Episode 172: Mind, Self, and Affect with Guest Dr. Drew (Part Two)

0:00 Drew: Please don't re traumatize me.

0:03 Wes: I think what we want to talk about next is this section that begins on page seven of Fonaghy's paper, Transmission of Attachment Security. Because the real thesis here is that the quality of an attachment to a primary caregiver will predict how well children do with various theory of mind tasks.

0:25 Drew: I wonder if we should dial back and just talk about what attachment is even.

0:28 Wes: Yes, good point. So on page eight, the bottom of the right column, he's really referring to other authors, as he does many times. But he says if secure attachment is conceived of as the acquisition of procedures of goal oriented rational action for the regulation of aversive states of arousal within relationships. Well, let's just leave it there. So that's one way to describe this. It does sound weird because I think the way we think of attachment in a very vague way is just sort of the closeness and lovingness of the relationship of the infant to the parent.

But in this more technical explanation, if we're thinking of quality of attachment, it's about how well the relationship with the caregiver helps the infant regulate its own distress, especially distress in the context of relationships with other human beings. Not that Fonagy goes into all this, but maybe we should go into the different types of attachment. Secure versus disorganized. And maybe Dr. Drew is the one to do that.

1:27 Drew: I think there are essentially four main categories of Attachment. And this is all based on observations not just of infants, but adults. We carry these attachment styles into our adulthood and then of course, into our parenting style as well. And one of the, again, back to the goals of treatment is to try to develop something like a secure attachment. So that model of security then gets reflected back into the interpersonal context in that person's life, whether it's in their romantic relationships, their friend relationships, or their parenting relationships.

So it's really a construct. And I do want to also read something that he said that I, I made emphasis of. He says, quote, there's general agreement that as the self exists only in the context of the other, the development of the self is tantamount to the aggregations of experience of self in relationships. And those experiences of self can be sort of parsed into four broad categories of relating. One of the ways they examine this is looking at the still face paradigm where the mom just sits there with a blank face and looks at the child and they see how the child responds to that and then how the dyad then recovers from that stress.

But it's interesting, you know, we're talking a lot about reflective function of this paper that it's so stressful to a child just to have a face go flaccid that they become acutely distressed within minutes. So that's how much interaction goes back and forth between a child, even pre verbally in face to face interaction.

3:03 Wes: So how do we feel about that definition of attachment?

3:06 Dylan: I like the example emphasizing how much of who we are depends upon the other, that it's not possible according to this. That would be the fact of the matter, that from infants all the way up to adults, we get our understanding of ourself by seeing it reflected in other people. That we don't just do it by ourselves.

3:26 Drew: Right? And there's templates that are left behind. People think about this as procedural memory. He says, given the features of attachment, the schematic representations postulated by attachment and object relation theorists are most usefully construed as procedural memories. In other words, not explicit memories, but just experiential templates that we automatically engage with.

3:53 Mark: So it seems surprising, given a lay understanding of attachment, that this would be so different than attachment to my security blanket, say.

4:02 Drew: I think the simplest way to think of it is that there are paradigms of attachment and there are healthy and unhealthy attachments. And the unhealthy ones fall into specific categories like avoidant or disorganized. And disorganized, unfortunately, is one of the more common things that we see today where the attachment is disorganized, the self is disorganized, the love and attachment is to an object which is also the source of distress and disorganization.

4:30 Dylan: I just wanted to ask one question, Drew, about when you say see more today when I read this, there would seem to be a separate conversation about what affect a particular time and place and era have on these effects in our psychology. But I've interpreted all of these things, including the notion of this attachment theory as being something that would be just characteristic of us as human beings. And it may be that we live in circumstances either individually or in groups that would cause for instance, more frequent disorganized attachment as opposed to healthy attachment. But that phenomenon categories are intended to be just true of human beings in general.

5:15 Drew: That's absolutely true. And everything of a psychobiological nature develops in a socio historical context. Right? So the four types is secure, anxious, preoccupied, dismissive, avoidant and fearful avoidant. Those are thought of as the four sort of common sorts of ways in which these things are categorized. And I don't think it's useful to go into the specifics of any of these things. But if you want to think of it practically a child that is stressed and then mom comes back and tries to re regulate with the child and the child diverts its head 90 degrees and sort of becomes flat with its affect and doesn't really engage. That's an attachment. That's an evidence of an attachment style.

5:53 Mark: So reading this specifically the Schore's attachment and regulation of the right brain made me feel better about my overattentive parenting when my kids are very small. Because you get the feeling at the moment when you're around a little baby that really as long as they're awake, ideally, if I was a good parent, I should be there kind of making faces, kind of paying attention to them, really locking eyes and not necessarily jumping to their every whim, but attending to them. And so to the extent that I just can't do this anymore, to the extent that I'm stressed, to the extent that whatever, then you feel like you're a bad parent after some time of that, then I shifted more to the camp of no, really, throughout history parents have not been that spastically attentive to their kids and they did just fine.

So really don't be so hard on yourself and reading this like no, actually my initial concern and my initial instinct in actually facing the kid seems like it was justified that it's this sort of reacting that is the healthy thing. And that if you're paying attention to your kid but have a flat face that's doing this experiment that you were just talking about, that this will freak the child out and you have to kind of do something to correct that.

7:00 Drew: That Mark, you're a good father. It's okay.

