Donald L. Nathanson, MD

In 1995, Gilbert Levin, PhD, Founder of the website Behavior OnLine, asked Dr. Nathanson to initiate the series of open Forums for which that site became known. Professor Levin had become well known as the organizer and director of the Cape Cod Institute, which he ran under the auspices of the Albert Einstein College of Medicine for more than 20 years, and now as the Professional Learning Network, LLC. What follows is an interview in which Professor Levin asked Dr. Nathanson to outline the course and direction of his interest in human emotion, material he had taught in eight presentations at the Cape Cod Institute.

A CONVERSATION WITH DONALD NATHANSON

BOL: Don, you first became prominent in our field by describing the phenomenon of shame. What is there about shame that makes it important and why did you choose to investigate it?"

NATHANSON: For some years I had been occupied with the problem of what is now called "interaffectivity," the way each of us gets caught up in the emotionality of others. At that time (1982) I thought of myself as a clinician with no scholarly identity, and wrote up my ideas more to get feedback from a few friends than with any thought of publication. One, a traditionally trained psychoanalyst, said "Oh, you're writing about empathy. There's a lot about that in the psychoanalytic literature," and I rushed to the library to check out references from the index of psychoanalytic writings, which more amused than enlightened me. A more senior analyst friend suggested I check out a recent paper by Michael Franz Basch, which put me on to the work of Tomkins.

At the same time, I decided to check out my concept (which broke with standard theory by suggesting that affective resonance is normal and that only by an "empathic wall" are we protected from unwanted resonance with others in our milieu who broadcast their own affect; and that the sense of self must be protected by this empathic wall lest we be taken over by those around us) by scrolling through a list of all known emotions to see if the idea worked for all of them. When I got to the letter "S" and ran into the shame family of emotions I was literally shocked to realize that not only did I know absolutely nothing about shame, but that I had never heard it discussed in any case conference or presented in any article on the defenses. I made a detour in my work on affect, affective resonance, and the empathic wall, and started to study shame.

After reading everything available in the English and French literature (about 85 papers and a handful of books) I came to the conclusion that there was a sizeable body of information about shame, even though nearly every author had, like me, come upon shame either by accident or by surprise. Most authors were almost totally unaware that others had written about shame! As I came to understand the ubiquity of shame experience, I decided that the real problem was not the nature of shame but the ignorance of shame common in our field and in the culture from which we therapists spring. It seemed only reasonable to do something about that latter problem, to which end I organized a symposium for the 1984 annual meeting of the American Psychiatric Association, at which a bunch of those who had written on shame would discuss their work. I acted as moderator, deferring to my colleagues who had done so much in this area and calling attention to their work. This became the basis of my first book "The Many Faces of Shame."

Paradoxically, the famous scholar to whom I had assigned the task of writing the lead chapter (on the development of shame in childhood and adolescence) told me that he had not a single idea how to do that chapter; late in the game, I was left with the job of playing catch-up. To my surprise, the work I had already done on affect theory and its relation to shame proved useful, and as a result of that effort I became known as an expert. In one swoop of the word processor I went from being a novice impresario to a "major theorist" without the slightest intent to be either.

At every step in the process I became increasingly convinced of the importance of the affect Tomkins called "shame-humiliation," and of the role of shame in all societies. Our shared contemporary world is much the worse for our ignorance of shame, and I accepted more and more responsibility for the dissemination of this information."

BOL: Your answer provides me a rich set of choices for follow-up. I could ask about affective resonance, the empathic wall and interaffectivity; about Basch and Tomkins; ---and in due course I will. For now, I wonder why shame was the neglected affect and what is the shame family of emotions?

NATHANSON: Remember, I began to study shame for all the wrong reasons. I had never done a research study looking for shame as a variable, never tried to see if one or another therapeutic maneuver made it go away, was never interested in the sociology/anthropology of honor vs. shame societies. I had been looking for anything that would disprove my theories about the ways we are affected by somebody else's emotions. My interest was not any single aspect of shame but rather the core of shame--what had to be happening inside a person for shame to be triggered, how that mechanism registered in the interpersonal field as well as the intrapsychic world, and the effect on both thinking and the entire range of emotionality of any episode of shame. Because I am a physician, and trained in both endocrinology and neurology, I took it for granted that whatever shame was (like all the emotions) it had to involve electricity and chemistry as well as philosophy simply because the brain seems to use both while it is working. To the best of my knowledge, my search was atheoretical or at least biased only by theories I didn't know I espoused.

