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Review: A Silvan Tomkins Handbook: Foundations for Affect Theory by Adam Frank and Elizabeth Wilson
Silvan Tomkins (1911 – 1991) is an innovative, ground-breaking interdisciplinary psychologist. Tomkins’ four volume Affect, Imagery, and Consciousness is a Mount Everest of the study of affects and the emotions. Like Mount Everest itself, Tomkins’ work is on the border of several gigantic kingdoms, extending from philosophy to psychology, neurology to evolutionary psychology, data rich empirical research to high speculation, phenomenology to an early version of critical theory, behaviorism to personality theory and psychoanalysis.
The result of the complexities and multidimensionality of Tomkins’ contributions is that his work has remained less well known, for example, than Tomkins’ student Paul Ekman, and Tomkins is regarded as hard to read, dense, difficult and even inaccessible. Until now.
A Silvan Tomkins Handbook: Foundations for Affect Theory by Adam J. Frank and Elizabeth A. Wilson (Minneapolis: University of Minnesota Press, 2020, 105 pp.) provides a sophisticated roadmap into the
complex terrain and intricacies of Tomkins’ innovative approach to the affects. Without oversimplifying and with admirable conciseness, Frank and Wilson engage with the tough issues and reliably clarify and illuminate them: the relation of Tomkins to Darwin – continuity or innovation; the philosophical deep structure of Tomkins thinking, including his PhD dissertation in philosophy on the Scottish enlightenment figure Bishop Butler; his work with W.V.O. Quine in logical empiricism and pragmatism; the debate about the affects as the bearers of propositional content; the relationship to Spinoza and the latter’s theory of desire, passion, and value; the adversarial relationship to Freud’s drive theory, while using psychoanalytically-informed listening to describe the affects in their intersubjective context; what happens to the affects in the human context of community, namely, affect control scripts.
Tomkins’ life spanned the time when the dominant design paradigms in psychology were behaviorism and psychoanalysis. As the authors, Adam J. Frank and Elizabeth A. Wilson, note, Tomkins himself underwent a seven-year psychoanalysis with Ruth Burr (p. 138), and said that it had cured him of his neurosis.
As usual, the devil and the innovations are in the details. The conventional wisdom is that a straight line exists between Darwin, Tomkins, and Ekman. Frank and Wilson demonstrate decisively that it is a best a zigzagging dotted line.
A biological dimension exists to the affects – neurological, glandular, muscular, parasympathetic, visceral, and so on. How society and community then take and elaborate, magnify, and transmute that biology are of the essence.
The difference between Darwin and Tomkins is substantial. Darwin sees the human smile (among many things) as a vestigial remnant of our canine ancestors baring their teeth to express the mixed message “I am friendly enough but also know how to be aggressive and bite” [or a sentiment to that effect]. If the smile expresses anything for Darwin, it is as a fossilized remainder of mammalian behavior, thereby making Darwin’s key argument of continuity between man and animals.
According to Frank and Wilson, while Tomkins does not contest Darwin’s finding, Tomkins’ thinking moves forward and perhaps at right angles. Tomkins endorse a “stored affect program” but does not reduce “affect complexes” to such a program (p. 35). Most authentically, Tomkins innovates an “inverse architecture” to the emotions whereby the affect of interest and excitement (“happiness”) is literally in the smile itself. Nothing is hidden. The affect lives in the smile.
Tomkins is just getting warmed up here: “the affects are also always necessarily social, conscious, facial, scripted, ideological, and interpersonal (p. 33). It is not even clear that Tomkins is a proper Darwinian: “What is evolutionarily basic for Tomkins is not fitness but rather the capacity to conjoin and disjoin and cleave” (p. 34), which provides the complexity of affects transmuted into emotions in real life social situations.
Neither Frank nor Wilson – nor Tomkins – are responsible that Darwin’s classic, innovative, ground breaking work on the emotions is deeply flawed.
Darwin’s work on the emotions took considerable pains to disagree with and refute Charles Bell’s assertion that the emotions were purposeful in a spiritual deistic sense, showing us the wisdom of the ultimate designer of the clockwork universe, as noted, the God of the deists and quasi-Unitarians. Apparently the emotions could not be both purposeful and perform the work of Darwin’s own quasi-divine first principle of adaptation, natural selection.
