The Primacy of Emotions: a Continuation of Dramatology

Archives of Psychiatry and Psychotherapy, 2015; 2 : 61–74 DOI: 10.12740/APP/42669

The primacy of emotions: a continuation of dramatology

Henry Zvi Lothane

Le coeur a ses raisons que la raison ne connaît point; on le sait en mille choses. (Pascal)

Summary: Psychiatry means healing the psyche or soul that belongs to an individual human being, that is, a person, with a body and a capacity for acting, feeling, emoting and speaking, perceived by the five senses or imagined, seen figuratively in the mind’s eye, in images of dreams and daydreams. Since the total person appears before us with all the characteristics, an all-in-one package, I ask, how is it that psychiatry has lost its psyche? Dramatology approaches human encounters, events, and scenes as dramatic enactments of characters in conflict and crisis. It comprises two forms: dramatisation in thought and emotion that involves images and scenes lived in memories, dreams, daydreams, fantasy scenarios, and dramatisation in act. This paper is a continuation of my earlier publication in this journal.

emotions / dramatology / Freud

Emotions in life, disorder and therapy cal treatment says more than that: it is treatment that has its beginning in the soul, treatment of For an introduction to the concept of drama- psychical or bodily complaints through means tology, please see Lothane [1]. (Mitteln) which operate from the start and di- Freud’s original insight into the reciprocal re- rectly upon the psyche or the soul of the per- lations of body and soul and its role in interperson. Foremost among such means is the use of sonal relationships can be seen in an early 1890s words; and words are the essential tool of psy- paper which Freud published in 1905 [2, 3]: chical treatment. “Psychische Behandlung (Seelenbehandlung)”, But ‘mere words’ is like being asked to believe henceforth cited as “Psychical treatment”, which in magic. And he will not be so wrong, for the begins thus: “Psyche is a Greek word which is words which we use in our everyday speech are translated in German as Seele, i.e. soul. One nothing but watered-down magic, [due] to their might guess what is meant by this: the treatment former magical power” (p. 283, my translation). of morbid manifestations of one’s emotional life. Words are the most important means by which But this is not the meaning of the word. Psychi- man seeks to bring his influence to bear on another; words are a good method of producing psychical changes in the person to whom they Henry Zvi Lothane: MD, Clinical Professor of Psychiatry, Icahn are addressed. We shall explain how science sets School of Medicine at Mount Sinai. E-mail address: Schreber@lo- about restoring to words a part at least of their thane.com former magical power. So that there is no longer 62 Henry Zvi Lothane anything puzzling in the assertion that the mag- chical, in the animals no less than in human be- ic of words can remove the symptoms of illness, ings” [2, p. 284], as taught by his predecessors. and especially such as are themselves founded Freud’s first mentor was the Viennese internist in psychical states (p. 292). Josef Breuer, who in 1882-1883 told him about In ancient Greek, psyche meant the breath the treatment of Anna O. Freud’s second teach- of life, the life principle, the living or besouled er, in 1885-1886 in Paris, was Jean-Martin Char- body (empsychon) of Aristotle. Freud [4] wrote: cot, who had restored dignity to the despised “the ego is first and foremost a bodily ego” (p. disease of hysteria and the derided treatment 26) – all ideas and feelings have their source of hypnosis [8, 9]. Returning to Vienna in 1886, in the body. In quoting from “Psychical treat- Freud married, and started treating patients ment” I avoided Strachey’s “mental treatment” with psychological and bodily disorders. In for “psychical” is the better English equivalent 1888, he translated the book on suggestion by of seelisch; “mental” denotes cognitive activi- his third mentor, Nancy professor of medicine ty and discursive reason while “psychical” in- Hippolyte Bernheim, who, in contrast to Char- cludes both cognitive activity and Seelenleben, cot, proved that hypnosis “was completely in the the life of feelings and emotions, the hallmark sphere of psychology”, establishing suggestion of Romanticism as against classical intellectual- as “the key to its understanding” [10, p. 75]. In ism, as expressed in Goethe’s Faust, frequently 1889, Freud, reviewing Forel’s book on hypno- quoted by Freud. “Feeling is everything,” says tism, noted “suggestion, familiar to physicians Faust to Gretchen, “name is sound and smoke,” from time immemorial” as a method of healing and “Grey, dear friend, is all theory, And green “by the power of personality and the influence the golden tree of life.” Freud also extolled the of words” [11, p. 94]. romantic Naturphilosophie, the philosophy of na- In 1892-1893, in the first volume of a periodi- ture, as having “achieved the greatest advances cal founded that year, the Zeitschrift für Hypno- alike as a science and an art” [2, p. 283], for ex- tismus, Suggestionstherapie, Suggestionslehre und ample, with its pairs of polarities, both antag- verwandte psychologische Forschungen, whose ed- onistic and complementary, such as body and itorial board boasted Dr Sigm. Freud (Vienna) soul, day and night, matter and spirit, male and alongside Prof. H. Bernheim (Nancy), Prof. Forel female, object and subject, conscious and uncon- (Zürich), and Dr Liebeault (Nancy), Freud pub- scious, logic and intuition, real and ideal, reason lished “A Case of Successful treatment by Hyp- and imagination. notism” [12]. In “Psychical treatment” Freud operational- The central idea of psychical treatment was ised psychotherapy as therapy of the word, as the role of emotions in life, disorder, and psy- Entralgo [5] would call it – or the talking cure chotherapy. Since the last was born of medicine, [treatment] as Anna O., called it – which Freud Freud claimed that “it is not until we have stud- restated thus [6]: “nothing takes place in a psy- ied the pathological phenomena that we can get cho-analytic treatment but an interchange (Aus- an insight into normal ones.”[2, p. 286]. Howev- tausch) of words between the patient and the an- er, he also knew that the commonest, everyday alyst. The patient talks and tells about his past example of the influence of the psychical upon experiences and present impressions, complains, the bodily, and one that is observed in everyone, confesses to his wishes and emotional impulses. is offered by what is known as the “expression The doctor listens, directs the patient’s processes of the emotions” (Ausdruck der Gemütsbewegun- of thought, exhorts, gives him explanations. To gen). A man’s states of mind are manifested, al- this day words have retained their ancient magi- most without exception, in the tensions and re- cal power” (p. 17). Freud omitted mentioning in- laxations of his facial muscles, his eyes, in the terpersonal nonverbal communication via emo- amount of blood in the vessels of the skin, in the tions and bodily motions. He would incorporate modifications of his vocal apparatus, and in the such ideas in The Interpretation of Dreams [7]. At movements of his limbs and in particular of his this stage, he studied “the indisputable recipro- hands (p. 286), in extraordinary changes that oc- cal connection between the bodily and the psy- cur in the circulation, in the excretions and the tensions under the influence of fear, of rage, of

