transference (and countertransference). The patient plays out with the analyst the expectations and responses encapsulated in the emotion schema (as the analyst necessarily does—perhaps in a different way—with the patient.)

We express and represent emotion schemas in two major ways: as nar-

ratings of specific episodes from our past, drawn from memory; or as enactments, a playing out of the schema  in the present,  the here-and-now. In either case, whether through retrieval from memory or as enactment, the activation of an emotion schema involves not only words and images, but also some degree of arousal of the sensory and bodily experiences of the affective core. Just as visual images are now known to activate the same neural pathways involved in visual perception, the activation of the affective core of a schema involves acmal physical pathways of pleasure and pain happening in the body in the present, to varying degrees.

The activation of the affective core in connection to the people and events of life is crucial to the emotional information-processing system, to enable emotional evaluation of events as they occur in terms of their impact on the person’s well-being. The person perceives an element of the event— an object in a particular place and at a specific time—or retrieves it from memory; the emotional information about this event comes from the activation of the subsymbolic sensory and somatic functions of the affective core. In adaptive functioning, that is how we use feelings to evaluate events, to know if something is good or bad for us.

Occurrence, Reactivation, and Reconstruction of Threatening and Painful Events

Characterization of Pathology

Pathology is determined by dissociation and distortion within the emotion schema, so that the emotional evaluation of the events of life is not effective. Thus new events are perceived in distorted ways, and the new information that is taken in does not correct the distortion but, rather, reinforces it.

Threats to the integration of the emotion schemas  occur  throughout life, primarily involving upsurges of arousal that are overly intense in relation to a person’s capacity for self-regulation. In healthy-enough development, upsurges of arousal are regulated initially through the relationship with the caretaker; the child gradually develops mechanisms of self-regulation and self-soothing in this relational context. Where arousal is overwhelming or the caretaker is dysfunctional, effective mechanisms of self regulation do not develop.

The failure of integration is particularly severe when the caretaker is herself a source of threat to the child’s well-being—terrifying, humiliating, or otherwise destructive. A schema of the caretaker as a threat, activating a response of terror in the child, is unbearable, in part because of the intensity of the experience, which overwhelms the child, and, most crucially, because the caretaker is the one to whom the child must turn for protection in time of danger. The schema of mother as a danger to oneself is incompatible with the schema of mother as protector; the child is under attack and there is no place to turn.

The child then attempts to deal with the threat in some way. She cannot realistically attack or escape physically; she is small and weak and fears being abandoned. What she can do is turn attention away from the threat

and from the perception of the caretaker as the source of terror; dissociation of the emotion schemas occurs through such a process. Bromberg (2001) writes about a patient who says:

then I was little and I got scared—scared because Mommy was going to beat me up I’d stare at a crack in the ceiling or a spider web on a pane of glass, and pretty soon I'd go into this place where everything was kind of foggy and far away, and I was far away too, and safe. At first, I had to stare real hard to get to this safe place. But then one day Mommy was really beating on me and without even trying I was there, and I wasn't afraid of her. I knew she was punching me, and I could hear her calling me names, but it didn't hurt and I didn't care. After that, anytime I was scared, I’d suddenly find myself there, out of danger and peaceful. I've never told  anybody about it, not even Daddy. I was afraid to because I was afraid that if other people knew about it, the place might go away, and I wouldn't  be able to get there when I really needed to [pp. 90W9051.

Dissociation and distortion within the emotion schemas may occur in response to acute external traumatic events at any time in life, as well as through more chronic problems of the caretaking situation. The development of general structures of dissociation in the context of chronic early stress will render the individual more vulnerable to the later events of life. We may see the processes of avoidance and dissociation in response to aversive threatening stimuli as having their roots in generally expected organismic responses to such events. The major types of response to threat for all organisms have been characterized as flight, freeze, and fight (Tim berlake and Lucas, 1989; Nijenhuis, Vanderlinden, and Spinhoven, 1998): these operate at different points in the occurrence of the threat and in response to different types of danger. Flight or freezing responses are most characteristic of a child who is powerless to attack the caretaker; freezing has the added physiological benefit of associated analgesia, reducing the level of pain. We see this in the example of Bromberg's patient quoted earlier. Threats occurring later in life or in other circumstances may activate the particular patterns of fight, flight, or freezing that constitute the

characteristic organization of a person’s response to threat.

In all cases, the response to threat involves some form of dissociation within or between the emotion schemas; these dissociations may take several major forms. Dissociation within schemas may emerge as arousal of the subsymbolic components of the affective core of terror with associ ated flee or attack or freeze responses, without recognition or acknowl-

edgment of the object that is the source of the activation; or a distorted image of the object may be experienced as split off from the subsymbolic components of the affective core. Dissociations within schemas also lead to dissociations between them. My claim is that such dissociative processes underlie all emotional disorders, whether or not a specific trauma is identified.

This formulation of dissociation within and between the emotion schemas as underlying emotional disorders is compatible with clinical observations and also with biopsychological data. Van der Kolk (1994) has described the occurrence of fragmentary memories with vivid, intrusive, unmodulated affect, not oriented to space and time, or generalized feelings of anxiety, anger, fear, or uneasiness, which he refers to as body memories. Such feelings have been characterized by van der Kolk and Fisler (1995) as disconnected images and waves of disjointed sensations and emotions. In multiple coding terms these are accounted for as dominance of the subsymbolic components of the emotion schema while avoiding acknowledgment of their source. Payne et al. (2004) have identified this form of dissociation with the defense of “undoing” (Freud, 1926) in which autobiographical information associated with the trauma is pushed out of awareness, leaving persistent, generalized, free-floating anxiety without an apparent source.

Clinicians have also identified the converse form of dissociation in which a person retains memories of abuse or trauma but affect is flat. This form of dissociation is related to the mechanism characterized by Freud (1926) as “isolation of affect” and may be described by clinicians as emotional blunting or emotional numbness. As Chefetz (2004) characterizes this phenomenon, the idea of a feeling is dissociated from the bodily or emotional experience of it; thus a patient may say, “I know I am angry, intellectually; I just can’t feel it, none of it” (p. 251). In such cases, symbolic elements of the schema remain accessible without connection to the associated bodily states.

The psychological formulation of dissociation within emotion schemas as underlying pathology is directly supported by biological evidence. Memories of specific events are experienced and stored in multiple systems, including all sensory modalities, motoric systems, and visceral and autonomic systems. Operation of emotional memory and emotional information processing depends on communication among hippocampal, amygdalar, and cortical networks. There is no single anatomical location for the representation of the stressor events; they are widely distributed

throughout the limbic system and cortical zones. The hippocampus and adjacent medial temporal regions are critical to the integration of components of information from these multiple systems in episodic  memory, and to orientation of episodes in space and time in autobiographical memory. Stress affects integration of information through direct impairment of hippocampal and cortical functions, and through disturbance in their modulation of the amygdala functions.

According to Jacobs and Nadel (1985), in the absence of an intact hippocampus-based memory system, the amygdala-based system stores emotional information unbound to the spatiotemporal context of the relevant events. This process results in a pool of emotional memories, essentially a population of sensory and perceptual fragments, that are acquired during the traumatic event but encoded without a coherent spatiotemporal frame to organize them.

There is also evidence that the brain regions and hormonal effects that are activated during encoding of stressful events are activated as well during retrieval of these memories (Damasio, 1994, 2003). Just as visual images are now known to activate the same neural pathways involved in visual perception, the arousal of the affective core of a schema involves actual physical pathways of pleasure and pain happening in the body in the present, to varying degrees, and may elicit responses  that are similar to the acmal event. This process accounts for continued proliferation and elaboration of these maladaptive perceptions and response patterns long after the external stressor is past, and is a crucial factor in treatment.

Attempts at Self-Repair

The affective core of an emotion schema is likely to be activated when elements associated with the schema occur in a person’s life. If the schema is one in which dissociation has occurred, these upsurges in arousal may have no apparent source. People seek in many ways to provide emotional meaning for these feelings of agitation and arousal, and will attempt to regulate and contain them. The regulatory and control strategies range from the apparently effective modes of resilience to the myriad forms of emotional disorders, from neurotic to severe posttrau matic forms. In apparent resilience, for example, the arousal may operate as motivation for achievement or may stimulate a lifetime of devotion to the welfare of others. In generally less adaptive modes, a person may attempt to seek meaning for the painful arousal in somatic complaints, in identifying potential aggressors, or by reinterpreting the arousal—for ex-

ample, interpreting unacceptable anger as anxiety; or by turning it against the self in depression and suicidal attempts. The many complex constructions of pathology, including addictions, phobias, eating disorders, and even psychotic symptoms, may be accounted for by such attempts at managing the effect of a dissociated schema and providing some symbolic meaning for the subsymbolic response; they may be seen in a metaphoric sense as disorders of the immune system in the psychic domain.

