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Maternal de-adaption and Alexithymia

According to Jan Abrams (1996), “In the successful version of the mother-child relationship, ‘the mother begins to emerge from her state of primary maternal preoccupation [towards her infant] and remembers who she is in terms of being an independent individual in the world. She is recovering, both physically and emotionally, from the last important stages of pregnancy, giving birth, and being merged in identification with her infant’s absolute dependence on her. The infant requires his mother to de-adapt, which is part and parcel of her remembering herself.

This “failure” on the mother’s part introduces the “reality principle” to the child and is part of the disillusioning process, related to weaning. By “failing” in this way, the mother, unknowingly, allows the infant to feel and experience his needs. This “failure” contributes to his developing sense of self — a self that is Me and separate from his mother. ” [italics mine] (a) If, however, the mother cannot gradually “fail” in the way Abrams describes (allowing the infant’s affective life to become self-regulated) then the infant’s drive to self realization of these potentials is impeded.

Donald Winnicott (1960) words the child’s dilemma in the following way: the infant who has begun to become separate from the mother has no means of gaining control of all the good things that are going on. The creative gesture, the cry, the protest, all the little signs that are supposed to produce what the mother does, all these things are missing, because the mother has already met the need just as if the infant were still merged with her and she with the infant. In this way the mother, by being a seemingly good mother, does something worse that castrate the infant.

The latter is left with two alternatives: either being in a permanent state of regression and of being merged with the mother. We see therefore that in infancy and in the management of infants there is a very subtle distinction between the mother’s understanding of her infant’s need based on empathy, and her change over to an understanding based on something in the infant or small child that indicates need. (a) Transitional objects: ‘Part of the de-adaption process involves facilitating the child’s use of transitional objects to symbolize inner object relations and their affective dynamics.

In the case of the mother who is reluctant to de-adapt from her maternal providence; ‘It has been observed also that some mothers interfere with their child’s creation of a transitional object, either by prohibiting every attempt on the infant’s part to use precursor objects, or by offering themselves to the infant as the only source of satisfaction (Gaddini 1978). Such intrusions inhibit the emergence of imaginal activities in the infant, including the ability to create fantasies and play, and thus block the development of important affect regulating capacities.

The associated restricted imaginal capacities also limit the extent to which alexithymic individuals can modulate anxiety and other emotions by fantasy, dreams, interest, and play (Mayes & Cohen, 1992). ‘ (b) ‘Most studies do not take account of [other] transitional phenomena, such as babblings, humming tunes, and creating imaginary companions, which many infants and children use to induce pleasurable affects or to modulate distressing states.

From its roots in the sensation-objects and transitional objects of the infant, and aided by the neocortical structures and functions (Schore, 1994), the child’s imaginal capacity evolves into forming a mental image of the mother in her absence, and eventually to creating fantasies, dreams, interests, and play that go beyond images derived from external objects. These capacities play an important role in personality development and in the self-regulation of affects throughout life.

As Mayes and Cohen (1992) indicate: Imagination encompasses a number of interrelated functions and concept, including the capacity to create a fantasy, the ability to use such a fantasy in the service of affect regulation and/or defense, the synthesis of memories and percepts into the mental image of a person or thing which is not present, and the inner world of mental representations, as opposed to the external world of sensory perceptions.

The role of fantasy in affect regulation, especially the induction of positive affective experiences, is very evident in children’s play, an activity which usually first occurs in interactions with parents. Singer (1979) regards play in early childhood as an adaptive resource by which children can organize complex experiences into manageable forms, and thereby avoid extreme negative affects and maximize the occurance of the positive affects of interest and joy.

Izard and Kobak (1991) similarly view play as one of the most important developmental processes through which children learn to integrate affect, cognition, and action, ‘It is through play that children have repeated opportunities to rehearse verbal and motoric responses to their emotion-feeling states. In their various types of play, children make connections among their feelings, thoughts, and activities’.

Children who have difficulty engaging in imaginative play show degrees of failure in integrating cognitions with emotions, as well as a disturbance in the symbolic function of fantasy and an inability to identify with the feelings of others (galenson, 1984; Tustin, 1998). Another important way in which imaginal activity regulates affects, as well as instinctual wishes, is through the creation of symbolic wish-fulfilling dreams.. ‘ (b) Inhibitive superego structures:

Implicated in the care style of the mother who does not de-adapt from primary maternal intervention is the possibility of introducing early superego inhibition towards imaginal and affective expression. This process in turn creates stagnation in affective and imaginal development, and the deficits associated with alexithymia. ‘Support for the presence and role of inhibitory structures, (rather than simplistic congenital deficit theories), comes from John H. Krystal, who writes: ‘Whether there is a true deficiency, however, is questionable.