7:07 Mark: They're teens now. I tried to do that now with them and it just freaks them out. Stand and stare at them and make

7:14 Drew: faces and oh my gosh. But yes, we don't do enough of it. And so the child is abandoned and abandonment is actually considered the most significant trauma you can possibly perpetrate because they are then left with no access to all of these mechanisms we're talking about now. I disagree with that. I actually think that you can be active in your abuse and that ends up being more shattering. But we have a lot of trouble with kids not being adequately attuned to during the early development when they really need lots of this. Lots and lots. And you're right that your instinct is correct, that who's doing it, how much they're doing it, how they do it, and how much the echoes of your own attachment styles are coming through in that interaction is hard to say. That's an interesting piece of this.

7:58 Mark: So I just want to let all the new parents listening that if you do feel like you're burned out and you just need to let the kid cry and go watch tv, you are a bad parent.

8:08 Drew: No, and by the way, a lot of the. A lot of the really good parent is about the repair. You know, leaving and coming back and how you repair the departures or the ruptures is really where a lot of the important stuff goes on. Turns out Wes and I have spent a little time on the couch too. That's another way to repair later. But it cost you more.

8:27 Wes: It's the surrogate parent.

8:30 Drew: Let me go back though, to people like Sartre. And it's a conversation that I hear you guys having on other podcasts, which is the idea that the subconscious doesn't exist or you have total freedom at all times to make every decision, that everything of a thought is conscious to you. That's total bs. We have templates, we have automatic behavior, we have implicit, procedural, all kinds of things in our brain we are either preconscious or completely unconscious of. It can be brought to consciousness, but it only does so in an intersubjective context. And that's the mechanism that Fonagy is working out. So I get very frustrated by guys like Sartre, even though I found his Conversations about consciousness. Interesting. His ideas about human sort of psychology and freedom I found just bizarre.

9:15 Dylan: Drew, when you say, let's call it self awareness of the procedural aspects of one's psychology only comes out through intersubjective interaction. That sounds like you're saying it only comes out by interaction with other people. And I would have expected that it would be possible to maybe at a point distant in time, but maybe not always so far, that a person would be able to be conscious of their own procedural aspects of their psychology.

9:40 Drew: To an extent you can, but there's aspects that you are not aware of, you're not seeing that another person can reflect back to you. And we think of it as almost the other person metabolizing it and then handing it to you. Or some sort of either procedural affect language that you can then go, huh, I didn't see that. That's a blind spot. And I guess you're right. I do do that. And I wonder what that is, you know, and then off you go. Wes, ever had that on the couch?

10:07 Wes: Yeah, but. Yeah, so the way it happens is through an emotional communication where it's not that your therapist tells you that there's something that you do, they don't. You're not told about a pattern, but it's revealed to you in the relationship

10:21 Drew: when you're the object of it, when you're the patient. It's mysterious because it seems to come out of nowhere. When you're the doctor, I find it a little more explicit in the sense that I will have thoughts, feelings, hear music, smell things that are just, quote, not mine. Just aware that it's something that I'm creating with the patient. And at the right moment, I'll go, you know, I'm having an experience. I wonder if this has meaning to you. They will just walk right into it as well. Of course, you know that about me. Even though it's some disavowed part of them that they really didn't really ever express, they will just matter of factly walk with you into that shared space of that experience.

11:00 Wes: It's sort of a parallel process to what goes on with mothering, let's say, or this development of reflective functions. Again, it doesn't have to happen through language. I mean, language can be helpful, but only insofar as it's doing something emotionally. And the emotional part of it is. Part of the problem is not being able to represent your own feelings to yourself. Right. That this is part of gaps in reflective function, not really knowing what you're feeling. And because of that not having the tools to regulate it. Those two go along with each other.

So if within the relationship with the therapist, you become aware, I mean, really, I think the experience as the analyst end, as we would put it in psychoanalysis, is of the patient is you realize that you feel things and that that realization comes about because of something effective that the therapist is doing that some sort of emotional communication which evokes better awareness of the feeling in you. So it's less of a blind spot

11:56 Drew: and it's back to get to the Schore stuff. We talk about amplification of arousal states. That's kind of what happens in that intersubjective experience. Your affective states are flowing together and going, this is getting weird. This is getting weird. Let me go back to the word. Let's go back to Fonagy's paper. He says, a dismissive caregiver. This goes back to the reflective function and the attachment. A dismissive caregiver may altogether fail to mirror. Again, I've registered my concern about that word. The child's distressed because of the painful experiences this evokes for her.

The mother. Mother. Or because she lacks the capacity to create a coherent image of the child's mental state, also called mentalizing. That's my words. By contrast, the preoccupied. Again, these are attachment styles. The preoccupied caregiver may represent the infant states with amplification and insufficient marking. Again, my words. It's that mirroring that's sort of a pretend nature. Or complicated by responses to the parent's ambivalent preoccupation with her own experiences. So much so that the symbolic potential for the exchange is lost.

That's where the attachment and the reflective function kind of come together.

13:03 Dylan: This reminds me of a point made earlier, that there's the reflection that articulates for the child, helps them interpret their own experience. But there's also the way out. Right? Because you have that subtle difference. It's not just that the mother or the caregiver is reflecting their anxiety directly to them.

13:22 Wes: Them.

13:22 Dylan: It's reflecting their anxiety, but also with this coping mechanism or whatever it happens to be to get them out of it. And it not being merely verbal, seems to me to make a big difference, particularly for children. My own experience with my own kids, especially when they're not talking or hardly talking and can't articulate in words what they're doing, it's often just the faces or just the physical proximity and touching of them where you're providing them a safe context.

13:50 Drew: Holding environment.