Dissociations within the emotion schemas can lead to dissociations between them. In reasonably adaptive functioning we maintain multifaceted complex images of others and of ourselves, coexisting in memory on a single autobiographical timeline. In some cases, however, the attempts at repair of the schemas lead to splitting of the representations of others and to breakdown of the self-representation and interference with the organization of autobiographical memory. An elaborated schema of one’s mother as benevolent and the source of sustenance cannot exist in autobiographical memory alongside an image of mother as threatening one’s life. An image of oneself as rageful and powerful that may be developed later in life as part of one’s body armor is not compatible with an early image of oneself as helpless and alone. Thus one may experience oneself as having separate parts of the mind that function with some autonomy; the syndrome of dissociative identity disorder (DID) may be understood as involving such dissociations among the emotion schemas, along with other features.

Summary of Pathological Processes

To summarize this very brief and oversimplified characterization of path-ology in multiple coding terms, I would like to emphasize several major points with respect to the several forms of dissociation that have been identified here:

First, it is the integrative function of the multiple code system, the referential process, connecting subsymbolic and symbolic processes  within the emotion schemas, that is impaired by trauma or chronic stressors, not one or the other of the processing systems. The individual continues to process information on the subsymbolic and symbolic levels, and both modes of processing may occur within awareness but without connections among these experiences. A young woman suffers from severe lower body pain, including stomach or menstrual cramps, which appear  to have no organic basis, and visits gynecologists repeatedly for this condition, even demanding surgery. She also has memories of sexual abuse

by her brother, largely devoid of affect but does not connect her current bodily experiences with her memories of abuse. A young athlete finds himself unable to perform adequately in a particular important game, and the self-doubt reverberates to destroy his coordination further; he remembers being beaten by his father and is grateful to his father for the discipline, but does not connect the experience of failure with the beatings.

Second, the name of pathology and the crucial problems for treatment are determined not only by the initial dissociations that occur in response to threat, but also by the secondary effects, the attempts at self-protection and development of emotional meaning for upsurges of arousal that a person employs once the dissociation has occurred.  We see this  process in both cases just described: the somatizing in the first case; the self-doubt and failure of physical coordination that is preferable to rage at the father in the second. These attempts at self-repair add layer after layer to the onion of pathology that must be addressed before  the initial avoidance can be understood.

Third, to emphasize again: there is a spectrum of dissociative processes that apply in all aspects of life, adaptive as well as maladaptive. It follows that analyses of the psychological processes of dissociation and their biological correlates apply to varying degrees and in different ways for all emotional disorders.

Implications for Treatment

For all psychic disorders, the minimal goal of treatment may be stated as enabling more adaptive and effective regulation of the painful hyperarousal of the affective core of the emotion schema, so as to provide a functional space for the patient to go on with life with reasonable satisfaction and without overwhelming pain. This may also require that the patient give up the modes of self-cure that have proven maladaptive. There are two major alternative therapeutic strategies for achieving these goals: one is to enable more adaptive means of affect regulation without addressing the initial sources of the dissociation; the other is to work toward integration of the schema; this would necessarily involve some reactivation of the initial threat. In actual clinical work, the two approaches are likely to interact to varying degrees.

To the extent that the effect is experienced as overwhelming, actually threatening homeostatic regulation, maintenance of the dissociative processes may be appropriate. This may apply for all patients at certain

times. The approaches of symptom management—developing mechanisms of self-soothing, building a sense of mastery, and prescribing medication—may also have positive secondary effects; patients learn to be less afraid of the emerging upsurges of arousal as they acquire better mechanisms of managing their effects, and may develop new and positive associations to the contexts in which such tension reduction occurs. They may gradually then become more amenable to techniques involving titrated activation of the schema’s affective core.

There are obvious problems if treatment ends without addressing the dissociation to some degree. What patients are able to avoid at certain times, in certain contexts of life, remains alive to trouble them later, when their life simulation has changed. The zones of relative comfort may diminish, as more experiences become colored by expectations of dreaded events. Through the activation of the painful affective core in different contexts, not recognized or understood,  the events and images that need to be avoided will expand. This is the developmental proliferation of pathology—the tunnel vision—that narrows the possibilities of life.

Bromberg’s (1998) portrayal of his patient Christina, "a beautiful and talented poet in her early 50s," illustrates the process of survival by maintaining a rigid dissociative structure, and its effects. Christina was a survivor of brutal childhood trauma, whom Bromberg describes as going seamlessly through the actions of life like a very effective wind-up toy, doing what is expected of her, entirely repudiating spontaneity of response. Her inner world remained vulnerable to sudden violent disruption in response to such events as thunderstorms and other loud and sudden noises, which she managed to some degree by a series of rituals. As Bromberg describes her, "Christina was a patient for whom life was a series of rimals to be performed while she was waiting for death, and therapy was simply one more ritual among many" (p. 323).

The second major strategy of treatment, working toward the goals of reintegration, requires the patient to break through the rimals and confront the demons, to allow the activation of the dreaded schema in the present to some degree, with its potential risks and rewards. Elsewhere (Bucci, 2002, 2003) I have discussed in detail how the referential process works in the context of the treatment relationship to bring about changes in the emotion schema—changes in what we perceive and feel and what we expect from others, not only in what we do. This basic process applies in any uncovering treatment, with variations depending on the nature of the emotional disorder.

The referential process involves three major phases: 1) arousal of the affective core of the emotion schema; 2) experiencing imagery of a specific episode and telling it in concrete detached or reenacting aspects of  it; and 3) some reflection and examination of the episode. Reintegration of the dissociated schemas requires repeated playing out of these phases in the interpersonal context of the relationship, so that the affective core itself gradually undergoes change in relation to perception of the present, memories of the past, and expectations of the future. The change in the subsymbolic processes of the affective core in relation to imagery and perception of objects and events is what we mean by working through.

The referential process applies in treatment of all disorders, whether or not specifically trauma related; the following specific issues need to be confronted when one is working with patients with severe disorders reflecting massive dissociation within and between the emotion schemas:

  1. Actual change, reintegration or reconstruction of emotion schemas, requires actual activation of the affective core of the dissociated schema to some titrated degree in relation to a new object and in a new context with a new recognition of the capacities of the self. We need to  recognize when it is useful to facilitate such activation and when it is not. We also need to keep in mind that the analgesic function of the freeze response to the original threat may not operate at the time of memory retrieval; survivors have described how the retelling of an event is experienced as  more painful than the actual occurrence.
  2. The protective processes that people have developed throughout life to shield themselves from the emergence of the dreaded effect will con tinue to operate in the treatment.
  3. In many cases, particularly in instances of long-standing and chronic abuse, the protective processes have become intrinsic components of the person’s self-schema, sense of self, and view of the world in relation  to the self. The patient may experience any challenge to these protective processes not only as a risk of activation of the physiological components of the dreaded affective core, which have the potential to threaten life, but also as threatening his sense of self. The anticipation of loss of self, with its component of shame and helplessness,  is in some  respects as painful or more painful than anticipated danger to life, as Bromberg (1998) has emphasized.
  4. If activation of a schema does occur to a relatively intense degree, even in a new context, there is the danger that the new context will be drawn into the schema, rather than the schema being perceived as new.
  1. Focus on general themes that do not involve the referential process and do not activate the affective core will leave the schema largely unchanged, although new strategies for avoidance may be enhanced by this means.
  2. The danger exists that pathology may be reinforced rather than alleviated through activation of the affective core. The danger is greater to the extent that the treatment situation actually shares elements with the initial traumatic events; as, for example, when a therapist maintains a neutral or distancing mode or focuses on interpretation of resistance with its element of blame  thus resonating unintentionally with the feelings of humiliation and powerlessness that are at the core of the patient’s distress.