Some of the first papers I read were fascinating. One writer pointed out that people who talk aloud to themselves seem suffused with shame. Helen Block Lewis said that shame means that we have raised our self-esteem unrealistically or come to believe we have attributes beyond what we really possess; she believed that the blush was a signal to others that we had recognized the error of such thinking and now wished to be accepted back into the herd. She made the useful distinction between shame and guilt, stating that shame was about the self while guilt was about our actions. Furthermore, she demonstrated that those fully analyzed patients who had seemed cured but who came back with new problems (as if the psychoanalysis had done little for them) were the ones with the most shame pathology. Freud thought that shame could occur only after we recognized that it was wrong to exhibit the genital, and that all shame was derivative of sexual shame. There was some confirmation of this view from experimental psychology, for good studies showed that children exhibited shame at their reflection in a mirror some time between 20 and 24 months of age.

Narcissism was a big explanation for some scholars, the furthest extension that of a British psychoanalyst who said that shame is what we felt when we shifted between "self-narcissism" and "object narcissism;" in answer to my queries about the definition of narcissism, he said that I had to take it at a symbolic level and just let it sink in. Everybody had a different definition of shame, embarrassment, humiliation, mortification, the experience of another's contempt, or the experience of being put down; every single writer made it clear that their personal experience of shame incorporated universal truths.

It was Leon Wurmser who made the most sense, suggesting that all the shame labels were cognates, words that could be used by anyone to express literally any range of the shame experience. He pointed out that shame usually follows the exposure of something we would have preferred left private, and that we are safer being exposed when protected either by love or sexual fascination. Where most writers on shame preferred to pass on Freud's dictum that shame was a peculiarly female preoccupation, Wurmser made it clear that there was no gender preference for this vast group of discomforts.

James Anthony once remarked that "uncovering psychotherapy is an arena of shame" because everything that is exposed had once been private; the work of therapy was to come to terms with what was now evident to both. Wurmser went even further, and said that every psychotherapy session is suffused with shame that is ignored by both patient and therapist. Studying audiotapes of psychotherapy/psychoanalytic sessions, Helen Lewis showed that shame occurred frequently, that it was misread frequently or nearly always, and that the cases in which her trainees paid attention to shame moved more rapidly and resulted in clinical improvement that lasted longer that those in which shame continued to be ignored.

What dawned on me slowly was the realization that this ignorance of shame was an artifact of the therapeutic techniques itself. Like it or not, we are all derivative of Freud, who suggested that we would increase the flow of "material" from the patient by refusing to jump in and rescue conversation when a patient grew silent. He believed that what he called "anxiety" was the prototype of all unpleasant emotion, and that it was produced when the sexual drive did not go forward to produce sexual congress. A classically trained psychoanalyst believed that any time a patient demonstrated an emotion, it was because sexual drive energy had not gone in the right direction; generations of psychoanalysts cultivated the famous "frozen turnip" stance so they could not be accused of incomplete transit through the famous psychosexual stages of development.

Yet what I came to understand was that the therapeutic decision to remain silent produced not "anxiety" but shame. The entire system of psychotherapy, as we had been taught it, worked only if we overlooked the shame that we produced day in and day out in our therapeutic work! No wonder there was so much shame left in the case failures Lewis studied. And if we psychotherapists, we apostles of the examined life, had neither been treated for our own shame conflicts nor trained in the techniques of reducing the shame of our patients, what was going on in the world at large? All at once it became clear that post-Freudian society had been treated for almost everything BUT shame, and that the degree and severity of undiagnosed and untreated shame problems far exceeded anything we had ever imagined. The emotion that produces hiding and withdrawal had even hidden itself from the legion of those who investigated emotion. As Wurmser said, we are so ashamed of feeling shame that we run from awareness that the emotion exists.

There was no choice but to start the study of shame as if it had never been examined before. And my cherished work on the interpersonal transmission of emotion was relegated to a back burner while shame moved into the forefront of my life.

BOL: What you have said makes a lot of sense to me and prompts me to ask you to describe one or two "techniques for reducing the shame of our patients." Also, before I forget, I wonder if you could briefly name the members of the "shame family." Finally, I know you are a great admirer of the work of Silvan Tomkins. I would like to know if there is a way to state in capsule form the essential contribution of Tomkins to your own work. I'm a little concerned that my questions may lead in divergent directions and it may be best to hold off on Tomkins till later.

