Jellema, A., 2005. An Animal Living in a World of Symbols. Reformulation, Autumn, pp.6-12.
Based on a paper given at the First International CAT Conference,Valamo, Finland, 5-8 June, 2003
Before this conference I read a little about psychology in Finland in the British journal “The Psychologist” (Helkama and Foreman, 2003). It mentioned Eino Kaila as a very influential Finnish psychologist. In one article there was a quote from Professor Martti Takala about Kaila’s work, which I’ve taken as the title of my presentation. The author summarised Kaila’s conception of a human being as, “an animal living in the world of symbols”.
I wanted to write something about attachment and Bakhtin after attending a useful workshop run for ACAT supervisors by Liz Fawkes, on Vygotsky and Bakhtin. My presentation today is about the importance of acknowledging that we are both physical creatures and symbol-users. Bakhtinian ideas stress the symbolic aspects of human behaviour; in contrast, attachment theory puts relatively more stress on what we are more likely to share with animals. I hope to show you that, while Bakhtinian and attachment ideas are distinctive, they can complement each other, and that we can value the contribution of each.
In contrast with Bakhtinian ideas, the place of attachment thinking in CAT is not so well established. I will use Jeremy Holmes’ (1993) definition of attachment: “The condition in which an individual is linked emotionally with another person, usually, but not always, someone perceived to be older, stronger and wiser than themselves.”
There are three major characteristics of attachment behaviour and feelings. These are to do with closeness and threat. Although we see them most strongly in children, they are also found in adults. They are (1) seeking proximity, or closeness, to the attachment figure, or the loved one, particularly when threatened or in danger. The relationship with the attachment figure provides us with a (2) “secure base”, which allows us to go off and explore the world with confidence. And when we fear that the person we are attached to may not be available, we may (3) protest about the separation from that person. Linked to these is another point - that we cannot always see evidence of attachment behaviour when a person is feeling safe - attachment may only become apparent when there is a threat to the person’s security.
The other main characteristics of attachment are to do with the importance of individuals, and the persistence of attachment in the face of experience. We attach to a few specific people. Attachment behaviour and feelings are very long-lasting. We cannot make these feelings go away, as we know all too well when we grieve for someone who has died. And attachment does not habituate, or lessen in strength, very much. Attachments also continue in the face of neglect and abuse – in fact they may even strengthen under these conditions (Weiss, 1991). These features of attachment have developed over thousands, even millions of years, through evolutionary processes - because they have helped us to survive as a species.
As a huge body of research and thinking about attachment has been generated over the last 30 years, (see e.g. Cassidy and Shaver, 1999) I would like to summarise briefly some of the main changes which are relevant to therapists, since Bowlby wrote his major text on “Attachment” in 1969. Attachment became the subject of intense research study by Mary Salter Ainsworth and her students. As far back as 1978 they provided clear empirical evidence as to how different patterns of childhood attachment came about, in response to various patterns of caregiving – so attachment has in fact always been a fundamentally relational theory (e.g. Ainsworth et al., 1978.). Bowlby’s “internal working model” is primarily a model of a relationship.
Since the mid 1980’s, two major developments in attachment research have occurred. Firstly, attachment workers looked in depth at how attachment experiences influenced our inner worlds. This resulted in the development of the Adult Attachment Interview, or AAI, to assess lasting patterns of attachment in adults (George et al., 1985; Main and Goldwyn, 1994). Although the AAI asks about the experiences of attachment the subject has actually had, the AAI is primarily an instrument for understanding how people make sense of those events – in other words, the AAI assesses how adults symbolise their attachment experiences.
The second new development has been that many attachment researchers now focus on attachment in children and adults who have been abused or neglected, rather than on so-called “normal” populations. This makes their work very relevant for therapy. In the modern world, we are in less danger now from animals or natural disasters; the main threats to us come from other humans.