Bromberg’s (1998) description of Christina’s treatment illustrates some of these issues. He reports that after about four years of treatment, experienced largely as hopeless by both analyst and patient  but with a few breaks in the wall of futility—Christina's long-anaesthetized appetite for life began to find voice and life began to seem worth the risk. At this point, Christina reported the following dream, which provides a good metaphor for the vicious circle of treatment of trauma and dissociation, with perhaps some hope:

She was walking along the top of a seawall that began to get narrower and narrower until she was at a place she couldn’t go forward without falling into an abyss. But she couldn’t go back because she couldn’t turn around. The scene then shifted to her looking at herself in a mirror and suddenly noticing a second head growing out of the side of her own head. The face wasn't there yet, and she was terrified of it appearing. She didn’t want to see it. 325].

Bromberg writes, “In allowing herself to dream the dream, she was conveying that although she felt her analysis might be leading her toward ’the black hole’ of madness she was no longer accepting the existential deadness of dissociation as the price for escaping potential retraumatization” (p. 325). In time, in the course of the analytic work,

Christina was now able to experience anxiety for the first time and distinguish it from the traumatic dread that had been her constant companion, telling her she was always on the edge of the “black hole”. She could now recognize anxiety as something unpleasant but bearable  something she felt rather than a way of addressing the world.    She recognized that she

was now taking  the risk  of  pursuing  a life that included  self-interest, and

that in choosing to live life rather than wait for it, she had accepted the in-

evitability of loss, hurt, and ultimately death as part of the deal [p. 328].

Strachey (1934) discussed the “neurotic vicious circle”; issues similar to those that Strachey noted apply in different ways to the broad range of patients who analysts see today. We need to recognize the risks and the rewards of this uncovering process. The tradeoff of psychic numbness coupled with chaotic intrusion on one side, against vulnerability to pain that is viewed as unbearable on the other, exists to varying degrees and in different ways for patients with all emotional disorders, not only for victims of abuse. The challenge of the treatment is determined by the intensity of the threat and its meaning for the individual. The challenge also depends on the mechanisms of repair that were overlaid on the initial dissociation to enable the person to go on. The circle will be broken as both the estimate of the magnitude of the danger and the estimate of one’s own strength are revised through exploration in the new context of the treatment relationship. The reward includes vulnerability to pain and fear, but also feelings like bravery, love and joy—a sense of self, a connection to others, and a sense of life.

REFERENCES

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ders IV. Washington, DC: American Psychiatric Press.

Bowlby, J. (19699, Attachment and loss: Vol. 1: ACachment. New York: Basic Books. Bromberg, P. M. (1998a, Standing in the Spaces: Essays on 'clinical Process, Trauma, and

Dissociation. Hillsdale, NJ: The Analytic Press.

Bromberg, P. M. (2001), Treating patients with symptoms and symptoms with patience: Reflections on shame, dissociation, and eating disorders. Psychoanalytic Dialogues, 11:891 912.

Bucci, W. (1997a, Psychoanalysis and Cognitive Science: A Multiple Code Theory. New York:

Guilford Press.

Bucci, W. (2001), Pathways of emotional communication. Psychoanalytic Inquiry, 20:40—70. Bucci, W. (2002) The referential process, consciousness, and the sense of self, Psychoana-

lytic Inquiry, 22:766-793

Bucci, W. (2003) Varieties of dissociative experiences: A multiple code account and a discussion of Bromberg’s case of William. Psychoanalytic Psychology, 20:542-557.

Chefetz, R. A. (2004a, The paradox of “detachment disorders”: Binding-disruptions of dissociative process. Psychiatry: Interpersonal and Biological Processes, 67:246-255.

Damasio, A. R. 11994), Descartes Error: Emotion, Reason and the Human Brain. New York:

Avon Books.

Damasio, A. R. (1999), The Feeling of What Happens. New York: Harcourt Brace. Damasio, A. R. (2003), Looking for Spinoza. Orlando, Florida: Harcourt.

Fairbairn, W. R. D. (1952), Psychoanalytic Studies of the Personality, Boston, MA: Routledge

& Kegan Paul.

Freud, S. (1926), Inhibitions, symptoms and anxiety. Standard Edition, 20:87—174. Howell, E. F. (2005), The Dissociative Mind. Hillsdale, NJ: The Analytic Press.

Jacobs, W. J. & Nadel, L. (19857, Stress-induced recovery of fears and phobias. Psychological Re i , 92:512-531.

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M. & Nelson, C. B. (1995a, Posttraumatic stress disorder. Archives of General Psychiatry, 52:1048—1060.

Lang, P. J. (1994), The varieties of emotional experience: A meditation on James-Lange theory. Psychological Reui‹nu, 101:211-221.

McClelland, J. L., Rumelhan, D. E. & Hinton, G. E. (1989), The appeal of parallel distributed processing. In: Parallel Distributed Processing: Explorations in the Microstructure of Cognition Vol. 1: Foundations), ed. D. E. Rumelhart, J. L. McClelland & the PDP Research Group. Cambridge, MA: MIT Press, pp. W4.

Nijenhuis, E. R. S., Van der Hart, 0. & Vanderlinden, J. (1999), The Traumatic Experiences Checklist (TEC). In: Somatoform Dissociation: Phenomena, Measurement, and Theoretical Issues, ed. E. R. S. Nijenhuis. Assen, Netherlands: Van Gorcum.

Nijenhuis, E. R. S., Vanderlinden, J. & Spinhoven, P. (1998), Animal defensive reactions as a model for dissociative reactions. Journal of Traumatic Stress, 11:243-260.

Payne, J. D., Nadel, L.., Britton, W. B. & Jacobs, W. J. (2004), The biopsychology of trauma and memory. In: Memory and Emotion, ed. D. Reisberg & P. Hertel, Oxford: Oxford University Press.

Reik, T. (1948a, Listening viii the Third Ear. The Inner Experience of a Psychoanalyst. New York: Pyramid Books, 1964.

Stern, D. N. (1985), `` Interpersonal World of the Infant. New York: Basic Books.

Strachey, J. (1934), The nature of the therapeutic action of psychoanalysis. In: Psychoanalytic Clinical Interpretation, ed. L. Paul. New York: Free Press, 1963.

Timberlake, W. & Lucas, G. A. (1989a, Behavior systems and learning: From misbehavior to general principles. In: Contemporary Learning Theories, ed. S. B. Klein & R. R. Mowrer. Hillsdale, NJ: Erlbaum.

van der Kolk, B.A. (1994), The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harvard fiez lieu› of Psychiatry, 1: 253-265

van der Kolk, B. A., & Fisler, R. (1995), Dissociation and the fragmentary nature of traumatic memories: Overview and exploratory study. Journal of Traumatic Stress, 8:505-525.

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Wilma Bucci, Ph.D. is a Professor, Derner Institute, Adelphi University; and Honorary Member, American Psychoanalytic Association and New York Psychoanalytic Institute

Derner  Institute Adelphi University Garden With, NY 11s JO

bucci8panther.adelphi.edu

—PART 2

THE SPECTRUM OF DISSOCIATIVE PROCESSES IN THE PSYCHOANALYTIC RELATIONSHIP 1

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Abstract: With his recognition of multiple systems of thought, and his emphasis on the relation of bodily and mental experience, Freud initiated a paradigm shift in the understanding of human inner life. A century later, we are engaged in another major advance within psychoanalytic theory that involves recognition of the inherently relational nature of emotional experience. This paper examines the basis for the relational perspective in current views of psychic organization, as formulated in terms of multiple code theory, supported by research in affective neuroscience, and also emphasizes the therapeutic implications of the new approach. As I discuss, the process of change in psychoanalysis requires an interpersonal space in which the threatening experience can play out, while the associated arousal of painful affect can be managed to an adequate degree. From this perspective, the authenticity of the therapist’s emotional engagement is crucial to enabling the explorations and enactments that are required, while avoiding (or minimizing) retraumatization.

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Keywords: affect, dissociation, enactment, interpersonal, intrapsychic, relational, trauma

IN INTRODUCING HIS VISION of a multisystem psych-ical apparatus, with separate and distinct processes of thought, Freud opened a new understanding of human inner life. He was also well ahead of his time in

recognizing the role of emotion and bodily experience as aspects of thought. The influence of these ideas can be seen today in affective neuroscience and cognitive psychology, although their psychoanalytic roots are generally not acknowledged (Bucci, 2000; Williams et al., 2007).

