Harry Stack Sullivan and the lizard's tale: between "family chaos" and "creative disorder". Psychosis as dysfunctional negotiation of interpersonal need for security.

Dott. Tiziano Carbone.
VIII INTERNATIONAL FORUM OF PSYCHOANALYSIS 2014,
17-19 September, 2014 Kaunas, Lithuania 
 

Harry Stack Sullivan and the lizard's tail: between "family chaos" and "creative disorder".

Psychosis as dysfunctional negotiation of interpersonal need for security.

Summary
Starting from the Sullivanian concept of "need for interpersonal security," the author offers a brief excursus through infant research, mentalization theory, attachment theory, and the thought of Donnel Stern and L.W. Sander, to illustrate how the processing strategies of anxiety in the infant-caregiver dyad  may lead human subjects to disfunctional negotiations with the "necessary environment": in this way humans can renounce  to symbolize consciously experiences that had been pre-reflexively identified as unbearably painful.
The author describes negotiation as a continuum between the motivation of a living system to interact with its environment - co-existing with that to maintain self-organization (pre-negotiation) - and the negotiation in a subject with implicit, and later explicit mental processing  skills.

In this framework, the human decision not to consciously formulate distressing relational experiences represents an evolution of coping strategies of  living systems to danger: this is only a more complex procedure to escape by losing important parts - although not vital – in order to save the global consistency.
The author formulates treatment as a re-negotiation of old anxieties coping solutions that had been crystallized in a “suicide of the conscious thought”; this re-negotiation should  be obtained through a new negotiation where the anxiety  manifestations - in the words of Donnel Stern "family chaos”- could become "creative disorder.”

 

                                                                                              

 

 

   History  scrapes the bottom of the sea

like a trawl with some tears  and more than one fish escapes.

Sometimes you can meet the ectoplasm

 of an escapee and it does not seem particularly happy.

It doens’t know to  be out, nobody told it about its situation.

The others, in the trawl, think they are freer than it.

 

                                                     (Eugenio Montale, History)

 

 

Poets are often able to summarize concepts for which scholars and scientists tend to develop long debates, in order to formulate an hypothesis on how the human mind works. In the quoted poem, Eugenio Montale describes History as a trawl, a big net that scrapes the bottom of the sea catching fish; but, in the process, the tears in the net let some fish escape becoming an ectoplasm, a ghostly and mysterious expression of a dead subject; it doesn’t look very happy and is unaware to be outside the net, while  those  still in the net patronizingly look at it and think to be freer.

Borrowing the metaphor of History as a narration of entire populations and applying it to individual stories, we might consider them as personal narrations constructed in a social context, such as a “trawl”, a net that captures gathering a group of people: in other words, humans create a conscious vision of themeself and of the world within a cultural context, maintaining their cohesion to the group and promoting cohesion within the group. But when the narration tears, "scraping the bottom of the sea", i.e. when some intolerable anxiety breaks in, tearing the narration/net’s texture, some "fish" escapes.

In my opinion these expressions are a poetic description of the fate of those preverbal experiences which, not being collected by a communicable narration net, have not been mentalized and can take the form of psychotic symptoms. Like those fishes escaped from the “trawl” mentioned by Montale, they take on strange shapes, "ectoplasm of survivors," ghosts of characters died because of secret and distressing facts; the “ectoplasms” do not appear to be happy and don’t know to be out of the net: "nobody  told it about its situation”.

The shareable narration can therefore be thought either as: a factor producing consciousness in a subject who belongs to a specific social group; a social mediated function which narrows the possibility to recognize in individuals working outside of the shared group language “unhappy ectoplasmatic manifestations": but they are still able to express themselves, althought in bizarre shapes. This happens due to a painful inability to make shareable narrations, and therefore these individuals are unaware of being "out of the net", and this unawareness is caused by being "out of the net."

