In old Japan, masters of the various temples would stand in the central square of Kyoto and discuss their views. After a while, people would assemble to listen, ask questions, and perhaps heckle. Those who found value in the discussions of one or another master were free to attend classes at the temple, and perhaps join as adepts. Behavior OnLine is the Kyoto of our time, providing in this case conference the sort of Town Square in which we are able to show how each of us might approach problems of interest to many.
In the week since Henry Stein's perplexing response to the next-to-last instalment of the case of Harold Payne, and my vexed answer, I have revisited Gil Levin's interview with Henry, Henry's biographical material, and the books of Adler in my own library; also have I read the totality of the posts on the Adlerian forum and the chapter written by Drs. Stein and Edwards available through hyperlinks in that forum. There is, of course, much to admire in this material, and much to respect in the attitudes toward our craft espoused by this worthy and vigorous group. These are good people who wish to do as much good as possible for those who approach their temple for instruction.
Yet each of my complaints remains pretty much as stated, even though I now understand why Dr. Stein and Edwards saw them as insulting to Dr. Stein as a person rather than illustrative of our differences. As I mentioned in the post that has been misinterpreted as a "fight," I was more than surprised that Henry knew so little about my published work (and the summaries of it that appear on BOL) and was innocent of my basic orientation. Because none of his adherents has looked beyond their own positions while defining mine as an attack on them, I will explain what I mean when I ask to relegate certain aspects of contemporary Adlerian practice to the other end of the century.
I see the individual at the intersect of a biological nature, a psychological history, and a social matrix; this biopsychosocial view corresponds quite well to the views of both Adler and Freud as well as many of our contemporary thinkers. Who we are at any moment in our trajectory through life is the result of all three realms. Using the language of our era, I have suggested an analogy to the common desktop computer that allows us to work because it contains hardware, firmware, and software. I define the hardware of human emotion as the brain (with all its wiring and chemical messengers), the skin and muscles of the face that acts as the display board of the emotions, and a host of endocrine and exocrine systems. Firmware, which in the computer is represented by the chips that contain instructions once written by intelligent individuals but now packed in containers that make these instructions inalterable, is represented by the drives and the affects, built-in mechanisms that tell us how to do a number of actions when we are too immature to do them on purpose. Computer software is the moiety of the system that is most variable—it is made up of instructions known as experience—and somewhat different for each of us. Therapists who study with us must become familiar with the workings of all three parts of the system, despite which part they choose to treat.
In general, each system of therapy addresses one or another aspect of the system. Although Adler recognized that the shame resulting from the experience of inferiority was likely to produce a host of defensive manoeuvers, the system of therapy devolving from his work ignores my observation that in many people the sense of inferiority results from disturbances of serotonin metabolism that can only be corrected by the use of an SSRI medication such as Prozac. There is an interaction between biology and biography that cannot be ignored. Of course I have seen witless pharmacotherapy that ignores the person who feels inferior; in my cosmology, neither may be ignored. I define Adlerian therapy as an excellent system of software improvement, but one limited by its apparent refusal to recognize the biology of the mind despite occasional clinical successes such as the patients Henry describes as refractory to biological treatment but amenable to his ministrations.
Furthermore, from my experience as a therapist I reject with enthusiasm Henry's contention that Harold Payne has striven for excellence in his chosen field because he is "driven by an unconscious, disguised, aggressive goal of burning ambition and revenge, one that needs to be fueled by very strong, hidden, negative feelings" (Henry Stein's post of 23 November 1996). Nor do I find that Harold's "seeming willingness to ‘submit to the will of the other' suggests a psychological crouch in preparation before the leap of retaliation" or that "In this context, adultery can be imagined as an ultimate revenge." From what I have read of Henry's work and orientation, such interpretations are theory-based, rather than experience-near understandings of the patient's inner workings. I believe that most people strive for excellence not to triumph over others and mitigate injury done earlier, but in order to enjoy the best use of their own equipment. Of course I have seen people whose life goals have been formed in response to injury, but I decry any pathomorphic distortion of either success or achievement.
As a psychiatrist, I am alarmed by a clinician who says (as does Henry in his above-mentioned interview with Gil Levin) that "I spend a good deal of time organizing, analyzing, and synthesizing the case material. This process is facilitated by the use of computer software programs, resulting in a series of conceptual maps: a multi-generational genogram that clarifies family member descriptions and relationships; a time-line diagram that highlights significant positive and negative events; and a matrix that organizes my conclusions about the patient's style of life, including: inferiority feelings, compensatory fictional goal, level and radius of activity, use of symptoms and emotions, degree of community feeling, private logic, earliest recollections, and the antithetical scheme of apperception. These maps provide an on-going guide for treatment planning." Even the electrocardiogram is best analyzed at the bedside, no matter how much information may be contributed by computer programs.
