Bernard Brandchaft - Systems of Pathological Accommodation

Bernard Brandchaft is one of the early co-founders (with Robert Stolorow and George Atwood) of intersubjective systems theory in psychoanalysis. Brandchaft (who died in 2013) is the co-editor and a contributor to The Intersubjective Perspective (1994, with Stolorow and Atwood), and co-author of Psychoanalytic Treatment: An Intersubjective Approach (2000, with Stolorow and Atwood), and Toward an Emancipatory Psychoanalysis: Brandchaft's Intersubjective Vision (2010, with Shelley Doctors and Dorienne Sorter), the later being a collection of Brandchaft's essays worked into a book format, with a couple of chapters by the co-authors.

One of the great innovations in post-Freudian psychoanalysis was the recognition that early relational experience shapes personality and the sense of self for the remainder of one's life, barring intervention. Attachment theory has demonstrated this and contemporary neuroscience has confirmed, especially the work of Allan Schore.

In Brandchaft's work, he developed an understanding of how children, even in infancy, develop "systems of pathological accommodation" as a self-preservation tactic to survive dysfunctional parents or caregivers.

What is presented below are some passages from this seminal article. This represents the first half or more of the article, while the remainder of the article goes into treatment - which I hope to share here as well.

Note: Brandchaft uses some of the language of the object-relations school, so "object" generally will mean the parent or caregiver, the subjective experience of which becomes an internal object (of the unconscious) later in life.

Systems of Pathological Accommodation and Change in Analysis

Bernard Brandchaft, MD
Los Angeles, CA
From: Psychoanalytic Psychology (2007); 24(4):667-687. DOI: 10.1037/0736-9735.24.4.667

When the child is required preemptively to adhere to an inflexible personality organization that caregivers bring to its needs for psychological distinctness, these earliest attachments exclude or marginalize spontaneous experience and second thought metacognitive processes of self-reflection. The child’s ability to process new information and, accordingly, to self-correct and grow are impaired as its emerging sense of self is usurped. By repetitive process, the child’s first reality becomes patterned into a set of immutable belief systems. These subsequently find their place in retrograde social systems in which authoritative first truths remain absolute. … The ensuing pathological accommodation continues to operate as an entrenched system beyond awareness, to preserve life by imprisoning it in archaic bonds. [668]

The sense of self established within this system is defined and appraised by alien referents, their origins buried in an antiquity that shapes experience by continuing to inform and deform. It is not subject to the rules of ordinary thought. [668]

The transfer from object tie to unconscious and depersonalized organizing principles (“internalization”) retains the quality of those archaic attachments. The structures of pathological accommodation, like the original ties, can be seen to regulate the first and only reliable cohesion that the individual has known. In this manner, they protect against the unbearable terror of early object loss and the dissolution of selfhood whenever fundamental differentiating change might occur. In the process, repetition is inexorably substituted for change while in this addictive-like process self-regulation remains the property of another. [669]

In the disorders I am describing, the reality that dominates is that of the caregiver in her/his impingement on or exclusion of whole domains of the subjective reality of the child. The expanding discipline of child observation in the past half-century has yielded findings that have contradicted prevailing notions about the quality of what had been regarded as average expectable environment. These studies have resulted in an awareness of the widespread extent to which real-life trauma, especially in very early development, is a primary etiological factor in what earlier had been ascribed to instinctual trauma or constitutional defect. In these disorders, the breakdown factors are embedded in the total infant-caregiving system. They are inexorably reactivated within succeeding attachment systems, including the analytic transference, when the child has remained totally dependent upon its ties to an attachment figure in order to sustain a belief in the continuity of his own existence. [669-670]

I have cited clinical examples to argue that the conflict embedded in the compromise formed by the structures of pathological accommodation, a quintessential element in the quality of superego pathology, have their origin in the caregiver-infant contextual domain within which self-differentiation and the ontogeny of the sense of self emerge (Brandchaft, 1988). The child’s development has been fatefully compromised by the compulsively selective inclusion/exclusion and dissociation of information that experience might otherwise provide, when such incremental self-mutilation is regarded as mandatory in order to preserve and protect a tie on which life itself depends. Obsessive–compulsive disorders display most convincingly the operation and imprisoning character of systems of pathological accommodation. [671]

A vast literature has begun to stress the role of trauma, incurring from the dawning of consciousness itself (Bowlby, 1969, 1973, 1980; Cicchetti & Greenberg, 1991; Crittenden, 1994, 1995; Main, 1995; Meares, 1998; Stolorow, 1999) that initiates the cocreation of complex systems of pathological accommodation (Brandchaft, 1991). These come to crystallize and occupy central experiential pathways in personality formation. The course and goals of a psychoanalytic treatment of developmental disorders must be based on bringing these Traumatic Attachment Systems to light and addressing them therapeutically. An understanding, in depth, of the effect of unresolved trauma requires a recognition of the ways it is contextually constituted…. [672]

It has come to be widely recognized that real life trauma constitutes an assault on nuclear formations of the personality at their onset. Winnicott defined trauma as an impingement from the environment and from the individual’s reaction to the environment that occurs prior to the individual’s development of the mechanisms that make the unpredictable predictable. He maintained that trauma at the beginning of life relates to the threat of annihilation. Subsequently, attachment studies show that its effect is felt on biological and behavioral systems at many levels and that the child’s ability to negotiate developmental tasks is severely challenged. [672-673]

Where such developmental trauma has become the average expectable environment, it has a pervasive impact on the primary relationship, playing a determining role in the subsequent course of development (Crittenden, 1994; Fonagy, 2001; Main, 1995). Here, the child’s first efforts are turned toward the task of dealing with pain and the encroaching experience of the extinction of life, commensurate in its massive impact with the infant’s total dependence upon its objects [caregivers]. An attachment system of complex interweaving between self and object occupies the center of the child’s attention and shapes initiative. Occurring at the dawning of consciousness, processes of pathological accommodation become the context within which translocation (“internalization”) occurs in the automatic processing of experience. From a bedrock position, they continue to exert an enduring influence on the formation of the child’s personality, the complex relationships of its experiential world, basic feelings about itself and life, and its expectations and subsequent relationship with objects. Systems of pathological accommodation, as prototypical forms of self and object reciprocal attachment, operate powerfully at preverbal and procedural levels. [673]

A radically different self-object system, however, has been created, and this system plays a greater, not a lesser, central and constitutive role than a responsive caregiving attachment might have played. This new system remains exquisitely context-sensitive and context-dependent with traumatic memory traces and ever-present proximity of life-threatening trauma at the core of the reality it attempts to organize. The harsh set of tasks involves preoccupation with strategies for maintaining attachment to the object, while simultaneously coping with the complex effects of relational trauma as development proceeds. The preoccupying mental state may well attain the proportions of an “attention deficit” disorder, especially when the caregiver’s attention continues in its fixation on what is “missing” in the child while that of the child remains focused on the lack of the object’s aware/responsiveness to the toxic state that is preoccupying child. [673]

Trauma such as that which accompanies a serious mismatch of the caregiver’s experience and response with that of the infant can be observed to result in a shock-like “toxic” state. In the instantaneous tsunami-like reaction, the time-space dimension of experience undergoes collapse while the fragile structures supporting a continuing sense of self are crushed. Trauma such as that which accompanies a serious mismatch of the caregiver’s experience and response with that of the infant can be observed to result in a shock-like “toxic” state. In the instantaneous tsunami-like reaction, the time-space dimension of experience undergoes collapse while the fragile structures supporting a continuing sense of self are crushed. The state, as it can be observed in the therapeutic interaction, brings together a cognitive/affective montage in which are indissolubly fused unconscious memories of life-endangering archaic experience and the shroud-like expectation of future threats of extinction. In this process, damage keeps being inflicted on the quality of one’s personal experience and entire spectrum of one’s relationships. The hole created will be filled in by a combination of compensatory enactments and distancing structures together with those of pathological accommodation, which “heal” the breach. [673]

A rigid template is formed through which all experience comes to be filtered. A patient so traumatized will frequently display a knowledge of the analyst’s unconscious intentions before the analyst knows about them (however reductionistic or distorted from the analyst’s point of view). [673-674]