Fishes, inside and outside the net, are always the same. In other words, the creative unconscious activity underlying all forms of thought - either contained in a shared language and therefore conscious, or, having not found its place, expressing itself spectrally - is always the same:  according to Donnel Stern (2007) "familiar chaos" and "creative disorder", are manifestations of the same process: in the first case being influenced by a relational climate dominated by anxiety; in the second case being influenced by a relational atmosphere of curiosity and appreciation. The latter condition allows the meanings to emergence in a conscious shared, because shareable, language.

But if the net is a metaphor for conscience, what is the tear?

 In the opinion of many scholars from different fields of science, neuroscience, cognitive psychology, complex systems theory (Liotti, 2003, Tronick, 2008), conscience is a human subject’s function prepared by less complex levels of organization and emergent in social interaction. Liotti (Liotti, 2003, p. 18), quoting studies of contemporary neuropsychology, says that conscience “is an intrinsically relational phenomenon, continually emerging in the communication between individual brain and the world, rather than a brain’s private property.”

In a similar way, discussing the concept of dyadic expansion of states of conscience, Tronick describes how mother-child interactions build states of conscience in both (Tronick, 2008, p. 241).

 

My theory is that socio-emotional exchanges between mother and child (and between all human beings) have the potential to expand the state of conscience of the individual, resulting in powerful consequences in terms of experience and development. The hypothesis of conscience dynamic expansion comes from the systems theory. One of the fundamental principles of the latter is that open biological systems, such as humans, work to incorporate and integrate increasing amounts of valuable information in more coherent states. ... This process is often considered as a characteristic self-generated by the systems, meaning that all systems are self-organizing. In fact, the systems are self-organizing, but equally it is important to emphasize that, in humans this is a dyadic process, involving two minds.

 

The process of interaction and mutual influence between two o more individuals is defined as a “negotiation” by a number of relevant relational authors such as Stephen Mitchell (1995), Lewis Aron (2004), Stuart Pizer (1998) and by some infant research authors such as Louis Sander (2007), Beatrice Beebe and Frank M. Lachmann (2003).

Sander uses the word "negotiation" to describe exchanges either between living systems at elementary levels, (Sander, 2007, pag  XXVIII) or between mother and infant in the early interactions, (Sander, 2007, p. 5) examined longitudinally in the first 20 months to see how some co-constructed sequences become stable patterns of behavior of the child.

 

Evaluating interactions, we have tried to catch these relationships by representing the achievement of this point in the form of negotiation of issues concerning the interaction. (…) The issue should be negotiated  when the baby’s expectancy crystallizes. (Sander, 2007, p. 8)

 

So, we can say that negotiation plays a fundamental role in shaping living systems from the very beginning. We can presume that it works in a continuum between elementary levels, where it simply mean the tendency of living systems to put together self–organization and interaction with environment to reach more coherent states, which I would refer to as “pre-negotiation” (Carbone T, 2005), and more complex levels, where negotiation becomes the activity implemented by human subjects relating with others. Negotiation occurs at implicit and explicit  levels of mental processing.

If possible outcomes of negotiations in a particular relational climate affects the subject’s foresight patterns, forcing him/her to leave holes in construction of the “net”/conscience process (is trauma the implicit order not to formulate conscious meanings?), I think it is possible to consider psychotic thought’s processes as the result of dysfunctional negotiations, deriving from an implicit commitment not to formulate a conscious meaning of  some specific relational situations.

Montale says, "nobody  told it about its situation": these words seem to suggest that being able to talk about “broken net” with "escaped fishes”, allows “family chaos” to become “creative disorder”, rinegotiating shareable narrations in a climate where old anxieties are held.

 

This would allow to “mend the net” of conscience in which it could be possible to give space and definition to "unformulated experiences".

If we assume that the net is conscience, tears are discontinuities co-constructed by individuals and social environment, what is the "motive"? Why does negotiation become dysfunctional in view of the fact that: “there is an intrinsic biological tendency or “factor” in the organism, which is directed toward maintaining or achieving mental health”. (Sullivan, 1940, p. 269)

In Harry Stack Sullivan’s thought, the need not to experience anxiety, namely the need for interpersonal security, is a main infant’s motivation in relation with the parent, and it is distinct from the needs belonging to "bodily organization" (Sullivan, 1940). Rather, it pertains a cultural dimension, including every social relationship.