Though this goes momentarily beyond the confines of Frank and Wilson, the matter is of the essence. The scandal is that Darwin, after banishing purpose from the human emotions to link them with the animals, then had to fall back on the [Lamarckian] inheritance of acquired characteristics (not natural selection!) to account for the continuum between the “expression” of emotion in man and animals. Animals such as dogs and chimps were indeed expressing their emotions; but man was performing habitual behaviors continuous with the behaviors of dogs and chimps without purpose that had taken on a fossilized life of their own in man in the species homo sapiens. The scandal grows as, for Darwin, the emotions are not even expressive (in a work with that title!) – the emotions are vestigial gestures.
Tomkins may have had an appreciation of the nuances of Darwin’s position that even Darwin lacked thanks to Tomkins’ work on Bishop Butler and the other Christian and deistic divines of the Scottish Enlightenment. But Tomkins never made explicit the noted limitation or background controversy.
Meanwhile, Paul Ekman has built on the work of the giant, Tomkins, that came before him. Ekman states he spent seven years on a potentially career ending research project to map Tomkins’ example that, in effect, happiness lives in the microexpressions of the smile on the face. Until his retirement, Ekman broke out of the academy and was consulting to the FBI and other large law enforcement organizations about how to tell if the would-be suicide bomber is unwittingly expressing his contempt for the capitalist dogs by focusing on the barely conscious microexpressions of contempt that provide “tells” of a hidden affect.
Given the authors sustained discussion of Tomkins interest in computers, cybernetics, automation, science fiction accounts of biological robots in Philip K Dick, they will be interested to learn (but do not note) that a version of Ekman’s facial action coding scheme has indeed been implemented by a company called Affectiva. To their credit, Affectiva has refused to do business with totalitarian governments, but that does not prevent the latter from trying to steal or reverse engineer the algorithms. The genie is out of the bottle.
Frank and Wilson point to the speculative deep structure of Tomkins’ thinking in the work of Spinoza. The crosscurrents and parallels are abundant – including quotations that echo one another: “It is our theory of value that for human subjects value is any object of human affect. Whatever one is excited by, enjoys, fears, hates, is ashamed of, is contemptuous of or is distressed by in an object of value, positive or negative (1:329)” 9p. 76). Freud was a secret – and not so secret – admirer of Spinoza, whose therapeutic project gives aid and comfort to all those fellow travelers seeking to extend the bounds of self-knowledge in transmuting affects into action, not mere cognitions.
Frank and Wilson consistently push back against the assertions of Ruth Leys on the rise of affect. Now one should never dismiss Leys’ penetrating and incisive commentary. If one is going to hunt and look to bring down big game, it makes sense to go after Ekman and Tomkins. No one is interested in refuting, for example, the author of this review, because few have heard of him (i.e., me). No glory there.
Frank and Wilson defend Tomkins against the assertion that he initiates the anti-internationalist movement (which, presumably, accelerates with Ekman). I summarize the defense: because affects are born in an unintentional (“non propositional”) context does not mean that they remain there.
Building on Tomkins’s account of affects, his theory of imagery and consciousness recruits significant propositional content in a powerful and therapeutically informed context of scripts. Frank and Wilson perform an admirable job of explaining the non-intuitive subtleties of affect control scripts. I provide an example:
Consider, for example, the section titled “Production of a Total Affect-Shame Bind by Apparently Innocuous and Well-Intentioned Parental Action” (2: 228), which begins, “Our hero is a child who is destined to have every affect totally bound by shame.” Over two pages, Tomkins sketches an excruciating set of hypothetical scenes that take place around a 1950 American dinner table in which a child is shamed by his parents for expressing each of the primary affects: “Don’ ever make that face again at the table – it’s disgusting” (2: 229), “Oh, Robert, you’d think you hadn’t eaten in a week, really!” (2: 229), “Robert, where are your manners? Sit up (2:229 – 30), “Robert, you could be a little more attentive, you don’t have to sit there like bump on a log. Say something” (2:230).”
This does indeed set up a script – an affect “out of control” script. As I read them, each of these is a micro-narrative – a script – in which a breakdown in empathy occurs, inflicting micro-aggressions in a context of affect amplification, psychological magnification, and a script for ongoing emotional disequilibrium. I hasten to add that the word “empathy” does not occur in Tomkins, but it lives there nonetheless in this and many other dramatic sections.