Also in place in such experience is the patient’s unquestioned belief that the analyst’s appraisal of her, and of himself, will be based at every stage on how well or poorly she is able to please and affirm the analyst by showing progress in the program on which he rests his claims for progress and the patient’s well-being. [674]

Within a secure developmental attachment system, sensitive caregiver responses form harmonious sequences with the child’s distinctive experience. Where repeated trauma prevails, the child’s natural rhythms and psychological states do not initiate harmonious interaction responses. Instead, the attachments serve as pathways for responses centered in the caregiver’s own insecure attachment patterns. In place of letting the child take the lead in the playful interaction, for example, the anxious mother, like the anxious therapist later, will direct the child, thus beginning the extinction of any center of initiative in the child. The obsessive caregiver will keep scrutinizing the child for flaws and defects, and they then become enmeshed into a ritualistic system of “fixing.” The center of the developmental stage is shifted from the child’s vitalizing expressions to the caregiver’s deadening, impinging, frightened, or abusive mismatch. Ever afterward, this sequencing will occur automatically beyond the influence of self-reflective awareness. Occurring at split-second intervals, the process results cumulatively in an “overburdening” exhaustion. If its triggering contextual origins go unnoticed, it may seem unexplainable and intractable as a characterological “volatility” in the patient, impervious to cognitive learning…. [674]

Well-being and happiness cannot be sustained within this system. Feelings of attractiveness come systematically to be extinguished and replaced by those of repulsiveness, aliveness by malaise. The repetitive sequencing of such states of mind takes the form of obsessive brooding and self-reproach from which patients cannot free themselves when they are alone. These states are frequently not clearly recognized as discrete states of mind and as reactive to psychologically complex triggering interactions. … Terror has been unleashed in the subjective world, and, as on the larger geopolitical stage of our contemporary world so dramatically, terror requires immediate preventive or preemptive intervention. [674]

Within traumatic attachment systems, the child develops a lasting hatred of reality and may spend a lifetime attempting to evade it or, “born again,” to superimpose a more acceptable substitute upon it. The hated reality is one has been imposed and has come to crush spontaneity and individual joyfulness. At its center, the traumatized child has come to feel itself as bad. Its experience has been interlaced with threats and episodes of abandonment, physical and psychological, and first belief in causality establishes that it has done something egregiously, malignantly, and selfishly “wrong.” The child has been forced to adopt or embrace, this alien impinging referent as not-to-be questioned Truth because such threats leave it helpless. Intense anxiety is aroused, and the anger generated is the only means the child possesses to attempt to prevent the caregiver from carrying out or continuing the threat. … Chronic rage and revenge follow, laying the foundation for sadomasochistic character formations. This child carries the stigma of badness driven into his selfhood and will never able to put the torment to rest: “Like damn little men pounding at my brain with picks and axes and chisels” (Stevenson, 1998, p. 36). [674-675]

In this context of repetitive/cumulative trauma, the child’s acute sensitivity will serve as an advance warning system, and his development will have to be patterned around a program of matching the caregiver’s mental state with a system of “shoulds” and “shouldn’ts.” An enduring template comes into being under wide areas of the child’s cognitive, emotional, behavioral and neurophysiological functioning, just as similarly had happened in the caregiver’s own childhood. This metasystem is established before symbolization has developed, and it will continue to operate largely beyond the corrective influence of subsequent relational experience or self-reflective awareness. Acting like a DNA-inherited pattern into which subsequent experience will be silently synthesized, it serves as a conveyer belt for future transgenerational transmission. Once established, “it filters experience in such a way that minimizes the likelihood of spontaneous change” (Sroufe, 1996). [675]

At the very foundations of personality formation, traumatic sequences (“schemata-of-a-way-of-being-with” Stern, 1985) are established in which the child’s connections with self and caregiver are repeatedly broken into by mismatching. [675]

The state of distress is brought to an end with the compulsive rematching of the child’s mental organization to that of the caregiver. The process takes place in milliseconds. Its hierarchical position is rooted in the procedural level of experience before the capacity for the representation of internal working models has developed. It is subsequently incorporated into such models acting as a compulsion in statu nascendi [in the state of being born]. Attachment observation yields conclusive evidence that infants attached to maltreating figures are not less attached - indeed they are likely to remain the more rigidly so by reason of their continuing insecurity and that of their attachment objects. Winnicott has traced the adult fear of a future mental breakdown to one that has already occurred so early in life that it cannot be remembered. [676]

Interview with Robert D. Stolorow (2011, at Figure/Ground)

If I could study with any living therapist, Robert Stolorow is one of three people I would pay to learn from (the others are Donna Orange [a frequent Stolorow collaborator] and Diana Fosha). [Well, okay, there is a fourth one, another frequent Stolorow collaborator, George Atwood.] Throughout his career, he has emphasized the phenomenological experience of the client in psychotherapy, often invoking philosophers such as Heidegger or Gadamer, and the intersubjective space created in the therapeutic dyad. 

I have read nearly all of his books, as well as a LOT of his articles. There is a near-full listing of his books in the introduction to the interview - of those (any one is a great read), I highly recommend World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis (2011), Working Intersubjectively: Contextualism in Psychoanalytic Practice (1997), Structures of Subjectivity: Explorations in Psychoanalytic Phenomenology (2014 [1984]. 2nd ed.), and The Intersubjective Perspective (1994), the latter being a collection of essays edited by Stolorow, George Atwood, and George Brandchaft.

Here is a passage from World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis (p. 44):

Trauma shatters the absolutisms of everyday life, which, like the illusions of the “they,” evade and cover up the finitude, contingency, and embeddedness of our existence and the indefiniteness of its certain extinction. Such shattering exposes what had been heretofore concealed, thereby plunging the traumatized person, in Heidegger’s terms, into a form of authentic Being-toward-death and into the anxiety—the loss of significance, the uncanniness—through which authentic Being-toward-death is disclosed. Trauma, like authentic Being-toward-death, individualizes us, but in a manner that manifests in an excruciating sense of singularity and solitude.

And this (p. 55-56):

Trauma devastatingly disrupts the ordinary, average-everyday linearity and “ecstatical unity of temporality” (Heidegger, 1927, p. 416), the sense of “stretching-along” (p. 426) from the past to an open future. Experiences of emotional trauma become freezeframed into an eternal present in which one remains forever trapped, or to which one is condemned to be perpetually returned through the portkeys supplied by life’s slings and arrows. In the region of trauma, all duration or stretching along collapses; past becomes present, and future loses all meaning other than endless repetition. In this sense it is trauma, not, as Freud (1915) would have it, the unconscious that is timeless.

Because trauma so profoundly modifies the universal or shared structure of temporality, the traumatized person quite literally lives in another kind of reality, an experiential world felt to be incommensurable with those of others. This felt incommensurability, in turn, contributes to the sense of alienation and estrangement from other human beings that typically haunts the traumatized person. Torn from the communal fabric of being-in-time, trauma remains insulated from human dialogue.

In the first paragraph, "portkeys" is a Harry Potter reference (that I was unaware of) and are defined as "objects that transported him instantly to other places, obliterating the duration ordinarily required for travel from one location to another."

Anyway, I could go on all day quoting Stolorow's texts and my appreciation for them.

All of this serves as an introduction to an interview of Stolorow from Figure/Ground back in 2011.

Interview with Robert D. Stolorow

© Robert D. Stolorow and Figure/Ground
Dr. Stolorow was interviewed by Laureano Ralón. June 13th, 2011.

