Getting there . . .

• Distress vs. anxiety by Don Nathanson, 7/12/96
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    • Affect-Based Diagnosis by Margaret Blakely, 7/15/96
      
      

Geography first---Cape Cod is in Massachusetts! And I got the flu while I was lecturing there, so it wasn't much of a vacation even though the quality of the therapists taking the course more than made up for my discomfort. That Cape Cod Institute is really a wonderful way of learning while vacationing.

If you study the graph Tomkins used to show the way each of the 6 primary innate affects relates to the others, it becomes clear that impediment to the steady-state affects of d-a and a-r reduces stimulus density and therefore produces e-j. I don't think you can reduce the square wave that makes us startle because of the nature of the stimulus---either it is sudden on and sudden off, or it is another stimulus profile and another affect. If you interrupt a too-rapid acquisition of information that is already triggering f-t, it produces a moment of e-j. In Shame and Pride I used the example of a horror or mystery movie in which the little girl is clambering through a house we know is dangerous, and opens a door behind which lurks not a baddie but a bunny rabbit. The audience laughs, not because the rabbit is funny but because of the sudden drop in stimulus density; in just a moment we will be frightened again as we and she return to the business at hand.

The only two primary affects that when reduced cause anything other than e-j are e-j itself and i-e. I've referred to the difference between shame (which Tomkins calls an affect auxiliary rather than a primary affect because it modifies or modulates other affects rather than acting as a response to pure alterations of stimulus density) and the 6 primary affects as the difference between rate and acceleration, or the difference between an equation and the first derivative of that equation.

Additionally, think about the affect dynamics SST described in chapter 9 of AIC-1. The incomplete resolution of shame produces excitement, while the complete resolution of chronic and enduring shame produces e-j. This fits the graph perfectly.

Nevertheless, shame can inhibit the display of any affect because we can learn that we will be ridiculed by others if we show that affect. That is not the innate affect itself, but a learned affect-affect bind; these are secondary effects of the affect. It doesn't seem possible for the infant to show guilt because there is no way an organism with no experience of rules or no way to understand the nature of rules can fear reprisal for violation of rules. Tomkins defines guilt as "immorality shame," the kind of shame we feel for violation of a norm, and I describe guilt as the fusion of shame (for exposure) and fear (of retribution), the fusion occuring early in development and going with us through life as an entity itself. But not as an innate affect.

In Vick Kelly's formulations for intimacy, shame is viewed as a major interference with intimacy because it turns the faces of the participants away from each other and prevents interaffectivity. Vick points out that intimacy requires the free expression of affect within a private interpersonal relationship, the deal being that the two people try to mutualize and maximize positive affect, and mutualize and minimize negative affect. We try to hear and feel each other's feelings, to make the bad things hurt less and make the good times last longer and more intensely. Shame comes to interfere with all those processes, and thus becomes a major focus of work early in therapy as couples learn to accomplish these three goals.

But try to answer your question another way. Take DSM-IV, flip to any page, and look at a diagnostic category. Try to imagine the patient in conversation with you (or try this with a real patient, which is a lot more interesting), and check to see which affects might be found in which patients. For example, I find that the steady pounding of thoughts in an obsessional patient acts as a competent trigger for distress-anguish, and that it is this affect which brings people into treatment rather than the "thoughts" themselves. I realize that often the thoughts in OCD may reference embarrassing or disgusting or dissmelling ideas, so then shame would be a factor in their presentation for therapy. Merely to look at the compass of shame, as you suggested, would show a great deal about a lot of diagnoses. I'm sure you read my article in Psychiatric Clinics of North America in which I demonstrated that every symptom seen in "borderline" illness can be placed on the compass of shame. The SSTI tapes for the 1993 conference cover a lot of that material.

Now back to you.

• Geography by Margaret Blakely, 7/16/96