NATHANSON: Even though we usually think of shame as something we feel when forced to think about our personal defects, embarrassment as shame experienced in a social setting, humiliation as the emotion we feel when the recipient of a shaming attack by someone else, mortification as being shamed to death, and consider the experience of being put down or treated with contempt as a separate category, Wurmser pointed out that each of us uses these words slightly differently. In fact, he said, we use them so differently that it is often difficult to know what another person is talking about when they use a shame word. What one person describes as massive humiliation may be little more than mild embarrassment for another, and so on. I think it is very important to accept Wurmser's idea so that we can go on to the deeper layers of shame.

I'd like to hold off on any suggestions for the treatment of shame until I define it more precisely a bit later in our conversation. It will become clear as we go on that once you understand the new language for shame that I have introduced, treatment is both intuitive and quite simple.

Your request for a capsule summary of Tomkins is reasonable but quite difficult to satisfy. It is critical to understand the intellectual milieu in which he worked. Born in 1911, he was exposed first to Freudian theory, which stated that negative affect was the unwanted result of sexual drive forces that didn't go forth to sexual congress. Freud really did teach that the reason anybody felt nervous, embarrassed, weepy, sad, disgusted, contemptuous, etc., was that one had become sexually aroused but not managed to have a true sexual experience. This theory was an upgrade of a popular 19th century idea that emotion appeared only when something went wrong for the organism. It has always seemed to me that these theories devolve from the Industrial Revolution factory, which was powered by a big steam engine from which great pipes ran to all sorts of machines. Every once in a while a pipe would break, sending hot steam all over the place, making a great deal of noise, and frightening everybody. That was emotion.

Tomkins thought differently. To say it quickly, he believed that we were born with the innate ability (requirement, really) to respond to certain qualities of stimulation with any one of 9 programmed mechanisms he called the innate affects. The function of the affects is to call to our attention something that is going on in the body; affect makes good things better and bad things worse. It is an amplifier system. Affect brings things into consciousness; in fact, there cannot be consciousness unless affect has been triggered. I have pointed out for years that "attention deficit disorder" and its relatives are not problems of neocortical cognition, but of maintaining attention, which by this definition must be an affect-driven process. The problem in ADD/ADHD is a disorder of affect, which is why all the medications that work in this cluster of discomforts are mood altering drugs.

So in the Tomkins system, there are six basic affect mechanisms, each of which is given a 2-word name, the first of which is the mildest presentation of the affect, and the second of which is the most intense. They are: interest-excitement, enjoyment-joy, surprise-startle, distress-anguish, anger-rage, and fear-terror. Two more affects derive from mechanisms that have evolved to monitor the hunger drive: dissmell (the response to a bad odor, which becomes the emotion we have when we call someone a stinker, and the reason our culture is so addicted to soaps and perfumes that prevent us from pushing people away by our odor---the sense of smell can govern interpersonal distance) and disgust (the response to food that has gotten past the sentinel of the nose, been tasted, and spit out because it tastes bad---we have disgust for anyone we have loved but now find distasteful). Finally, a late-evolving mechanism that limits the positive affects of interest-excitement and enjoyment-joy (which latter I often call "contentment" to differentiate it from the various ways one may have fun but are exciting rather than calming), shame-humiliation is the response to anything that interferes with positive affect.

(The astute reader will have recognized that there are lots of ideas here that were picked up in the 1870s by Charles Darwin, to whom credit must be given for discovering the discrete categories of affect. Little or none of his system could become a psychology until the work of Tomkins.)

Most importantly, when an affect is triggered, it causes something to happen in the skin and muscles of the face, as well as certain alterations of breathing, voice, posture, and odor. You must think of the face as the display board for the affect system.

Aren't you glad you asked for a quick tour of Tomkins?!!! It is a daunting system that requires one to drop nearly everything you knew about emotion in favor of a tightly knit group of ideas.

Shift, for a moment, to the contribution Michael Franz Basch offered in the mid-70s: He suggested that we consider the innate affect mechanisms that Tomkins described as the biology of emotion, and that we use the word "feeling" to represent that situation in which affect has come into our awareness. We are aware of an affect much as we are aware of a somatic feeling like heat, position sense, pain, etc. I have pointed out that in the language offered by Basch, it is therefore affect that is responsible for the shift from biology to psychology!