13:51 Dylan: Holding environment. Yes.

13:52 Drew: It could Be literally holding, or it could be emotionally holding. I have a question for you guys, and I get anxious whenever Mark goes silent, which is that I was wondering, and this may be an unfair and just impossible question, but I was so curious about how you guys would interpret the ontology of all this, how it sort of reflects on the phenomenological continental heritage. Is that too broad a question?

14:15 Wes: I think Mark can answer that,

14:20 Mark: but

14:20 Drew: you know what I mean. I was like, I wonder what these guys are going to say about this stuff.

14:23 Mark: I was thinking about this in terms of the. Well, I mean, you brought up Sartre again about his issue with freedom. That I think if you were going to respond to that, you'd have to say that all this kind of programming is part of our facticity.

14:34 Wes: So just like the essence part.

14:36 Mark: Yeah, right. Of course we don't have the freedom to fly, or we don't have the freedom even psychologically. We've got all these patterns and things that we're unaware of that are pushing us this way or that. But nonetheless, you could still, from an ethical point of view, given the way things seem to you, you always seem to have absolute freedom to choose whatever you want. It could be really difficult. I can't just choose to be. Not addicted to cocaine or whatever if I am. But you could choose to kind of point yourself in that direction and try. You know that even if you're chained up, you still have the freedom of choice in terms of fundamentally oriented, you know, so that's weak. That's not a very good consolation if you are imprisoned.

15:18 Drew: It's interesting because it drives back towards the Stoics a little bit, doesn't it? I think of Epictetus when you say that. That's really kind of interesting to me.

15:25 Mark: Per my ranting on the Epictetus episode. I think that's pretty weak tea. If you really have a lot of hard psychological problems that simply willing yourself in the right direction, the freedom is pretty thin. Existentially, we often talk about the isolation. Wow. We're all fundamentally different from each other. Our minds can never connect. We just had a discussion on movie analysis episode for Vertigo, of how even sex, you're not really having sex with another person. Even in that physical relationship, you're kind of relating to your own sensations and to an image you have of them.

That we're all fundamentally isolated in this way that seems to have an emotional connotation and not merely an ontological connotation. Like why you'd want to bother to say that is because you actually do feel I'm so bleak and I must sit at the cafe and smoke my cigarettes, and we're all isolated. Like, if it was purely an abstraction, then existentialism wouldn't have caught on as a thing. But reading all this stuff about attachment, it really does seem like. No, actually, if you feel that isolated, there is something wrong with you. You didn't have the correct attachment when you were a kid, and that's what's going on right now.

And maybe some therapy can address that, even if not completely undo it.

16:39 Drew: I'm glad to hear you say that. Let me put even a finer point on this. And I know, Mark, you listened to the podcast I did with Wes on my own podcast. For those that did not, I want to bring this up again. I have my own interpretation of the brain in the VAT paradigm, which is not so much about the brain in the vat but about the process of signing up to become the brain in the vat. There's one thing about what we call the phenomena of being a brain in the vat that is simply can't be escaped. Even though you are experiencing. Let's say I had infinite powers and can give you the perfect life as the brain of the vat, you'd be experiencing the perfect life.

You would think you were in the world. You would think you were with all your loved ones, but the raw fact would be you would not exist to others. And that fact is so powerful to human beings that in my experience, I go out there and I ask people this question all the time, particularly drug addicts. And about 85 to 90% of people would not sign up to be the brain of the vat, because it's so powerfully important to us to exist to others. We have to exist to others to make meaning of life.

17:43 Mark: Right, Right. Robert Nozick's experience machine is the thing that we talked about on previous episodes with this.

17:48 Wes: Yeah, that's what I couldn't remember when I was on. Yeah, yeah.

17:52 Mark: That you could be basically plugged into a video game and accomplish whatever you want. And what we're supposed to get out of that, according to Robert Nozick, is just that we want to actually do things. We don't want to have the experience of doing things. So that, you know, utilitarianism or anything that says, well, if you have the most pleasure, then win. And that's the goal of life, is to get the most pleasure. Well, I could give you the most pleasure. But if you knew that it was just because you are in the experience Machine, then you wouldn't want that.

And even if you wouldn't know while you were in the experience machine, you still would not choose to get in the Matrix to get in the experience machine. And the wrinkle that you just pointed out and I think we pointed out at the time is that, well, what if you could be like in the Matrix, in the experience machine with other people? You're not actually accomplishing these goals in terms of you're not actually climbing Mount Everest, but if you get elected president, you're actually still getting elected president. Like, that's a social construct and there are other people in with you so that you can actually.

18:45 Wes: I think if we could all be in the virtual world together, I think people might choose it. Right? As long as there are other minds there, I think.

18:51 Drew: But then you're in this world, right?

18:53 Wes: Exactly.

18:53 Drew: But you're just controlling it, which other people wouldn't sign up for.

18:57 Dylan: There's a crucial distinction, right, between the notion of it being true or not. Just thinking about the issue in the Matrix, I forget the guy's name who was in previous movies that the Wachowskis had done, who makes the deal, betrays everybody, makes the deal to go back into the Matrix. He's the guy who thinks the real world sucks and much prefers the Matrix, right? But it seems to me, like all the rest of them, it matters. It matters that there's this distinction, there's an important distinction between your physical self and the one that you're plugged into in the Matrix.

19:32 Drew: I would argue that doing things, though, is doing things in relation to and for others. That's really where the doing creates meaning. You're not just doing things for yourself. I mean, some of it is that. But you could do that in the Matrix. But doing it is for others is what really gives us our reward.