To tie together nonintentional affects with the propositional content of affect control scripts, an account of emergent processes, properties, and relationships is required. Although elements of such an account are to be found in the systems thinking, and feedback mechanisms that inspired Tomkins in the works of Norbert Wiener and the early cyberneticists, I do not believe a complete or satisfying answer is to be found there – or, for that matter, in any philosophy of science or design paradigm. This is not a criticism of Tomkins or the fine work of Frank/Wilson; but points to one of the great intellectual challenges of our time – a coherent account of emergent properties in context.
Another one of the take-aways from my reading of Frank and Wilson is that some of the best work being done in psychoanalytically-oriented circles is occurring in comparative literature, gender studies, and the like. While not narrowly psychoanalytic, this work is an example of that latter.
Psychoanalysis as a clinical practice continues to succumb to self-inflicted wounds of arrogance, elitism, cost, scheduling, and intermittent dogmatism. Today’s analysts are simply practicing cognitive behavioral therapy (CBT) and asking clients about their dreams between homework assignments.
Psychiatry does allow for some simple affects as anxiety (fear), low spirits (depression), high spirits (mania), or anger; but, notwithstanding Panksepp or LeDoux, psychiatry lacks a sufficiently complex or nuanced account of the affects. “My amygdala made me do it” may indeed be true in specific instances of traumatic activation or “being triggered,” but it does not clarify the rich affective detail, nuances, human blind spots, struggle and effort in people’s lives, relationships, communities, and, ultimately, it demonstrates you’ve just got the wrong philosophy of science. A better one based in systems theory that allows for the emergent properties of the affects in their richness and complexity in biological and sociopsychological context is brought forth in the course of Tomkins’ contribution and this guide to it.
(c) Lou Agosta, PhD and the Chicago Empathy Project
Online [cyber] therapy: The genie is out of the bottle
The genie is out of the bottle. The day that the first therapist invited his one-on-one client (who had an urgent need for a conversation but an inability to get to the office) to
CoverArt: Theory and Practice of Online Therapy ed. Haim Weinberg and Arnon Rolnick
put down the phone and dial into Skype, the genie escaped from the bottle.
The reader will recall that in the 1001 Arabian Nightsthe Genie was very powerful but a trickster and nearly impossible to control. Making wishes is tricky, and if one is not careful, the sausages end up stuck to one’s nose and one must waste the last wish to get them off. In this case, the Genie is Internet technology such as Skype and Google Groups and the emerging conveniences, affordances, complexities, entanglements, and even resistances that it offers.
In the Arabian Nights, the hero, Aladdin, had to trick the Genie to getting back in the bottle by appealing to his narcissism. “You are not all powerful,” Aladdin said. “A large creature like you could not possibly fit in that small bottle!” The Genie’s wounded narcissism caused him to prove that he can indeed fit back in the bottle. Aladdin puts the stopper back on – trapped! However, in the case of the Internet and online communication tools, do not look to be able to turn back the clock.
But there is good news. The human face is an emotional hot spot. It is rich in micro-expressions many of which are available and visible even though the “real estate” on the screen in less rich in detail than an in-person experience. Indeed it is not even clear that the face as presented online is “less rich.” It is the only thing being displayed, and the viewer is led to concentrate on it in detail. But here the trade-off of bodily presence versus the imaginary comes into the foreground.
The criticism fails that the online conversation between persons lacks the reality of the in-person encounter. But this criticism fails, in a surprising way. The criticism fails notbecause the online media is so real. Rather the criticism fails because the in-person psychotherapy encounter is shot through-and-through with the imaginary, with symbolism, the imaginary and irreality. The “irreal” includes the symbolic, the imagined, the fictional, the part of reality which is distinct from the real but includes the past and the future and the imaginary, which are not really present yet influence reality.
In psychotherapy, the in-person encounter is precisely about the symbolic and the imagined – the transference. The basic definition of “transference” is that the person relives emotionally the relationship to objects (persons) from the past, persons who are not physically present in the room (or in the virtual space online).
What we are calling the “virtuality” of the technology media adds an additional dimension of irreality to the symbolic and imagined transference relationship. Yes, the media is the message (as Marshall McLuhan famously wrote), but with the arrival of online therapy the media is first and foremost the transference. The message now occurs with a strike-through, message.The online technology itself becomes a source and target of transference.