Robert D. Stolorow, Ph.D., is a Founding Faculty Member and Training and Supervising Analyst at the Institute of Contemporary Psychoanalysis, Los Angeles; a Founding Faculty Member at the Institute for the Psychoanalytic Study of Subjectivity, New York City; and a Clinical Professor of Psychiatry at the UCLA School of Medicine. He is the author of World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis (2011) and Trauma and Human Existence: Autobiographical, Psychoanalytic, and Philosophical Reflections (2007), and co-author of Worlds of Experience: Interweaving Philosophical and Clinical Dimensions in Psychoanalysis (2002), Working Intersubjectively: Contextualism in Psychoanalytic Practice (1997), Contexts of Being: The Intersubjective Foundations of Psychological Life (1992), Psychoanalytic Treatment: An Intersubjective Approach (1987), Structures of Subjectivity: Explorations in Psychoanalytic Phenomenology (2014 [1984]. 2nd ed.), Psychoanalysis of Developmental Arrests: Theory and Treatment (1980), and Faces in a Cloud: Intersubjectivity in Personality Theory (1993 [1979], 2nd. ed.). He is also coeditor of The Intersubjective Perspective (1994) and has authored or coauthored more than two hundred articles on aspects of psychoanalytic theory and practice. He received his Ph.D. in Clinical Psychology from Harvard University in 1970 and his Certificate in Psychoanalysis and Psychotherapy from the Psychoanalytic Institute of the Postgraduate Center for Mental Health, New York City, in 1974. He also received a Ph.D. in Philosophy from the University of California at Riverside in 2007. He holds diplomas both in Clinical Psychology and in Psychoanalysis from the American Board of Professional Psychology (ABPP). In 1995 he received the Distinguished Scientific Award from the Division of Psychoanalysis of the American Psychological Association, in which he is a Fellow.

What would you define yourself as – an author, a thinker, a public intellectual?

Being a weird interdisciplinary creature, I have to define myself somewhat complexly. I definitely think of myself as a psychoanalytic and philosophical thinker and author. Additionally, I am a practitioner of psychoanalysis and a teacher of both philosophy and psychoanalysis. In recent times, I have also been publishing articles and blogs applying my ideas about collective trauma and defensive ideologies to the socio-political sphere, so I guess that might make me a public intellectual too.

Who were some of your mentors in university and what were some of the most important lessons you learned from them?

I earned a doctorate in clinical psychology at Harvard in 1970 and a doctorate in philosophy at the University of California, Riverside, in 2007, and I reaped rich benefits from mentors during both periods of graduate study. My principal mentor at Harvard was Robert White, from whom I acquired an abiding interest in and respect for the uniqueness of each individual’s world of experience. My principal mentor at Riverside was my dissertation chair, William Bracken, who, although relatively unpublished, is perhaps the most brilliant Heidegger scholar I have encountered. I owe him an enormous dept of gratitude for his contributions to my development as a Heideggerian philosopher. Other important mentors at Riverside from whom I learned a great deal were Kantian philosopher Andrews Reath, phenomenologist Charles Siewert, and another brilliant Heidegger scholar, Mark Wrathall.

You trained both as a philosopher and a psychoanalyst. How did the two careers reinforce each other?

Wow, I would have to write an intellectual memoir to address this question adequately! I’ll try to hit the highlights. I first became interested in the interface of psychoanalysis and philosophy as an undergraduate in the early 1960s when I encountered the writings of Ludwig Binswanger, Medard Boss, and Rollo May, early pioneers who recognized the relevance of Heidegger’s existential philosophy for psychotherapy and psychoanalysis. While a graduate student in clinical psychology, I became disillusioned with empirical psychological research, feeling that it stripped psychology of everything humanly meaningful, and toyed with the idea of doing a second doctorate in philosophy (an ambition that had to await several decades before coming to fruition), which at the time I thought could provide tools for cleaning up the mess that was psychoanalytic theory. However, during my clinical internship I found that I really enjoyed psychoanalytic work and, after completing my doctorate, decided to go to New York to pursue psychoanalytic training instead.

A nodal point in my intellectual career occurred in 1972 when, still in psychoanalytic training, I took a job as an assistant professor of psychology at Rutgers where I met George Atwood, who became my closest collaborator. George (an autodidact with an encyclopaedic knowledge of Continental philosophy) and I embarked upon a series of psycho-biographical studies of the personal, subjective origins of the theoretical systems of Freud, Jung, Rank, and Reich, studies that formed the basis of our first book, Faces in a Cloud: Subjectivity in Personality Theory (Aronson, 1979). From these studies, we concluded that since psychological theories derive to a significant degree from the subjective concerns of their creators, what psychoanalysis and personality psychology needed was a theory of subjectivity itself: a unifying framework capable of accounting not only for the psychological phenomena that other theories address, but also for the theories themselves. In the last chapter of Faces, we outlined a set of proposals for the creation of such a framework, which we called psychoanalytic phenomenology. We envisioned this framework as a depth psychology of personal experience, purified of the mechanistic reifications of Freudian meta-psychology. Our framework took the experiential world of the individual as its central theoretical construct. We assumed no impersonal psychical agencies or motivational prime movers in order to explain the experiential world. Instead, we assumed that this world evolves organically from the person’s encounter with the critical formative experiences that constitute his or her unique life history. Once established, it becomes discernible in the distinctive, recurrent patterns, themes, and invariant meanings that pre-reflectively organize the person’s experiences. Psychoanalytic phenomenology entailed a set of interpretative principles for investigating the nature, origins, purposes, and transformations of the configurations of self and other pervading a person’s experiential world. Importantly, our dedication to illuminating personal phenomenology had led us from Cartesian minds to emotional worlds and, thus, from intra-psychic mental contents to relational contexts. Phenomenology had led us inexorably to contextualism.

Once we had rethought psychoanalysis as a form of phenomenological inquiry, a focus on the mutually-enriching interface of psychoanalysis and Continental phenomenology became inescapable, and I began reading phenomenological philosophy voraciously. In 2000, I formed a leaderless philosophical study group in which we devoted a year to a close reading of Heidegger’s Being and Time and another year to Gadamer’s Truth and Method. Philosopher-psychoanalyst Donna Orange had joined the collaboration with Atwood, and she brought to our phenomenological contextualism a perspectivalist hermeneutic sensibility and a view of psychoanalytic practice as a form of phronesis rather than techne.

A second nodal point for me occurred when I turned my attention to the phenomenology of emotional trauma in the wake of the death of my late wife, Dede, in 1991—a massive trauma that shattered my world. The close study of Being and Time in 2000 proved to be critical. On one hand, Heidegger’s ontological contextualism (In-der-Welt-sein) seemed to provide a solid philosophical grounding for our psychoanalytic phenomenological contextualism. Even more important to me at the time, Heidegger’s phenomenological analysis of Angst, world-collapse, uncanniness, and thrownness into being-toward-death provided me with extraordinary philosophical tools for grasping the existential significance of emotional trauma. It was this latter discovery that motivated me to begin doctoral studies in philosophy and write a dissertation on trauma and Heidegger, which eventuated in my two most recent books, Trauma and Human Existence: Autobiographical, Psychoanalytic, and Philosophical Reflections (Routledge, 2007) and World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis (Routledge, 2011). In the last book, I showed both how Heidegger’s existential philosophy can ground and enrich post-Cartesian psychoanalysis and how post-Cartesian psychoanalysis, by relationalizing Heidegger’s conception of finitude and expanding Heidegger’s conception of relationality, can enrich his existential philosophy. I feel that in this book I have, in my sunset years, come into my own as a philosopher.

In your experience, how do you think the role of university professor might have evolved since you were an undergraduate student?

Perhaps partly because I have not been a university professor (in psychology) since 1984 when I moved to California, I have not noticed significant changes in the role of university professor. I was very struck by the enormous devotion to teaching, guiding, and mentoring shown by my philosophy professors at Riverside. Perhaps the biggest change for me as a graduate student was the current importance of the internet and the need for me to become computer-literate fast!

How do you manage to command attention during your talks and lectures in this “age of interruption” characterized by fractured attention and information overload?

When I first began lecturing and then presenting in the early 1970s, I learned to bring my affect into my speaking. This has served me well ever since. I have found that the affect-laden quality of my recent work has been especially appealing to young philosophers.