Next, Basch suggests that we reserve the word "emotion" for the specific situation in which we link the affect triggered in any moment to our memory of previous experiences of that affect. I have mentioned that "affect is biology, while emotion is biography." Furthermore, you can go a step further and understand that normal mood involves the recursive experience of an affect triggered by any stimulus, that next coughs up memory of some situation that brings forth more affect and more memories, all of which keep looping around to maintain the affective state for a long time. Normal mood can be dispersed when any new source of affect appears (the telephone rings, etc.).

Lastly, I point out that there is such a thing as a disorder of mood, in which some biochemical glitch causes the more-or-less constant experience of some affect, to which we have lots of associations and therefore what I have just defined as a mood. This, of course, is the kind of mood that never goes away in confessional therapy but usually needs some sort of medication to shift. A good example of this is all the people who take too much pseudoephedrine (Sudafed) or caffeine and tell us they are "nervous" about some event or particular line of reasoning. Withdrawal from the noxious chemical stops the mood.

There, in brief, is a theory of affect, feeling, emotion, mood, and disorder of mood that is based entirely on the normal, on what you can see in the face of the infant, and on what we think goes on in the adult. Affect theory says that we are born with a distinct group of normal emotional mechanisms, that these emotion mechanisms are essential to normal life, and that the ways we learn to handle affect is central to the formation of a personality.

Back to you, Gil

BOL: I get it. An affect is an innate biological response that registers in the body--period. Any awareness we have of it is a feeling. When the affect (or is it the feeling?) triggers memories it is an emotion; and a mood is a fairly OR VERY stable state of interacting memories and affects.

Let me think out loud about my question in parenthesis above: The set of feelings is not obliged to be equal in size to, nor isomorphic with, the set of affects. There are nine of the latter, but there could be only six or six hundred of the former (for all I know now) and one person might have a wider repertoire of feelings than another person. Affect #1 could trigger Feeling A or B in me and Feeling D in someone else. I think I could make similar comments about emotion and mood. I guess what I am getting at is there needs to be a typology of terms at each level in your system and some linking principles between them. I find this interesting to learn about, but must leave it to you to judge whether it is profitable for us to continue along these lines now.

I am glad to know about Tomkins. I think I "studied" him many years ago in a graduate school course in personality, but only his name remains in my memory. Putting aside any assumptions about the age or state of my brain, I think the reason is that I failed to grasp the implications of his system and I thank you, as I am sure many do for making that clear.

On the topic of therapeutic method, it seems that the theory would lead one to a therapy that would inventory the patient's resources and deficits at each of the levels of the theory, or am I getting ahead of myself?

NATHANSON: I left something out in the previous answer. The Tomkins concept (of an affect system that has evolved to respond to increasing or decreasing gradients of stimulation and to varying levels of stimulus) forces us to give up one of the hoary old concepts of academic psychology. In any life form that has an affect system, there simply is no such thing as Stimulus-Response pairs. No stimulus can evoke a response unless it first triggers an affect, and it is to the combination of stimulus and affect that we respond. All the teaching about S-R pairs is wrong, and must be replaced by the study of S-A-R triplets.

Your question about the inherent variability of what Basch called "feeling" goes right to the heart of a debate between Basch and Tomkins that affected their relationship deeply. Although Basch's use of "feeling" makes sense from the standpoint of a clinician, Tomkins disliked it greatly. Silvan felt that it distracted from the essence of this concept of innate affect in that it made one category of affective experience more specific than it really was. Although I use Basch's language in my own writing, and teach it, in my heart I know that Tomkins is right to say that the word "feeling" is unnecessary. We are dealing with the nearly infinite variety of affective experience, and the wide range of assortments of stimulus, affect, and response that the affect system makes possible.

Similarly, although he accepted my reasoning about normal mood and disorders of mood, he insisted that it was also unnecessary to use the word "emotion" in the way Basch defined it, saying that "The coassemblies of memorialized affect triggers and current affective experience do not deserve so specific a name." His reason for this was quite complex, and really will draw us far from the current thrust of your questions: the sort of coassemblies to which Basch referred are now thought of as "scripts" and far more complex than the simple construct for affect outlined above.

