Tag Archives: John Bowlby

Life weans the giraffe

 

Not so randomly placed in mine and Joe Farley’s book, Getting Real About Sex Addiction, are the ontological issues surrounding the term sex addiction. It’s in the title, even, this suggestion that what we’ll be doing is examining the term sex addiction more than any other mental health abstraction and therefore addressing the problem of problem sexual behaviors: is this a thing, a variously skeptical public asks? The members of Sex Addiction Anonymous (SAA) have of course made their decision on this question. Committees of The American Psychiatric Association and The World Health Organization have not quite made theirs, rejecting the proposed diagnosis Hypersexual Disorder in the case of the former body, and recently (and provisionally) accepting the diagnosis Excessive Sexual Drive in the case of the latter organization. To be clear (or not), neither of these terms are synonymous with the construct of sex addiction, but we’re in the same ball park here. The issue is complex. It is medical, psychological and meta-psychological, as in ontological: is a human being’s sexuality a function of biological drive and are problem behaviors therefore a matter of excess desire? And even if that natural conclusion is drawn, where is the role of nurture in the matter of etiology? Are we talking about an interpersonal versus an intrapsychic event, as in a phenomenon derived from early childhood development—a weaning that went awry versus a web of innate fantasy (or phantasy as Object Relations terms it) within an infantile mind? Or is the broader social and cultural environment the more prominent accomplice in a dysfunctional sexual development?

We’d prefer to think so, at least. And so we hear weary chestnuts that even the most progressive-minded observers must be tired of hearing by now: theories of pubescent or post-pubescent development wherein boys are subject to mores that encourage their essentialist aggression, their concomitant sexual freedom, with consequent pressure to conform and therefore perform when being so deterministically sexualized. Meanwhile, girls are discouraged by societies across cultures from expressing freely their sexuality; they are raised to be demur, ashamed of their sexuality, and therefore passive or possibly manipulative in their sexual expression. And even if this is changing somewhat in a millennial age (really, have you noticed?), then it is surely a reaction to those previous oppressive norms, yielding a confusing transition phase wherein girls, boys, or those along the gender fluid continuum (suggesting a flight from binaries) switch roles at times, thus conforming to a newly burgeoning if less-defined ethos. And so we observe a faction of diffident men and boys who speak of respecting the feminine as if they are resisting in their stance a combined biological and social force upon their being. And we observe women and girls who seem increasingly aggressive and entitled in their sexual freedom while proclaiming the lack of freedom that is afforded them by an arbitrary social reality. In analytic terms, this is the realm of the unconscious but not the repressed, these habits and mores that we download from the culture. By unrepressed I mean something that is not kept away. Isms and other mores may be unconscious, but as we routinely observe, they are hardly kept away. They leak and make a mess, pervading our experience.

The premises of these positions must be difficult for the average mental health professional to sustain given the contradictions of theory and life itself. Firstly, within our profession’s demographic map, that average person is likely female, white and therefore privileged in terms of race, at least. She has been raised and subsequently educated within an atmosphere that encourages or affords (not privileged—we only use that word in this context if we’re feeling critical) a social justice lens, which means supporting narratives that advocate for the underprivileged. In Getting Real, I argue that within the niche field of sex addiction treatment (and perhaps psychotherapy as a whole), this demographic phenomenon of recent generations results in a skew that targets a privileged (non-ironic diction) client population–heterosexual men—for devaluation. The aggregate of thought suggesting how males and females are socialized towards sexual behaviors and identities emphasizes the post-pubescent experience, which for some might imply agreement with an embattled psychoanalytic idea: that pre-pubescent and certainly pre-verbal sexuality is repressed, as in kept away, and for the most part is not leaked and is therefore a lesser factor in pre-teen childhood development. There is no scientific evidence of an Oedipus Complex, say critics of psychoanalysis. There is evidence of pre-verbal attachment styles, the capacity to communicate and comprehend on a pre-verbal level, thus children’s psychological development is profoundly impacted from birth onwards by events, both benign and traumatic, that occur perpetually.