19:49 Wes: As long as there are other minds. That's like another discussion of the ontology of things. Is it all matter? Is it all mind? Is it all video game? Is it all something else? Functionally, it doesn't make any difference. What does make a difference is if

20:01 Drew: there are other minds but existing minds, not just Matrix minds, right?

20:06 Wes: Not simulated minds, but real people who can see us and recognize us.

20:10 Dylan: So what you're saying is that aspect of it being of truth or something like that falling in here is not so much in that there's the distinction between, say, being plugged into the Matrix versus not being plugged into the Matrix, and that's what they're attached to. It's that the Attachment is with respect to the reality of the mind. So what matters in the Matrix when you're plugged in? You end up having experiences where you're interacting with entities that you know are not just part of the Matrix.

20:37 Drew: No, no, no. Even if you didn't know that when you were in the Matrix, you would refuse to sign up for the Matrix by virtue of that fact that all

20:45 Dylan: of the entities you interacted with were.

20:47 Drew: Grant me infinity powers. So the infinity powers is, when I put you in the vat, you're having the perfect life. You don't know you're in a vat. You experience all other minds as real minds with contact, interacting in the world, and that's that. But because you, when you sign the piece of paper to become the brain of the vat, know for a fact you won't be there with other minds. You will not sign up to be the brain of the vat.

21:12 Mark: Let me connect this with our Buddhism episode, or mysticism more generally. So what if you think that the divisions between people are somehow not real? That ultimately we all are one. And so I and you and Wes and Dylan are all just different fingers of the same hand. So this is kind of like I'm in the experience machine.

21:31 Wes: So if I'm in the vat, everyone's in the vat man anyway.

21:34 Mark: Well, no, I'm just saying. So this is kind of parallel to the idea that, what if I set you in the experience machine and they were apparent to other people, but they weren't real other people. Well, this is what the mystic says. Real life is that I think I'm interacting with you as other people, but really you're all just kind of parts of me. And so even the dealing with other people should be similarly meaningless. And so the question is, do we need real otherness? Which is what I think Drew's point is. We wouldn't be satisfied by the fake otherness of the fake minds in the Matrix. But it wouldn't be real otherness. So there'd be something wrong with that. Well, maybe real otherness, according to the mystic, is not even available, but yet, clearly, we are satisfied with that. Like, you don't need radical real otherness, you just need phenomenological otherness.

22:20 Drew: Yeah, I think you're actually going a little too far with the logic of what I'm saying, which is that once you were the brain of the vat, you'd be perfectly satisfied with those other minds. The problem is, the other, in reality is so important to us, is such a priority that we wouldn't sign up to be the brain of the vat.

22:39 Wes: You'd only be satisfied if you didn't know that they were zombies. But if you knew they were zombies, then, well.

22:43 Drew: But even if I could promise you you wouldn't know, you still wouldn't sign up.

22:48 Mark: Well, but maybe that's because of your lack of knowledge. Like how. How would we rely on your.

22:53 Drew: Wes, Send Mark in. Send him in, and when he gets back, he can tell us being in

22:57 Mark: the abstract, or let's say you're actually last human being on earth. So there actually are no real people, but yet the experience machine is just still sitting there and like, well, you could have the experience of fake other people or you could have nobody. No fake people, no real people.

23:15 Drew: Well, you. I'm glad you brought that up. The movie Castaway brought that to light very clearly and right. And when you don't have others, you'll create something, Wilson. You create another. You need others so vitally that we create them, even we don't have them.

23:30 Mark: We've been talking about how we need attachment, we need other people. And clearly if something went super wrong with attachment early on and you're manifesting these destructive relationships later in life that come out of that. Some therapy is called for, but I'm trying to determine sort of the percentage of. Of benefit that is coming from the therapist's expertise and using of the therapeutic tricks and just the being with another person and being able to talk openly and honestly and create this interpersonal space. In other words, Schore is talking about creating an interpersonal space with a therapist, but certainly when you're in a romantic relationship or just a really good friendship or whatever, you're not simply reenacting old patterns like you can hopefully establish an interpersonal space in which maybe not healing of the worst kind of early injuries can occur, but like the kind of maintenance that we need for our attachment can take place.

24:27 Drew: Okay, so you bring up a really important topic, and it's the dirty little secret in the talking therapeutic field. I would say a yes, having a really intimate friendship could serve that function. But we tend to pick our friends based on our attachment templates and our object relation templates. So if we could pick somebody that's not so gratifying to us and sort of see ourselves through a new pair of glasses and develop an intimate contact with that friend, yes, that would work. Fonagy. When I hear him speak, one of his primary preoccupations is trying to figure out why no matter what therapeutic technique you Use some people's patients get better and some people's don't.

And this has been researched in a number of different ways, and it generally in the literature, under the heading of empathy, the therapists that have a capacity for empathy seem more efficacious. Fonagy is taking this into a deeper zone and trying to look at really what the qualities are. In fact, I heard him give a talk once where he said he went out looking for the therapist that had the best outcomes in England. And he finally came upon this woman that had extraordinary outcomes. And she was just this little woman in the Cotswolds who would bring people into her home and sit and listen them.

And she had no particular therapeutic technique other than deep ability to relate, reflect, and create a safe holding environment. So to your point. Yes, that. That probably is more important. These mechanisms we're talking about, probably more important than any particular therapeutic, as you say, trick.