The one thing that immediately occurred to me: Psychotherapy invokes a virtual reality all of its own – even without cyber space. This is especially the case with dynamic psychotherapy that activates forms of transference in which one relates to the therapist “as if” in conversation with a past or future person or reality, the latter not physical present. Indeed, with the exception of being careful not to step in front of a bus while crossing the street on the way to therapy, we are usually over-confident that we know the reality of how our relationships work or what people mean by their communications. This is less the case with certain forms of narrowly focused behavioral therapies, which are nevertheless still more ambiguous than is commonly recognized. Never was it truer that meaning – and emotions such as fear – are generated in the mind of the beholder.
While virtual reality (VR) goggles as such are not a part of any online therapy group process, VR goggles are currently being used in individual psychotherapy with clients who are dealing with phobias and related individual issues. [See www.psious.com– an engaging start up which is promoting the VR goggles for psychotherapists. The author (Lou Agosta) reports: I have no financial relationship with this company, and I wrote a blog post in 2016: “A Rumor of Empathy at Psious”: https://tinyurl.com/jyuxedq]
For example, it is much easier for someone with a fear of flying to put on a set of VR goggles in the therapist’s office and take a virtual trip to the airport, board an airplane (in VR), and be taxing down the run away (in VR), than it is to do this in the real world. The next step in a group process is to create an avatar that resembles one’s individual physical self, warts and all, and to join the other avatars in an online virtual reality group session. New possibilities are opened up by this form of therapy for dealing with all kinds of emotional and mental issues that are beyond the scope of this article.
Here the point is just to look at how virtual reality (“virtuality”) already lives in the in-person psychotherapy session even as it might have been conducted in 1905. There is a strong sense in which the conversation between a client and a psychodynamic therapist already engages a virtual reality, even when the only “technology” being used is a conversation is English or other natural language.
For example, when Sigmund Freud’s celebrated client, Little Hans, developed a phobia of horses, Freud’s interpretation to Hans’ father was that this symbolized Hans’ fear of the father’s dangerous masculinity in the face of Hans’ unacknowledged competitive hostility towards his much loved father. The open expression of hostility was unacceptable for so many reasons – Hans was dependent on his father to take care of him; Hans loved his father (though he “hated” him, too, in a way as a competitive for his mother’s affection); and Hans was afraid of being punished by his father for being naughty.
So Hans’ hostility was displaced onto a symbolic object, the horse. Hans’ symptoms (themselves a kind of indirect, “virtual reality” expression of suffering) actually gave Hans power, since the whole family was then literally running around trying to help him and consulting “The Professor” (Freud) about what was going on. In short, the virtual reality – now remove the quotes – made present in the case is that the horse is not only the horse but is a virtual stand-in for the father and aspects of the latter’s powerful masculinity.
So add one virtual reality of an imagined symbolic relatedness onto another virtual reality of a simulated visual reality (VR) scenario, the latter contained in a headset and a smart phone. Long before VR technology, therapists of all kinds, including behaviorists, used VR by activating the client’s imagination by asking him or her to imagine the getting on the feared airplane. One may try to escape virtual reality by not going online, but the virtuality follows as long as human beings continue to be symbolizing, imagining creatures.