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  • An earlier version of this paper was presented in April 2006 at an all-day seminar on “The Dissociative Mind: Psychological Roots and Psychoanalytic Processes in Action, “The International Society for the Study of Trauma and Dissociation, at Adelphi University, Garden City, Long Island.

' This is the second of two papers presenting a new and broader understanding of dissociative processes as they operate in adaptive functioning, in pathology, and in psychoanalytic treatment, viewed from the perspective of multiple code theory.

In Freud’s (1900) formulation, the mechanisms of the primary process of thought, such as condensation, displacement, and imagery, are explained in terms of unbound psychic energy pressing for discharge and carry all the implications of the energic framework. They are determined by the motivation of forbidden wishes and drives; associated in the first topography with the unconscious, the system Uscs and in the second topography or structural model with the instinctual energy of the Id; and characterized by these associations as nonverbal, irrational, chaotic, infantile or regressed, and dominant in altered states.

Freud himself recognized, to some degree, the contradictions inherent

in these formulations. The first model assumed a necessary association of the features of thought with level of consciousness (referred to by Freud as the qualities of mind); but phenomena such as organized unconscious fantasies and unconscious defenses, the operation of language in dreams and fantasies, and the presence of primary-process forms in waking life, as in parapraxes, violated this premise. The structural theory, based on  the agencies (id, ego, superego), rather than the qualities, of mind, was formulated to address these issues, but raised difficulties of its own.

In developing his second model, Freud was never fully reconciled to giving up the first; he never abandoned his emphasis on the crucial role of the systemic unconscious in the organization of the psychical apparatus (Arlow and Brenner, 1964; LaPlanche and Pontalis, 1973; Bucci, 1997). In his final work, Freud (1940) wrote about the distinction of the qualities of mind as entirely parallel with the agencies:





 

The inside of the ego, which comprises above all the intellective processes, has the quality of being preconscious. This is characteristic of the ego and belongs to it alone. The sole quality that rules in the id is that of being unconscious. Id and unconscious are as intimately united as ego and preconscious; indeed, the former connection is even more exclusive [pp. 162—163]. 

In that passage, the insights that motivated Freud to revise his theory are somehow lost. Freud’s unresolved struggle in characterizing the domain of thought outside of standard linguistic and logical forms remain with us today. We have difficulty emerging from the shadow of the energy model, playing out in the concepts of unconscious, id, and primary process forms associated with forbidden wishes and drives. Psychoanalysis retains a deep-rooted, but somewhat unacknowledged, view of the nonverbal as the “other," in the postmodern sense of the other—the alien, the outsider, the not fully known, with a corollary assumption that the full sense of knowing, in consciousness, must involve standard logical principles and verbal thought. Within this framework, the goal of treatment is to occupy that alien domain—to make the unconscious conscious, to place ego where id has been.

Outside psychoanalysis, in cognitive science, neuroscience, and related fields, there is now widespread recognition of multiple modalities of thought, and more complex views of the features of the different systems. The characterization of the systems and the basis for their differentiation has been a matter of intensive empirical investigation and revision during the past several decades. As I discussed in Part I of this paper (Bucci, 2007), the new findings concerning the organization of thought that have emerged in empirical research need to be considered in developing the psychoanalytic theory and as a guide for treatment.

The multiple code theory retains the core psychoanalytic premise of diverse modes of mentation, without basing the systemic distinctions on particular contents associated with fantasies, wishes, or desires, on one hand, or principles of reality, on the other. The multiple code theory also retains the fundamental psychoanalytic insight concerning interaction among cognition, emotion, and bodily experience without calling on drives or related energetic concepts.

In contrast to the assumptions of the metapsychology, the modalities characterized as subsymbolic and symbolic nonverbal and verbal forms of thought are not distinguished as more or less dominant, higher order and lower order ways of knowing, nor as more or less alien, but as operating differently from one another, following different principles. Status of consciousness is not a determining factor in this differentiation; the relationship of the different modes of thought to conscious or unconscious states and to wishes and bodily needs is complex. Different states,  different ways of being and knowing may be activated and may be within awareness at certain times; other ways of being exist as potentials, to be activated in particular contexts, with different purposes and functions. From this perspective, there is not an insider or an outsider in this population of potential states that constitute human personality organization; there is

not a privileged mode of processing with special access to consciousness or reality; there are diverse domains with different features and functions, operating in different ways at different times.

A crucial corollary of this new view of multiple systems, and multiple ways of being operating within the psychical apparatus is that there are also different degrees of integration of the various systems with some extensively connected to others and some proceeding largely in their own modalities. The degree of integration is determined to some extent by neural structure and function and is further influenced and modified by life events. The variations of connection and disconnection, integration and dissociation, may be seen in normal adaptive functioning as well as in the variations of pathology. Dissociation should not necessarily be understood as separation of zones of functioning that are normally integrated but, in many cases, involve systems operating effectively in their own forms without need for interaction.

The shift in theory has specific implications with respect to treatment goals and methods. The goals of treatment are not to replace one system with another, with the ultimate ideal of developing a single dominant processing mode operating in consciousness or dominated by what are characterized as “ego functions." The multiple systems remain active and functional throughout life; pathology is determined by particular types of dissociation that are maladaptive in the context of a person’s current life. The goals of treatment, then, concern reorganization among the systems, with their different functions and forms. Optimally, treatment facilitates integration of sub symbolic and symbolic components of emotion schemas to allow adaptive evaluation of new experience, while also retaining and eventually enhancing the capacity for effective functioning of these systems in their own modalities.

Given this formulation of goals, we can identify two modes of emotional communication that are needed in the treatment situation (as throughout life): intrapsychic communication among system subsymbolic, symbolic nonverbal, and symbolic verbal—within each individual; and inter-psychic communication on any of these levels between people. To a not inconsiderable degree, whose extent we do not yet know, these are faces of the same inherently dyadic process of emotional communication. Intrapsychic communication among  the various modes of thought within each person is based on emotion schemas that are inherently relational; emotional communication between people is determined by the connections activated within each individual. 

The Neural Circuitry of the Emotion Schemas

The model of pathology and treatment based on multiple code theory, as proposed in Part I of this paper (Bucci, 2007), is compatible with current work in affective neuroscience and also with bio-psychological observations. Here I emphasize certain aspects of the neuroscientific basis for emotional arousal and emotional communication that have particular significance for the therapeutic process.

An emotional response can be activated directly by sensory features in perception or drawn from memory; we see something that frightens  us; we get bad news; something makes us angry; a smell or a song arouses a set of feelings; some fragment of imagery comes to mind in a memory or a dream. Damasio (2003) terms such an object or event, which has the power to arouse an emotional response, an emotionally competent object, or emotionally competent stimulus (ECS). A:n ECS can be actual, as a perception, or recalled from memory, as an image; in either case it must be represented in one or more of the brain's sensory systems.

Once an ECS has been received there are two processing routes; LeDoux (1998) has studied these routes particularly in the case of the fear response. One route, which LeDoux has characterized as the "low road" to the amygdala (p. 164), passes from the stimulus through the sensory thalamus directly to the emotion triggering sites, which include particularly the amygdala as well as the prefrontal cortex. The triggering sites then activate a number of emotion e:xecution sites that lead to the playing out of the somatic and motoric and visceral components of the emotion response—changes in body chemistry, heart beat, respiration, facial expressions, vocalizations, body postures, and specific behavior patterns such as attack, freezing, and flight in response to threat. These are components of what I have called the affective core of the emotion schema, playing out very rapidly, largely in subsymbolic form, in response to an emotional stimulus.

The connection between trigger and execution is built into the system, both instinctually and later through the experiences of life. Once a trigger site has been activated, in reality or in imagination, the physiological components of the emotional response will play out to some degree, even where we do not recognize the source of an emotion or its meaning. The system of response to threat operates throughout the animal kingdom; we share these emotional patterns with our phylogenetic ancestors. In humans the categories of events that may serve as the ECS extend more widely and become more complex, and the responses of avoidance or attack also take a variety of complex forms.