Briefly, script theory states that the human brain is an engine for the analysis of variance, forming and comparing patterns at all times. We define each sequence of Stimulus-Affect-Response as a "scene," and state further that when we recognize that certain scenes contain the same sequences, we group them into families of scenes. When the newly grouped family of scenes is recognized, it then triggers an affective response. Take, for instance, all the times you go to the supermarket because there is an advertised special but are disappointed to find that they have run out of the special. When you group all these sequences into a family of scenes, and react with disgust to this new entity, disgust affect now does something to all the information held in the grouped sequences. We say that the new affect (in this case, disgust) magnifies everything within the supermarket advertisement and disappointment scenes. The coassembly of bundled scenes with their magnifying affect is now called a script.

Although the neonate may have the privilege of responding to entirely novel stimuli (even though I suspect lots of affect is triggered in utero), by the time we get to be a few months old, everything is scripts rather than innate affect. Everything we do to modulate the affective output of an infant or growing child gets "recorded" in the form of scenes that are constantly being grouped into scripts. Past infancy, everything is scripts rather than affect. I'm sure you recall that Daniel Stern spoke of "RIGs," "Representations of Interactions that have become Generalized." RIGs, as long as you understand that these scenes don't have to involve interactions with other humans and therefore be interpersonal, and as long as you understand that these interactions must involve innate affect, as what we mean by the early form of scripts.

You will agree that this is both reasonable/logical and maddeningly complex. Script theory is a thing of rare beauty, and a magnificent way of understanding complex human function. But this very complexity is the reason I teach the more simple language of Basch in the beginning of every course of affect theory, and certainly to all clinicians. So, in answer to your initial comment and question, either you stop asking about the real nature of feeling, or we have to get further into the wide range of specific scripts. Soon enough, we will talk about scripts, because that is what I have postulated for the real nature of shame---a series of four patterns of response I characterize as the Compass of Shame.

But let's get back to your last question about the therapeutic implications of affect theory. Tomkins called me a "biologist" because I kept forcing him and his theories back into the body. In 1988 I introduced the concept of Hardware, Firmware, and Software in the world of human emotion. I suggested that just like the ubiquitous personal computer, our emotion system can be divided into these three moieties.

Everything that whirs and buzzes when you click the "on" switch of the computer may be considered Hardware; in the human, this is the realm of the central nervous system with its cell structure, neurotransmitters, and capacities for storing, retrieving, associating, and handling data. As for Firmware, the affects and the drives are pre-written instructions resembling ROM chips (instructions once written by extremely intelligent people but encrypted in such a way that it cannot be altered without destroying the mechanism). Firmware, of course, is something between Hardware and Software in construction. Computer software is a bunch of instructions written by intelligent people, but written in such a way that we can mess it up if we play with the system and ruin things. In the human emotion system, software is the result of experience, training, socialization.

Using this concept to build a model for psychotherapy, you can see that most of what we do with medication involves hardware, while verbal psychotherapy always involves software. Our understanding that there is no response in the human that has not been motivated by affect lets us conceptualize all attempts to change behavior and feeling states as software patches. Psychotherapy becomes the task of determining what affects are responsible for the experience of the moment, learning what scripts are involved in the handling of that affect, and the development of new systems for affect modulation.

At the 27-29 October 1995 national meeting of the Tomkins Institute I will present a new way of assessing patients on the basis of the affects involved in the initial presentation for therapy. It will be seen that short-term therapy requires little more than new systems for the modulation of the affect brought into the treatment situation, and may involve the use of cognitive-behavioral technique, medication, advice, or any other method that reduces affect in the short run. Long term therapy involves the development of entirely new scripts for affect management in an individual whose previously existing scripts were not adequate to allow either a wide range of affective experience or enough periods of positive affect to make life worthwhile. It is because these new scripts involve high density affect triggered in the context of an intense relationship with the therapist that transference is inevitable.

BOL: While the computer analogy interests me (a lot, actually), I want to return for now to two other themes in your last set of comments. Could you elaborate on scripts and the response patterns that constitute the compass of shame? And now, or soon, could you discuss the general approach required to handle transference in your therapeutic system?

NATHANSON: Start with the idea that everything we know about shame has to be put on hold for a little while. We are going to introduce a new concept of treatment that encompasses everything that's been used before and adds a lot of new ideas, but it will be based on our growing understanding of developmental theory.

Earlier, I introduced Tomkins's idea that the basic physiological mechanism underlying all shame phenomena is something that has evolved as an auxiliary to the positive affects of interest-excitement and enjoyment-joy. Just as dissmell and disgust operate to turn off hunger when that drive is at its height, and are therefore properly called drive auxiliaries that have evolved into the status of affects, the affect Tomkins calls shame-humiliation starts out as a mechanism triggered whenever one of the good feelings is impeded. Even the slightest impediment to the experience of interest, or the mildest interference with the experience of laughter, whether during an interpersonal interchange or when we are by ourselves, will trigger shame affect.