This blog post is an excerpt from: Lou Agosta’s article “Empathy in Cyberspace: The Genie is Out of the Bottle” in Theory and Practice of Online Therapy: Internet-delivered Interventions for Individuals, Groups, Families, and Organizations edited by Haim Weinberg and Arnon Rolnick. London and New York: Routledge: To order the complete book, click here: Theory and Practice of Online Therapy [https://tinyurl.com/yyyp84zc]
(c) Lou Agosta, PhD and the Chicago Empathy Project
The Theory and Practice of Online Therapy: Internet-delivered Interventions for Individuals, Groups, Families, and Organizations, eds., Haim Weinberg and Arnon Rolnick, published by Routledge:
Table of Contents
Acknowledgments
Introduction to the book Haim Weinberg and Arnon Rolnick
Section 1 General considerations for online therapy edited by Haim Weinberg and Arnon Rolnick
Chapter 1 Intoduction to the general consideration section: principles of internet-based treatment Arnon Rolnick
Chapter 2 Interview with Lewis Aron and Galit Atlas
Chapter 3 Empathy in Cyberspace: the genie is out of the bottle Lou Agosta
Chapter 4 Sensorimotor psychotherapy from a distance: engaging the body, creating presence, and building relationship in videoconferencing Pat Ogden and Bonnie Goldstein
Chapter 5 The clinic offers no advantage over the screen, for relationship is everything: video psychotherapy and its dynamic Gily Agar
Chapter 6 Cybersupervision in psychotherapy Michael Pennington, Rikki Patton and Heather Katafiasz
Chapter 7 Practical considerations for online individual therapy Haim Weinberg and Arnon Rolnick
Secion 2 Online couple and family therapy edited by Shoshana Hellman and Arnon Rolnick
Chapter 8 Introduction to the online couple and family therapy section Shoshana Hellman and Arnon Rolnick
Chapter 9 Interview with Julie and John Gottman
Chapter 10 Internet-delivered therapy in couple and family work Katherine M. Hertlein and Ryan M. Earl
Chapter 11 Digital dialectics: navigating technology’s paradoxes in online treatment Leora Trub and Danielle Magaldi
Chapter 12 Practical considerations for online couple and family therapy Arnon Rolnick and Shoshana Hellman
Section 3 Online group therapy edited by Haim Weinberg
Chapter 13 Introduction to the online group therapy section Haim Weinberg
Chapter 14 Interview with Molyn Leszcz
Chapter 15 Oline group therapy: in search of a new theory? Haim Weinberg
Chapter 16 Transformations through the technological mirror Raúl Vaimberg and Lara Vaimberg
Chapter 17 Practical considerations for online group therapy Haim Weinberg
Section 4 Online organizational consultancy edited by Rakefet Keret-Karavani and Arnon Rolnick
Chapter 18 Introduction to the online organizational consultancy section Rakefet Keret-Karavani and Arnon Rolnick
Chapter 19 Interview with Ichak Kalderon Adizes
Chapter 20 All together, now: videoconferencing in organizational work Ivan Jensen and Donna Dennis
Chapter 21 A relexive account: group consultation via video conference Nuala Dent
Chapter 22 Practical considerations for online organizational consultancy Rakefet Keret-Karavani and Arnon Rolnick
Epilogue Arnon Rolnick and Haim Weinberg
This blog and blog post (c) Lou Agosta, PhD and the Chicago Empathy Project
Conversion Disorder: The Human Body is the Best Picture of the Soul
Jamieson Webster writes like a combination of an Exocet missile and a feline feather tease. Webster has previously published on The Life and Death of Psychoanalysis (2012) and with Simon Critchley on Hamlet (Stay Illusion! The Hamlet Doctrine (2014)). Her latest contribution is Conversion Disorder: Listening to the Body in Psychoanalysis (Columbia University Press, 2019, 303 pp. ($33)).
Between Jacques Lacan, Giorgio Agamben, and Michel Foucault, Conversion Disorder is
Cover Art: Conversion Disorder
a challenging read, though the effort will be rewarding for many. The audience for this book is largely academics engaged by the some version of psychoanalysis, drawing mainly on Lacan and Freud. Much is to be admired in this courageous work, but since this is not a softball review, I have some criticisms, too. Webster has given us a brilliant work, though a deeply flawed one.
After such a significant effort, I am going to have some fun with this one.
Webster exemplifies a kind of postmodern writing that assumes one has read everything and therefore context is not required. Ideas streak through the text like ciphers from the Oracle of Delphi, whereas the statements are just ideas of university graduate level complexity being quoted out of context. Summaries are sometimes provided at the end of arguments, resulting in a benefit to those who decide to read the text backwards. Nothing wrong with that as such, but the approach does seem to be limited to intellectual haunts in Southern Manhattan, The New School For Social Research, the academic suburbs of London, and comparative literature seminars at the more prestigious universities.
With any book on psychoanalysis, the recommendation is to read the Appendix and endnotes first. They are the equivalent of a literary slip of the tongue, a symptomatic action, a parapraxis, revealing the subtext. Reading the book backwards works well in this case.