For, although the patients do not produce these fantasies spontaneously, they can “share” or “borrow” them or form them when presented with them in things that they read or see. The earlier mentioned alexithymic patient who tried in vain to imagine what she would like to do for fun on a vacation was certainly able to understand what other people would do and imagine doing and enjoying. ‘ (b) Role of imagination in affect regulation

Several theorists have pointed to the imaginal and affective inhibitions and/or deficits in alexithymia as co-present, and have cited the special role played by imagination in processing affect. ‘Fain and David (1963) studied impairment in dreaming and unconscious fantasy formation in alexithymic patients. They showed that there was particularly a failure to create fantasies to deal with infantile and present day conflicts. Since fantasies are not elaborated, the observations generated in psychoanalysis regarding the patient’s character are mostly of a negative kind: the missing element.

Stephanos (1975), explained… that by virtue of the absence of fantasies, there is an inability to develop attachments and there is a “psychic emptiness,” which he likened to Balint’s (1968) “basic fault” and Winnicott’s “environmental failure. ” McDougall focused on the difference between alexithymic patients and neurotics: Alexithymics “often show little spontaneous fantasy, whether attached to their somatic affliction or other aspect of their lives, it is an important note for the attuned ear of the analyst.

One may become aware as it were of listening to a song in which the words are present but the melody is missing. ” As she saw it, these patients manage to totally destroy the mental representations of their own parts and parts of their object representations. The outcome is a robotlike existence, with what appears to be a superadaption to reality after the world of imagination and feelings has been eliminated. The supernormal robot is the future of the psychosomatic patient.

Lacking knowledge of their own emotional experiences, alexithymic individuals cannot readily imagine themselves in another person’s situation and are consequently unempathic and ineffective in modulating the emotional states of others (Goleman, 1995, Krystal, 1979, Lane & Schwartz, 1987). As Newton & Contrada (1994) point out, however, alexithymic individuals are distinguished from high-anxious individuals by their diminished fantasy life and externally orientated cognitive style.

As Grotstein (1986) has elaborated, there are deficits not only in the capacity to regulate affects by way of mature ego defenses, but also in the capacity to mythicize primitive affects and drives into dreams or fantasies. ‘ (b) Vicarious regulation of affect: Alexithymics characteristically defer affect processing to other people, prefering to live out feeling states vicariously, by borrowing from, or actively evoking feelings in surrogates -friends, partners, parents, therapists- which can then be re-stated and utilized as one’s own feelings.

Higher functioning alexithymics may be able to form and express some coherent feelings, feelings which are not infrequently accompanied by a notable body tension and anxiety. Just recently an alexithymic woman recounted to me her experience at a P&C school meeting, where she had posed a public opinion regarding how the school might provide education for the children, but in this act felt that she had usurped the role of the woman facilitating the meeting (usurping the role of Mother? ), after which event she came home “feeling horrible and lay down on the bed all seized up, and not knowing why”.

This distraught reaction is common from this woman after verbalizing certain feelings which are not vicariously expressed i. e. , she would have prefered to ‘quote’ the appropriate feelings from another person, rather than offer her own. This woman does not often allow herself to have a feeling about a matter, and will usually quote the feelings that another person expresses which incorperate her own ‘unspeakable’ feelings. We might hypothesize that the internal superego prohibitions move the alexithymic to exploit other people’s words, which provide the forbidden expression for them.

In an article by Donald Winnicott he notes several degrees of false-self organization, of which the following matches the vicarious expression found in alexithymia: (d) ‘The False Self defends the True Self; the True Self is, however, acknowledged as a potential and is allowed a secret life. When the degree of the split in the infant’s person is not too great there may be some almost personal living through imitation, and it may even be possible for the child to act a special role, that of the True Self as it would be if it had had existence.

In its function of vicarious identification, perhaps the earliest description of an alexithymic condition comes from Carl Jung’s coarse description of the daughter who lives through her mother: “Identity with the mother — If a mother-complex in a woman does not produce an overdeveloped Eros, it leads to identification with the mother and to paralysis of the daughter’s feminine initiative. A complete projection of her personality on to the mother takes place…

Everything which reminds her of motherhood, responsibility, personal relationships, and erotic demands arouses feelings of inferiority and compels her to run away -to mother, naturally, who lives to perfection everything that seems unattainable to her daughter. As a sort of superwoman (admired involuntarily by the daughter), the mother lives out for her beforehand all that the girl might have lived for herself. ” (e) Image focussed Therapy Image focussed therapy is particularly intended for those in whom the capacity to imagine is stifled, undeveloped, or repressed.

This method is particularly helpful in altering states of depression and depersonalization (f), and as an essential aid in making cognitive clarification of affective states: “Image-based psychology reverses the relation of feeling and image: feelings are considered to be, as William Blake said, “divine influxes,” accompanying, qualifying, and energizing images. They are not merely personal but belong to imaginal reality, the reality of the image, and help make the image felt as a specific value.

