06/23/2025
Attached is an essay I posted to our AMP ListServ today 06/22/2025:
When we are faced with momentous events on the global scale we are reminded of how the "body and mind of the collective" parallels and interacts with that of the individual, the dyad, the family and the group
Practical conflicts -- "We only have so much bread (or land, or resources) to share between us. How should we divy these so that each has enough to stay well and function, cooperatively, for the good of all, including, perhaps toward working together to make more bread" -- can be solved directly through gathering data, applying induction and deduction, dialogue, planning, assessing and analyzing
Once emotion enters in, however, the "problem-solving" process becomes much more complicated. "You took more than your share" (and, unspoken: "Now, I'm angry"), "You think you have more rights than I do" (and, unspoken, "Now, I'm incredulous, resentful and indignant"), ,"You are trying to deceive me," (and unspoken, "Now, I'm suspicious, resentful and vengeful"), "You deserve to be deceive -- or controlled, or manipulated, or punished -- in return" (unspoken, "Now, I'm feeling vindictive, seething and hostile")
On the individual level it is at Stage 2 -- "Emotions have now become part of the problem" -- that people enter therapy. People don't generally come to therapy on the basis of "practical problems," e.g., financial, logistic. They may go to an advisor or coach but, unless an emotional barrier, associated defenses, stress, resultant physiological changes and a "mental disorder" emerge they do not generally come for psychotherapy
Why do difficulties handling emotions lead to individuals seeking psychotherapy while practical problems can be addressed by other sorts of experts? Psychotherapists generally understand that emotional experience and the handling and mishandling of emotions are an interpersonal event (developmentally or situationally, usually both) and the interpersonal response necessary for addressing same requires special training in both the dynamics of the interpersonal-affective process and self-awareness (generally, in psychotherapy, revolving around the transference-countertransference dynamic). "I need to have an understanding of what obstructs my pt.'s direct access to his or her emotional experience -- and the defenses he or she puts in place of that access -- and, I also need to be aware of any defenses I might put up reflexively replicating my pt's misattunement experience so that I can attune with -- and thus, sooth, contain and foster my pt.'s modulation of -- his or her own affects.
One barrier that can be particularly resistant to attunement is compulsion. Compulsion, from a psychodynamic perspective, can be understood as "replacing affect with drive." So, instead of, say, feeling my affects: anger, hurt or sadness, I experience drive: aggression, sexual arousal/urgency or acquisitiveness. Neither anger, hurt or sadness nor aggression, sexual arousal or acquisitiveness are necessarily destructive. The former are emotions (not actions) and the latter, while actions can have their protective, procreative and thriving applications. We may need aggression as a component of self-defense, sexual arousal as part of intimacy, bonding and procreation of the species and acquisitiveness for purposes of gathering resources for harder times
However, when a drive is put in place as a defense, i.e., in place of addressing my affective experience -- for example, though there can be many combinations: violent aggression in place of anger and healthy expression of anger, sexual addiction/predation/offending in place of hurt, attachment needs and also anger and greed, usory, gambling addiction in place of sadness, fear, loneliness -- the potential for destruction is very high.
As therapists there are multiple methodological approaches to addressing compulsions but curative processes are generally some combination of limiting the compulsive acting out through behavioral and environmental controls, on the one hand while, simultaneously increasing pt experience of and access to affect attunement, soothing and affect containment on the other. "Put a 'no admittance' block on the casinos and gambling apps; but, also we need to address your loneliness, doubts about self-worth and hurt associated with your losses." One or the other alone will typically not do. E.G., AA/NA and the other self-help organizations require total abstinence. But they also offer unconditional acceptance (a component of attunement), connection, reassurance (soothing) and are affectively containing in this way
Psychophysiologically the cortico-basal-ganglial-thalamocortical circuits (CBGTC) are thought to play a central role in mediation of compulsive behaviors. Neuroscientific, psychiatric and biomedical literature will sometimes infer these circuits are causal determining factors but, we know from observation of the effect of psychotherapeutic, MICA/CAMI group and "12-step" type groups that there are more fundamental interpersonal, psychosocial environmental causal variables afoot. Then again, versus other mental disorders these domains may share more equal weight where compulsions are concerned) Studies have suggested here may be epigenetic prenatal programming in some cases though more research is warranted.
The CBGTC is involved in processes of "reward learning" and timing of behavior-reward relationship. In general pathology, problems of the CBGTC can be associated with Parkinson's Disease and Huntington's. However, with mental disorder, e.g., compulsions, OCD and other action-reward related disorders it is believed that anticipation of delayed reward is reduced such that there is an increase in pursuit of "instant gratification" producing behaviors. This could include "positive reinforcement" producing behaviors such as come from the variable ratio reinforcement (VRR) contingencies of gambling or negative reinforcement such as the relief from anxiety-provoking obsessions when the ameliorating compulsion is performed in OCD.
If we think about how these effects might be related to defensive redirecting from affect processing to drive pursuit we can consider the developmental processes associated with learning frustration tolerance and gratification delay. From the beginning of life the infant learns to tolerate the internal physiological-cum-affective experiences associated with not being able to have what one wants in the moment through the soothing effects of the attachment figures (AF) attunement with the infant's feelings of distress including hurt, resentment, anger and frustration itself while enduring the waiting process until a need is gratified. Without the affective accompaniment of the AF and associated soothing of anxiety associated with these emotions, over time the child may learn to substitute other experiences including psychological defenses. Where the intolerable affective experience is frustration itself the child may learn to substitute other, more immediate gratifications in a cycle that results in both difficulties tolerating painful affects -- again due to the lack of supportive interpersonal processing -- and proneness to cope with the discomfort through more immediately acquirable drive gratifications. "Mommy or Daddy won't help me with my angry feelings. I'll just break my sister's toys. Or, perhaps eat them. {Pica is considered a compulsive eating disorder BTW)."
Awareness of mediating neuroanatomical structures and neurophysiological process variables linking causal interpersonal-affective and interpesonal-affective-developmental event variables and outcome clinical symptom presentation, including symptoms clustering as specific mental disorders can help us better visualize and conceptualize the progression from disease etiology through to the establishment of interpersonal-affective->physiological->clinical presentation pathways, their reciprocality (e.g., the feedback loops of compulsive behaviors), points of intervention and how these can help to ameliorate the disorder and potentially resolve the pathological conditioning replacing it with healthier interpersonal-affective, behavioral and cognitive responses to stressors
On a global scale shifts in emphasis in leadership toward personal power and wealth acquisition (not in any one country; these shifts have been observed across the globe with increased trends toward autocracy and "leader-centered" governments) results in unmodulated responses among the masses who rely on those leaders to foster diplomacy and a sense of international cooperation toward a greater good WIthout a healthy, functioning "CGBCT" leadership to guide populations toward greater international interpersonal dialogue and toward greater understanding and resolution of heightened emotions, the emotions associated with political conflict "get the upper hand" and responses like "aggression", "predation" and "extreme acquisitiveness" become as acceptable to "the people" as they are motivating to the leadership. Individual Medical Psychologists can decide, for themselves, of course the degree and ways in which we might contribute to a more modulated world dialogue. In the meanwhile, in our clinical work understanding the parallels between the collective and individual levels of system disorders like "compulsion" can help us put our individual pt's struggles in perspective including the additional barriers to addressing interpersonal-affective experience in a larger environment that is pulling further and further away from such processes toward more compulsive responses
Dr. Jeff Cole