The other route, the indirect road, which LeDoux (1998) has characterized as the “high road" (p. 164), also passes from stimulus through sensory thalamus, but then connects through the hippocampus to the cortical association areas, the source of our general knowledge of the world and the source of our individual autobiographical memories, registered on the timeline of our lives. The activation of these cortical areas is what permits appraisal of a situation and enables delay, modulation, regulation, and redirection of the immediate affective response.

For instance, a woman takes an immediate dislike to a new co-worker, finds him rude and unfriendly. They are assigned to work together on a project; the co-worker turns out to be hard working, and  helpful.  Now she sees him as maybe a little odd, funny rather than rude, shy rather than unfriendly, perhaps uncomfortable in the unfamiliar situation. They turn out to have many interests in common. She helps him to feel more at home in the new environment. They work well together.

The hippocampus and related processes constitute the pivot of a welloperating integrated emotion system that permits people to take in new emotional information, to see others in a new light, and to use this new knowledge to direct how to respond. The hippocampus connects in one direction to the cortical association areas and, in the other, to the emotional triggering and emotion-execution sites of the amygdala, limbic systems, and brain stem. The pathways join here: the cortical hippocampal system enables regulation and modulation of the thalamic-amygdalar activation, based on the experience of life; the effective activation feeds back to provide the emotional evaluation of new situations.

Effect of Stress on the Emotional Circuitry

Stressor events, whether chronic or acute—neglect or abuse in childhood, early loss of parents, the traumas of war—specifically affect this integrative process by which new emotional information is taken in, through direct impairment of the hippocampal and related functions and disturbance in the modulation of the amygdala-ar functions. Such impairment contributes to the various forms of dissociation that I outlined in Part I (Bucci, 2007).

The effects of stress on the emotional circuitry are well known (Payne et al., 2004). Stress is specifically defined as activation of a physiological system that functions, primarily through release of the adrenocorticotropic 

hormone (ACTH), to facilitate organismic response to threat. There are dense concentrations of stress hormone receptors in the pivotal hippocampus system. Activation of these receptors in the hippocampal system contributes centrally to the cognitive and emotional effects that are observed.

If a threat is experienced, activating an emotion schema, the triggering and execution sites will play out, in humans as in all species, and lead to the various emergency responses of attack or avoidance, including freezing and flight. In the normal course of events, again across all species, when an acute threat is past, the response pattern shifts; the flight or attack is halted; the freezing lifts. The naturally induced analgesia associated with the freezing response, mediated by endogenous opioids and other mechanisms, may, however, also dissipate, leading then to an increase in pain. In adaptive functioning, and in well-operating interpersonal contexts, the return of pain perception instigates recuperative behaviors, including self-care and soothing as well as social support. The person (or other organism) then gradually returns to the prethreat state, the normal way of being.

Elizabeth Howell (2005) describes her experience on the morning of September 11: exiting the subway at the station before the World Trade Center; seeing the “twin towers three short blocks away, burning rapidly, like matchsticks”; rushing across the Brooklyn Bridge to her home in Brooklyn; closing her windows “against the now arrived black cloud of soot and burned remains.” She says, “I remained calm. It was a heartrendingly emotional time, but I thought  that  psychologically,  I was fine." We can see this as the analgesia of the freezing state, the built-in physiological protection against overwhelming  arousal.   Howell  Inc it was a “heartrendingly emotional time,” but she was somehow insulated from it.

The freezing response gradually lifted; the impact of the experience then hit her a few days later:

I realized that I narrowly missed being caught in the conflagration.

I worried about all the people in the subway, some with whom I had spoken, who had not left.... When I realized how imminent the danger had been, I couldn't stop telling anyone who would listen. Fortunately for

me, I received enough understanding that my mild posttraumatic stress symptoms abated [pp. 14—15].

We see the mechanisms of affect regulation and the importance of social support in Howell’s recovery from her traumatic experience. As she says, “Although I felt like Coleridge’s Ancient Mariner (who had to wander from town to town, endlessly telling his story), I began to heal” (p. 16).

The individual schemas that define a person’s expectations and beliefs about the interpersonal world will determine the management of such crisis states from the beginning of life. If the child has been able to experience painful arousal in a context of emotional support, schemas of affect regulation that serve well later in life will be developed.

In some cases, however, where pain is overwhelming, the stress is chronic, or the situation is adverse in other ways, the person lacks sufficient means, intrapsychic or social, to heal in this way. We can see the effect of stress on the organization of emotion schemas in sharp relief in the memories of Holocaust survivors. Each stage of the process of response to trauma, as I have outlined, may be traced in their words.

The freezing response is dominant in their reports. Kraft (2002, 2004) analyzed more than 200 hours of oral testimony given by survivors of the Holocaust.2 In these testimonies, Kraft (2004) reports, more than 75% of the survivors who described their emotional state during the horrors said that they were numb:

They use a variety of phrases to elaborate this state of numbness: “in a trance,” “like a piece of wood,” “frosted over,” “like a stone,” “hibernating,” “like a vegetable,” “like robots,” “in a catatonic state.” ... The numbness is so alien and so pervasive that some survivors say they were given drugs [p. 357].

The numbness persisted throughout the war and into the liberation:

There is one thing I have to say: that throughout my experience then, I don’t remember feeling fear.... What I remember feeling is numbness [Testimony of Meir V., 1992, p. 350].

I didn’t feel anything. I didn't even feel the elation that I thought I was going to feel. It really didn’t make any difference. So we are liberated, so what?

[Testimony of Daniel F., 1980, p. 350].

They retained this dissociation during the decades following the war; the demands of daily life provided meaningful distraction from the potential triggers of painful affect:

Alan Z. says that he suffered great fears and nightmares after liberation, but these fears and nightmares went away with the distraction of work andhttps://docs.google.com/drawings/u/3/d/sfF3nJYqVge-aniMrapN4Uw/image?w=145&h=1&rev=1&ac=1&parent=1oc687wp7v_2yc0uhWEgkrSCr4ETwKe6-

° Drawn from a collection of more than 4000 testimonies held at the Fortunoff Video Archive for Holocaust testimonies at Yale University.

family. He says, “After I came to the United States, and I started to work, everything disappeared. I mean, my life changed drastically. My work,

I was involved in my business. And raising my family. And it just moved away from me” [Testimony of Alan Z., 1984, p. 3741.

For some of them, the avoidance was an intentional decision, and they varied in degree of awareness of the dissociative processes:

I believe I am a successful professional in my field But as a person, as a

Jew, I feel I'm sitting on a volcano [Testimony of Karl S., 1980, p. 3751.

The survivors referred in many different ways to the dissociations in their experiences of themselves. They spoke of a double life, two different worlds. One referred to “two separate units in one's experience the

me that is the wartime and pre wartime me and me that is the postwar time”; another said that her children do not know the “real me,” that she is playing a part. They talked of “emotional masks,” behind which they hide their Holocaust selves (p. 380).

Even during the active period of their middle lives, during which the distractions were most effective, events would occasionally intrude to trigger an effective response. The sight of large dogs or men in uniform, a bonfire in the park, or news reports of war or devastation or famine triggered responses of disorientation and panic that were physical and overwhelming. The emotional responses that were activated in memory  were in some cases experienced  as  more  painful  than the  original  events; the responses of numbing and analgesia that accompanied the actual onslaughts of terror were not in place.

For many of the survivors, the strategies of distraction became less effective as the demands of life eased:

Alex H. says that for many years after the war, he was so involved in the fight for a new existence that he did not think about the past.  Beginning with no family, no schooling, and the wrong language, Alex says the daily fight to establish himself used all his energy. In fact, he suppressed his time in the concentration camp until 3 years before he came in to give testimony. He describes the result of having accomplished his goals. “My past is starting to haunt me and I feel so depressed, very often. That I actually feel

that I—very often feel that I lived long enough” [Testimony of Alex H., 1985, p. 376].

.

The torment of memories returning was described by many of the survivors and may have been in part what motivated them to agree to give their testimony. For many their testimony was their first extended recall in more than 40 years. We hear the conflict—wanting to distract ourselves, not being able to; not wanting  to talk, but needing  it over and  over in  their testimony as well.