Over the past six or seven years Tony Ryle and I have had an ongoing dialogue about the place of attachment in CAT. We may never be entirely in agreement about this – which makes for some interesting debate! Some of his criticisms of current attachment theory and research in the recent textbook (Ryle and Kerr, 2002) are valid. But I do think that the phenomena of attachment warrant an important place in CAT. Attachment issues become more important, the more we work with very disturbed and traumatised patients, as many of my patients have taught me.
In discussing attachment and Bakhtinian ideas in CAT, I want to make five main points:
(1) Attachment helps us keep aware of the importance of the body, complementing our focus on language in CAT;
(2) An attachment perspective helps us keep in mind the importance of danger and fear in psychopathology;
(3) Research on Dismissing attachment stresses that language can sometimes be deceptive;
(4) Bakhtin’s idea of the “super-addressee” has similarities with the notion of the “secure base” in attachment;
(5) Making more use of the Bakhtinian concepts of “dialogue” and “voices”, combined with an attachment perspective, will help emphasise the importance of power relationships in human distress.
(1) Firstly, an attachment perspective helps keep in mind the importance of the body in communication, and in therapy in particular. This complements the more symbolic focus in CAT on sign mediation, which has been developed through the influence of Bakhtin’s ideas.
Modern attachment theory is a biopsychosocial model. The biological basis of attachment has now become well established through empirical research. Over the last fifteen years, we have learnt that although the basic biological mechanisms of attachment are similar in all mammals, attachment processes are strongest of all in humans (Polan and Hofer, 1999, p.163). This is because they are reinforced by symbolic means. We know now that attachment between an infant and its mother regulates the infant’s behavioural and physiological systems. Attachments involve physiological interdependence between the partners – when an attachment relationship is lost, bodily functioning is also disrupted. Physiological soothing is a major feature of a secure attachment relationship, so that when a relationship breaks up, so does the bodily regulation of both parties, at least for a while; adults can “die of a broken heart” when a beloved partner dies.
Turning to sign mediation, signs can take different forms – for example, words that are spoken or written, images, intonation, and gestures (see e.g. Leiman, 1992, 1995). As a literary theorist Bakhtin was of course primarily interested in words as a type of sign, and tried to understand human behaviour through the use humans make of language. (Holquist, 2002, p.33)
Bakhtin also stressed the importance of context in understanding signs. In his famous “snowflake” example, Bakhtin, writing as Voloshinov (1976), stresses the importance of the whole context to be able to make sense of the utterance of one word, “Well!” “Two people are sitting in a room. They are both silent. Then one of them says, “Well!” The other does not respond. For us, as outsiders, this entire conversation is utterly incomprehensible. Taken in isolation, the utterance “Well!” is empty and unintelligible. In order to disclose the sense and meaning we must analyse it. But what exactly is it that we can subject to analysis? Let us suppose that the intonation with which this word was pronounced is known to us; indignation and reproach moderated by a certain amount of humour. This intonation somewhat fills in the semantic void of the adverb well, but still does not reveal the meaning of the whole. We lack the “extraverbal context” that made the word well, meaningful for the listener.” (The context was that both people looked up at the window and saw that it had begun to snow in May; they were tired of the winter and were very disappointed that spring was not yet here).” (in Holquist, 2002, pp.62-63).
Here, not just the historical context, but also the bodily context of this verbal utterance, are necessary for us to understand its meaning. In everyday situations, we often express what we mean more through intonation and non-verbal communication than through the actual words we speak, particularly when we are communicating interpersonal attitudes and emotions. If there is a discrepancy, it is the non-verbal aspects we are more likely to believe (Argyle, 1972).