The following guest question was drafted by Professor Iain Thomson: “Do you think all resurrective ideologies necessarily deny human finitude? What about the later Heidegger’s postmodern idea that truly acknowledging human finitude can give us insight into the inexhaustible nature of being?”
This is a great question. There have been two contexts in which I have written about “resurrective ideology.” One has been my effort to extend my ideas about trauma to the socio-political sphere. In my 2007 book on trauma, I contended that the essence of emotional trauma lies in the shattering of what I called the “absolutisms of everyday life,” the system of illusory beliefs that allow us to function in the world, experienced as stable, predictable, and safe. Such shattering is a massive loss of innocence exposing the inescapable contingency of existence on a universe that is chaotic and unpredictable and in which no safety or continuity of being can be assured. Emotional trauma brings us face to face with our finitude and existential vulnerability and with death and loss as possibilities that define our existence and that loom as constant threats. Often traumatized people try to restore the lost illusions shattered by trauma through some form of resurrective ideology.

Consider, for example, the impact on Americans of the terrorist attack of September 11, 2001, a devastating collective trauma that inflicted a rip in the fabric of the American psyche. In horrifyingly demonstrating that even America can be assaulted on its native soil, the attack of 9/11 shattered Americans’ collective illusions of safety, inviolability, and grandiose invincibility, illusions that had long been mainstays of the American historical identity. In the wake of such shattering, Americans became much more susceptible to resurrective ideologies—e.g., that offered by the Bush administration—that promised to restore the grandiose illusions that have been lost.

The other context, actually the original one, was a psycho-biographical account of Heidegger’s fall into Nazism, which I wrote in collaboration with Atwood and Orange and incorporated into my 2011 book. There we contended that Heidegger’s enthusiastic embrace of his version of Nazism, whose grandiose quality was chillingly manifested in his Rector’s Address, “The Self-Assertion of the German University” (1933), represented his effort to resurrect his sense of agentic selfhood, which had been crushed by the combined emotionally annihilating impact of three circumstances: His muse and lover Hannah Arendt’s withdrawal from him; his magnum opus Being and Time’s being met by the academic world “by hopeless incomprehension”; and his mother’s essentially disowning him on her deathbed for his having broken with the Catholic Church.

After resigning as rector of Freiburg University in 1934 and disengaging from political involvement, Heidegger largely withdrew into a life of solitary philosophical and spiritual reflection, wherein the “turn” in his thinking gained momentum. I think Iain Thomson is right when he claims that the later Heidegger’s acknowledgment and acceptance of an aspect of human finitude—namely, the historically and temporally embedded limitedness of any understanding of being—gave him insight into “being as such,” the inexhaustible source of all intelligibility that resists any attempt to conceptualize it. And yet, do we not glimpse a trace of the old restorative grandiosity in Heidegger’s self-designation as the agent of a new “other beginning,” the initiator of a new epoch in the history of being?

Other emotional themes in Heidegger’s later philosophy are apparent to a psychoanalytic eye. Heidegger is often rightly criticized for never having openly expressed remorse about his Nazi involvement. Yet the whole tenor of his later philosophizing—wherein the grandiose, aggressive, goose-stepping self-assertiveness of the Rector’s Address is replaced by a view of the human being as the “constant receiver,” the “shepherd” and the protector, of the “gift” of being—can be seen to reflect his recognition of his dreadful, deplorable mistake.

Moreover, there is another dimension of human finitude—the finitude of human connectedness, of our “being-with-one-another”—that goes largely unnamed throughout Heidegger’s philosophizing. In my 2011 book, I claimed controversially (with Critchley and Derrida) that human finitude is relational, that being-toward-death always includes a being-toward-loss of loved others, and that death and loss are existentially equiprimordial. In the chapter on Heidegger’s Nazism, we contended that for Heidegger the threat of loss of connectedness with others was built into the quest for authentic individualized selfhood, as was shown vividly in his wrenching struggles to separate himself from the Catholic Church of his family and in his mother’s deathbed renunciation of him for doing just that. In the poetry of Holderlin, Heidegger found the powerful theme of returning—returning to being-at-home and to the lost god that had disappeared—imagery in which we discerned his longing to restore connections lost in his pursuit of individualized selfhood, such as those with his mother and the Catholic family of his childhood. The later Heidegger returned home.

Returning for a moment to your dual training as a philosopher/psychoanalyst, do you think any insights from the social sciences might help transform the philosophical profession for the better and vice versa? Should fields like philosophy and psychology/sociology remain separate, or are there advantages to bridging the existential and existentielle dimensions of human reality in the spirit of interdisciplinary studies and methodological pragmatism?

Clearly, as an interdisciplinary creature myself, I am an advocate of interdisciplinary cross-fertilization (of which my 2011 book is a clear instance), rather than disciplinary insularity. Heidegger’s Being and Time is filled with examples of the advantages of bridging the existential and the existentielle, the ontological and the ontical dimensions of human reality. It is my view that academic psychology made a big historical mistake when, caught in the grip of modern scientism, it separated itself from philosophy in order to become a “hard science.” I regard psychoanalysis, or at least my brand of it, as being neither a branch of medicine nor of psychology, but as applied philosophy.

You have defined your intersubjective-systems theory as a “phenomenological contextualism.” How is your own brand of contextualism similar and/or different from the relational model put forth by social constructionist thought?

There are of course many similarities, but I think there are subtle differences—differences in sensibility—as well. I would say that my brand of contextualism embraces a hermeneutic rather than a constructivist sensibility. Following Gadamer, I would say that all understanding involves interpretation, and this seems different to me from saying that all understanding is constructed. Interpreting something—i.e., understanding it from a particular perspective—seems different to me from constructing a narrative about it.

I assume you are familiar with Speculative Realism and Object-Oriented Ontology. Since your approach to psychiatry is both phenomenological and contextual, I will quote a passage from Graham Harman’s Guerrilla Metaphysics and ask you to reflect on it: “What I am advocating is a reversal of the familiar social pattern in which everyone proves their adequate philosophical training by jabbing a few more daggers into the corpse of realism. From the flintiest analytic philosopher to the most dashing Francophone icon, philosophy today is united through a shared contempt for any probing of a real world in itself. Like all broad fashions of any era, this disdain begins to take on the character of an automatic reflex, and like all mental reflexes soon decays into compulsion. Given this atmosphere, it is widely supposed that substances are championed only by reactionaries living in an irrelevant past, while innovation seems to be on the side of relations and contexts, not individual things. On a related front, it is supposed to be the reactionaries who believe in substances independent of our perceptions, while the self-proclaimed avant-garde delights in bursting this final bubble of the true believers – a tedious drama of canned iconoclasm playing out across the decades. The champions of wholes over parts and the doubters of independent realities can continue to mock the conservatism of their foes if they wish, but the fact is that they have now largely defeated those foes. Holism and antirealism, their days of novelty long past, have become the new philosophical dogmas of our time. The sole difference is that the old orthodoxies viewed their opponents as dangerous cutting-edge transgressors, while the new ones have so exhausted the field of critique and transgression that they are likely to view their challengers only as conservative throwbacks.” Is metaphysics a thing of the past in your view, or do you tend to agree more with Harman?

I don’t really know whether metaphysics is a thing of the past. Heidegger certainly thought that it was, or wished it to be so. What I would say is that metaphysical questions, like the debate between realism and anti-realism, fall outside the domain of phenomenological inquiry (except insofar as metaphysical systems can be historically contextualized and deconstructed, as Heidegger attempted to do). I think Husserl got it right when he characterized the intentional structure of consciousness phenomenologically as always as if directed toward an object, where the “as if” indicates that the metaphysical question about the reality of the intentional object is not to be asked by the phenomenological inquirer.

In agreement with Nietzsche, Heidegger, and Gadamer, my own phenomenological-contextualist viewpoint holds that all understandings of the “real world” are deeply perspectival. A passage from my 2011 book makes this claim very strongly: “Corresponding to its Cartesianism is traditional psychoanalysis’s objectivist epistemology. One isolated mind, the analyst, is claimed to make objective observations and interpretations of another isolated mind, the patient. A phenomenological contextualism … reunites the Cartesian isolated mind with its world…. Correspondingly, intersubjective-systems theory embraces a perspectivalist epistemology, insisting that analytic understanding is always from a perspective shaped by the organizing principles of the inquirer. Accordingly, there are no objective or neutral analysts, no immaculate perceptions (Nietzsche), no God’s-eye view (Putnam) of anyone or anything” (p.20).