The operation of dissociation in the emotion schemas is seen in the nature of the survivors’ memories. Many survivors remembered emotion without specific event information and recalled events without emotional experience:

Arnold C. flatly describes the aftermath of allied bombing at Zeldenlager: “In the morning, there were arms and legs all over the place, on the wires, on the barbed wire, got caught. I must admit that it was the first and only place where I saw cannibalism. I saw two people take a piece of meat from a body and try to make a fire and cook it. The German officer who walked by, who saw it, shot them immediately." [He then gives an affirming nod to the camera, as if to say, I witnessed this and I can talk about it.] [Testimony of Arnold C., 1983, p. 3641.

As Kraft notes, Arnold C. did not talk about his emotional response or show the disgust or anger that might have been activated in him by the narrative (and that is generated in the listener or reader). "His motivation is to tell the events clearly and directly” (p. 364).

For many of the survivors, however, the retelling of specific episodes in the oral testimony had the effect of activating emotional experience that had been dissociated and the reliving was experienced as intolerable. There are many examples of survivors who cry during testimony, while describing a specific event, express surprise at their emotions, and then often apologize, indicating that they cannot control the pain of the memory, and attributing it to the recall of the specific event. There were some survivors who gave testimony more than once. At  the second interview, as Kraft—describes, they all reported that giving testimony was deeply distressing, and they were all surprised at the intensity of their distress. One said: "I didn’t realize that it’s going to take me to the depths of depression for months. I didn’t realize it.” Another reported that she needed to be tranquilized afterward because of the powerful emotion that was released (p. 364).

When they could tell their stories in general terms, they experienced the value of educating new generations and commemorating the lives of those who were lost. They may have gained a sense of purpose, hope and sharing.

Alan Z. said he does not cry when he talks to individuals and to larger groups about the loss of his family during the Holocaust: “Only when I go back that far is there a lot of detail. You see, when you go to speak somewhere to a school or to the synagogue, I don’t go into these details where it makes me emotional.” [p. 364].

They learned to avoid the triggers, internal or external, in memory or in

life, that had the potential to activate the schemas.

I think the problem is I’m afraid if I open it up, I'm going to have night-

mares that I had for years and years, and I will not allow this. I’m afraid

it might destroy me [Testimony of Martin S., 1988, p. 351].

We see the avoidance of detail throughout the testimonies, in many

cases stated quite explicitly:

The only question was, “Where were you during the war?” “I was in a concentration camp.” That’s it. “I was in ‘the partisans’.” That’s it. “I was hiding in the—some place.” That’s it. Nobody spoke any details. It seems that the people wanted to block it out from their mind [Testimony of Ruth A, 1994, p. 365].

The conflict concerning the value of talking about emotional experience, and by implication the nature of treatment that is most helpful for survivors of traumatic experience, remains unresolved. This has been an issue for mental health workers in the aftermath of all tragedies. As Kraft observed, the retrieval and retelling of specific memories in the context of the testimony does not facilitate new understanding or even release of tension: “Traumatic memory seems to be a self-generating source of emotional pain ... (andJ the power of emotional memory is not diminished through the release of emotions during testimony” (p. 365).

Opening the wound may be experienced as devastating, but without opening it healing may not occur:

Certain people, they stay with you and they can’t  get away,  they can't,  they just can’t get away. Anyone, if he thinks, he sees the hole  in  his  heart,  is— not getting smaller, is getting bigger [Testimony of Abe L., 1990, p. 3751.

.

A Broader View of Traumatic Events

The patterns of response to extreme assault and stress that are seen in relatively pure form in the testimonies of the Holocaust survivors can also be traced in a broad range of emotional disorders. We can identify similarities and differences between the effects of specific, acute trauma and those of more chronic stress, abuse, and neglect, with corollary implications for treatment.

For acute traumatic events, the source and name of the trauma are known, publicly and to individual survivors, and are shared by members of the survivor group to some extent. In cases of chronic abuse and neglect, usually within families, the events that constitute the source of the trauma are often not identified and are largely specific to the individual situation. The identification of a caretaker as an abuser would be a source of devastating anxiety, leaving the child with no safe place to be. The emotion schemas are organized to avoid this knowledge.

Even for the survivors of known catastrophic events, however, the experiences include not only shared and public elements, but also aspects that are specific for each individual, and perhaps not identified. The events affect each person in different ways; the nature of the person’s responses at the time of the event will differ depending on his situation and his capacities; and will affect his memories of the events in crucial ways. Hints of such individual responses—involving such affects as guilt, shame, and humiliation—appeared in the testimonies of the Holocaust survivors. Part of the unbearable effect that threatened to emerge in telling the specific episodes lay not in activating the traumas that were acknowledged and shared, but in connecting to private emotional meanings that had been warded off.

For all survivors, of chronic as of acute trauma and stress, when the initial threat is past, the patterns of response and attempted self-regulation—the numbing, the dissociative strategies that are developed to maintain the numbing, the inevitable intrusion of  triggers  that activate the dreaded schemas, the resultant extension of the strategies of dissociation—become the problems that interfere with life and that need to be addressed.

In general, treatment needs to address the maladaptive means of self regulation as well as the source of the initial threat. It is also necessary to recognize that these strategies of avoidance and self-regulation, which may be damaging in current life, were the means that enabled the person to survive in the past; they have become components of the person's self schema, part of the structure underlying his or her sense of self.

One may enter the circuitry of the emotion schemas at various levels to achieve particular therapeutic goals. Different modes of treatment may be required for different goals, for different individuals, and at different phases of the treatment. Psychotropic medications operate directly on the physiological circuitry of the trigger and execution mechanisms; methods of exposure and desensitization operate primarily on the feedback loops among these mechanisms. Behavioral and supportive treatments may be useful in providing means of self-regulation that are more effective and less damaging than some of the strategies—such as addiction, eating disorders, somatization, self-inflicted injury, and emotional isolation—that people have developed to regulate themselves. Alternative methods, such as meditation and yoga, also provide mechanisms that enable  regulation of the arousal and related response patterns.

The various procedures that operate directly on the regulatory mechanisms may also help to establish an emotional environment of reduced stress in which the possibilities of exploration inherent in psychodynamic treatment may be attempted, but the goal of  psychoanalytic treatment goes beyond the development of such regulatory mechanisms. Ultimately, where possible, the psychoanalytic objective is to bring about change in the emotion schemas in such a way as to enable registration of new information concerning the individual’s interpersonal world and his self in relation to this; to identify the triggering mechanisms; to enlarge the range of affective experience, including painful affect, without being overwhelmed; and to differentiate threats that are real from ones that are no longer potent in the context of the individual’s current interpersonal simation and current powers.

As discussed in Part I (Bucci, 2007), these objectives ultimately require

that the patient experiences some aspects of the affective core of the dissociated schema in vivo, in the session. The process will involve representation of specific events associated with the schema in memory or in the relationship. The patient will report an episode, memory, or fantasy  whose connections to the schema may not be recognized and will also enact elements of the frozen relationship that the schema represents.

It is precisely here, through representation of specific events in the present or as retrieved from memory, that the opportunities for change in the emotion schemas as well as the risk of overwhelming affect arise. Specific events occurring in the present, and also as retrieved from memory,

.

are powerful cognitive-emotional operations. They are the activators of the hippocampal pivot enabling interconnection of components of the emotion schemas, and enabling connection of affective arousal in the present to autobiographical memory. The schemas of self and others in autobiographical memory are built on specific events and are vulnerable to their activation. One cannot bring about change in the emotion schema without the connecting process, but as the connections come alive the freezing lifts, the pain increases.

Clinicians are familiar with the phenomenon in which a session of powerful exploration and discovery is followed by one of avoidance, anger or self-injury. This was illustrated clearly in a case example presented by Richard Chefetz (2006):

She reported by telephone the next day that she'd had all of one hour of really feeling good after that session. She said that she could feel her body, her mind was clear and crisp, and she had a lot of energy. But she was reporting this in the context of “Is that all that I get, one hour?!” What she went on to say was that as soon as the hour had passed her mind was flooded with new thoughts, images, sensations, and other pieces of memory from an abortion, as a teenager. She was terribly distraught, miserable, and the feeling of her suffering was again the most salient experience in talking with J.

