Checking in. More on affect being multideterminate.

Hello. I have been unable to check the forum for a number of weeks due to chaos and other time commitments. Have read a good bit of what's been posted this spring and found it enlightening. Great to see interest in affect theory from so many thoughtful folk in widely varied locations.

I am finding that a number of patients in my adult general psychiatry practice resonate strongly with Tomkins and Nathanson's work. For example, a couple of years ago, the face of a person I was seeing for chronic pain/substance abuse/depression just lit up when I started talking about shame.

More recently, I have been talking with people about the fact that affect is multideterminate. Vick Kelly's marvelous vignette about his different response to his wife's shoes on different days (4/30/97) is similar to one I have been relating to patients recently. We will react to the same stimulus differently if any number of factors change. One might be in a very different mood in response to anything if construction noise has been going on outside the office all day. Or if one is premenstrual and has a baseline level of distress. Or if one is coming down with the flu, if one has just gotten a raise, or just had a beer, or if one is withdrawing from cocaine and feels already irritable and paranoid. Or if, based on a script, one expects that this interaction will have a particular negative outcome. Obviously, psychotropic medications help people to have a more normal affect range and more plasticity of affective response. Someone was telling me yesterday that her husband was extremely irritable and critical for years and is back to his normal self with medication for his chronic depression. Needless to say, the affective climate of the relationship is markedly more positive.

My husband and I have found that if we take a long walk together before dinner, when we are hungry and tired, we are irritable and it is a rather punishing experience. If we eat first and go later, we are playful and pleasant and we usually have a higher level of interest-excitement and enjoyment-joy. I remind people to plan for success. If possible, don't try to discuss difficult things when you are ill, exhausted, intoxicated, hungry, or otherwise already in any negative affect.

• Nesting by Don Nathanson, 7/14/97