Let me use another example here to illustrate the importance of the bodily context. Here is a quote from James Zappen, a commentator on Bakhtin: “In “Problems of Dostoevsky’s Poetics”, (Bakhtin) illustrates dialogic interrelationships with reference to two judgments: “Life is good”. “Life is good”. From the point of view of logic these are absolutely identical judgments. Each expresses the same semantic orientation towards its referential object. Considered as a dialogical interrelationship, as the utterances of two successive speaking subjects, however, these two judgments express affirmation or agreement between the two speaking subjects”. (Zappen, 2000)
But two such voices are not necessarily in agreement. Let’s suppose the first voice says, (confident, happy, a bit smug) “Life is good”. The second voice then says to the first, (incredulous, sarcastic, angry) “Life is good?”. The whole meaning of the dialogue has now changed. They are no longer in agreement, but are in profound disagreement, once we take account of the expressivity and intonation of the speakers, which is an aspect of their bodily communication.
Of course Bakhtin did recognise physical expressivity as an essential feature of an utterance, (“In this dialogue (of life) a person participates with……his whole body”) but the body is de-emphasised in Bakhtin. Many words and gestures gain particular force precisely because of their strong connection to bodily states and physical relationships - for example, those relationships which involve fear and danger. This brings me to my next point:
(2) An attachment perspective emphasises the importance of recognising real danger and fear in therapeutic situations.
Bowlby (1969) described attachment as a process which helped ensure safety in the face of fear. Of course, all experience is mediated, but some experiences are more directly mediated than others, such as the physiological experience of fear.
Fear is one of the basic emotions, (Oatley and Jenkins, 1996), which is experienced very rapidly in areas of the limbic system such as the amygdala and in the autonomic nervous system; this happens prior to symbolic processing in the highly developed cerebral cortex. Over thousands of years of human evolution, our nervous system has become biased towards the perception of fear, because it has a major survival function - sometimes we need to run away before taking any time to think.
It is not often, though, that a patient is referred for psychological treatment who is described as being “afraid”, or “fearful”. What we do get, though, are plenty of patients in mental health settings who are described as being “anxious”. So what is the basic difference between these terms?
Rycroft’s Dictionary of Psychoanalysis (1968) describes fear as “a primary emotion evoked by impending danger…”, or as “objective anxiety”. He describes anxiety as “irrational fear”, “out of proportion to actual danger”. So the key issue in distinguishing the two terms, is the reality of the danger a person faces.
One so-called “anxious” patient who has stuck in my mind for many years, is an agoraphobic woman who attended a day-unit; no matter how I tried to help her go outside, she continued to be anxious. Her symptoms made sense eventually when it emerged that her husband was obsessively jealous, and would follow and threaten her whenever he could get away from work. No-one involved in her case had initially thought to ask whether there might be a real, meaningful basis to her discomfort – that she was really more “afraid” than “anxious”. A CAT therapist treating this patient now, would be likely to pick up on the real danger to her quickly – by asking about her husband’s behaviour in relation to her anxiety. Reciprocal roles are key to this understanding. But I think an attachment perspective reinforces CAT’s perspective by highlighting even more the reality of the danger that such a woman could face. There are real things to be afraid of, in the here and now, but this is not always evident in therapy, since language can be used to obscure as well as to clarify.
(3) Research on Dismissing attachment also highlights that the use of language is not always helpful or positive – it can often deceive.
We now know a lot about the differences between securely attached adults, and those who are insecurely attached. Securely attached people are able to make use of a wide variety of thoughts, feelings, and physiological sensations and consequently they are less likely to suffer mental health problems (Dozier et al, 1999). Insecure attachment is a risk factor for mental health, because in all the insecure patterns, particular thoughts and feelings are excluded, ignored or dissociated. Dismissing and Preoccupied attachment are broad attachment strategies shown by many patients (Jellema, 1999, 2000, 2002). In brief, Dismissing patients devalue or cut off from past and present attachment experiences, and minimise their importance in their current lives, preferring to see themselves as self-sufficient. Preoccupied patients veer towards the other extreme; they are emotionally enmeshed with attachment figures with little sense of personal autonomy.
Two American researchers, Mary Dozier and Roger Kobak (e.g. Dozier and Kobak, 1992; Dozier and Lee, 1995) focus on differences in the use of emotion; they talk about Preoccupied patients as having “hyperactivating” affective strategies, exaggerating attachment-related emotion. In contrast, Dismissing patients use “deactivating” affective strategies where emotion is downplayed.