 

On the other hand, the pursuit of security pertains rather more closely to man’s cultural equipmment than to his bodily organization. By “cultural” I mean what the anthropologist means-all that which is man-made, which survives as monument to preexistent man, that is cultural. And as I say, all those movements, actions, speech, thoughts, reveries and so on which pertain more to culture which has been imbedded in a particular individual than to the organization of his tissues and glands, is apt to belong in this classification of the pursuit of security (Sullivan, 1940, p. 13).

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

This fundamental theme of Sullivan’s thought is very important to understand psychotic mental functioning and experience, because it explains how infant-environment negotiations are crucial because dissociation occurs.

 

Very intense anxiety precipitated by a sudden, intense, negative emotional reaction on the part of the significative environment……. tend to erase any possibility of elaborating the exat circustances of its occurence, and about the most the person can remember in retrospect is a somewhat fenestrated  account of the immediate neighborhood… All this almost undifferentiated, sudden, violent anxiety is experienced as uncanny emotion….. In later life, this all-encompassing anxiety shows some slight elaborations, which are hinted at by four words in our language-awe, dread, loathing, and horror. (Sullivan, 1953, p. 314-15)

 

For Sullivan, "seminal author for modern relational perspectives and attachment" (Albasi, 2006, p. 127), the critical steps in shaping subject’s conscience are played entirely in the relationship between infant and care-giver.

The fate of the experiences - whether they can be processed into conscious experiences or not - is marked by the amount of anxiety that child's behavior produces in the caregiver; in fact, according to Sullivan, a source of intolerable anxiety in the caregiver is empathically perceived by the child and experienced  as "a blow on the head" (Sullivan, 1953, p. 314). This event can disrupt the experience, and “cut off foresight” (Sullivan, 1953, p. 44) leaving space only to “awe, dread, loathing, and horror” to be experienced in later life: in this way, every conscious elaboration is prevented.

The process takes place within levels of experience defined by Sullivan as prototaxic and parataxic, incorporated and developed by later writers such as Ruth Lyons in the concept of "procedural knowledge," or "implicit relational knowing", (Lyons-Ruth, 1998) or as in Beebe-Lackmann "model of experience”.

Beebe-Lackmann (Beebe-Lackmann, 2002, p. 12) say: “Early childhood experiential models are organized as sequences of mutual exchange expectations and are associated with particular self-regulatory styles”.

 

Therefore "security operations" described by Sullivan as a lack of processing, which we could also refer to as a kind of marking to prevent access to conscience, could be considered as a self-regulatory style in which the infant, at an implicit procedural level, "decides" to sacrifice conscious symbolization of distressing interactions with the adult, in order to preserve the relationship with him/her.  They can range from "selective inattention" - by which interactions may also become conscious, but cannot be undestood in their implications,  being the subject not able to grasp them - to real "dissociation".

  The sacrifice of a non-vital but important piece of a living system is not new in the world of living organisms, in order to save life. According to the logic of complex systems (Sander, 2007), in less complex levels, systems pursue the state of wholeness looking for the maximum level of coherence in a constant equilibrium with environmental stresses. For example, a lizard attacked by a predator can leave the tail in the mouth of the latter as a strategy to save its life.

From an evolutionarily point of view, this behavior is very effective to preserve the organism and its species.

 

In the development of the interaction, there is always the perception of one’s one and others’ state, also useful to describe the flow of energy through the individual-environment living system. (...) The state of wholeness becomes  the motivational push, as a crucial impetus to try to regain the coherence in a creative organizating process as the individual is more engaged in an ever-increasing complexity of involvement with the environment (Sander, 2007, p XVIII).

 

The child-caregiver self-adjusting system aims at the child/future adult’s dissociation/psychosis, because the relationship prevents some aspects of the interaction from being processed in their implications at the conscious level. Mentalization about specific issues, like lizard’s tail, must be sacrificed (a partial suicide) in order to secure a more important priority. The interpersonal security ensued by preserving the relationship with the caregiver is the reason why the infant “decides” that some well-identified experiences shall not be communicable. This is a security operation of the subject and of the group, whose coherences could blow up if some relationship implications underwent conscious processing. Thus, dysfunctional negotiations shape the subject’s conscious self-representation repertoire, and the latter will be actively pursued as one’s conscious identity.