The onset of sexuality is a function of hormonal development, says a medical argument—not some manner of release from childhood repression. Puberty is the psyche’s sexual alarm clock, indicating that it’s time for play of another kind; an incipiently adult kind. Feelings like joy, excitement, wonder, fear, shame, and guilt may all be observed in small children, some pre-verbal, some not. Emotional expression, proximity-seeking, may be developed or not, contingent upon the presence and consistency of a capable adult. The nature of a child’s attachment to a parent (or primary caregiver) will be internalized as a working model of attachment that will further shape development and relationships, possibly over a lifetime. That was John Bowlby speaking and writing over fifty years ago, saying something similar to what D.W. Winnicott was teaching, only with more attention to physical need than the fostering of a distinctive, creative mind. If you the reader are silently nodding in agreement, then you’re joining at least two generations of mental health providers who generally agree with these principles while implicitly thinking that sex is not part of the early attachment equation. You’ve likely been taught to believe that proximity or object seeking, plus patterns within those relational drives, are shaped interpersonally and by broader environmental norms; that we have implicit (neurobiologyspeak for the unconscious) memory of early attachment patterns, whether they were traumatic or not; that we have implicit bias (social justicespeak for the unconscious but not repressed) in relationships, yielding prejudice directed at distinct social groups. Yes, joy, creativity, and some of that bad feeling stuff is indeed fostered in a child’s development, but not sex. Not arousal, or longing. That potential is activated later…when it’s appropriate, of course.

So, why are there excesses? Why this untidy disorder, this chaos of spillage, as if life were some kind of cosmic dumping. There, says…something: here are your tools in a pile and a flood. Do with them what you will. Is addiction, for example, a blend of natural hormonal excess negatively complemented by an insecure attachment style, of weak or failing repression barriers? And if this shaping does occur both intrapsychically and interpersonally, shall we break with our profession’s current theoretical orthodoxy and resolve that sexual nurturing largely coincides with biological schedules and is dominantly imparted with the help of the cultural village? A village that also fails, perhaps. Because if this isn’t the roughly hewn plan then we must revisit what our developmental theories otherwise imply: go back to society with ideas it doesn’t want to hear and consider taboos, as in pre-teen or even pre-verbal sexual exposure, as the original source of sexual development. We’d have to imagine that arousal and longing are part of the same dyads or village-child-passing-around norms that bring food, enable good sleep, play and a spark of imagination. We’d have to imagine that breast-feeding, or the bathing of infants’ genitalia, or the physical control of their evacuations are truly antecedents of sexual desire, or that excesses in this private realm nurture later distortions of sex as much as any unconscious yet unrepressed social message conveyed via so-called modeling to a conscious mind.

Though it would likely elicit thought-blocking accusations of misogyny or homophobia, we’d need to re-think child-rearing in a way that might stir panic; contemplate sexual orientation in a way that would challenge etiological assumptions. If the excesses of sex addiction are rooted in early childhood development, trauma specialists sometimes suggest (but don’t prove) that childhood sexual abuse is an accomplice to later sexual acting out. In this way, modern psychology comes full circle, revisiting Freud’s original Seduction theory, only with a significant permutation. Instead of conversion symptoms like the paralysis of limbs, patients present with compulsive behaviors, what Freud described as repeating versus remembering, or the shorthand, repetition compulsion. Sandor Ferenczi later gave us the term and concept “Identify with the aggressor”, attempting to rescue Seduction theory from its then-exile, to denote a relational identification between victim and abuser—to indicate a kind of psychic hostage-taking. If the vast majority of sexual abuse perpetrators are male, as a mother-idolizing culture would have us presume, then why doesn’t a corresponding majority of male molestation victims report or manifest ego-dystonic feelings of same-sex attraction? Or perhaps they do and are therefore, in keeping with analytic thought, manifesting the defense of reaction formation via a false heterosexual identification. Does it seem complicated, this human development? Maybe that’s why it seems to be taking longer and longer for children and young adults to grow, with the meta-tasks of an internal, interpersonal, and collectivist set of systems to navigate. I understand that some animals in the wild are able to walk within a day or an hour of their births. They grow up quickly in less complicated systems, with simple brains that are mindlessly free of sexual neurosis. Are the plainer brutalities of nature—the ubiquity of predation, or the threat of being left behind if not ambulatory—the forces that force giraffes to their feet? Do their hormones help? Or do they “grow up” quickly in other ways, if you know what I mean? What if our life expectancies were less than a decade? Would we evolve a quicker, more expedient onset of the pubescent watershed, becoming unrepressed yet thoughtless, and actively or relentlessly sexual, all because it was necessary to survive?

 

 

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The ultimate risk of addiction treatment

 

In the field of addictions work, so-called, it is common for practitioners and later patients who integrate ideas to cast addiction as a problem of emotion.

The addictive personality is one who is pleasure and novelty seeking, and risk taking, it is said. Risk-taking except in the area of intimacy, wherein he/she is likely avoidant. Psychoanalytic theory, attachment theory, and a host of techniques derived from either, are supported by neurobiological research, which affirms that unconscious process, communication that occurs implicitly, via eye contact, body language, and voice prosody, is mediated via the prefrontal orbital areas of the brain, and nurtured (or not) in human beings during early childhood development. The role of the therapist in our society, not unlike that of the early caregiver in some respects, is to serve as an auxiliary ego, using words, reflection, tone and physicality: to connect.