Pat Crittenden (e.g. 1997) adds a cognitive emphasis; Dismissing patients rely too much on cognitive understandings and dismiss much emotional experience - they are “thinkers” rather than “feelers”. Preoccupied patients use the opposite strategy, valuing emotion too much and finding it difficult to think about difficulties and what might be their contribution to them. Dismissing patterns are more common in Western societies than Preoccupied ones, (Britain and Finland included!) so I want to focus here on Dismissing patients.
Crittenden, Dozier and Kobak all agree that people with Dismissing attachment strategies act as if many attachment-related experiences and emotions are of little or no concern to them. But bodily emotional states signal what is of most importance in our lives. Keith Oatley, an eminent psychological researcher into emotion, states that: “….emotions…..are the guiding structures of our lives - especially of our relations with others.” (Oatley and Jenkins, 1996, p.124) The neurologist Antonio Damasio (1999) has shown how we cannot make effective plans or decisions using reason alone - emotion must also come into the equation.
Dismissing attachment patterns downplay danger and insecurity. These patterns develop through relationships with parents who themselves dismiss children’s attachment feelings or intrude their own needs inappropriately. A person’s attachment needs “go underground” or temporarily extinguish when there is no chance of their being met.
In 1990, Mary Main wrote about primary and secondary (conditional) attachment strategies, in a way that is similar to what Ian Kerr (2003) described at Valamo when he distinguished different types of reciprocal roles (primary and compensatory). Main sees expressing attachment needs as a primary strategy, but one that can be overridden – at a price. The AAI asks what happened at home in childhood if the patient was upset in some way. Many Dismissing subjects report that they were ignored, criticised, or told to “stop being such a cry-baby”. If the child was physically hurt, or ill, then the child was in some real bodily danger – but parents ignored this and so the child learnt to inhibit such signals. Crittenden (1997) shows how Dismissing patients have been deceived by the words their caretakers have used, and how they in turn then deceive themselves about the nature of their distress.
But attachment needs are biologically based and so it is unlikely that they can ever disappear fully. In Dismissing patients there may be some dissociation of experience between the physiological and the verbal levels. These are the patients who are most likely to complain of somatic symptoms, while denying that there is anything wrong emotionally.
So, for Dismissing patients, it is the more “symbolic” aspects of life – words and verbal thinking - which take precedence over the less symbolic, more “animal” aspects of existence – such as emotions and their accompanying physiological sensations. While this would have been the adaptive strategy while they were young, as adults this is much less advantageous to them.
With these patients, to be able to really help them, we as therapists have to be prepared to work more with our own bodies – to be particularly alert to our physical counter-transference, as sometimes this will be the only way we can really pick up what is the matter with the patient. Words, as linguistic signs, are vital to help heal the patient in therapy - but sometimes they may also mislead us when we are working with such Dismissing patients.
So in some ways an attachment perspective can complement a more Bakhtinian approach. Now I would like to make a point about similarity between the two perspectives:
(4) Bakhtin’s idea of the “super-addressee” has similarities with the notion of the “secure base” in attachment theory.
Mikael Leiman (1997b, 2002) has recently introduced the idea of the “super-addressee” into his writing on psychotherapy. Every utterance, according to Bakhtin, is meant for somebody – in his language, it has an “addressee”. Bakhtin stresses that we need our words to be heard and responded to by somebody:
“(the word) wants to be heard, always seeking responsive understanding, and does not stop at immediate understanding, but presses on further and further…..For the word, (and, consequently, for the human being) there is nothing more terrible than a lack of response”. (Bakhtin, 1986)
But, says Leiman, there is plenty of evidence from therapy transcripts, of there being another addressee in the patient’s speech. It is as if there is an unseen person that the patient is also addressing, someone else beyond the person to whom the speech is actually addressed: “The person who understands becomes a participant in the dialogue, although on a special level….Understanding itself enters as a dialogic element in the dialogic system and somehow changes its total sense. The person who understands inevitably becomes a third party in the dialogue….but the dialogic position of the third party is a quite special one. Any utterance always has an addressee…whose responsive understanding the author …seeks and surpasses. This is the second party…But in addition to this addressee (the second party), the author of the utterance, with a greater or lesser awareness, presupposes a higher super-addressee (third) whose absolutely just responsive understanding is presumed…” (Bakhtin, 1986).