25:59 Dylan: And this would make sense on this understanding of self, because what you're really doing is providing the capacity for the self to repair itself.

26:11 Drew: You're creating that environment for this exchange that we've been sort of analyzing to develop. And as such, access disintegrated or disavowed or disconnected or unregulated parts of self. Yes. Yeah.

26:24 Dylan: In fact, maybe it's a bit of a mistake to say repair as much as, to me, this is where it lines up with all the discussion about development. And so all of this interest in infant development and what the path is to normal, flourishing, mature functioning is the nub of that research. And what we're talking about with this case of this little old lady in the Cotswolds, I would understand it as being that interaction allows those individuals to key into that developmental process so that they can move into flourishing, mature individuals.

27:03 Drew: No, that's right. Exactly right. And this is something we have not made explicit. So let me do so, which is it begs the question, why don't we go out there and access this ourselves? You know, why don't we just continue this developmental trajectory? The reason is, first of all, you have your attachment template, and that's kind of set. Unless somebody can help work with that in such a way that it becomes a more secure attachment. And it's hard to do that without somebody that really kind of knows what they're doing doing. The other thing is that if you're traumatized during this developmental trajectory, these kids then exit that intersubjective frame.

They can't trust it to enter this frame. We've been talking about requires a certain degree of trust. And when kids are traumatized, the intersubjective frame is the source of the trauma. They don't trust it. They now avoid it and stop that developmental trajectory. Does that make sense?

27:56 Dylan: It does, but it makes me also think about things like ptsd. I mean, unless you said that PTSD only occurs in people who have other histories of trauma, that a given traumatic event keys into their lack of developmental flourishing or something like that. So that'd be one possibility. The other possibility is that a traumatic event in adulthood that results in ptsd, which seems to me in this context, a breaking of the mature flourishing mental activity that needs similar repair. In that case, it would be more like repair. Right.

28:33 Drew: Let me frame it this way. And yes, your point is well taken in that a, if you've had attachment issues or some sort of early childhood trauma, you're way more likely to get chronic post traumatic stress disorder after an adult stressful event. So the answer to your question is yes. Yeah, that's what sets that up, but not exclusively. I would say it more in the sense of, well, you can break your brain's regulatory capacity. You can't exceed its capacity. And as such, the way we heal it, not very good. We're not very good at that one, because it really is kind of broken at that point.

And again, the way the brain deals with it is by sort of pushing it away. And in the intersubjective context, we're calling it back out again. And so PTSD survivors often avoid that intersubjective experience. Ultimately, PTSD is a bodily based memory. There's a guy named Van der Kolk that's really working on trying to figure out creative ways to make the memory more manageable and explicit. And I think they're getting close.

29:28 Dylan: What you just said. Bodily based memory makes a lot of sense in context with what we've been talking about, about developmental psychology and the generation of the self as being bodily

29:39 Mark: Based on a perhaps related issue that I wanted to get clear on in the Schore's right brain affect regulation article toward the end about shame that we've been talking about what hurts the formation of self, and that there are certain experiences that are, say, too terrifying and so they don't become integrated with the self. That all I understand. But he was talking about shame specifically as something that signals not just sort of bad juju in the self, self. You could certainly have a self that you build because your elders tell you that you're bad.

And so you have all these negative things built into the me that then has to get rehabilitated in some way. Like no, no, that's the wrong way to build that. But the way Schore is talking about shame is not something in the self, but the actual breakdown of self itself. So that shame has more to do with dissociation in the way that you were talking about. Can we say a little more about how that works and why Schore thinks that that is improperly neglected in therapy?

30:35 Drew: I think Schore's point in the article was that it mobilizes the therapist shame when the patient's shame is activated. And shame is a very dangerous disintegrating feeling. By avoiding shame, you're not helping the patient. And even though shame is very difficult and your own shame issues are mobilized, you better get on that sort of thing is what he was saying. Shame is complicated. Shame is not. I did something bad, which is guilt. Shame is I am bad. And shame is trauma. At the core of trauma is shame. That's the emotional experience attached to trauma. And so shame based affects are common and again very difficult to manage.

31:12 Mark: There was something where shame was in particular associated with unconscious right brain stuff. In other words, not even all right brain stuff is unconscious stuff. Right brain has to do with affect generally. Some affect obviously we're aware of, some affect we are not aware of. And the shame dynamics he thought were particularly connected to that part of the unconscious which as opposed to anxiety.

31:34 Drew: Well, no, this is the parasympathetic disintegrating downregulating porges has tons of stuff on this, the low arousal states.

31:42 Mark: Right. So therapists are pretty good. He thinks that reacting toward, you know, this kind of thing stresses me out. I'm afraid of this. Like that that's emotive. But that high arousal stuff stuff, hyperarousal stuff. So he thinks that this low arousal stuff, this shame, that there's something that is neglected about that that you need to.

31:59 Drew: Let me read. I've got something. States of right hemispheric parasympathetic dominant. Again, we have a sympathetic and parasympathetic nervous system. Energy conserving hypoarousal generate a massive density of intense low arousal negative affect shame. In these latter affective states, arousal levels are so extremely reduced that they interfere with the individual's capacity to adaptively disengage from the social environment. So the reactivated transference counter transference enactments manifest in dysregulated autonomic hyper arousal associated with sympathetic dominant affects, panic, pain as well as dysregulated autonomic Hypoarousal and parasympathetic dominant affects shame, disgusting disgust, hopeless despair.

32:46 Mark: And I'm so glad that now the listeners can share our pain. And exactly how that reads I can.