Sullivan describes the “dynamism” through which some experiences will become “not-me”(Sullivan, 1952, p. 161) - the part of the personality outside of the conscience of the subject, being not approved by parents -  as the result of a kind of inertia, for which one would focus only on known interactions. Thus, due to an impersonal mechanism, every innovation would have no chance of entering the conscience; the author does not explain the selectivity of the proto-parataxic experiences - that do not reach consciousness - in terms of a person who "decides what to avoid."

But, at this point, we should ask ourselves: if the purpose is to avoid the unknown and there are no clear indications in the mind such as "danger, already seen, do not go on", this avoidance should be indiscriminate. But the “diversionary maneuvers” implemented by psychotic patients, in order to avoid "dangerous issues" and avoid to experience “awe, dread, loathing, and horror”, are not at all generic: psychotic patients do not avoid new experiences in general, but they avert them in specific areas which they do not consciously know: they cannot formulate any meaning, but a dangerous approach to “hot spots” is invariably marked by the emergence or increase of delirium: it happens as if the experiential meanings were known, feared and therefore avoided. The subject is not conventionally conscious: paraphrasing Donnel Stern "experience is unformulated," but procedurally s/he knows what it is better not to elaborate and allow to become conventionally conscious. S/he already knows, but s/he can not say it to him/herself in the group’s language. S/he doesn’t formulate what s/he knows that must not be formulated.

In the words of Sullivan, subject would be divided into a conscious part,“good-me” and “bad me”, and an unconscious one, the "not-me": the conscious self is the result of approved or not overtly criticized interactions by the parents, while the not conscious self is the part that caused strong adversion, and therefore anxiety, in the parent. “Not-me,” with associated proto- parataxic experiences, does’t not disappear, but it is manifested in projections, enactements, and it is out of the conscience of the subject. Therefore it would seem that in Sullivan’s theory, there is a subject - not impersonal instances, - although not conscious in verbal shared modalities.

At this point, the matter becomes confused because it is not possible to understand if an impersonal force or a subject, no matter how unconscious, decides.

Sullivan arrives to a paradox by saying that dissociation causes conscience to keep actively out of conscience some part of one’s living: this is how to say that it keeps out itself.

 

 Dissociation can easily mistaken for a really quite magical business in which you fling something of you out into outer darkness, where it reposes for years, quite peacefully. That is a fantastic oversimplification. Dissociation works very suavely indeed as a long as it works…it works by a continuus alertness or vigilance of awareness, with certain supplementary processes which prevent one’s ever discovering the usually quite clear evidences that part of one’s living is done without any awareness. ( Sullivan 1953, p. 318)

 

Sullivan could not rely on current neuroscience knowledge about implicit and explicit processing systems, but when he speaks the first time about awareness in the above quoted phrase about the effects of dissociation on conscience, he seems to refer to an implicit unconscious awareness, working with strange means (supplementary processes) in order to secure that some part of one’s living will not reach classic awareness.

I think that Sullivan was trying to explain – with the tools that were available at the time -  what every clinician dealing with psychotic patients experiences; i.e. the feeling that the patients know much more than they tell us, or tell themselves. They are afraid of the consequences caused by knowing. So clinicians must say that patients, somehow intentionally, hold something outside the field of consciousness, but the words available in the shared language are insufficient to describe, and contradictions and paradoxes appear.

All these aspects represent an important theoretical issue, object of heated debate (for a review see Stern, p. 232) i.e, in Sullivan’s words, the relationship between proto-parataxic (pre-verbal unconscious) and syntaxic experiences (verbal shared conscious).

About this issue, Donnell Stern critically notes how Sullivan believes that proto-parataxic experiences can be uniquely translated into verbal form.