Archives of Psychiatry and Psychotherapy, 2015; 2: 61–74 The primacy of emotions: a continuation of dramatology 63 psychical pain, of sexual delight (p. 287). Strict- in “pictures of imagination, dreams, and fanta- ly speaking, all psychical states, including those sies” (p. 280). The “needs of the total person- that we usually regard as “processes of thought” ality” lead to the “principle that the emotional are to some degree “affective” and not one of life [is] the nucleus of psychic experiences and them is without bodily manifestations or the ca- the immediate expression [of] the life forces” (p. pability to modify bodily processes. Even when 283). All of this is part of “the life experiences of a person is quietly engaged in thinking in ideas the individual, the life situation, the inner histo- (or images), there is a constant series of excita- ry” (p. 300). Schilder [14] argued against “psy- tions, corresponding to the content of these ide- chic elements”; emotions of joy, fear and grief as, which are discharged in smooth and striated and feelings are localised in the body: anxiety muscles (p. 288). in the heart, restlessness or peace in the geni- It is essential to underscore the similarities and tals, one is feeling happy around the stomach. differences between feelings and emotions. A In emotions we are aware of a great participa- feeling is an impression, a perception, an aware- tion of the self and the body when directed to- ness of something experienced, a self state. wards a situation which we perceive. This defi- An emotion is a motion, an expression, ex- nition immediately ends the artificial separation: perienced as Bewegung, a feeling-driven mo- every situation comprises perception, sensation, tion in oneself and addressed at another per- feeling, emotion and motility, in the total aspect son. Freud spoke of psychic reality, I propose of behaviour (pp. 177-180). the term emotional reality inseparable from the Polymath Schilder would have embraced the person’s living body. Similar ideas are found in work of today’s neuroscientists working on the Paul Schilder [13, 14]. Paul Ferdinand Schilder, emotional brain [15] and self, or soul, and the born in 1886 in Vienna, was killed in 1940 in a brain [16]. He [14] places action in the social con- car accident, days after his wife, child psychol- text: human action has aims and goals. The per- ogist Lauretta Bender, whom he had married sonality and the body express the needs of the in 1937, gave birth to their third child. He be- personality, in the sense of an immediate expe- came doctor of medicine in 1909 and obtained rience, in the sense of the body image. We also a PhD in philosophy in 1922. In Halle he served experience an outer world and a direction to- under Gabriel Anton, teacher of the notorious wards the outer world. There are definite ten- Otto Gross, in Leipzig under Schreber’s psychi- dencies and attitudes without which a body is atrist Paul Flechsig, acknowledged for his neu- but a lifeless mass. From the point of view of so- rological contributions. By 1923 he began work- cial psychology we not only experience our own ing on the body image. Schilder [13] examined body but we also experience other human be- “the libidinous structure of the body-image”, ings as personalities with definite drives and di- the connection between emotions and eroto- rections which are expressed in their bodies. Ac- genic zones, building on Freud ideas and cul- tion means a dynamic change in the body image minating in the “sociology of the body-image”. (p. 233). In a continual process of construction, He found that the body image is “a social phe- action, trial and error play outstanding parts, nomenon”, that “one’s own [body image] is at and through this process a picture of one’s own the same time the construction of the body im- body, as well as pictures of the bodies of others, age of others, a desire to see and to be looked at” is gained. Every sensory impression has its own (p. 216, 217), that “a body is always the body of a motility. It leads immediately to action of either personality, that has emotions, feelings, tenden- tonic or phasic character, which in turn enriches cies, motives, and thoughts” (p. 218), intentions the impression. The separation between sensory and “expressive movements that are communi- impressions and motility is more or less artificial cations” (p. 223). Thus “masturbation is specifi- (p. 242). Our behaviour takes place in this world. cally social, an attempt to draw the body-images The opinions of Kant, Berkeley and Hume ne- of others, especially their genitals, nearer to us” glect this fundamental relation and overrate the (p. 237), in movements of imitation and identi- power of reasoning and self-observation in com- fication, “adopting a part of the emotions, expe- parison with behaviour, attitude and perception riences, and actions of other persons” (p. 251), (p. 365). The primitive unit is a sensory-motor-