This is reminiscent of attunement - see Stern (1985), and Trevarthen and Aitken (2001). But I think that the super-addressee which may be detected in the dialogue of many patients is more than the idea of an understanding, attuned other – via the super-addressee, a traumatised patient may be seeking the back-up of an other who offers safety and support – in other words, an attachment figure, providing a secure base (Bowlby, 1988). One of the major functions of attunement is to promote attachment, and thus to ensure the safety of the child in the presence of danger. When we are securely attached, we feel there is someone who is ultimately on our side - who we hope will support us with words, and deeds if needed, if we are threatened.
Not all patients attach to therapists, in the proper sense of the word. But some will. To recap, when we talk about our attachments, we are talking about relationships we have with a few people who are very special to us. Although attachments develop primarily in early life, they are also a feature of adult relationships that mean the most to us. Attachments are unique relationships, in which particular individuals matter to us – we “accept no substitute”. This perspective is also shared by Bakhtinian theory. Chris Fujiwara, a recent commentator on Bakhtin (1998), has written, “the third party of the super-addressee is to be sharply distinguished from the neutral, depersonifying observer of the sciences, also called a “third” party, in whose world ‘everything is replaceable’”.
So attachment theory would suggest that with very damaged patients, the therapeutic relationship is likely to matter more than the particular techniques or tools which we are using to help the person. (c.f. Lambert, 1992). The sense of safety in an attachment relationship is normally a felt bodily experience, of calming and soothing. For those patients who have had little of this early on, they need us in person, as well as our symbolic presence in the form of our CAT letters and diagrams. Some may need a relationship with us beyond the usual time-scales for therapy, in order to learn how to soothe themselves effectively for the first time. Attachment theory reinforces that we should always keep in mind the patient’s real needs for safety, now. This takes me to my final point:
(5) I would like us to make more use of the Bakhtinian concepts of “dialogue” and “voices” in CAT. Recent understandings of attachment stress the importance of danger, which is of course about power; and we can see “dialogue” and “voices” as concepts related to social power.
In CAT, we talk about unhealthy reciprocal roles - but why are certain roles unhealthy? Often, it is the nature of the dialogical relationship between the roles that is key. In any relationship, are we talking about true dialogue between the parties, or is it more like a monologue on one person’s part? The difference between good sex and rape primarily lies in the power relationship, so that in the first case we talk about loving reciprocal roles, in the second we are talking of abuse, because one partner overwhelms the other.
In their latest CAT textbook (2002, ch. 4), Tony Ryle and Ian Kerr refer to a paper by Cheyne and Tarulli (1999). Drawing on ideas from Bakhtin, Cheyne and Tarulli suggest that there are different forms of dialogue in the Zone of Proximal Development. Two of these are the Socratic form, and the Magistral form. A Socratic dialogue, in the true sense, involves questioning, mutuality, openness and relative equality between the participants. This is in contrast with the Magistral form of dialogue, in which one partner is seen as having the authoritative voice, and so is superior to the other partner. So the differences between these forms of dialogue are essentially to do with power.
Much so-called “psychopathology” has come about through the person’s relationship with Magistral voices of parents and abusers. The more abusive and neglectful the early experiences of the patients, the more damaged they are likely to be in later life (e.g. Zanarini et al, 1989; Zanarini et al, 1997). I think we in ACAT could do more to promote and publicise our understanding of severe disturbance – that much of it has originated in inappropriate Magistral power relationships. Bill Stiles’ recent work (1997, 1999) on suppressed, hidden voices in psychotherapy, can help make the power formulation clearer. These voices derive their power from embodied experience, from real-life experiences of not being allowed to speak.