We say that each affect is an analogue of whatever triggered it (the moaning or sobbing of distress-anguish is steady-state, like its trigger; the action of startle is as sharp and brief as its trigger, etc.) and by calling the trigger to our attention, therefore an analogic amplifier of its trigger. Well, the affect of shame-humiliation is an analogic amplifier of an impediment by making the impediment all the more salient. Whatever has caused a momentary interference with our interest in something will now be experienced as a very significant interference with it. (Naturally, the interest-excitement that powered our attention to a television program is turned off completely when the electricity goes off, thus removing the video information as a possible source of interest; that situation does not trigger shame affect.)

But as Tomkins was so fond of saying, shame affect is recruited any time desire outruns fulfillment. Any time we reach higher than our grasp and are "disappointed," that failure, that impediment to the positive affect that had powered our reach will now trigger shame affect. It is experienced by the organism as an amplification of impediment, and therefore an intensification of impediment. Whatever affect had been powering or motivating our attention is now turned off, and with it, the kind of neocortical activity associated with that attention. Remember---in higher organisms, only through amplification by affect can any source of information that causes a neural event move from background to foreground and become the subject of conscious activity by higher neocortical centers. This is so for all the affects: Even though we pay strict attention to something that frightens or disgusts or enrages or amuses us, most of what we call "normal attention" is neocortical activity on data made into a source of attention by the affect interest-excitement. It is for this reason that I have commented so often that "Attention Deficit Disorder" is not a defect in neocortical processing mechanisms but a defect in the maintenance of the affect interest- excitement probably related to the mechanism for shame affect as triggered when any episode of interest is impeded.

Affects are triggered not by the information contained in a stimulus, but by the pattern produced by the way that information comes into the system. As soon as there is any impediment to the optimally rising tide of information that triggers and maintains interest-excitement, or to the decreasing tide of information that triggers enjoyment-joy, this impediment is registered as the trigger for shame affect. When set in motion, the innate, physiological sequence for shame affect causes an immediate interruption in whichever of the two positive affects had at the moment been in charge of consciousness---the affect shame makes important and urgent whatever had just a moment ago interfered with the good scene then in progress. As a result of this interruption in the positive affect that had been powering normal attention, we suffer what I have termed a "cognitive shock" in which we are suddenly unable to think clearly. Darwin commented that no one can think clearly in the moment of shame; Sartre said that shame came on him like an internal hemorrhage for which he felt always unprepared.

There is more: By this physiological mechanism, whether we like it or not, the gaze is averted from the previously pleasant scene; tonus in neck and shoulder muscles is reduced and the head slumps; the vasculature of the facial skin dilates to produce the blush; and whatever communication had only a moment ago been produced by interaffectivity is now terminated. This is the physiological phase of the shame experience.

Yet no experience of any affect is entirely new. Speedily, we recover from the cognitive shock as neocortical cognition shifts from whatever had been the work of the moment toward whatever shame affect now makes salient. Shame-based cognition now forces us to review all of our past experiences of shame affect, all of which have already been bundled into families of scenes and to which families we have developed affective responses that make them into scripts. In order to write Shame and Pride, I decided to determine and codify every single possible situation in which this affect of amplified impediment to positive affect might occur. There is no way I can summarize easily what took a third of a book to write, but suffice it to say that these scenes fit into eight clusters. In the section below, I have listed these eight categories of shame experience, along with a sample of the kind of cognition that occurs with each. The list appears on p. 317 of Shame and Pride

THE COGNITIVE PHASE OF SHAME
Search of memory for previous similar experiences. Layered associations to:

THE COGNITIVE PHASE OF SHAME
Search of memory for previous similar experiences.

Layered associations to:

1. A Matters of size, shape, ability, skill. (I am weak, incompetent, stupid.)
2. B Dependence/Independence. (Sense of helplessness.)
3. C Competition. ("I am a loser.")
4. D Sense of self. ("I am unique only to the extent that I am defective.")
5. E Personal attractiveness. ("I am ugly or deformed. The blush stains my features and makes me even more a target of contempt.")
6. F Sexuality. ("There is something wrong with me sexually.")
7. G Issues of seeing and being seen. (The urge to escape from the eyes before which we have been exposed. The wish for a hole to open up and swallow me.)
8. H Wishes and fears about closeness. (The sense of being shorn from all humanity. A feeling that one is unlovable. The wish to be left alone forever.)