Archives of Psychiatry and Psychotherapy, 2015; 2: 61–74 64 Henry Zvi Lothane vegetative unit in a unified attitude, which is ei- as, delusional ideas, insanity” [p. 286]. On the ther a complete or incomplete action (p. 375). other hand, there is no lack of instances of a se- Similar ideas were formulated by the eminent vere fright or a sudden distress that may have a Russian psychologist Lev Semionovich Vygot- healing influence on some well-established dis- sky (1896-1934). In his posthumous The Theory of ease state or may even bring it to an end. Final- Emotions [17] Vygotsky quoted German, French, ly, there can be no doubt that the duration of life American and English sources, and a great deal can be appreciably shortened by depressive af- of Spinoza. As clarified by philosopher Susanne fect and that a violent shock, a burning morti- Langer [18], “emotional language and represen- fication or a deep humiliation may put an end tational language are older than discursive lan- to life. Strange to say, this same result may be guage, the latter fit for expressing purely intel- found to follow too from the unexpected impact lectual ideas. We humans, in addition to artic- of great joy (pp. 287-288). ulating in words, express love, anger and hate Freud connects emotions with the psychother- in the symbolic arts of dance, music and lyri- apist’s ethics. The modern psychical treatment cal poetry, or the language of the emotions” (p. began when it was realised that the physician 63). Intellectual and abstract ideas are different can no longer command respect as a priest or from feelings: to abstract is take away, to bracket as the possessor of secret knowledge but that emotions; René Descartes’ cogito ergo sum is dif- he should use his personality is such a way as ferent from his les passions d’âme, the passions to gain his patient’s confidence and to some de- of the soul, as expressed by Blaise Pascal in the gree his affection. He himself may succeed in do- motto of this paper: “the heart has its reasons ing this with only a limited number of patients, that the reason knows nothing of” [Pascal, Pen- whereas other patients, according to their incli- sées, #423]. A mathematician can be passionate nations and degree of education, will be attract- about mathematics, but mathematics is cool, ab- ed to other physicians…if the right of the pa- stract thought. However, in life the primacy of tient to make a free choice of his doctor were the emotions begins in the communications of suspended, an important precondition of influ- the preverbal child, who expresses his needs and encing him mentally would be abolished (pp. feelings through bodily movements and vocal- 292-293); Freud’s emphasis. isations, through babbling, calling out, crying, This rapport between doctor and patient, re- appealing to mother to satisfy his needs, and lated to suggestion, is thus shaped by an “ex- continues throughout life. pectation coloured by faith” (p. 292), as shown In “Psychical treatment” Freud [2] shows feel- “in real life only by a child towards his beloved ings and emotions to play a central role in func- parents, or the attitude of similar subjection on tional or psychosomatic disorders: the so-called the part of one person towards another in certain “functional” disorders: headaches, disturbed love relationships where there is extreme devo- digestion, fatigue and sleeplessness, “pain or a tion, a combination of exclusive attachment and weakness resembling a paralysis…symptoms credulous obedience, among the characteristics [that] are very clearly influenced by excitement, of love” (p. 296). The fact that “psychotic people emotion, worry, etc., and they can disappear cannot be hypnotised” places limits on hypnot- and give place to perfect health… Examination ic suggestion as the preferred treatment method of the brain and nerves of these patients with and points the way to a new one in the future: these symptoms revealed no perceptible chang- all the psychical influences which have proved es and an exhaustive examination or the brain effective in removing illnesses have something (after the patient’s death) has been… without re- unpredictable about them. Thus, suggestion is sults. In every instance it is to be observed that not certain as a matter of course of defeating the the symptoms can disappear and give place to illness. It is a good thing for the patients to be perfect health.” [2, pp. 285-286]. Opening quotes aware of these weaknesses in hypnotic thera- and page number missing, please provide] This py and the possibilities of disappointment. On method heals psychosomatic disorders as well the other hand, it may safely be anticipated that as “neurasthenia and hysteria, and such psy- systematic modern psychical treatment, which chical symptoms as so-called obsessional ide- is quite a recent revival of ancient therapeutic