Webster recognizes that her relationship with her own body is troubled – the work is acknowledged as an attempt at self-help. It takes courage to make oneself vulnerable by this manner of self-disclosure: Diets, Pilates, yoga, purges, mega-purges, and more purges. Within the realm of the fundamental unity of mind and body, psyche and soma, this self-treatment triggers a full-blown appendicitis in the author. Literally. What happened? A powerful demonstration of the inseparability of, yet tension between, psyche and soma?
The final three words of the book (p. 272) assert that the conversion disorder in question is “my conversion disorder” – i.e., Webster’s. The microcosm is the macrocosm. “Conversion” is writ large. Very large. Many other conversions and conversion disorders are engaged along the way.
Webster asserts that her work has aspects of a memoire, and the reader does eventually get to meet the parents (who had their own struggles to survive) in the last ten pages of the book. However, I was disappointed in that I got no sense of the “good parts” of the memoire – what the author had to survive or how she ended up becoming a psychoanalyst, which is surely a courageous project, and not an undertaking for the faint of heart.
Webster repeatedly calls out psychoanalysis as an “impossible” profession, notwithstanding the paradox that she credibly claims to practice it. Here Webster walks the semi-sacred ground mapped out by Janet Malcolm in a book of the same name (Psychoanalysis: The Impossible Profession, Alfred Knopf, 1977/1981). Webster might usefully have invoked Janet Malcolm and whether her (Webster’s) contribution is a debunking in the same or a different sense than Malcolm’s. How about a footnote? This is the sort of thing I would have expected the editor (Wendy Lochner) to catch, but editing is not what it used to be.
Another editorial pet peeve: The words “abjection” and “abject” are used as if they are clear to the reader. Context? Julia Kristeva is not in the references, though she is the one who gave “abjection” currency and a certain popularity. It is not otherwise defined. A criteria: If you do not already know what it means or are prepared to live with this uncertainty of not knowing, then this text is not for you. Once again I would have hoped that the editor would have intervened with guidance: “Please define one’s terms.” Once again, editing is not what is used to be.
Meanwhile, on how psychosomatic physical symptoms – migraines, lower back pain, headaches, which are notoriously difficult to diagnose – get “hijacked” by the emotions and become the source of substantial psychic suffering, there are more recent treatments, including Webster’s, but there is quite simply no better one than Arthur Kleinman’s The Illness Narratives (1988). An engagement with Kleinman will decisively change one’s listening – as, of course, will reading Lacan or being hit in the head with a rolled up newspaper – but Kleinman will also deepen one’s empathy, humanity, and toleration of uncertainty, which the former will not do.
Webster engages with biopolitics (key term: biopolitics) and the institutional dynamics around psychoanalysis. On the professional issues confronting psychoanalysis – and there are many self-inflicted wounds here – Kate Schechter’s The Illusion of a Future (2010) deserves honorable mention and more – and Schechter provides a far superior treatment of psychoanalytic gossip than Webster – very juicy indeed and funny in a satirical sort of way – albeit in the context of the Chicago Institute for Psychoanalysis. While Webster talks a lot about “courage” and she demonstrates much, noticeably absent is any trace of speaking truth to institutional power that might ruffle any feathers in the local establishment. Courage indeed.
My complaint? There is something fake about “I don’t want to be a psychoanalyst” – if one does not, okay, then stop and do something else – practice CBT, DBT, ACT, primal scream therapy (joke!) or take up water colors. At no point does the two ton elephant in the living room get noted – the dirty little secret: most of the psychoanalytic “patients” are behavioral health professionals (graduate students in psychology or psychiatric residents) aspiring to be enrolled in the pyramid. Nothing wrong with that. These good folks need help too. And it is a shame that psychoanalysis has fallen on such hard times as it can get results that no other intervention seems able to produce. But what does one have to do to get a piece of the action – a piece of the objet (petit) a? If one has doubts about the viability of psychoanalysis, this text will do little to dispel them.
Therefore, get ready for – biopolitics!? Webster follows Giorgio Agamben, who, in turn, follows Foucault off the biopolitical cliff into the abyss of – what? The objet (petit) a– we are now speaking French – which, according to Lacan, is not to be translated, the unattainable object, the part object (penis, breast, foot) – perhaps the Kantian thing in itself. Another cipher = x, that which is being converted in somatoform disorder?