What are you currently working on?

I’m planning a paper elaborating on Heidegger’s use of mood as a bridge between the ontical or psychological and the ontological, a bridge to the “truth of being.” In this paper, I want to counter two criticisms of Heidegger: (1) that he fails to distinguish sufficiently the phenomena of mood, emotion, and feeling, and (2) that he neglects the ontological significance of the body.

Shattered Worlds/Psychotic States: A Post-Cartesian View of the Experience of Personal Annihilation

Many longtime readers of this blog are aware of my infatuation with the work of the intersubjectivist, relational psychoanalyst, George Atwood, a man who has specialized in working with psychosis in a field that once believed psychosis is untreatable.

The text below is from an article by Atwood, Donna Orange, and Robert Stolorow, Shattered Worlds/Psychotic States: A Post-Cartesian View of the Experience of Personal Annihilation, that appeared in the Spring 2002 issue of Psychoanalytic Psychology, 19(2), pages 281-306. Atwood is the lead author on this piece, which in their work indicates that these are predominantly his ideas. The paper was downloaded from his page, linked to above.

I deeply appreciate the relational context in which they view the symptoms of psychosis. Rather than seeing it as a brain disease, as does the majority of mental health professionals, they understand that, fundamentally, "the experience of personal annihilation reflects an intersubjective catastrophe in which psychologically sustaining relations to others have broken down at their most fundamental level" (Working Intersubjectively: Contextualism in Psychoanalytic Practice, Orange, Atwood, & Stolorow, 1997). I have seen, in depth, how this loss of psychologically sustaining relationships can push someone into a mind-state we have named psychosis.

[That book, by the way, is one of the best introductions to the intersubjective-systems theory of relational psychoanalysis.]

The text below offers one of the most succinct and compassionate elucidations of the subjective experience of psychosis.

The Experience of Personal Annihilation

An aura of impenetrability has always surrounded the psychoses, which have seemed far removed from ordinary experience and therefore extremely difficult or even impossible to reach empathically. This felt difficulty is indeed inherent in the very definition of these conditions, insofar as their essential feature is regarded as being a departure from the putatively true and real world a normal person inhabits. The obstacles to establishing empathy for the subjective states appearing in this extreme range of psychological disorder, however, are not in our view solely attributable to the experiences involved being at some distant remove from the average, normal life of a human being. A very powerful impediment arises from an altogether different source, namely, the assumptions of the observing clinician about the nature of experience itself and ultimately about the nature of a person. When one is regarded as possessing a mind, and this mind in turn is conceived as having an interior that is occupied by conscious (and perhaps unconscious) psychic contents, a structure is being imposed that sharply delineates the boundaries of one's personhood in respect to an objectively real outer world. Such a picture dichotomizes the subjective field into an inside and an outside, reifies and rigidifies the distinction between them, and envisions the resulting structure as constitutive of human existence in general.

Once we understand how the Cartesian view of the person reifies and universalizes this very specific pattern of experience, we can also see why the subjective states that appear so prominently in the psychoses could never be adequately encompassed by a conceptual system resting on Cartesian premises. These states include experiences of the dissolution of boundaries demarcating I and not-I, of the fragmentation and dispersal of one's very identity, and of the disintegration of reality itself. A phenomenological framework, by contrast, is unencumbered by objectifying images of mind, psyche, or psychical apparatus, and is therefore free to study experience without evaluating it for its veridicality with respect to a presumed external reality. The exploration of annihilation states accordingly presents no special philosophical difficulty, for we are concerned then only with the person and his or her world, in whatever state they may present themselves.

In the study of psychological annihilation, one may focus on self-experience or, more broadly, on world experience, where the former is seen as a central area included within the latter. Experiences of self and world are inextricably bound up with one another, in that any dramatic change in the one necessarily entails corresponding changes in the other. Self-dissolution, for example, is not a subjective event that could leave the world of the individual otherwise intact, with the selfhood of the person somehow subtracted out. The experience of self-loss means the loss of an enduring center in relation to which the totality of the individual's experiences are organized. The dissolution of one's selfhood thus produces an inevitable disintegrating effect on the person's experience in general, and results ultimately in the loss of coherence of the world itself. Likewise, the breakup of the unity of the world means the loss of a stable reality in relation to which the sense of self is defined and sustained, and an experience of self-fragmentation inevitably follows in its wake. World disintegration and self-dissolution are thus inseparable aspects of a single process, two faces of the same psychological catastrophe.

The experience of annihilation lies at the heart of the psychoses, and this is often expressed directly in statements to the effect that the person is dead or dying, that he or she has no self, does not exist, or is absent rather than present. It is also frequently said that the world is not real, that it has broken apart into pieces, and even that it is coming to an end. Sometimes the destruction of one's personal reality appears in an experience of falling forever, of spinning out of control, of shrinking endlessly and disappearing, or of being swallowed up into the environmental surround. More commonly, however, reparative and restorative efforts to reestablish a sense of existing predominate in the clinical picture, and these efforts appear in a wide variety of forms. A sense of being or becoming unreal, for example, gives rise to a preoccupation with one's mirror reflection, as if sustained attention to the visual outline of one's bodily being could compensate for a vanishing sense of personal selfhood. The experience of a deadness at the core of one's existence leads to asearch for a counteracting sense of aliveness, provided by the intensity of sensation in self-inflicted pain, in bizarre sexuality, or in thrilling, death-defying adventures. The dissolving of bodily boundaries and a terrifying feeling of melting into one's surroundings occasions the wearing of multiple sets of clothing, one on top of the next, expressing an attempt to reestablish and protect a devastated sense of bounded self-integrity. A breakup in the felt continuity of personal identity over time brings about an obsession with recalling and mentally reliving large numbers of events from the recent and remote past, the calling up of the various events embodying an effort to bring the temporally separated fragments of history together into a single whole. An experience of the disintegration of reality itself, of the falling apart of the world into a jumble of unconnected perceptions and meaningless happenings, gives way to delusions of reference in which the isolated elements are woven back together and given a sinister, directly personal significance. Small changes in the appearance of familiar persons seem to indicate global changes and breaches of identity, heralding the fragmentation of the world's stability into temporal chaos, and these breaks in continuity are repaired and smoothed over by the delusional idea that these persons have somehow been replaced by nefarious imposters. In each of these instances, a countervailing effort to reintegrate a fragmenting world and restore a sense of continuous and coherent being is most salient, while the underlying annihilation state recedes into the background.

In other cases, the annihilation itself is foregrounded, often in vividly concrete symbols, so that images of personal destruction pervade and dominate the individual's experience. Here the extremes to which the concretization is carried assist in maintaining the state of one's dissolving selfhood in focal awareness. The image of being poisoned by deadly chemicals or invisible gases, for example, concretely portrays a sense of being infiltrated and then killed off by the impinging, intrusive impacts of the social surround. Picturing a distant machine that sends influencing rays into one's mind and body, likewise, articulates an experience of the loss of agency [3] and of falling under the obliterating control of an alien agenda. Murdering assassins or conspiring government agents are imagined, and these figures concretize the threat of psychological obliteration in the face of irresistible pressures from emotionally significant others. A takeover of one's brain by a supernatural entity is suddenly felt to occur, symbolizing an overpowering invalidation and usurpation of one's subjectivity.

