Authenticity & Self-Knowledge in Somatization: Reformulated Object-Relations Theory

1. Authenticity & Self-Knowledge (ASK) in Somatization: A Reformulated Object-Relations Theory (RORT) Approach. Golan Shahar, Ph.D. Ben-Gurion University of the Negev, Israel Yale University, USA Lane Psychosomatics Conference November 1st , 2018

2. Lets Face It… • Missisippi(Missi), 27yo, a “stuck” undergraduate. • Presenting problems: Bipolar II (DD: Cyclothymic), Trichtolomania; Cluster B PD features (DD: Complex Trauma), Substance Abuse Disorder, risky sexual behavior, ADHD. • Medical context: Somatization: Severe non-specific facial pain. • Hx: -- Childhood tremendously traumatic: Physically, emotionally, financially. --- Mother died by cancer at 12yo. --- High intelligence but severe fluctuation in performance across development. --- An extremely high SAT but dropping out academically. --- Desperately in pursuit of a bf had has few female friends. Themes surfacing in Tx: --- Onset of facial pain after mother of best friend died by cancer. --- Intensifies when she studies for exams.

3. Talk Outline • Emotions and authenticity. • Emotions as a mean for self-knowledge. • The communicative functions of emotion. • Emotions in Object Relations Theory (ORT). • From ORT to RORT. • Theoretical and clinicalimplications.

4. Emotions and authenticity No such thing as an “inauthentic” emotion. Carl Rogers (1959): Organismic Experience is biologically-based, but is expressed via emotions. D. W. Winnicott (1965): The “true self” is based on “going-on-being”, a free expression of emotions. An existential-Humanistic-Psychodynamic Perspective: Allport (1965), Bollas (1987), Horney (1950), Jung (1971), Kohut(19781), Laing (1969), Maslow (1968) => Emotional awareness is a precognition for identifying our true being (Lane et al., 2015).

5. Emotions and self-knowledge EarlieHochschild’s (1983) emotional labor. Emotions serve as signals in the formation of self-definition (Frijda, 2001, 2007, 2013). The scarring hypothesis (Lewinsohn et al., 1981): Emotional disorders feed-back to the self.

6. Scarring findings

7. Contd.

8. Contd. The Self-Critical Cascade Self-Criticism Negative Environment Distress

9. Defending the Self However, The self is vigorously defended: Defense mechanisms. Fundamental attribution error. Self-serving bias and self-enhancement. Sullivan’s (1953) “Not me”. The self is the last to know – Itself.

10. Rogers’ Organismic Valuing and the Self S O S O S O

11. Self Acceptance and Change

12. Authenticity and Self-Knowledge (ASK) An unending existential quest. Is inherently, mathematically, complicated. But – Is attainable. Symptoms are propellers of A in the absence of SK. Symptoms should be both alleviated (support, active techniques, medications) -- -- and listened to (exploratory work) -> Psychotherapy integration.

13. From Rogers to Winnicott Rogers assumes: Congruence is predicated upon parental positive self-regard. Let the child feel! However – Emotions are complicated, intense, and -- are often conflicting. We need others to mirror What we feel, Who we are.

14. Enters the (M)OTHER Deciphering mirroring rests on making sense of the object. Melanie Klein’s Positions(Klein, 1928, 1935, 1940, 1945):

15. Emotions as Communication Emotions are the cornerstone of interpersonal communication and influence. --- Projective identification. --- Facial emotional expressions. --- Emotional contagion. --- --- Coyne’s (1976) seminal study. Emotions: At the cross-road of self-with-other.

16. From ORT to RORT Accepting Klein’s notion of Positions. Highlighting the reciprocal nature of emotions and representations. Broadening the scope of emotions (beyond anxiety). Introducing the future. “If he is interested in psychiatry, he is almost certain to come to consider the role of foresight in determining the adequacy and appropriateness of the energy transformations, his overt and covert activity, with respect to the actual demands of the situations in which he finds himself involved with significant others” (Sullivan, 1955, p. 369).

17. From ORT to RORT --- Goal concepts in psychology (Austin & Vancouver, 1996): Personal Strivings, Life Tasks, Personal Projects. --- Abstract projectuality and human cognition (Amati & Shallice, 2007). --- Seligman, Railton, Baumeister, & Sripada (2013). Navigating into the future or driven by the past. “I am saying that, circumstances not interfering, man the person lives with his past, the present, and the neighboring future all clearly relevant in explaining his thought and action; and the near future is influential to a degree nowhere else remotely approached among species of living”. (Sullivan, 1955, p. 369; italics in the original).

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19. From ORT to RORT

20. The Reformulated Depressive Position.

21. Lets Face It… • Missisippi(Missi),27yo. • Increasingly expresses rage, protest, and envy – • -- in and out of treatment. • The pattern: Anxiety -> Rage  Protest  Envy. • Best worked through via -- • -- the processing of object representations. • Increasingly tied to the facial pain. • “When my face hurt, I know I am angry” • (Mad, protesting). • “It was painful to see that Lilly has a family”.

22. The Psychosomatic Position

23. Theoretical and Clinical Considerations • Suspected affect propelling SILA: Envy, hatred, shame, horror. • SILA: State, not (necessarily) trait. • Affective agnosia (Lane et al., 2015)->SILA. • Affective agnosia: Hipocognition for affect? • Alexithymia is pervasive SILA. • Symbolization? • Long-term work needed? (but see Abbass’ work). • Centrality of the transference.

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