32:52 Drew: You got to get used to Schore. It's like reading Kant. You gotta get used to his language. But once you do, it's very rewarding. My own personal experience of that as a patient was I would sink into these states that were almost like fugue like. And my therapist would just stay with me in those states. I wasn't aware I could even have that state, state. But she stayed with me and I would just sort of come out of them and they got shorter and shorter and shorter until they just kind of went away. So in terms of the experience of being in a therapeutic relationship, you have to be in those states and learn to tolerate them and regulate them. And it's that presence of the holding other and the reflective function that she was offering me in those moments that let me know she was with me that allowed me to tolerate.

33:39 Mark: So what would we as philosophers have to say then about the ontology of shame based on any of that? I was just trying to connect this to, you know, what like Nietzsche has to say about stuff like this. And I wasn't really sure how to fill out this picture.

33:52 Drew: In those moments of shame. I'm sitting at the contraction of existence and existing in hypo hypostasis, which I thought was, by the way, the Levinasian stuff, just worthless. He's just making stuff up. But here it may have relevance right here.

34:09 Wes: So here, I mean, I think so we could relate shame back to this. So one of the more general things that Fonagy says at the beginning is that our representation of ourselves involves. Implicit in that is the fantasy or imagining of the effect of our self on the mind of another. That's sort of the general gist of Fonagy. He actually says that at the beginning. And then we go into the details of that. But any self representation, representation includes again an imagined effect on the mind of another. And indeed the way mentalization arises on Fonaghy's account is that our sort of teleological pre verbal construct of the intentionality of others, once we see their intentionality directed towards our intentionality, the two teleological things sort of combine.

And that synthesis gives you the mentalization version where you're attributing desires and beliefs and so on to the other person. So that's the sort of Hegelian reflection back and forth that's supposed to sort of let self consciousness supervene on the relationship between two people. But I think, you know, shame here comes in and it's very important politically as well, concepts of humiliation and shame to political irrationality and violence and all that sort of stuff. Because it's really about our fantasy of the way other people are looking at us or some group that we identify with.

And if we think of the other as malevolent. And that's where I think shame comes in. It's sort of a. You've internalized an other that is implicitly malevolent towards you or degrading towards you. I don't know if I would call that ontology, but that's the way I think of shame. And maybe, maybe that's not right.

35:51 Mark: Well, this is just. It's confused me. You know, the basic Hegelian picture is that you've got the master and the slave, and the slave is the one who just is restrained, who can't do whatever you want, and so gains a sense of self by being bounced off of the master. The master by having to pay attention to what the master thinks of him. The master doesn't give a crap about the slave. So the master doesn't gain a sense of self. The master is just sort of this all powerful idiot remains. But the slave gains depth. But that picture makes it sound like it doesn't matter whether when your self is being determined, being built with the help of another, it doesn't matter whether it's positive or negative feedback coming from that person.

As long as there's any feedback, as long as there's any representation of you, then you can build a certain self. But what we've been building in this episode is a much more refined picture that no, it actually matters a lot. You know, if you were going back to parent and child, what kind of feedback they're giving that, you know, it's probably not going to be that you're going to be a super attentive parent, but yet also negative. I mean, I suppose that's one of the bad ways of forming attachment, but it seems like the neglect and negativity kind of go together.

So that shame would be something that's not just, again, bad juju in my completely robust self that I've built. But it is the lack of completion in the building of the self that shame is some kind of decay, is a cancer within the self that keeps it from being this, you know, unified, robust thing.

37:20 Drew: It is. It's that hypoarousal, you know, destructive state. Wes I want to go back to what you're saying about the political. Did you get fonagy stuff about psychic equivalence mode? Because in there he was saying that if there was not sufficient sort of pretend play and attentive play and reflective function and play, you stay in psychic equivalence. Where as I understood it, again, I had trouble with that. And whenever I've heard him speak, he always goes, I could go into detail about psychic equivalence. I won't. He just always skips it. And it's sort of what you were talking about in terms of seeing malevolence in others. It's like endowing others contents of mind with whatever you need to make sense of things rather than mentalizing them.

38:00 Wes: So the psychic equivalence mode, right? Yeah. So he gives this sort of theoretical model for the development of mentalization, sort of steps one through three. And then so at three to four years old, the psychic equivalence mode, the expectation is that our internal world of self and others corresponds to reality. And then when you get pretend play, the child will know that the internal state doesn't correspond. Right. You could pretend the banana is a person, a telephone while you're playing, or a telephone. So they know that what's going on in the head is not necessarily going to correspond to reality.

But the way he puts it, that's not seen to have any sort of relationship to the outside world. I think in a sense that they still can't grasp the idea that someone else would have a false belief. Right. So if you put the candy bar in a box and then you have someone leave the room and then someone switches the candy bar to the other box and that person comes back into the room and you ask the child, where will they look for that candy bar? Well, until they're four years old, they'll expect the person to look for the candy bar in the place where it actually is instead of the place where it originally was, they can't understand that this person would actually have a false belief about the world.

And then according to Fonagy, you integrate A and B, you integrate the sort of equivalence mode and then the play mode to get reflective mode. And that's the mode in which you would pass that false equivalence test because you know that there is this relationship between potentially things that don't correspond in the mind of the world. And then so you know, people can have false beliefs.