 

But Sullivan also seems to believe, along with most other theorists of his time, that there is an exact correspondence between the parataxic meaning and language that could be used to express it, i.e., parataxic experiences can be validly formulated only in one way . It's an unconscious experience, such as the contents of the Freudian unconscious, which simply has to be combined with verbal labels in order to get to the conscious dimension. (Stern, 2003, p. 99)

 

Donnell Stern, on the contrary, thinks:

 

The parataxic meaning is therefore unknown even to ourselves, and insight is not simply a matter of learning what we already know. The parataxic meaning does not exist in some areas of the mind in which it barricaded itself; rather it has never been formulated. As we don’t trust the unknown, fearing it could threaten our security in the future, we are not particularly inclined to simbolize the new experience in consensually validated terms. (D. Stern, 2003, p.95)

 

I think that this antithesis between a correspondentist and a constructivist-hermeneutic position is an expression of the difficulties in formulating a theory of the subject that considers a continuity between levels of organization of living systems, from the biological to the self-conscious one; in my opinion this represents a persistence of the problems introduced by Cartesian dualism.

In essence, an arbitrary separation is assumed to exist between a part of the subject able to say "I am me" (res cogitans), and a non- thinking, unconscious part,  (res extensa), which are separated by an unbridgeable gap. The conscious subject is the only interpreter who is capable of speech, but convicted to a mere hermeneutic exercise without even being remotely able to  access the experiences that found its own being.

The problem is tackled by Egdar Morin, (Morin E, 1981, p. 270) scholar with multiple skills (Doctor of History, Sociology, Economics, Philosophy and Law) but for the purpose of this work illuminating as an expert in complex systems, who states that  being a subject able to say "I am me",  is implied since the first levels of living systems:

 

Now we come to the concept of the subject ... emerged in watermark in the scientific field of immunology (..) immunology has been forced to rely on the idea of the self/non-self opposition: this distinction "self/non-self" is thus a distinction of cognitive nature. ( ... )

The specific aspect of every living organization... is its cognitive dimension, inseparable from organization.

Now the bacterium lives, organizes itself, with evidence, by itself and for itself ... but this "computation per se" can be called self-centered, if one gives to this word a strictly literal sense: "I am the center of my world in order to deal with it” (..)

OneYou can then say "computo ergo sum,"only in the first person. "I exist as a subject."

 

Thus, the “soggetto referente unitario” (unitary referent subject) (Minolli, 1993) can be thought as a continuum in which the "res extensa" is already fully subjective and source of the emergence of consciousness, the "res cogitans". In the words of Morin:

 

The error, the illusion of metaphysics, was to believe that there was a notion of inseparability between the subject and the notion of consciousness, but consciousness is the ultimate  efflorescence of subjectivity, as far as we currently know

(Morin, 1981, p. 272)

 

So, from the most basic levels of organization, the subject develops ever more advanced functions in the "computation" of interactions: these functions are the subject’s expressions, develop along a not dissectable continuum and emerge from an ongoing negotiation between autopoiesis and social interaction. The separation between cognitive functions that found “implicit consciousness” from those that underly explicit conscience is artificial, being the second always "decided" by the first. In a sort of "reversal of powers" between "Secretariat" and "Directorate-General", the contents that must or can get to explicit conscience are continually selected by the implicit “consciousness”, as amply suggested by Donnel Stern when he describes how every creative aspect of thought, such as every important development in therapy, appears to conscience from unconscious as a surprise, despite it sounds like something always known,  thus causing the "shock of recognition" (Stern, 2007, p. 121)

 

The effective surprise distinguishes the symbolization of the experience, the creative use of language, the flourishing of the explicit meaning. The formulation of the experience is a mystery; it really belongs to us more than we can belong to anything else, but we are not able to control it.  It produces  in us the feeling of recognition, the shock of recognition, because we've seen it before in the amorphous, parataxic form that we experience in our feelings of intentionality.