Unpleasant thoughts, all of them. And yet, once they have scrolled through consciousness, memory made salient by courtesy of the associative cortex, we have some choices. It is this moment that I call the Decision Phase of the shame experience, for now we have the choice of adjusting our self-concept to fit whatever new information about us had been the source of the impediment. For example, the grimace that interrupted your telling of that great joke, the look of disapproval that greeted your communication of sexual interest, your fourth consecutive double fault in tennis---all of these involve impediments to positive affect that bring messages about our competence or desirability. As a result, during the brief decision phase, you and I can decide to alter our view of ourselves---we can decide that we are not as good as the comedian from whom we'd heard the joke, not as sexy as we had hoped, or a considerably worse server than we'd thought---and take action to repair or reframe our identity.

But this is not what most of us do. We defend against these awful feelings, these terrible memories that have been bundled into unpleasant scripts. All of our reactions to this sequence of triggering source, physiological affect, and the cognitive phase can be placed somewhere on the compass of shame. I don't know how to make a drawing on your computer screen, but imagine a traditional 4-point compass, with the words Withdrawal at the North Pole, Attack Self the East, Avoidance South, and Attack Other in the West. Each pole of the compass is actually a library in which are stored a huge number of scripts for action in response to the sequence we have presented so far. Not until one of these scripts is brought into play can we really be said to have had a shame experience!

At the Withdrawal pole lie all the ways we obey the physiological action of shame affect itself. We withdraw when we turn away from the offending stimulus, hide, act shy, run away, grow silent in a therapy session. Each script library contains a full range of behaviors from the most mild and normal to the most seriously pathological. We use scripts from the withdrawal library when, as little kids, we hide behind mother's leg while trying to scope out a stranger, just as when in the throes of a morbid depression we may not be able to meet the eyes of another person for years. You have heard me say for years that I am the sole member of an international commission devoted to stamping out the use of the term "depression," and it is for reasons like this that I take this position. Everything we call depression is actually the stable experience of one or another of the six negative affects. Prolonged shame is what we call "atypical depression," while the specific coassembly of shame affect with fear of reprisal is what we call guilt and therefore typical of "classical depression." The term "depression" is far less useful for the patient than a careful survey of the actual affects being displayed.

When someone is in the state of withdrawal, that individual is demonstrating quite clearly the presence of shame in the interaction, and why it makes no sense to remain silent in the face of a silent patient. Although psychoanalytic theory stated that therapist silence produces "anxiety," it is by now clear to the reader that anxiety is a subset of the affect fear-terror, and that silence on the part of the therapist is experienced as an impediment to normal social (interpersonal) interest and therefore a trigger for shame. If you already know from the silence of the patient that shame is present, why increase it and make things worse? Understanding the compass of shame allows us to take an empathic stance, to define the impasse as a moment of embarrassment, and to work together with our patient to find its source as well as its associations.

Little as any of us likes the Withdrawal pole of the compass of shame, there are those among us (again because of scripts formed as the result of life experience) for whom the moment of withdrawal produces a literally terrifying period of isolation and the feeling of abandonment. In such situations, every moment of shame is dangerous and must be handled in such a way as to prevent isolation. It is in these moments when any of us (all of us some of the time, some of us all of the time) react by addressing others as if they were much, much bigger and more powerful than we, and to put ourselves down in order to curry favor with them. The normal range of the Attack Self pole of the compass includes all the ways we are deferential to others ("Yes, officer, thank you. Yes, sir, of course I'll be more careful next time. Thank you for the advice, sir.") when to do otherwise would be dangerous. But it also includes ways we demean ourselves in order to curry favor from truly monstrous others in the mode we call masochistic. I've never seen any benefit from calling people masochistic---they quite rightly take that as a shaming assault. But it has proved very useful to explain to people that this system of trading loneliness for dangerous safety can be altered when its basis in shame is understood.