The difference in our approaches to the patient are inherent in the paragraphs above. Although I am quite alert to all of the information that fascinates Henry, I am even more interested in the data that passes to and from patient and therapist as the affect of each is expressed, transmitted, mutualized, and interpreted by both partners in the interaction than in any analysis that may be provided by a computer program. I believe that we are born with the biological equipment to experience nine innate affects, each of which is a patterned reaction to the ways stimuli enter the central nervous system, reactions that have nothing at all to do with the actual information carried by the stimulus. Our response to a stimulus will contain elements of both the physiological affect mechanism and our subsequent appraisal of the stimulus with which it has been associated. No one of these nine innate affects is more important than any other, and none is by its nature associated with any drive or any psychological function.
Whenever I see a clinician/theorist leap to the conclusion that the untoward actions of a patient are caused by unconscious hostility, I worry that the clinician may retain more of Freud's theories about emotion than s/he knows. Freud (and, as far as I know, all members of the Vienna Psychoanalytic Circle) believed that all emotion came from drive forces that were unable to unable to achieve their aim. I know of nothing in Adler's work that says otherwise, even though I know very well that Adler championed a retreat from Freud's position that the energy from the sexual drive powered most of psychology. Henry's misunderstanding of my patient in terms of aggression and hostility seems to have no root other than this theoretical orientation, which I reject firmly and to which I have devoted a great deal of my writing. It is this theoretical basis, and this alone, that I wish to relegate to the prebiological phase of psychotherapeutic practice and that I challenge at every level. I am aware (and gratified) that so many of our colleagues have gravitated toward the work of Alfred Adler, whose humanity is essential to his work and that of his followers, but I sure wish the entire group were willing to think a bit more deeply about the aspects of emotion I have described in my work.
I will try to summarize my therapeutic goals so that Drs. Stein and Edwards may be spared attention to my books and papers. People come to us only because they are involved in an affective experience for which they have no adequate system of modulation. Through our initial history we try to figure out whether this affect comes from a problem with hardware or software, and to provide treatment based on that assessment. Usually, however, both are involved, for affect and experience are always intertwined; it is our job to minister to both. I see the nine innate affects as a bank of spotlights, each of a different color, each encouraging us to act in a different manner, each turned on by its specific biological trigger, and each making us pay attention to its triggering source in its specific way. Nothing may become the source of our attention until and unless it has triggered an affect, and nothing may be said to be conscious until it has been moved into a special realm of neocortical operation by the action of an affect.
The innate affects are primarily facial mechanisms; what information they provide is displayed first on the signboard of the face as well as by certain alterations of pulse, respiration, odor, and voice. Each affect is an analogue of its triggering stimulus, and each of these analogues acts as an amplifier that makes its trigger more of whatever it was before it was amplified. Affect makes good things better and bad things worse. It is from the intensity of the affect triggered that we learn or assign the importance to us of that trigger in that moment. Because the affect of the individual is transmitted into the interpersonal space, and because we tend to mimic the display of the other person, we experience that other person's affect by the process of interaffectivity. As we gain more experience with our own affect and that of others, we learn enough that interaffectivity gives way to mature empathy, the process through which we feel the emotions of others. Much of what we call intimacy is based on such interactive processes, which are managed by what I have called the "empathic wall," and which my colleague Vernon C. Kelly, Jr. has discussed in his chapter "Affect and Intimacy" for our recent book "Knowing Feeling."
All nine of the affects are equally important to us, and we work in therapy to undo misconceptions, early scripting, biological glitches, bad habits, and a host of other impediments to affective freedom. Our aim is that the adult live with the ability to respond like the Zen Master—free to experience any affect triggered by any stimulus, and to act on the trigger of that affect in the way best for that individual. We do not have a system of therapy, rather, what we have come to call "the Philadelphia System" is a plea to avoid systems in favor of a more free- form approach. We take it for granted that the competent therapist will know at least a little bit about every major and most of the "minor" techniques of treatment and be able to use each as indicated. While it is true that in this current period we pay a lot of attention to the biology and psychology of shame, this derives more from our experience that the shame family of emotions had for too long been ignored by our field than from any belief that it is more important than the other eight.
We want our colleagues to change their work in only one way. It is important to us that our profession recognize that what in the adult is known as emotion is the end-product of a group of innate biological mechanisms that have evolved as amplifiers of other human functions; that there are nine of these mechanisms; and that whenever we deal with the human we are working with matters of hardware, firmware, and software. We really don't care what system therapists use as long as they pay attention to affect, for we believe that good therapy comes from good people and that the way people do therapy is based in their own personalities, their own essence. We believe that people are inherently good, that they strive to minimize negative affect and maximize positive affect, and we set as our primary goal our work to assist nature toward its primary goals.