Archives of Psychiatry and Psychotherapy, 2015; 2: 61–74 The primacy of emotions: a continuation of dramatology 65 methods, will provide physicians with far more with loss or injury. In Breuer & Freud [19, 20] powerful weapons for the fight against illness the love model was enlarged by the addition of (pp. 301-302). transference love. In 1900 it was completed by This future became a reality in 1893 with the the dream model of disorder. In their 1893 pref- publication by physicians Breuer and Freud [19] ace, [20] it was Freud who regretted the “lack of of their Preliminary Communication, their shared evidence that “sexuality seems to play a prin- psychoanalytic manifesto, based on Breuer’s cipal part in the pathogenesis of hysteria as a new cathartic “method of psychotherapy, a radi- source of psychical traumas and a motive for de- cal one and far superior in its efficacy to removal fence”( p. xxix), and would wrongly blame Breu- [of disorder] through direct suggestion practised er for his lack of interest in sexuality. The pre- today by psychotherapists” [19, p. 17], a meth- sumed lacuna was filled in the canonical Three od he borrowed from the French psychological Essays on the Theory of Sexuality [25], based on a mesmerists such as de Puységur. Like an over- monadic drive model of disorder, a concept that ture to an opera, Preliminary Communication con- kept crumbling under the weight of its own im- tained a number of themes that would be elab- plausibility. orated by Breuer and Freud in their Studies on Hysteria [20]. Clinically the pair were influenced by Charcot’s concept of traumatic neuroses, in Sexual and other feelings and emotions which “the operative cause was the psychical trauma, any experience that calls up distress- Psychoneuroses ing affects of fright, anxiety, shame or physical pain” or a cluster of traumas in a “history of ill- Freud outlined the causal role of sexuality ness and suffering (Leidensgeschichte)” [19, pp. in disorder in two papers [26, 27], transition- 5-6], resulting in observation that traumatised ing from sexology to psychoanalysis in the lat- patients suffer mainly from reminiscences. The ter [27]. Thus, sexologically, the aktual or current focus of the new method consisted in “bring- neuroses were sexual dysfunctions, neurasthe- ing clearly to light the memory of the traumatic nia, a syndrome of exhaustion due to “excessive event by which it was provoked and in arousing masturbation and frequent emissions”, and anx- its accompanying affect, and when the patient iety neurosis due to “incomplete satisfaction and had described that event in the greatest possi- unconsummated excitation, e.g., coitus interrup- ble detail and put the affect into words, which tus and abstinence” [26], long recognised by au- the patient had previously wished to forget and thorities [27, p. 268]. In the second paper, [27] the therefore intentionally repressed, inhibited and psychoneuroses were also defined as caused by suppressed from his conscious thought, thus “childhood experiences, impressions concerned making them unavailable for working through with sexual life of children, capable of every psy- as obtains in states of uninhibited association” chical sexual activity” [27, p. 280], foreshadow- [19, p.6], later called free association. Trauma or ing the Three Essays. stress, in life, disorder and therapy will remain The first of the Essays, about “sexual aberra- Freud’s enduring method: from The Interpreta- tions” based on “the well-known writings of tion of Dreams (the day residue of a dream), to Krafft-Ebing” (inventor of the labels sadism, Beyond the Pleasure Principle [21] (the foundation masochism and fetishism), starts as follows: “The of post-traumatic disorders), to the role of trau- fact of existence of sexual needs is expressed in ma in Jewish history in his last published work, biology by the assumption of a ‘sexual instinct’ Moses and Monotheism [22]. In summary, contrary on the analogy of the instinct of nutrition. Eve- to the claims of authors influenced by Greenberg ryday language possesses no word for [sexual] & Mitchell [23], Freud was an interpersonal psy- hunger, but science makes use of the word ‘libi- chotherapist and his treatment method was con- do’ for that purpose” (p. 135). This statement is sonant with a dyadic or interpersonal theory of inaccurate: first, libido means lust, second, food disorder as well [24]. I like to call it Freud’s love hunger serves self-preservation and is continual, model of theory and therapy, conjoined with the whereas sexual hunger, whether serving procre- trauma model, the wounds of love threatened ation or recreation, is intermittent. Sexual hun-