Bromberg (2001) also provides a clear example of this process:

After a session that seemingly went well, a depressed patient with a longstanding eating disorder left a message on my answering machine late that night: ‘Memories are beginning to come up that I’ve never had before, and it’s very disturbing. It’s like I’m watching them from a different part of my brain', she said. “It's very weird.” Her voice sounded upset, but not in a panic. Next morning, someone I hardly recognized showed up for her session, and growled menacingly:

“I’m the one you need to ask permission from! Who do you think is going to pay the rent if you keep going the way you are going? You said that I would be able to carry on with my life and my work if we agreed to do this therapy. This is bullshit! There is nothing to be gained from this. This work changes nothing. It's expensive and a waste of time. You remind her of how alone she is, how alone she has always been, and this is supposed to be of help? She's nothing but a fat, ugly, poor kid in pain, and she has suffered enough! I won't let her suffer anymore! She knows that no one will suppon her if I don't. Not even the shrink will be there if the bills don't get paid.

DISSOCIATION AND MULTIPLE CODE THEORY—PART II 31f

Who do you think pays the bills anyway? I won’t allow this! I will not allow this! mi// not allow this'As long as you threaten to disable me, I will not allow this. I am not nice and I don’t care what you think of me” [p. 910).

We need to recognize and respect the extreme power of  the activation of a specific event in memory or enactment. The arousal that occurs in response to imagery is physical and real, operating through the thalamic amygdalar route; it is similar to the response to the actual threat itself.

To be helpful in achieving a new integration of the emotion schemas that have been dissociated, the telling or the enactment of specific memories requires an interpersonal space in which the arousal of painful affect can be managed while the schema of threat and the processes of protection and avoidance can play out. This basic therapeutic process  applies for survivors of all forms of emotional assault, chronic as well as acute, in different forms and to varying degrees.

As memory is evoked and new connections opened, there is continuous danger that the current context will be drawn into the schema, rather than the schema being perceived as new. We see this in the examples  from the work of Chefetz and Bromberg. The patient may experience any challenge to these protective processes not only as threatening  his  life, but also as threatening his sense of self, evoking dread of a different sort; for example, the therapist will be seen as the predator, the aggressor, the seducer, the humiliating agent. This is an opportunity as well as a threat; what happens next is the question: how is this activation used?

The Role of the Analytic Relationship in Bringing About Change

Here I want to focus on what we can understand about the role of the therapeutic relationship in this process of change. Emotion schemas are intrinsically relational. Change in the emotion schemas, like their development, depends on connections between internal affective  experience and the emotional expressions of  other  people.  If  the  schemas  are  to be changed rather than reinforced, the new interpersonal context must be genuinely new, different from the interpersonal context in which the initial dissociations occurred.

As indicated by the outline of neural circuitry given earlier, behavioral expressions of affect—particular facial expressions, vocalizations, body postures, and patterns of behavior—are inherent elements of an emotion schema. We have limited control over the execution of these expressions;

we are not aware of carrying out most of these expressions; we cannot carry them out in the absence of the feeling state, and we cannot avoid them once the feeling state has been activated. The inherent link between affective arousal and expression determines the nature of emotional communication in all interpersonal contexts, including the psychoanalytic situation.

Damasio (1999) has described this linkage very specifically and clearly:

Once a particular sensory representation is formed, ... whether or not it is actually part of our conscious thought flow, we do not have much to say on the mechanism of inducing an emotion. If the psychological and physiological context is right, an emotion will ensue. The nonconscious triggering of emotions also explains why they are not easy to mimic voluntarily... A spontaneous smile that comes from genuine delight or the spontaneous sobbing that is caused by grief are executed by brain structures located deep in the brain stem under the control of the cingulate region. We have no means of exerting direct voluntary control over the neural processes  in these regions. Causal voluntary mimicking of expressions of emotion is easily detected as fake—something always fails, whether in the configuration of the facial muscles or in the tone of voice App. 4W9).

What this means is that analysts are necessarily genuine in their emotional communication. The analyst is communicating what she feels, independent of what she says, even when she is not explicitly aware of what she feels; and the actual emotional meaning of her expression is received by the patient even when the patient may not be explicitly aware of what that meaning is.

We are now beginning to know more about the wiring that connects internal experience with perception of the expressions of others. Neurons, termed mirror neurons, have been found in the frontal cortex of monkeys and humans. These mirror neurons represent, in an individual’s brain, the movements (or expressions) that the brain sees in another individual, and produce signals to sensory and motoric structures so that the corresponding movements or expressions are either “previewed” in simulation mode or actually executed in trace form by the viewer (Rizzolati et al., 1996; Rizzolati, Fogassi, and Gallese, 2001). The implications of these new findings are potentially enormous for understanding emotional communication in development and throughout life.

Change in the emotion schemas depends on the connection between what the patient knows emotionally about herself, about the analyst, and about their relationship, and what the analyst is expressing. What the patient knows emotionally is that being invalidated by the analyst raises the risk of reinforcing the dissociated schema rather than enabling new connections. Bromberg (1994) expresses this precisely:

A pattern of pointless retraumatization in analysis can take as many forms as there are analytic techniques, and any systematized analytic posture holds the potential for repeating the trauma of nonrecognition, no matter how useful the theory from which the posture is derived. Nonrecognition is equivalent to relational abandonment, and it is that which evokes the familiar and often bewildering accusation “you don't want to know me.” In other words, it is in the process of “knowing” one’s patient through direct relatedness, as distinguished from frustrating, gratifying, containing, empathizing, or even understanding him, that those aspects of self which cannot “speak” will ever find a voice and exist as a felt presence owned by the patient rather than as a “not-me” state that possesses him [p. 5361.

Analysts can decide how to work in treatment, while recognizing that what they feel will be communicated on some level. This communication will occur in a range of channels in face-to-face treatment and will occur in auditory channels, paralinguistic as well as linguistic, when the patient is on the couch.

Implication Regarding the Analyst’s Engagement in the

Therapeutic Situation

The analyst, like the patient, views all things through the lens of his emotion schema; there is no other way.  Countertransference is ubiquitous— as is transference—in this sense. The analyst will bring himself, with his dissociated as well as integrated schemas, into the therapeutic encounter; he differs from the patient in that part of his emotional baggage, for good or ill, also derives from his training and his theory, and he will presumably be continuously monitoring his actions and his state.

The issue of the analyst’s authentic engagement with the patient, and the expression of this engagement, is a complex question at the center of our psychoanalytic controversies today. Our understanding of emotional development and emotional interaction and  their  neuropsychological base have thrown new light on this question, but have also made the issue more crucial and more controversial, rather than resolving it.

Freud went through many changes in his views on the analyst’s engagement, gradually moving from his early view that the treatment required a whole human relationship to his later view of the analyst’s engagement as a danger to the treatment. In discussing the case of Frau Hirschfeld, his “Grand-patient and Chief-tormentor,” Freud wrote to Jung:

I gather ... that neither of you JJung and Pfister] has yet acquired the necessary coolness in practice, that you still engage yourselves, give away a good deal of yourselves in order to demand a similar response. Permit me, the venerable old master, to warn that one is invariably mistaken in applying this technique, that one should rather remain unapproachable, and insist upon receiving. Never let us be driven crazy by our poor neurotics [From Falzeder, 1994, p. 314; discussed by Friedman, 1997, p. 27).

The patient must be emotionally engaged, under the influence of the analytic situation; yet Freud (in his somewhat burnt state following the treatment of Frau Hirschfeld) was saying that the analyst must remain unengaged. Friedman (1997, 2005) has addressed these issues from a somewhat classical perspective in two searching (and engaged)  papers.  In the more recent paper, he examines many aspects of the analyst’s involvement and response or nonresponse to the patient’s appeal. He addresses the question of whether “there might be a universal and peculiarly psychoanalytic something in the analyst’s feelings that somehow deserves the name of love, since analysts through the generations have seemed to think so":

The patient may look for ordinary (forthright) love ... but the classical analyst hopes to avoid it, because, as Nussbaum points out, the pressure of love is always, to some extent, confining and demanding of the beloved Psychoanalytic treatment was born in the discovery of the unique effects of not wanting anything from the patient—or at least trying not to want anything [Friedman, 2005, p. 385J.