Sometimes the imagery of annihilation is intermixed with or even supplanted by what appear to be grandiose or highly idealized visions of oneself or others. These latter images express efforts to resurrect all those parts of one's selfhood and world that have become subject to shattering and erasure. The concepts of grandiosity and idealization are, however, problematic when understood in the context of the phenomenology of personal annihilation. Identifying a particular experience as idealized or grandiose involves a judgment and a standard defining what is and is not reasonable for a person to believe. Grandiosity means appropriating to oneself a significance, power, and perfection one actually does not possess. Idealization, as this term is traditionally employed, means correspondingly exaggerating the significance and perfection of some emotionally important other. In the context of personal annihilation, however, it cannot be said that so-called idealization and grandiosity appropriate or exaggerate anything. What appears, from an external point of reference, to be an outrageous exaggeration, may, subjectively regarded, be understood as accentuating the sense that one exists, that one possesses agency and subjectivity, that one's experiences belong to no one other than oneself, and that one's personal world has coherence and is enduringly real. A delusional claim to be the owner of the world, for example, may contain at its core a dissolving sense of one's perceptions and thoughts being one's own. Seemingly extravagant assertions of personal achievement and capability may crystallize and intensify an otherwise threatened experience of agency and autonomy. Visions of descending from a royal lineage or of being a specially chosen child of God accentuate and protect a disappearing sense of connection to a world-sustaining other. An idea that one has penetrated the ultimate secret of the cosmos, the key to understanding the interrelationships of all existing things, enshrines and preserves the integrity of one's personal world in the face of a threat of its total disintegration. In each of these last examples, the problematic issue is not that unrealistic grandiose or idealized qualities are being ascribed to oneself or others; it is rather that the individual's personal universe has come under assault and is in danger of annihilation. Let us turn now to the intersubjective contexts in which the experiences we have been describing take form.

The Intersubjective Context of Annihilation

In Working Intersubjectively: Contextualism in Psychoanalytic Practice (Orange, Atwood, & Stolorow, 1997), we said that the experience of personal annihilation reflects an intersubjective catastrophe in which psychologically sustaining relations to others have broken down at their most fundamental level. In what does this breakdown consist? It consists in the loss of affirming, validating connections to others and the shattering of the subjective world by impingement and usurpation. Although the concrete events and life circumstances playing a role in the origin of annihilation states are highly varied, they have in common an effect of undermining one's sense of existing and of being real in its most basic aspects, including the experience of oneself as being an active agent and subject, as possessing an identity that is coherent and felt as authentically one's own, as having a boundary delineating and delimiting I and not-I, and as being continuous in time and over history.

Viewing psychological annihilation in the context of an intersubjective field means that this experience is interpreted as occurring within a living system of mutual influence. The visible manifestations of the experience are therefore not seen to emanate from a pathological condition localized solely within the patient; nor, however, are they regarded simply as reactions to a primary victimization at the hands of others. Such unilateral conceptions, emphasizing an exclusive determination either from the side of the patient or from the side of the human environment, fails to take into account the complex transactional process occurring between the two. Sometimes persons undergoing the experiences described here are viewed as carrying a special vulnerability or even predisposition that is then seen as a determinative factor in the genesis of personal annihilation. The problem with such an idea is that it represents a return to Cartesian and objectivist thinking, within which factors somehow located "inside" an individual—in his or her mind or brain—become operative causes in the unfolding of subjective states. We then have a picture of an isolated mind, containing predisposing sensitivities and vulnerabilities, which collapses in the face of objective external pressures of some kind. In an intersubjective framework of understanding, there are no fully isolable vulnerabilities that exist inside anyone, because what appears or does not appear as a vulnerability only materializes within specific intersubjective fields.

Imagine a patient who feels she is not present, does not exist, and has no self. Imagine further that someone not familiar with such states asks her, "How are you today?" The use of the second-person pronoun "you" implies to the patient a degree of existence she does not experience, and a gulf of misunderstanding and invalidation opens up between her and the questioner. Perhaps the patient gives the answer, "A billion light years," expressing how far away she feels from the questioner in view of the naive assumption having been made that there is a "you" to whom the inquiry would be intelligible, a "you" that could report on how it feels at the time. Perhaps the patient also experiences an invasion and usurpation by the questioner's unfounded assumptions, and she begins to speak of a machine sending rays into the center of her brain, to give this deepening annihilation experience form and substance. From the standpoint of the questioner, one who takes a Cartesian view of things, the patient's replies are utterly incomprehensible. The question, after all, has been appropriate and clearly phrased, and the answers coming back are without apparent connection to all that is true and real. The patient is at most a few feet away rather than a billion light years away, and there is no machine in the world that can perform as the patient has now begun to claim. Clearly, he thinks, this patient's sensitivities and vulnerabilities are such that the slightest human interaction triggers bizarre reactions stemming from pathological processes taking place inside the patient's mind, body, or both. A reciprocally reinforcing intersubjective disjunction has thus arisen in which the questioner ascribes defects to the patient's mind and brain even as the patient experiences her mind and brain as being penetrated and inhabited by a foreign influence.

Now imagine a second individual who speaks to the patient differently, who finds a way to acknowledge her sense of nonbeing and who understands as well the patient's readiness to surrender herself to whatever is attributed to her. He speaks to the patient in the third person, conveys his knowledge of how terrible it is not to exist, and in a variety of highly concrete ways lets the patient know she is not alone in the catastrophe that is the ongoing situation of her life. The patient, surprised by this different approach, actually begins to feel understood and, paradoxically, begins also to feel a flickering of her own existence, moments of directly sensed being alternating with the continuing feeling of nonexistence or nonbeing. These moments of being, occurring because of the validating experience of being seen and acknowledged, have a painful aliveness about them, draniatically contrasting with the numbness and deadness accompanying the sense of nonexistence. Perhaps the patient, after a period, says she has been stung by a swarm of bees, concretizing the sporadically recurring moments of aliveness as they alternate with episodes of the familiar deadness and nonbeing. Let us imagine further that this second person perceives the metaphor of this transitory delusion as well and finds ways to address the ambivalent experience the patient is having of coming back to life. Her sense of existing thus becomes strengthened again, by the incomparable power of human recognition. The patient's readiness to surrender to others' attributions and definitions, itself embedded in a complex, lifelong history of intersubjective transactions, is not engaged in the foreground of this second interaction and therefore does not appear as an operative defect or vulnerability in the experiences that unfold. This is because the intersubjective field in this instance is characterized on the one side by gradually developing understanding and on the other by a predominance of validation and an increasing sense of being.

In the example cited, we see how a clinician operating on Cartesian assumptions is not in a position to understand experiences of nonbeing. To such an observer, it is simply not true that the patient does not exist, it is not true that she is absent, and her claims about penetrating rays from influencing machines appear extravagantly delusional. Any reaction on the part of the clinician communicating this view, of course, intensifies the patient's experience of invalidation and annihilation, giving rise to a spiraling of disjunctive worlds in which the patient elaborates ever more concretized images of her obliteration and the clinician becomes ever more appalled by the spectacle of madness unfolding before his eyes. The patient's so-called delusions, in the context of this vicious spiral, emerge as expressions of subjectivity under siege, products of a war of the worlds constituted by mutual misunderstanding and mutual invalidation.

To further define and illustrate the context of personal annihilation, let us consider another patient, a young Catholic woman who for years had been preoccupied with visions of herself as having a special connection to God. In vivid hallucinations and elaborate delusions, she experienced a oneness with God the Father and God the Son, variously identifying with the Holy Virgin, the Holy Ghost, and Jesus Christ Himself. Claiming at times to have undergone sexual union with Jesus, to have physically flown to Rome to be held in the arms of the Pope, and to be channeling God's healing, peacemaking powers to the entire human race, this patient's ideas and beliefs were such that those around her could not relate their own experiences to hers in meaningful dialogue. Accordingly, the patient was said to have lost contact with the real and to be psychotic. Phenomenologically, of course, no such judgment or diagnosis occurs, as one seeks instead to understand the patient in her own subjective terms, exploring the history of events that could make her situation humanly intelligible. This inquiry disclosed a pivotal incident in the patient's middle childhood years, the sudden suicide of her beloved father following devastating personal disappointments and failures in his professional life. It was discovered as well that the death was covered over by the family, falsely redefined as having been accidental, and then hidden away behind a wall of impenetrable silence. The affairs of the family thus continued as though the father's suicide had never occurred, so little being said of him that he was relegated to the effective status of someone who had never been. It was the family's turning away from the father's death and life that was the context of a gradually deepening sense of inner deadness and isolation in the years that followed. This was also the setting for her first ruminations on the figure of Jesus Christ and a special place she imagined for herself in the Holy Trinity. Over a period of more than a decade, secret religious thoughts about her relation to God gradually blossomed into full-fledged delusional realities, finally bursting forth in the family with great violence and precipitating the first of many psychiatric hospitalizations. Central in the patient's expressions at this time were loud, imperious demands that she immediately be united with Jesus, who she believed had been miraculously reincarnated in a church-affiliated counselor she had once known and depended on for a brief period.