 

So the experience only seems to have been translated into a conscious verbal meaning, but its parataxic form had already been "seen", although in a different way: if it had been seen, it must have produced a memory in the mind. Stern seems to contradict his earlier statement when he says: "parataxic meaning does not exist in some areas of the mind in which it barricaded itself". Certainly, it had never been consciously formulated, but I think there is a problem of language: why can we speak of subject "formulations" -  symbolic productions corresponding to an idea causing a specific behavior about a given topic - only at explicit level? Cannot an esplicit conscious thought/formulation simply be considered as one of the possible manifestations of thought, "the last efflorescence" that an underlying unconscious thought/formulation produces?

Based on Stern’s studies on unsymbolized experiences, (Stern, 2007, p. 95) dissociated experiences in psychosis should be simply unknown too: on the contrary, we must say that psychotic patients avoid well-known experiences, which are symbolized, processed at preverbal unconscious levels, prevented from accessing conventional conscience and actively maintained in such state, in order to respect the “status quo”, the coherence of the subject and of the social group.

So, one does not avoid new issues, one avoids disfunctionally old isues, and dysfunctional patterns go on because some aspects of the thought cannot “go through customs” towards shareable language: in such a condition, they continue to work and generate  meanings in a spectral mode, perpetuating "family chaos"(Stern, 2007, p. 86). The appearence of some thoughts in the coscience is the result of what subjects at implicit levels negotiate to be knowable at the explicit level: this is only a particular form of consciousness processes, shared because shareable by the group. If we had to restrict conscience to this communicable self-reflexive manifestation, we should  say that conscience ignores itself.

Borrowing Morin’s words:

 

One could argue that it is strange that our knowledge ignores itself. Yes, it's very strange: our knowledge ignores much of itself, it comes from a background of unconsciousness and grows through the unconscious processes. (….)

In fact, when we say “I think”, this implicitly means "I think that I think," and it is clear that "I think" is a reflective operation that separates itself from the fact that 'I think'.

 

But explicit conscience is not at all the full expression of the whole subject, and perhaps not even the most conscious part of the subject; it is just a final “efflorescence”, whose emergence modalities will be decided in the negotiations between human subjects in the implicit consciousness level. Therefore, conscience may present discontinuities (Liotti, G. 2003), while the "computing" manifestations of human subjects defined as unconscious, including the "spectral psychotic” ones, do not present discontinuities: the subject continues to process them, and they look strange just because some “meshes of the net”, the group’s shareable code, the so-called conscience, have succumbed. To use the words of Montale "they are out the trawl".

But they are not less free, they are just waiting for more favorable conditions to go back to communicable forms, to be integrated.  This process of looking for and pursuing more favorable conditions, seems not to be governed by esplicit levels: “familiary chaos” becomes “creative disorder” and generates conscious meanings only if something at implicit level has changed, allowing something new to flourish in conscience.

In the opinion of some authors like Lyons Ruth, Tronick, Sletvold (Svetvold J, 2014) therapeutic effectiveness does not depend on interpretations but on “something more.” Tronick argues that therapeutic change depends on “dyadic states of conscience”, which are essentially emotional and procedural co-creations, in other words implicit negotiations: “they give impetus to change the mental organization of the patient, thus offering that “something more.” (Tronik E, 2008, p. 247)

In a similar way, Jon Svetvold speaks of “embodied self-experience” and “embodied intersubjectivity” to explain clinical interaction, whose effectiveness is not determined by explicit experience (Svetvold , 2014, pag. XV).

 

So, in my use, a meeting of two (embodied) subjectivities, for example analyst and patient, can be characterized either by a low or a high degree of (embodied) intersubjectivity, understood as a low or high degree of shared experience and mutual recognition.

The ability to experience both similarities and differences between our body states and those of others constitutes the basis for the registration of significant affective experiences that emerge in a relationship. These registrations take place without the involvement of reflective thought or traditional forms of symbolic representation. These nonverbalized registrations, I will argue, are critical for our ability to navigate analytic interaction.

 

They are implicit, unconscious or “unformulated” experiences, resembling those occuring in infants that sacrifices some areas of possible future conscious thought - the lizard’s tale - in order to secure the attachment to the parent.

 

 

 

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