39:35 Dylan: Here's a quote from Fonagy, just after that section that you mentioned about psychic equivalence. In playfulness, the caregiver gives the child's ideas and feelings when he Is only pretending a link with reality. By indicating the existence of an alternative perspective which exists outside the child's mind, the parent or older child also shows that reality may be distorted by acting upon it in playful ways. And through playfulness a pretend but real mental experience may be introduced. And that last part, I think is really key. Right. That they are pretending, but their mental experience is real.

40:11 Wes: Right, Right. So then he says, in traumatized children, there's a failure to undergo this integration between the equivalence mode and the play, the pretend mode. And that's because when the caregiver is mistreating the child, the things that are pressing in the child's mind, the sort of things that come out into play, that's too threatening to the caregiver. Right. The child is aware of being mistreated.

40:32 Drew: Also they don't want to contemplate the contents of the parent's mind who intends to hurt the child. So both those things operating and what

40:40 Wes: that means is they can't move beyond the psychic equivalence mode in relation to their own feelings. Like their own feelings are basically, that must be what's going on in the world.

40:53 Drew: That's right. That's exactly it.

40:55 Dylan: And importantly, what they lose is resilience. Right. What I found so helpful here, effectively the ability to pretend and this playfulness, the mentalization or reflective mode is really one of the keys to resilience, that you're able to deal with complex situations and in fact very challenging situations, because your able to imagine how you're going to get out of them.

41:23 Drew: Right. And no one has ever really defined what mental health is. You use the word flourishing a lot. I like that word. But it's, you know, fully integrated, fully adaptable and dealing with reality as it exists to the extent that we can. Reality's terms, which includes what's going on in other people's minds accurately.

41:42 Wes: And I think the shame part of thing, part of what's traumatic is if you're a child in distress and the healthy thing that's supposed to happen is that the caregiver reflects some of that back to you. But with the other affective stuff that says it's okay, it's okay to have this feeling, this feeling is forever, it's not what the world is, the world is something else. And this feeling can change. And as the world changes and things like that, suppose a parent reacts to that well, just with irritation or you're bad kid for interrupting my me time.

And parents could have all kinds of really destructive reaction to that affect. So the child loses the ability to Represent that affect to themselves. But there's also part of that is that there's this implicit sense that even having certain kinds of feelings is wrong or shameful or even being an effective creature, even being the kind of creature that has feelings is wrong. And I think that's intimately related to shame. Maybe I'm wrong about that, but that's my guess.

42:44 Drew: But no, no, that's absolutely true. That's absolutely true. And we're now starting to talk about how this mechanism goes wrong. You can create contagion. Right. Every time I have a feeling, it exists in the other. So kids learn that their feelings exist out there rather than inside. They also learn to avoid having affect because it triggers it's contagious. And mom may drink or mama use when I, you know, I get upset. And that makes her upset. And now she has to have a drink. And so now I better manage her affects and not mine. And then ultimately, what you're talking about, and this is the shame, is I'm bad. I'm not worth what I need. And there's a inadequate connection between the primary affect states that we all are born awash in and the second order representation we're supposed to develop in the setting of reflective function. That makes sense.

43:31 Mark: Yeah.

43:31 Wes: So it's just.

43:31 Mark: It was kind of a surprising thing that having shame, having a bad self image.

43:37 Drew: Right. That's. That's bad self image is something else.

43:40 Mark: No. Okay. All right. Well, being awash in shame and thereby not having the self properly fully developed is correlated with failing stuff like this false belief test. It's correlated with not fully appreciating the existence of other minds.

43:55 Drew: If you notice these days. I mean, I don't know if you guys encounter this, but I encounter this all the time. I was in a car accident the other day, and this was woman turned into a girl who's riding her bike on the wrong side of the street. And a witness came up from behind and went, I saw what she did. She looked at that woman, took aim and got her. And I was like, what? She had a car full of kids going to a little league game. What is in it for her to aim at a chick on a bicycle today? She really didn't want to go to that little league game. I mean, what. And the witness bore. No issue could not be discussed. I saw it. That's what she was doing. She wanted to get that girl on the bike. Crazy. Crazy.

44:28 Mark: And so you sat him down and say, what are you ashamed of?

44:32 Drew: No, it's what happened to you. But I have a couple of other questions which is we've not really defined mentalizing a reflective function. And I know they kind of defy definition in a weird way. You know, as we're wrapping up here, want to kind of describe how we understand those two things because I'm not sure I fully can define either of them.

44:51 Mark: Frankly, I thought they were the same.

44:53 Drew: No, they're a little different.

44:55 Wes: He says we consider reflective function to be the mental function that organizes the experience of one's own and others behavior in terms of mental state constructs.

45:06 Drew: I would argue to that extent that is more like mentalizing in my head. The reason I brought this up is I want to make the point that reflective function includes our response in the intersubjective space which is we reflect on our faces a pretend or an appreciation of other people's affects states. And that's part of that reflective function. So it's also, it's reflecting on self and reflecting on other and having a motoric response. And he didn't make that terribly explicit in this article. But again when I heard him speak, he makes a lot of that.

45:40 Dylan: Yeah. I have to say I understood mentalization and reflective mode as being exactly the same thing. At least a couple times he just puts an or between them.

45:49 Drew: I think mentalizing is reflective function in its sort of of individual operational sense. And reflective function per se can be in an intersubjective space like I mentalize other people and that allows my reflective function to fully operate. I always think of mentalizing more in terms of my understanding of other people's content of their minds. I understand it's also about my mind. Maybe it's because I'm a codependent that I put. I prioritize other minds. But I always think of mentalizing more about my understanding of other minds.