Ah, but there are other times for all of us, and a lifetime for some of us, when any moment of shame is unbearable. Anything we do to make the feeling go away without dealing with its causes can be subsumed under the rubric of Avoidance, the third pole of the compass of shame. Shame is soluble in alcohol and boiled away by cocaine and the amphetamines. When we distract the eye of the shaming other toward whatever brings us pride ("Hey, look at my new car! Look at these great pectoral muscles! Looky here, looky there, but don't look where I can't stand to see myself.") we have used scripts from the avoidance pole of the compass. Drugs, hedonism, disavowal, and machismo are all examples of this system; the assignment of degree of pathology is directly proportional to the fraction of the self being so disguised. It does little or no good to inform a patient that they are narcissistic, because that is too shaming. Freud was right when he talked about the "stone wall of narcissism." Those who are already overdosed on negative self-images cannot stand any new insight because it can only bring more shame. Treatment works far better when we explain the nature of shame, indicate that it is a universal and inevitable physiological experience, and demonstrate ways of handling it that are not so toxic to interpersonal life.

Finally, there are all those moments when by our own hand we can do nothing to increase our own self-esteem, periods in our life when everything that happens serves only to prove that we are inferior. You've had them, I've had them, and they are awful moments. It is at such a time that we act according to the Chinese proverb "He who lands the first blow was the first to run out of arguments." We use Attack Other scripts when we can feel better only by reducing the self-worth of another person, and we accomplish this reduction by put downs, banter, physical abuse, contempt, character assassination, calumny, blackmail, and sexual sadism. Any time we define a shaming remark as an insult or an example of disrespect, and respond by attacking with words or harmful actions, we are involved in an attack other script.

In fact, everything we have earlier called sadistic behavior is only action undertaken to reduce shame---a fact that makes treatment much more approachable. It will, of course, be obvious to this readership that people with attack self and attack other scripts hang together because they need each other; this is quite an upgrade on the concept of sadomasochism because the latter is based entirely on sexual drive language, and the new system is based on what we now know about the nine innate affects and makes the clinical situation far more accessible to treatment.

Even the most cursory study of social and political history must suggest to a psychotherapist that in our civilization, over the past 40-50 years, the dominant, culturally expected, normative response to shame has shifted from Withdrawal and Attack Self to Avoidance and Attack Other. We have gone from a culture of politeness and deference to a culture of narcissism and violence, all of which must be understood as alterations in scripted reactions to shame affect. I have written a good deal about the implications of this shift, and become involved with several factions of the movements to make our society a better place to live through better understanding of its affective responses.

Earlier, I mentioned that biological glitches can produce nearly any affect in the absence of the normal physiological triggers for that affect. I believe that among the millions of people who achieve tremendous benefit from the SSRIs (Prozac, Zoloft, Paxil, Luvox, etc.) are many who suffer disorders of shame affect that are expressed at one or another pole of the compass of shame. The shy person who does not seem particularly "depressed" but responds with tremendous improvement in self-esteem is not a victim of "cosmetic psychopharmacology" as Peter Kramer suggested in "Listening to Prozac," but one whose mild shame illness was poorly understood by doctors who insist on explaining the normal only in terms of the abnormal.

Medical science differs from biology in that it deduces the normal from the study of disease. How I wish Dr. Kramer had really listened to Prozac and learned something about innate affect! I recall a radio interview in which he was asked by a host familiar with my work whether his studies had made him think about the biology of normal emotion, and he responded "Is there a biology of normal emotion?" I believe not only that there is a biology of normal emotion, but that it exists on a continuum with the most severe disorders of affect physiology, and that we must understand the logic and dynamics of innate affect in order to treat people most effectively. The modern psychotherapist is part of a team and must be sensitive to all these issues.

There is no such thing as shame, no unitary definition of an emotion called shame, embarrassment, mortification, etc. There are four shames, four patterns of response to a physiological affect mechanism that must be triggered any time there is an impediment to the wonderful feeling of positive affect. And our concept of human emotion must be upgraded to accept that each moment of emotion, no matter how intense or how mild, is a gestalt phenomenon---for every emotion there must be a triggering source, a physiological affect, a scan of previous experiences stored as scripts, and a pattern of response directed by those scripts.

An emotion is the entire gestalt of Stimulus-Affect-Response, and emotion is best capable of understanding and perhaps alteration when seen as nested within the entire life experience of the individual. Through the action of the affect Tomkins called shame- humiliation and our complex responses to it, we learn about the nature of our self and the range of our limitations. The study of shame teaches much about everything that is beautiful and everything that is ugly within the human soul; this study is central to the development of competence as a contemporary psychotherapist.

(end of 1995 interview with Dr. Nathanson)

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