Addicts and trauma survivors would appear to have something in common: a penchant for disconnection, or dissociation, as trauma researchers indicate. John Bowlby, the founder of attachment theory in the latter half of the twentieth century, offered that psychoneurosis derives from protracted separation anxiety: that children deprived of maternal care first protest, then despair, and then finally exhibit detachment, which is characterized by dissociation, a state of disembodied escapism. What latter day research indicates is that infants and toddlers’ levels of the steroid hormone cortisol maintain elevated levels when a caregiver is either absent or insensitive. If such a child is deprived of all caregiving, cortisol levels stay chronically high and therefore children will develop passive parasympathetic strategies of dissociation. Habituation of the brain to the opioid-releasing state of dissociation thus becomes a “default mode” of affect regulation. The result: a predisposition to addictive behaviors, and insecure attachment in the form of an unresponsive, intimacy-avoidant personality.

This perspective is a paradigm shift for many seeking treatment for problems of substance abuse, sexual acting out, food addiction, and such, because society’s inclination is to externalize the problem of addiction: it is the substances that are addictive, for example—not so much that a predisposition within an individual exists. Meanwhile, sex addiction is a term used by some to exert an alternative, moralistic argument against sexual promiscuity, or alternative sexual lifestyles, rather than an assessment term that draws attention to a mood or mind-altering use of behavior. Food addiction is a label that is likewise criticized for being a thinly veiled attack upon the obese, especially obese women. The problem with labels is that they elicit persecutory anxiety, especially in those prone to what Melanie Klein once termed the paranoid-schizoid position, a primitive stage of childhood development. The benefit is that labels, like any succinct form of communication, draws quick and urgent attention to problems that merit just that.

The reason why the paradigm shift is important is so that preventive measures can flourish. Education is of course important, but education in the cognitive, Socratic sense is only the beginning, not the end of the intervention. We can, as we have for decades as a mental health community, provide appropriate medical care for those whose dependencies (to opioids and alcohol, for example) merit such monitoring and focus; we can concurrently and thereafter dogmatize that the consequences of addiction (jails, institutions, and death, to quote 12-step programs) are prohibitive; we can gingerly (or not) shame addicts into realizing that their behaviors are self-centered and immature, and we can impose various consequences based upon the premise that imposing limits will alter behavior (actually, limits are a good idea, but are mostly beneficial for friends and family—not as an agent of change in treating addiction). But for real change, the following is necessary.

Consciousness. Structure. Honesty. Time. Consciousness comes first. Not consciousness of the problems outlined in the last paragraph. There’s plenty of consciousness-raising about that already. Consciousness of feeling states, beginning perhaps with bodily sensations, as mirrored, amplified, and sometimes spoken to by an observant other, perhaps a therapist: someone who will monitor the moment-to-moment reactions of the patient; modulate closeness, sensitive to the fears that may manifest as withdrawal, whether the person is aware of their defenses or not. Structure comes in the form of routines: go to therapy, 12-step meetings, work and family obligations, etcetera—those necessary things to do to support growth and recovery. Time: the re-building of this afflicted self takes time, patience, and ongoing consciousness, about things like bodily sensations, feeling states that are felt and not—about that which has been driven underground, into the unconscious, and otherwise discharged via behavior.

This recovery process is another kind of risk. The biggest risk of all: to re-attach.

 

Graeme Daniels, MFT

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About reviews, popularity

Ever get the feeling someone’s trying to tell you something by not telling you something? Psychotherapists (that identifier feels awkward for some reason) have to learn to interpret the unsaid, by thinking about non-verbal information: everything from muted sighs to averted glances at a hidden clock, to I’m-running-late text messages, belated vacation or business trip announcements; e-mail terminations. Relationships in some people’s lives end with tumbling regularity. Exchanges are transient. Promises are easily given, and more easily withdrawn or better yet, forgotten. If you wrote it down, good for you. Kudos for the documentation, signifying that something meaningful happened.