Feelings elaborate the complexity of the image, and feelings are as complex as the image that contains them. Not images represent feelings, but feelings are inherent to images. Berry (1974) writes: “A dream image is or has the quality of emotion, and emotions adhere or inhere to the image and may not be explicit at all…. We cannot entertain any image in dreams, or poetry or painting, without experiencing an emotional quality presented by the image itself. ” This further implies that any event experienced as an image is at once animated, emotionalized, and placed in the realm of value.

The task of therapy is to return personal feelings (anxiety, desire, confusion, boredom, misery) to the specific images which hold them. Therapy [of the imaginal] attempts to individualize the face of each emotion: the body of desire, the face of fear, the situation of dispair. Feelings are imagined into their details. This move is similar to that of the imagist theory of poetry (Hulme 1924), where any emotion not differentiated by a specific image is inchoate, common, and dumb, remaining both sentimentally personal and yet collectively unindividualized.

Hillman also describes troubling affective symptoms as resulting from restrictions in imagination: “Restrictions of imagination appear as excessive emotion. For when an emotion is not held aesthetically within its images –when the images have been reduced in quality… — then emotion runs rampant and we have to damp it down with drugs or exorcise it through therapies of release and expression. Instead, I am suggesting that restoration of the imagination is the fundamental cure of disordered emotion” (h)

According to Segal (1981) and Taylor (1987), ‘Individuals with an inadequate ability to symbolize are unable to transform affective experiences into creative stories; consequently, their dreams are either banal or highly disturbing, the latter type appearing to attempt to regulate intense emotions through ‘evacuation’. (b) Animation of feelings Hillman writes, ‘Ours could be called an image-focused therapy. Thus the dream as an image or bundle of images is paradigmatic, as if we were placing the entire psychotherapuetic procedure within the context of a dream.

It is not, however, that dreams as such become the focus of therapy but that all events [ie. , including experiences of emotional states] are regarded from the dream-viewpoint, as if they were images, metaphorical expressions. ‘ “Stick to the image” has become a golden rule of archetypal psychology’s method, and this because the image is the primary psychological datum”. (g) In this procedure it is assumed that when spontaneous images are evoked in connection with emotional arousal, then a cognitive-verbal description can be more easily formed.

This of course can only come about after an initial vicarious transference has been formed, and the therapist can slowly begin to offer measured “permission”, and space, for self expresion. As Henry Krystal writes, “Eventually, the benign mental representations become so secure that the direct use of a security blanket can be given up. Dreams, fantasy, and play can be used to activate the image of mother so that self-caring can be carried out. But with this creative solution, the illusion is built up that the mother continues (for the life of the child) to control all vital and affective homeostatic functions.

The mothering parent or maternal-transference objects (God, doctors) have to be mobilized -in person or symbolically- to dispense the enabling in order. ” (i) Facilitation of a steady reduction in the vicarious transference I would like to finish with three more quotes, one from an alexithymia sufferer, and the other two from Donald Winnicott, both of which show the need for a gradually reduced vicarious transference, in favour of an increasing ability of the patient to articulate their own affective feelings without help: Something I warn people about who are trying to help alexs [ie. people with alexithymia] is not to come in too close.

This happened to me with my ex husband. He would always be trying to work out what was wrong with me, and find solutions because he could see that I had no idea what I was like. Although he meant well, I always felt disempowered by this taking place, but I would never say so. It would infuriate my ex partner that I never tried to put any of his ideas into practise, and in the end he was so devasted that he had to give up. Maybe alexs need their partners to show them just how much of a deficeit they have and then stand back a bit and let the person take on their own problems.

An alex needs to solve their own problems. My ex now gives me this kind of feedback, but in a detached way (this allows me to own the information) so that I feel in control of my emotions and my decisions. I worry that I am feeling what the other person has put into me, so if I’m given information that has no emotional content in it, it makes it easier for me to work out what I really do feel, and so what needs to be done. ” [by ‘Anne’] What I have to say in this present chapter is extremely simple.

Although it comes out of my psychoanalytical experience I would not say that it could have come out of my psychoanalytical experience of two decades ago, because I would not then have had the technique to make possible the transference movements that I wish to describe. For instance, it is only in recent years that I have become able to wait and wait for the natural evolution of the transference arising out of the patient’s growing trust in the psychoanalytic technique and setting, and to avoid breaking up this natural process by making interpretations.

It will be noticed that I am talking about the making of interpretations and not about interpretations as such. It appals me to think how much deep change I have prevented or delayed in patients in a certain classification category by my personal need to interpret. If only we can wait, the patient arrives at understanding creatively and with immense joy, and I now enjoy this joy more than I used to enjoy the sense of having been clever. I think I interpret mainly to let the patient know the limits of my understanding.

The principle is that it is the patient and only the patient who has the answers. We may or may not enable him or her to encompass what is known or become aware of it with acceptance. ” (j) At the end of merging, when the child has become separate from the environment, an important feature is that the infant has to give a signal. We find this subtlety appearing clearly in the transference in our analytic work. It is very important when the patient is regressed to earliest infancy and to a state of merging, that the analyst shall not know the answers except in so far as the patient gives the clues.

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