Archives of Psychiatry and Psychotherapy, 2015; 2: 61–74 66 Henry Zvi Lothane ger and desire are expressed in everyday Ger- with serious forensic consequences: the religious man words Lust (lust), Wollust (sensuality) and and statutory persecution of homosexual and Wolluststempfindungen (highly pleasurable sen- other variants of sexuality. In real life there are sations, p. 186). Freud might have read in Cat- no such elements, only persons interacting with ullus about cupidae mentis satiata libido est (sating each other, sexually or otherwise. Human sexu- desiring mind’s lust is sated), but he did read in ality is more than animal sexuality: it is biologi- Schiller’s poem The Philosophers that the world is cal as procreation but cultural and interperson- moved by “hunger and love”, the words in that al as recreation. opening sentence [25]. In 1764 Schiller [28] used Freud was neo-Freudian in “Psychical treat- the term Geschlechtsliebe (sexual love), whereas ment” [2] before he turned orthodox Freudian Freud’s word was Liebesleben. Freud also noted in the Three Essays. However, there was a lib- that in the act of suckling, “the child’s lips be- ertarian pleading in the scientific renaming: it have like an erotogenic zone, and no doubt stim- made prurient and criminal male homosexuality ulation by the warm flow of milk is the cause of natural and respectable by explaining its genet- pleasurable sensation (Lustempfindung), associ- ic roots, exemplified as a mother fixation in Le- ated with the need for nourishment, [such that] onardo or a father fixation in Schreber. Lesbian sexual activity attaches itself to functions serving sex did not require such legitimising. In the age the purpose of self-preservation” [25, pp. 181- of decriminalising and depathologising lesbian, 182] (emphasis added), where sexual was a syn- gay, bisexual and transgender (LGBT), of legal- onym of sensual. Equating sensual with sexu- ising gay marriage, such theories are no long- al created problems for friends and foes of psy- er needed. Already in 1920 Freud [29] proffered choanalysis alike, for religion had equated sexu- this, wittily summing up: “It is not for psycho- al with sinful and mired during two millennia of analysis to solve the problem of homosexuality. misunderstanding and malediction, demonising It must rest content with disclosing the psychi- libidinous carnal desires as signs of diabolical cal mechanisms” (p. 171). One must remember grossness, lasciviousness, lechery and obscenity. that normal sexuality also depends on a restric- Freud’s other synonym of Wollust, meaning vo- tion in the choice of object. In general, to under- luptuousness, is Wonne (bliss, delight and rap- take to convert a fully developed homosexual ture)a, exemplified by “thumb-sucking (sensual into a heterosexual does not offer much more sucking, Wonnesaugen)” [25 p.179]. On the oth- prospect of success than to do the reverse, ex- er hand, the word sensuous is associated with cept that for good practical reasons the latter is sublimated aesthetic sensations: “Poetry is more never attempted (p. 151). simple, sensuous and passionate than rhetoric” The pivot of Freud’s theory of sexuality, hete- (Milton) Entry “sensuous” in Webster’s Diction- ro- or homosexual, was that infantile sexuality ary of Synonyms, 1951, Springfield, MA: G.& C. was not only a genetic precursor of post-pubertal Merriam Co. sexuality, when “the new sexual aim in man con- Clearly, Freud should have started with in- sists in the discharge of the sexual products” by fantile sexuality and then used it to explain so- the erect penis in man and in woman the transfer called aberrations, i.e. perversions, the latter “from the clitoris to the vaginal orifice” [25, p. term showing the influence of religious teach- 221], but that it functions as a switch leading to ings on the varieties of normal human sexuali- orgasm: all the erotogenic zones are used to pro- ty. The supposed scientific intent of “introduc- vide a certain amount of pleasure that leads to ing two technical terms, calling the sexual per- an increase in tension, which in turn is respon- son from whom sexual attraction proceeds, the sible for producing the necessary motor ener- sexual object and the action towards which the gy for the conclusion of the sexual act by a re- instinct tends, the sexual aim” [25, pp. 135-6], flex path. The former may be suitably described the vaunted scientific gain in replacing every- as “fore-pleasure” in contrast to the “end-pleas- day language with abstract terms is looking du- ure” or pleasure of satisfaction from the sexual bious. The impersonal renaming breaks up the act. Fore-pleasure is thus the same pleasure that total sexual activity into artificial elements to be has already been produced, although on a small- recombined as diagnoses labelled perversions, er scale, by the infantile sexual instinct (p. 210).