I don’t spend a lot of time documenting psychotherapy, largely because it makes for dull reading, the type of notes one is meant to write for nosy overseers. It makes for good stories however, not that I can lift them directly from my clients’ shares. Instead, it’s an exercise in grabbing at pieces, tossing them at a blank page, worrying later about the links. For my first four novels I’d picked sketchily from my clients’ backstories, preferring to represent moments, unidentifiable fragments of individuals’ lives, maintaining everyone’s confidentiality. Except mine, of course. It’s several years since my first effort, the much somethinged Living Without Blood, about somebody named Eric Metcalf and his friend Richard something else, coming together after years of gradual estrangement in order to…actually, I’ve forgotten what they did together. I loved LWB at its time of publication—2009. It was my first-born: a sloppy, muddled beginner trying to find its legs after a nine-month labor, but occasionally standing tall, inspired by a self-consciously prosy flow. Skip to 2012: the release of Crystal From The Hills, a picaresque adventure that I’d conceived as a 600-page novel, only to split the story in half, releasing its follow-up, The Situation, two years later. Crystal took three years to write, in sporadic bursts in between semesters of my post-graduate training program at the Masterson Institute. Written three times, suffered over like a still-birthed thesis, it was my best effort thus far I thought, and I was confident enough of its value to submit a manuscript for review, with Kirkus magazine, a reputed den of literary cognoscenti.

Kirkus didn’t like Crystal From The Hills, calling it “sprawling”, “meandering” (a reference to its many flashbacks, childhood background material to make John Bowlbyesque sense of my protagonist’s disturbance). I got my first real taste of a reviewer’s, and presumably an average reader’s distaste for disrupted narrative, impatience with detail. I learned that some might find my prose difficult to read, for it was “ponderous”, “stacking of clauses and syllables”; containing way too much minutia. Gee, had they ever read David Foster Wallace? There wasn’t much complaint (from Kirkus) about the plot as such, or about character development—rather a suggestion that readers prefer heroes to be heroes, or at least charming, as opposed to being self-absorbed underdogs, or as one reader put it, losers. Ironic, for the novel’s underlying theme was empathy, so I did indeed fail in my task. I absorbed the criticism graciously, I think, noting that for my modest investment I’d received more honest feedback in two paragraphs—indeed more feedback, period—than I’d received from most non-paid (friendly or not) readers over the previous three years. Seriously, outside of the odd sympathetic review posted on Amazon, my readers, which include one loving family member, plus a rough crossection of my friendship circle, have given me little interest over the years. Some of them don’t care for psychodrama, preferring sci-fi, fantasy, non-fiction, or pleasant yarns about dogs or foreign travelogues. I think some struggle with the opening pages of my books, are left sucking oxygen within minutes having regarded my prose as if it were like the text of vacuum cleaner manuals. Most think that theme is subordinate to plot, which I agree with to some extent, except that some just don’t register ideas, only action. And some just don’t read. Period.

Oh well.

The effort to engage strangers moved on. The Situation received a warmer review from Kirkus, as in lukewarm, with concessions that it contained less of its predecessor’s flaws, as in less background material, less “meandering” plot. This was a somewhat hollow non-criticism, as the novel was a sequel and therefore did not require much backstory. However, other elements, like theme, the relatively fast pace or crisp prose, plus what I thought were clever plot devices (For example, Crystal’s opening, “He’s dead”, regarding a referenced character named Weed, is mirrored by Weed’s opening line of Situation: “I’m alive”. Reaction from Kirkus: nothing). Clarion/Foreword reviews didn’t notice this and other plot tidbits either, but otherwise offered a glowing review of The Situation, giving me four stars out of five, and remarking that my text was “captivating”, my writing assured; the story humorous, adventurous and fast-paced: gratifying, if not quite redemptive of the story as a whole. Kirkus’ reticence continued to irk me. I held the impression that their reviewer was holding something back, thinking my novel worthwhile but not wanting to say so.

This idea was reinforced earlier this year by their latest (and likely the last I’ll solicit) review, for my new novel, Venus Looks Down On A Prairie Vole. I was cautiously optimistic this time, half thinking my third submission would be the charm, otherwise simply believing my latest novel is pretty damn good. Alas, it was not to be. Upon providing a typically competent synopsis of the plot and a begrudging recognition that I was “drawing attention to an important issue”, Kirkus then complained that my protagonist, the sarcastic, at times pathetic Daniel Pierce, is not likeable. No kidding. According to them, he is pompous, contrarian (like that word, actually), and anti-feminist—a problem, apparently. Actually, as a therapist he’s resolutely neutral: a Bionion depository, as he puts it, “lacking memory or desire” (a famous Wilfred Bion quote). Outside his office he’s not so much anti-feminist as anti that which co-opts platitudes for self-serving aims, which is why he might be unlikeable. I suppose that negativity is not likeable, which I further suppose depends upon point of view. Anyway, it should tell me something, this reaction: something I’ve known at least since high school: in this world, in nearly all endeavors, it’s not enough to be good. BTW: my novel is damn good! But here’s the thing: you have to be liked.

 

 

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