If one wants to bring biopolitics into the vicinity of hysteria, then ditch the Agamben. Take a look at Arthur Miller’s The Crucible, which is a re-telling of the Salem Witch Trials using a lens from the 1950 McCarthy Hearings on House Un-American Activities. Politics and hysteria are front and center. Once the authorities agree to admit spectral evidence – not unlike fake news or alternative facts – including the hysterical utterances of over wrought pubertal girls, then the audience of The Crucible knows things are not going to go well for the adults. If one is going to make a deal with the devil, be sure to read the fine print. The pact with the devil results in a commotion – a literal witch-hunt – and a slaughter of innocents. The emotional anguish and suffering is wide spread and the audience is vicariously traumatized.
Webster has considerable “skin in the game.” Webster is suffering, too, though admittedly not to the degree of John Proctor (protagonist of The Crucible). Webster is engaging with conversion because she has a contribution to make in disentangling the complexities of the phenomena. What really interests her is how the [counter]transference of hysterical symptoms occurs from patient to analyst (e.g., p. 74). Webster is Exhibit A – and proud of it.
Webster tells the reader as much: “Who would want to make themselves the vessel for so many others in this way? To have them repeat their pain and unlived life in your flesh?” [P. 54.] This is her “day job.” Once again, there is nothing wrong but there is something missing – empathy.
The lack of well-regulated empathy leads to compassion fatigue, burn out, and empathic distress. Apparently it also leads to an appendicitis. Her own appendicitis (see the Appendix) is not a hysterical pregnancy, but then again her patient is confronted with one of those – and see Freud’s comments on Negation. (When the patient says “now that is not my mother,” then strike though the not: not. Who do you think it is?)
The word “empathy” plays no explicit role in the text, though I suggest empathy’s breakdown is the underlying mechanism is many examples of conversion. I am not saying Webster has too much empathy. I am not saying Webster lacks empathy. I am saying: expanding empathy is hard work. Webster is no natural empath, as near as I can see from here, but a committed professional – and a celebrity academic. She is on the path of bearing witness and self-disclosure, but something is off the rails. Webster suffers from a breakdown of empathy specifically in the regulation of empathic receptivity.
Webster “picks up” the patient’s somatization – whether it is mirror neurons, neuropeptides, the adrenal pituitary axis or simple muscle mimicry (which is not so simple). The emotional receptivity breaks down into an individual form of emotional contagion so the therapist suffers too. The educated guess is that, being all-too-human, some unprocessed sex and aggression lurks near by, but mostly unprocessed narcissism, a term conspicuous by its absence.
People seeking dynamic psychotherapy (and its extreme form in psychoanalysis) are suffering. Sometimes after much work and effort and self-overcoming these same people become therapists. All well and good. The process is daunting and not to be made light of. However, Webster is so overwhelmingly taken with the significance of the process that no room remains available to enjoy a lighter moment. In addition to expanded capacity to love and work, Heinz Kohut (dismissed by Webster in the closing pages) pointed out how a successful psychoanalysis of the self may expect to transform frozen narcissism into expanded humor, empathy, and even wisdom. Here the narcissism is ultimately untransformed – and unconverted?
Webster quotes the Diagnostic and Statistical Manual of Mental Disorders, Version 5 (2013), the deeply flawed but consensus-forming, boundary defining “bible” of the behavioral health world. Webster “gets it” that something essential is missing. “Hysteria” in the narrow sense of a signification (representation/symbolization) of an underlying sexual or aggressive content was removed from the manual several editions ago. Yet hysteria in the narrow sense lives on in Webster’s practice, in her transference, and (here is the courageous part) especially in her counter-transference.
In the DSM itself, mental and emotional disorders are described at the level of behavior and constellations of symptoms. It is a check list manifesto (with apologies to Atul Gawande) that enables the therapist (or prescribing psychiatrist) to map symptoms to treatments without having to unmask, go “under the hood,” or seek for hidden causes = x. Ideal for those prescribing psychotropic medications.
While Webster is a strong advocate for a close reading of Freud, this is precisely the area in which she is significantly at risk. The hazard of Jacque Lacan’s guidance of “getting back to Freud” is that what Lacan really means is “replacing Freud with Lacan.”
In a separate interview, the Webster notes: “When I read him [Lacan], it changes the way I listen.” Of course it does. So does being beaten about the head with a rolled up newspaper (once the ears stop ringing).