The bond to the father, something that centrally sustained this patient as a young girl, had been lost when he died. Compounding this loss, however, his death occurred as an intentional suicide, which was unthinkable if, as she had believed during her early years, he actually loved her. Her unbearable experience of having been deserted by him, however, had itself been suppressed by the family's denial, so that the reality of all she had known with him when he was alive and all she had felt on losing him when he killed himself was undercut and nullified, eventually undermining her very selfhood as the feelings of deadness expanded and deepened. How is one to understand this patient's seemingly fantastic religious claims and demands, in view of this context of abandonment and personal devastation? The Cartesian analyst, following Freud, inevitably focuses on the wide disparity between the patient's beliefs and the purportedly objective truth of her life situation, perceiving a deficiency in reality testing, a break with the objectively real and the setting up of an idealized alternative in its place. The streaming religious fantasies and delusions, from such a viewpoint, appear as wish-fulfilling substitutes for the lost connection to the father, and the patient's disturbance seems to consist precisely in her immersion in these fantasies at the expense of attention to her actual, painfully sad situation. An intersubjective analysis, by contrast, focuses on how the patient's so-called delusions protect and preserve a shattered world, how they reinstate a personal reality that has been substantially annihilated, how they embody an effort to resurrect a world-sustaining tie in the midst of an experience of complete obliteration. Far from expressing a flight from painful reality, according to this post-Cartesian view, she is understood to have used the symbols of her faith to encapsulate a remnant of the destroyed bond to her father and thereby to maintain a hold on all that was most real in her experience of herself and her world. The patient's demands to be united with Jesus Christ, urgently and aggressively reiterated in the early course of her treatment, were thus cries for the world-preserving connection on which her very existence depended.

Viewing a person such as this as delusional highlights the disparity between her experiences and beliefs and the conditions of supposed external reality. From this perspective, a goal inevitably materializes to bring the patient's ideas into conformity with all that is generally agreed on as real and true. These normative beliefs have no place for special linkages to Jesus Christ and unassisted flights to Rome, such ideas being seen as pathological fantasies that need to be interpreted, relinquished, or suppressed. What, one may ask, is the effect on the patient of being seen and treated in this way? Such a view inevitably communicates a message that the patient's most urgently felt desires are misguided and that her sole remaining hopes for restoring herself and her reality are without foundation. This message repeats and reinforces the emotional abandonment and invalidation she experienced at the hands of her father and her family, and its effect is to accelerate the delusional process as the patient seeks her own survival in ever more concrete, vividly dramatized ways. A vicious spiral has thus again sprung into being, in which disjunctive worlds war with one another in unending cycles of misunderstanding and reciprocal invalidation.

An analyst who understands the meaning of this patient's cries, by contrast, comes to her with no agenda to realign the content of her experiences; his purpose is rather to introduce a new element into her devastated life, one around which she can refind the felt core of her existence. This element will be embodied in her experience of him and his understanding, something with a powerful emotional impact, calming and reassuring in its effect. This analyst will establish his presence, at first physically in space and time, by regularly appearing and reappearing, and by engaging- the patient's attention through concrete, simple interactions of various kinds. When eventually the full force of her delusional efforts to salvage herself and her world become directed toward him, as inevitably they will, and she pressures him to reunite her with the man she believes to be Jesus Christ, he will respond gently but definitively by telling her that there is only one person in the world she should be concerned about seeing, and that he is himself that person. He will explain further that there are to be no meetings with anyone except for those that he and she have with each other, for it is in their work together that she will become well again and return home to be with those who love her. In all of these interventions, the analyst is guided by an understanding that he must himself become the inheritor of the patient's strivings and that his relationship to the patient is the central battleground on which her psychological survival is to be worked out. How does she respond to all of these things? The delusional process, far from being exacerbated, actually begins to recede as the analyst is established as someone in relation to whom she can recover a sense of herself and of the reality of her destroyed world. At first, her dependence is extreme, and she even intimates that her newfound therapist might indeed himself have some special status with respect to God Almighty. Such expressions are understood as reflecting the power of the bond that is forming, a bond that undergirds a shattered universe in the process of being reassembled. The analyst accordingly gives no response to such attributions on the level of their literal content and occupies himself instead with reinforcing the developing connection she has begun to experience between them. Each step in the solidification of their tie is accompanied by a further stabilization of her world and a continuing decentralizing of her religious images as their function passes over onto the therapeutic relationship. In the early stages of this healing process, any disturbance in the tie that has been evolving produces extreme reactions of terror of abandonment, and sometimes also a resurgence of the religious fantasies. As the threatened tie is reinstated in each instance, the terror disappears and the religious imagery recedes. In this way, the conditions are gradually established within which her experiences of abandonment, betrayal, and invalidation can begin to be addressed and healed on a lasting foundation.

Once a post-Cartesian attitude toward the psychoses is adopted, as the two cases described here illustrate, new understandings crystallize and previously unseen opportunities for therapeutic intervention appear. Let us continue to pursue the implications of this shift in perspective by discussing two other important issues in clinical psychoanalysis to which an understanding of annihilation states is centrally relevant: the problem of mania and the nature of psychological trauma in its most extreme forms.


Note:

3. Terms such as agency, authenticity, cohesion, and others are used here in an exclusively phenomenological sense, referring to dimensions of self-experience along which annihilation states typically take form (Orange, Atwood, & Stolorow, 1997, chapter 4).

George Atwood - Lectures on Abnormal Psychology

George Atwood is one of the co-founders (with Robert Stolorow and others) of the intersubjective systems theory model of post-Freudian, relational psychoanalysis. He is professor emeritus in Clinical Psychology at Rutgers University.

He also is the author of The Abyss of Madness (2011), one of the best books I have ever read about working with clients who are experiencing psychotic symptoms. You can read the first four chapters for free online.

He is co-author of Psychoanalytic Treatment: An Intersubjective Approach (with Robert Stolorow and Bernard Brandchaft), Contexts of Being: The Intersubjective Foundations of Psychological Life (with Stolorow), and Working Intersubjectively: Contextualism in Psychoanalytic Practice (with Donna Orange and Stolorow), among many others. Working Intersubjectively is also one of the best books I have read in this field, and I have read most of them.

The playlist below contains 36 videos (19 lectures - all but 2 are two parts) and 19 hours of education.

George Atwood, Ph.D - Professor of Psychology at Rutgers University - New Brunswick
Course: Abnormal Psychology
Recorded in Spring 2012

George Atwood - The Abyss of Madness

[NOTE: I originally posted this in August of 2012. However, I am seeing clients who would fall into the definition Atwood uses for "madness."]

I am reading George Atwood's The Abyss of Madness (Psychoanalytic Inquiry Book Series) (2011) as part of an intersubjective, relational psychoanalytic study group I have been a part of for the last two and a half years. Aside from a few essays, this is is the first work I have read that is specifically Atwood's own thinking (most of the other books he had co-authored with Robert Stolorow).

Here is the description of the book from Amazon:

Despite the many ways in which the so-called psychoses can become manifest, they are ultimately human events arising out of human contexts. As such, they can be understood in an intersubjective manner, removing the stigmatizing boundary between madness and sanity. Utilizing the post-Cartesian psychoanalytic approach of phenomenological contextualism, as well as almost 50 years of clinical experience, George Atwood presents detailed case studies depicting individuals in crisis and the successes and failures that occurred in their treatment. Topics range from depression to schizophrenia, bipolar disorder to dreams, dissociative states to suicidality. Throughout is an emphasis on the underlying essence of humanity demonstrated in even the most extreme cases of psychological and emotional disturbance, and both the surprising highs and tragic lows of the search for the inner truth of a life – that of the analyst as well as the patient.

I very much like the way he conceptualizes these issues, even when I do not agree with his perspective on the mind. The way he talks about mental illness feels right in terms of how the client experiences it, and in the relational/intersubjective model, meeting the client in his or her own reality is essential.