Mary Zanarini’s research has addressed the early experiences of borderline patients; research using the AAI by Fonagy et al (1996) and Patrick et al (1994) relates to the impact on the adult of such early difficulties. They have clearly shown that most BPD patients have basically similar attachment patterns; their attachment style is usually Fearfully Preoccupied, and they also often show Unresolved trauma or abuse, as well as loss (E3/U). But in many cases of abuse or trauma, the “gang” or “mafia” described by the analyst Herbert Rosenfeld (1971) is not just a state of mind, but is real – and not just in the patient’s past life. There often are people in abused people’s current lives who really are out to “get them”.
Some of our patients have experienced forms of abuse which are more like torture – and torture usually brings permanent changes. I remember James Low on the second CAT Advanced course telling us that he thought it was possible to change people’s reciprocal roles for good in only ten minutes. We were puzzled – how could this happen? James’ answer was simply, “Through torture”. A number of my BPD patients have suffered, and sometimes continue to suffer what I consider to be torture – for example, one of my women patients has often been forced by her mother to watch her father slit his stomach open.
Perhaps we should also think more about why it is mainly women who are diagnosed with BPD? Attachment theory has something to say about the different evolutionary adaptations of men and women (Perry et al, 1995). Hagan and Smail’s (1997) work on power-mapping shows the crucial importance of real-life support in getting disempowered women to change, particularly with very deprived women. So I would also like us in CAT to give more attention to gender issues.
In Tony Ryle’s letter to the Conference yesterday, he mentioned the “violent century” we have been living through. So I hope we can also allow ourselves to know more about our own powerful and damaging reciprocal roles. We do not have to agree with Kleinian theory to appreciate Melanie Klein’s emphasis on the more aggressive aspects of our relating (bearing in mind Al Qaeda, and suicide bombers. The more we treat severely abused patients with CAT, the more we need a “theory of evil” (Mollon, 1996). Once again, an attachment perspective with its focus on safety and danger, helps us keep power in mind.
Our world today has been described as a “postmodern” world. In such a world, where, it is said, “everything is relative”, everything can seem equally valuable, or valueless. But in different ways, both Bakhtin and attachment theory have something important to say about value. Bakhtin steered clear of the “nihilistic trap” that deconstructionists like Jacques Derrida fell into (Honeycutt, 1994). Bakhtin’s ideas about dialogue make it clear that we cannot live in the world and be neutral observers.
The work of Bowlby and his followers also offers a welcome corrective to endless relativism. The most meaningful events of our lives – birth, marriage and death – derive their force from attachment, because attachment is a crucial motivational system with a strong biological basis, formed over thousands of years of the history of our species.
I would like to finish by mentioning another idea from Bakhtin, that of the “surplus of seeing” (Holquist, 2002, p.36). People never can expect to agree entirely with each other - because each of us sees the world from a different bodily standpoint. For example, I cannot see the back of my own head; nor can you see yours. However we can learn from each other’s viewpoint. And so together, we can work out more fully what the world looks like. The same applies to how we understand the world – and human distress. Bakhtinian and attachment ideas can complement each other here. I hope I have demonstrated that there can be more of a “marriage” between the ideas of Bakhtin and Bowlby in CAT – and, as in a good marriage, that each “partner” can be valued for the individual qualities they are able to bring.
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This paper was presented to an audience whose first languages were primarily Finnish and English. Many thanks to Liz Fawkes for her comments on this version, adapted for Reformulation.
We would like to encourage other contributors to the Finnish conference to submit their presentations to Reformulation.
CAT and the Cultural Formation of a Case of Anorexia Nervosa: An Italian Case Study
Cristina Fiorani and Marisa Poggioli, 2005. CAT and the Cultural Formation of a Case of Anorexia Nervosa: An Italian Case Study. Reformulation, Autumn, pp.13-17.
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