My concern? I believe that it is possible for one to read too much Lacan or Foucault – like sniffing too much glue – it does make one high, but after a certain point the consequences are irreversible. [See Webster’s interview with Cassandra Seltman (01/05/2019 https://blog.lareviewofbooks.org/interviews/cost-alone-cassandra-seltman-interviews-jamieson-webster/ )].
For Webster, “conversion” is not restricted to the somatization of psychic or emotional conflict into physical systems that present in a human body. “Conversation” also refers to religious transformation as might have interested William James or Giorgio Agamben or any radical discontinuity in experience that profoundly shifts the experience of the subject in a lasting and sustainable way. So it’s all fair game and whatever comes up, comes up. Quite a lot comes up.
“Conversion” is writ large, as noted, but I suspect most readers will require more guidance than is provided by Webster. For example, a person is under extreme stress. The person develops irritable bowel syndrome, lower back pain, or migraine headaches. That is direct somatization – conversion of the stress into a physical symptom (pain) – depending on whether one has a weak head, intestine, or lower back – depending on whether one has a disposition or microscopic, subclinical injury that is exacerbated by the stress.
Next comes extreme stress resulting in hypochondriasis – now called “illness anxiety” – where the person is not in pain but is literally worried sick, for example, believing the sebaceous cyst in his neck is incurable cancer or the headache means an inoperable brain tumor.
The third form (which is the one Freud engaged with most insightfully) is exemplified as the conversion disorder takes on an unmistakable symbolic expression. The patient’s
Jean Martin Charcot (one of Freud’s mentors) working with a hysterical patient
hand is neurasthenic – loses feeling and the patient is unable to control it. The paralysis ends at the wrist, which confirms that the paralysis does not map to standard neural anatomy. The patient’s leg is paralyzed, but in such a way that his paralysis does not map to standard neural anatomy. The patient is asked to free associate and her reflections go in the direction of her shame and conflict over masturbation – with the hand in question.
In a different example, Freud’s patient Frau Emma von N is accused by her late husband’s relatives of poisoning him (an accusation that is fake and self-serving). Emma develops a persisting burning on her face – on her cheek – as if she had been slapped!? Insulted? Trigeminal neuropathy? Freud after all was a neurologist. (Note this is Freud’s example, not Webster’s.) She talks about it with Freud, and it gets better.
For Freud when libido (desire) is directly transformed into bodily symptoms, the result is an “actual neurosis” (better translated as a “contemporary neurosis,” but, in any case, a technical term) – the body directly translates the psychic suffering as physical symptoms – paralysis, cramps, in extreme cases symptoms like epilepsy – except there is no anatomic lesion.
In some cases, these symptoms are painful; in other cases they are just disruptive of daily life – as when the patient loses consciousness. However, for Freud, when libido (desire) is unable to be directly expressed in bodily symptoms due to repression, then the desire (libido) gets expressed in bodily symptoms that enact sexual representations. Desire finds a way to become articulate, symbolizing forth what it has to express by means of bodily signifiers (i.e., symptoms).
For instance, the patient is conflicted over marrying her brother-in-law (once again Freud’s example, not Webster’s), the husband of her late sister (who has just died). The patient is free to remarry and (a crucial condition) such a thought is abhorrent to the patient. It has no where else to go to be expressed than to be translated into a bodily symbol.
Although I believe Webster gives examples of this third kind, to the best of my knowledge (and I have read every word), no where does she make the point that the symbolism expresses sexual or aggressive or a conflict-inspiring violations of conventional community standards – which is precisely what has fallen out of the latest editions of the DSM.
By the way, Ludwig Wittgenstein, who was a tortured soul for reasons completely unrelated to conversion disorder, wrote: “The human body is the best picture of the human soul” (Philosophical Investigations, 1950, tr E. Anscombe, p. 178e).
Perhaps it is so obvious to Webster that it does not require mentioning; yet unless one is steeped in these matters, this loss in the DSM is of the essence. In short, if one is looking for a book on conversion disorders that does for them what the late Oliver Sacks did for migraines, Tourette’s syndrome, music, or diverse anomalous neurological disorders (a high bar indeed!) that work has yet to be written.
References
American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders. DSM-5, Fifth Edition. Arlington, VA: American Psychiatric Association.
© Lou Agosta, PhD and the Chicago Empathy Project
Lou Agosta, Ph.D., Listening With Empathy 