46:20 Dylan: That would make sense. I mean early on in his discussion of mentalizing he has the section Secure infant becomes mentalizing child. So that part of the development of the child is having the capability of mentalizing. But in that way reflective function would seem to be like a grown up version of mentalizing.

46:40 Drew: Fully actualized.

46:42 Dylan: Yes, yes.

46:43 Mark: Well, I know that after this now when I'm walking down the street, instead of looking at someone saying you looking at me, I'm going to say keep your motoric responses to yourself.

46:52 Drew: Stop mentalizing me.

46:54 Mark: You're mentalizing me with your eyes.

46:56 Wes: Stop shaming me.

46:58 Dylan: Yeah, I'll go pick up Mark at the hospital. He gets the crap beat out of him from somebody not understanding what he just said.

47:04 Drew: Are we wrapping up? Because if so, I'm dropping into parasympathetic hypoarousal, I think. So. I'm very unhappy. This has been a real pleasure for me, and I'm just geeked out over it. I appreciate you guys so much and what you do. And now my arousal system is coming back engaging again. More on the sympathetic side. When I found you guys, I can't say it enough how happy I was. And just to be able to sit and spend time with you has really been a profound privilege.

47:31 Wes: Well, we were very aroused to have you on. No, but it's a privilege for us. This has been great.

47:38 Dylan: I can say that I think you've been one of the best guests we've ever had. Drew, I was thinking the same thing. It's just been fantastic, but it's built

47:47 Drew: off the education you guys have given me. And trust me, I use philosophy. You can only go so far with science and clinical work many times, and you end up having to stand back and have a philosophical reflection about what you're doing. I deal with all the time when somebody doesn't want to get well. What is my job here? What is my role? To what extent do I have obligation over that person's life and desires and priority states? And even when it's in a. I know, In a biological distortion position, how much responsibility or how much can I responsibly or realistically force somebody to do something when they don't want to?

And that's hard. And end of life stuff, it comes in useful and then just trying to navigate through life, it's important stuff. And I came to it through the great courses. I had a political philosophy class in college, and it just engaged me. It was just like an elective at the end. I was busy with the biology and stuff, and I was at a liberal arts college, and I didn't take enough advantage of what they had, and it was always bothering me. And so I started reading history, and then I came to philosophy through their great courses, and I just devoured everything.

And then I found Dreyfus at the Berkeley itunes U thing. And I was like, oh, I'm getting in deep with this. Do you ever listen to those lectures, by the way, by him?

49:01 Mark: Yeah. Well, and that's our hope that we have people start by listening to philosophical greats like Hubert Dreyfus. And then they. They say, say, but what do amateurs think? Let's turn to the partially examined life.

49:12 Drew: Stop it. What I thought was, I'm tired of this undergraduate level of discussion. Dreyfus is getting close to a graduate level sort of symposium. Where could I find just a deeper conversation about this? And I came upon you guys and I thank you for continuing to do this podcast. I listen and listen to and re listen to stuff.

49:29 Mark: That's what makes us think that you're a great guest because you're really familiar with how we do things here and you're prompting me individually and you know, that sort of listening behavior. I'm sure it's not a coincidence that that is involved in your profession.

49:45 Drew: No. You like me because I love you guys. I'll tell you that.

49:49 Mark: I've come out of this with a greater sense of self. That's all I'm saying.

49:53 Drew: All right, well, with that, I thank you.

49:56 Wes: Yeah.

49:57 Mark: So next time we're going to be discussing some Native American philosophy, we have a guest, a guy named Jim Marunick who did his master's on the topic. He pulled out two articles from the 2004 collection American Indian Thought. The essays are called what Coyote and Thales Can Teach, An Outline of Native American Epistemology by Brian Yazzie Burkhart and Philosophy of Native Science by Gregory Cajete, as well as he pulled out a short chapter from the 1932 book Black Elk Speaks. Some more exciting stuff, some more interesting guests. Drew, plug all the stuff that you want to plug.

50:31 Drew: Oh, yeah. My wife, who produces a lot of my podcasts, always gets on me about this. Go to DrDrew.com, we have a whole family of podcasts there. Wes is on the Dr. Drew podcast. You can hear him ruin philosophy for everybody.

50:41 Mark: Yes, and we really want to hear what folks think of this. Go on our Facebook group, on our blog, on our Twitter, you can respond to the episode. You can tell us what you think. If you submit additional questions to Dr. Drew, maybe he'll see them. Or we'll forward them on.

50:56 Drew: We'll do a follow up or whatever. Or we'll bring Wes back to my podcast and answer him there. By the way, there's no way I'm better than Lucy Lawless. That's just a lie.

51:04 Mark: I don't think anybody is. So there you go.

51:06 Drew: That's what I'm saying.

51:07 Mark: Our closing song is by guitar great Steve Hackett, formerly of Genesis. This is one of the songs that was featured on Nakedly examined music number 45 called Anything But Love. Check out the interview@nakedly examinedmusic.com thanks, everybody and good night.

51:21 Wes: Good night.

51:22 Drew: Good night.

51:22 Dylan: Good.

52:28 Mark: You can blow me a kiss before meeting your love. You can flash a sweet smile? Never blowing your cover? Been screaming rage at my misdemeanors? Gaslight my days in the dance? Where you're the need? But you'll never get away? With anything but love? You can ridicule my dreams? When I say my friends? Tell me over you are wearing scratching ends? Leave me with your picture and keep me in the dark? Tell me I'm sudden? Best to all be like a star? But you never get away with anything? We know, Sam.

54:25 Drew: It.