Martha Nussbaum (2005), referring to the Stoic view of the emotions, has argued that all major emotions have one central feature in common: “the thought that the emotion's object matters greatly for the life of the person experiencing the emotion” (p. 379; italics added). It is this element that Freud in his writings on technique, like the Stoics, felt it important to avoid, as setting oneself up for damages and reversals; putting oneself at the mercy of fortune, as Nussbaum describes (Freud 1912, 1915). It is this element that patients truly seek, and the absence of this element, the absence of longing and suffering, of true human vulnerability, is experienced by the patient, correctly in Nussbaum’s terms, as the absence of actual “real” love. Friedman (2005) concludes on a note of failure concerning his attempt to identify a particular psychoanalytic “something” that may be characterized as love: Were the analyst to settle into a love relationship in the ordinary sense, Friedman says, the patient's  freedom  would be at risk, since love is, to varying degrees, necessarily “confining and demanding of the beloved” and would, in any case, not be the idealized love for which the patient yearns (p. 386).

The new work in affective neuroscience brings the question of the

authenticity of the analyst’s response front and center in a new way.

The stoic solution of avoidance will not work.

The analyst must experience real activation, longing, suffering, vulnerability;

must really care;

must really feel attacked;

not in an 'as if’ sense;

the analyst’s experience must be real in the moment.*

Here is where our new understanding of dissociative processes as normal, adaptive, and indeed necessary in emotional functioning provides a resolution of the dilemma posed by Freud, and by Friedman, Nussbaum, and many others.

The analyst’s emotional experience, his schema of interaction with the patient, is fully genuine in the moment, but in a local and, we may say, dissociated form.

The fundamental analytic attitude that is needed here  is to recognize that there could be other emotional states and riff be others while subjective consciousness, working memory, is engaged with any given one. The particular name of this dissociation that makes it both tolerable and effective is that, while one emotion schema is aroused and dominant in working memory, the analyst yet knows that there are others in the wings.  The schema that is activated is fully genuine in the moment, but in the context of a background knowledge that it is only one and that there  are others that will be activated in different contexts and that they are all held within one overall autobiographical frame.

All of our self-states are self in relation to others. We each have a pool of affective components and response patterns that emerge in different

https://docs.google.com/drawings/u/3/d/soNUrFMUK7tT4mAe573GJdA/image?w=146&h=1&rev=1&ac=1&parent=1oc687wp7v_2yc0uhWEgkrSCr4ETwKe6-

I have presented this in a stanza form, following principles for representing narrative discourse suggested by Gee (1986).

situations, just as we can know we are different with different people and hold this knowledge within a more or less unitary sense of an autobiographical self. Sometimes, of course, for everyone, the internal worlds collide; nothing is simple.

I think we can talk about effective analytic work in this way—the power to maintain diversity in persona, expressed in particular forms in particular contexts, connected sufficiently to the spine of autobiographical memory. It is not only emotional authenticity in interaction with the patient, but also emotional insight that is facilitated for the analyst by the capacity to enter flexibly into different states that are activated by the actual interpersonal context. The analyst can know emotionally only what he can feel, and he can process and work only with what he can know.

The  Role of  Language Remains

Finally, I want to add here that for effective therapeutic work it is necessary but not enough to form emotionally. The paradigm shift that is now occurring in psychoanalysis involves the increasing recognition of  the role of nonverbal thought and communication. We are still, however, in a transitional phase of this shift; we are experiencing, in some psychoanalytic approaches, a pendulum swing to emphasis on the importance of the nonverbal domain at the expense of the role of language.

The fundamental argument that I have tried to make concerns the equal as well as separate status of all systems. In trying to develop a common psychological language for psychoanalysis, and to develop a new theoretical framework, we need to recognize the role of all the systems of thought, symbolic verbal as well as bodily, emotional, subsymbolic, and nonverbal; the need for their integration in certain aspects of functioning; and the fundamentally partial name of such integration in adaptive functioning.

Given the reformulation of the psychical apparatus that I have proposed here, the problem that we face is like that of the analytic patient: "It has long been recognized that every patient enters psychoanalysis with the same ‘illogical’ wish—i6e risk to stay the same while changing' (Bromberg, 1998, p. 170). In developing our theory and methods of treatment, we need to face a similar question: how can the field change in significant ways while retaining its identity as psychoanalytic? I have proposed that our core psychoanalytic identity lies in the recognition of multiple systems and multiple ways of being. In the context of new scientific findings we need to carry through this core idea more fully by investigating the features of the multiple systems of thought and examining their implications with respect to such concepts as transference and countertransference, regression, resistance, conflict, and even repression itself. As for the patient who is able to open new connections, the reward of our psychoanalytic self-examination will be new discoveries and a more vital and expanding field.

REFERENCES

Arlow, J. A. R Brenner, C. (1964), Psychoanalytic Concepts and the Structural Theory. New York: International Universities Press.

Bromberg, P. M. (1994), "Speak! That I may see you”: Some reflections on dissociation, reality, and psychoanalytic listening. Psychoanalytic DiD! 8ues, 4:517—547.

Bromberg, P. M. (1998), Standing in the Spaces. Essays on Clinical Process, Trauma, and

Dissociation. Hillsdale, NJ: The Analytic Press.

Bromberg, P. M. (2001), Treating patients with symptoms-and symptoms with patience; Reflections on shame, dissociation and eating disorders. Psychoanalytic Dialogues, 11:891—912.

Bucci, W. (1997), Psychoanalysis and Cognitive Science: A Multiple Code Theory. New York: Guilford Press.

Bucci, W. (2007), Dissociation from the perspective of multiple code theory — Part I: Psychological roots and implications for psychoanalytic treatment. Contemporary Psychoanalysis, 43: I6M 184.

Chefetz, R. (2006), Suffering as relatedness and affect regulations. Presented at seminar of International Society for the Study of Dissociation, Garden City, NY, April.

Damasio, A. R. (1999), Be Feeling of What Happens. New York: Harcourt Brace. Damasio, A. R. (2003), looking for Spinoza. Orlando, FL: Harcourt.

Falzeder, E. (1994), My grand-patient, my chief tormentor: A hitherto  unnoticed  case  of Freud’s and the consequences. Psychoanalytic Quarterly, GS:297—331.

Freud, S. (1940), An outline of psycho-analysis. Standard Edition, 23:14W207.

Friedman, L. (1997a, Ferrum, ignis and medicina: Return to the crucible./ourna/ of1fie Amer-

ican Psychoanalytic Association, 45:21-36.

Friedman, L. (2005), Is there a special psychoanalytic love? Journal of the American Psychoanalytic Association, 33:349-375.

Gee, J. P. (1986), Units in the production of narrative discourse, Discourse Processes, 9:391M22. Howell, E. F. (2005), The Dissociative Mind. Hillsdale, NJ: The Analytic Press.

Kraft, R. N. (2002), Memory Perceived. Recalling the Holocaust. Westport, CT: Praeger.

Kraft, R. N. (2004), Emotional memory in survivors of the Holocaust. In: Memory and  Emotion, ed. D. Reisberg, & P. Hertel. Oxford: Oxford University Press, pp. 347—389.

Laplanche, J. & Pontalis, J.-B. (1973), The language of Psychoanalysis. New York: Norton. LeDoux, J. (1998), Be Emotional Brain. The Mysterious Underpinnings of Emotional I ife.

New York: Touchstone Books.

Nussbaum, M. C. (2005), Analytic love and human vulnerability: A comment on Lawrence Friedman’s “Is there a special psychoanalytic love?” Journal of the American Psychoanalytic Association, 53:377—383.

Payne, J. D., Nadel, L., Britton, W. B. & Jacobs, W. J. (2004), The biopsychology of trauma and memory. In: Memory and Emotion, ed. D. Reisberg & P. Hertel. Oxford: Oxford University Press.

Rizzolati, G., Fogassi, L. & Gallese,  V.  (2001),  Neurophysiological mechanisms  underlying the understanding and imitation of action. Nature Review Neuroscience, 2:661—670.

Rizzolati, G., Fadiga, L., Gallese, V. & Fogassi, L. (1996), Premotor cortex and the recognition of motor actions. Cognitive Brain Research, 3:131—141.

Williams, J. M. G., Barnhofer, T., Crane, C., Hermans, D., Raes, F., Watkins, E. & Dalgleish, T.

(2007a, Autobiographical memory, specificity, and emotional disorder. Psychological Bulletin, 133:122-148.

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Wilma Bucci, Ph.D. is a Professor, Derner Institute, Adelphi University; and Honorary Member, American Psychoanalytic Association and New York Psychoanalytic Institute.

Derner Institute Adelphi University Garden City, NY IU 30

bucci8panther.adelphi.edu

 

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