When he speaks of madness in these passages, he is referring to psychosis and schizophrenia, or even bipolar disorder in its manic stage. These are not cases of simple depression, although there is certainly some similarity at a much lower intensity. And all these terms are things that he rejects as scientific defense mechanisms against our own fears of the abyss and what that means for our shared sense of being human.

It's worth bearing in mind that the psychoanalytic school refused to treat the "psychotics" for decades following Freud based on his assumption that they were not amenable to treatment. Harry Stack Sullivan, in the late 1920s, was one of the first psychoanalytically trained therapists to work with schizophrenics, and he did so based on his "problems with living" definition of mental illness. Sullivan was also one of the first psychoanalysts to focus on the "self system" as the outcome of relational patterns in the child's life (eventually giving rise to attachment theory). Atwood is definitely a lineage holder in the tradition Sullivan created that has been expanded upon by Stolorow, Donna Orange, and others.

Here a few quotes that I have highlighted in the text that I think are illustrative of his thinking.

Phenomenologically, going mad is a matter of the fragmentation of the soul, of a fall into nonbeing, of becoming subject to a sense of erasure and annihilation. The fall into the abyss of madness, when it occurs, is felt as something infinite and eternal. One falls away, limitlessly, from being itself,  into utter nonbeing.  (p. 40)

* * * *

Madness is not an illness, and it is not a disorder. Madness is the abyss. It is the experience of utter annihilation. Calling it a disease and distinguishing its forms, arranging its manifestations in carefully assembled lists and charts, creating scientific-sounding pseudo-explanations for it--all of these are intellectually indefensible, and I think they occur because of the terror. What is the terror I am speaking of? It is the terror of madness itself, which is the anxiety that one may fall into nonbeing.

The abyss lies on or just beyond the horizon of every person's world, and there is nothing more frightening. Even death does not hold a terror for us comparable to the one associated with the abyss. (p. 41)

He suggests that death offers a potential reunion with loved ones, or conversely, a release or relief from the sorrows and pains of our lives. We can rage against the dying of the light, or marvel at our capacity to contemplate our own demise, or even imagine the world without us.

But the descent into madness, into the abyss, offers no such relief.

It is the end of all possible responses and meanings, the erasure of a world in which there is anything coherent to respond to, the melting away of anyone to engage in a response. It is much more scary than death, and this proven by the fact that people in fear of annihilation--the terror of madness--so often commit suicide rather than continue with it. (p. 42)

* * * *

People often fall not because the bad happens, but rather because the good stops happening. Sanity is sustained by a network of validating, affirming connections that exist in a person's life: connections to other beings. If those connections fail, one falls. The beings on whom one relies include, obviously, other people, sometimes animals, often beings known only through memory and creative imagination. It some instances it is the connection to God that protects a person against madness. Strip any person of his or her sustaining links to others, and that person falls. No one is immune, because madness is a possibility of every human life. (p. 43)

* * * *

What a person in the grip of annihilation needs, above all else, is someone's understanding of the horror, which will include a human response assisting in the journey back to some sort of psychological survival. A person undergoing an experience of the total meltdown of the universe, when told that his or her suffering stems from a mental illness, will generally feel confused, invalidated, and undermined. Because there are no resources to fight against such a view, its power will have a petrifying effect on subjectivity and deepen the fall into the abyss. (p. 45)

Atwood contends that an objectified psychiatric diagnosis is the antithesis of what is needed - essentially mirroring and validation. He offers a thought experiment: Imagine a young man, maybe in his early 20s, who is in the midst of a fall into the abyss. This young man finds himself committed to an in-patient psych ward where he is given the diagnosis of a brain disease called schizophrenia.

The annihilating impact of such a view then becomes symbolized in the patient's unfolding experience that vicious, destructive voices are speaking to him over invisible wires and saying repeatedly that he should die. In this way a spiraling effect occurs, wherein the operation of the medical model further injures the already devastated patient, whose reactions to the new injuries in turn reconfirm the correctness of the diagnosis. (p. 45-46)

He prefers to be with the client in whatever space they inhabit, to show them that he is listening and trying to comprehend their experiences as much as he is able - and, above all else, that he is prepared to do whatever is necessary to help.

I have had clients in the past who I felt unable to help, because I was unable to be with them in their abyss, to extend my empathy into what I experiences as their delusional states. I failed them. Even as I sat with them and tried to understand what they were telling me, I did not understand that their delusions were their psychic organizing principles, were their symbolic truth of how the world has betrayed them.

Atwood, in the many case studies he presents, is revealed as someone who can feel into the annihilation his clients present him with, but he also acknowledges how challenging it is:

Working in the territory of annihilated souls is never easy. To really listen to someone, anyone, to hear the depth of what he or she may have felt, to work one's way into realms of experience never before perceived by anyone and therefore never articulated--all of this is as hard a task as one may undertake. (p. 51)

It is indeed. And it is also rewarding when the therapist can do so successfully and allow the client to feel heard and validated - maybe for the first tine in their lives.

I want to wrap up this post with a few more passages that deal with etiology. I posted some thoughts recently on a more relationally based diagnostic manual for counselors and therapists - Atwood conceptualizes cases in a way that fits with what I would like to see.

Those who feel they are not present, and who affirm the existence of machine that controls their minds and bodies, are often the products of profound enmeshment with their caregivers in childhood. An accommodation has taken place at a very young age in which the agenda of the caregiver--it can be the mother, the father, or both--becomes the supreme principle defining the child's developing sense of personal identity. The experience of the child as an independent person in his or her own right is nullified, so that they child the parents wish for can be brought into being. Very often thee are no outward signs of anything amiss, as family life unfolds in a seeming harmony. Somewhere along the way, however , the false self begins to crumble, and a sense of the degree to which the child has been absent from life arises. This emerging sense of never having been there, of having been controlled and regulated by outside forces, is so unstable and fragmentary that it is given concrete form. What is seen from the viewpoint of others as a delusion then begins to crystallize, for example in the image of an influencing machine (Tausk, 1917; Orange et al., 1997, chap. 4). Within the world of the child, now perhaps chronologically an adult, the so-called delusion is a carrier of truth that has up until then been entirely hidden and erased. What looks like a breakdown into psychosis and delusion thus may represent an attempted breakthrough, but the inchoate "I" does require an understanding and responsive "Thou" in order to have a chance to consolidate itself. (p. 60-61)

 That last sentence is the essence of the relational model - we are relational beings, the damage to our sense of self that we experience is nearly always relational, and if there is to be healing of that damage, that too much be relational - it requires mirroring, validation, and the sense of human connection that is vital to sanity for all of us.

Robert Stolorow Interview - Heidegger and Post-Cartesian Psychoanalysis

From New Books in Psychoanalysis, this is a cool interview with Robert Stolorow, one of the founders of intersubjective systems theory in psychoanalysis.

Robert Stolorow: World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis

by Tracy D. Morgan on January 6, 2014

In this interview with one of the founders of intersubjective psychoanalysis, Robert Stolorow discusses his interest in Heidegger and the implications of that interest for the psychoanalytic project overall. What do “worldness”, “everydayness”, and “resoluteness” bring to the clinical encounter? What is the role of trauma in bringing us to a more authentic place?

Stolorow is interested in pursuing both what Heidegger can do for psychoanalysis and what psychoanalysis can do, in a sense, for Heidegger. The development of “post-cartesian psychoanalysis” has embedded within it a critique of Freud’s intrapsychic focus. Analysts of the post-cartesian stripe seek to unearth “pre-reflectivity”, those modes of being that are part and parcel of us but remain out of our awareness. There is also expressed an interest in contextualism–and towards that end this book looks at Heidegger’s forays into Nazism as evidence of his own limits, precipitated perhaps by the loss of Hannah Arendt’s love and admiration. But for Stolorow, analytic work is best done by employing the tripartite perspective of phenomenology, hermeneutics and contextualism. Whereas Descartes separated mind and body, psyche and world, Stolorow argues for the importance of bringing those very same things back together.

 

Interview with Robert Stolorow [ 1:04:46 ]  Play in Popup | Download