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Fore- and end-pleasure are also called foreplay an either/or but a dialectic of this-and-that. Psy- and endplay but, curiously, the word orgasm is choanalysis must be interpersonal or it is empty never mentioned. It was left to Wilhelm Reich of love. In the masturbatory activity of the anal [30] to bestow due dignity upon orgasm and its zone Freud noted that “children who are making social role, since intercourse means both inter- use of the susceptibility to erotogenic stimula- change of sex and interchange of words. Freud tion of the anal zone betray themselves by hold- maintained that man is active and woman pas- ing back their stool to produce powerful stim- sive in sex, a mistake corrected by the poets and ulation of the mucous membrane, causing not by Reich [31]. Surprisingly, Freud’s 1908 plea only painful but also highly pleasurable sensa- [32] against abstinence and “demands of civili- tions” as well as the interpersonal significance sation” and for sexual gratification sounds posi- of faeces as gift, either bestowed “as active com- tively Reichian, barring contradicting prejudices pliance with the environment” or withheld as in the Three Essays. Thus, Freud classed as an ab- “as ‘naughty’ disobedience” (p. 186); the latter a erration “the use of the mouth as a sexual organ, component of the pre-genital “anal-sadistic or- as a perversion, if the lips (or tongue) of one per- ganisation” (p. 198). Lastly, “the pleasurable feel- son are brought into contact with the genitals of ing which the genital part of the body is capable another, but not if the mucous membranes of the of producing should be noticed by children even lips of both of them come together” [25, p. 151]. during their earliest infancy, and should give rise Nowadays, fellatio performed by a woman or to a need for repetition. The future primacy over cunnilingus performed by a man are viewed as sexual activity exercised by this erotogenic zone normal foreplay and, thankfully, in 2014 it was is established by early infantile masturbation” decriminalized in the State of Virginia (http:// of the phallic phase (p. 188). Here, too, the au- thinkprogress.org/lgbt/2014/03/06/3369331/vir- toerotic and the interpersonal form a continu- ginia-sodomy-repealed/). ous back and forth. In addition to internal causes To mitigate pejorative implications, perverse of infantile bodily stimuli and sensations, Freud habits, impulses and fantasies, exhibitionism, also adduced “accidental external contingencies, voyeurism, sadism, masochism and fetishism the effects of seduction, which treats a child as are now called paraphilias, a term invented by a sexual object prematurely and teaches him, in the prolific Wilhelm Stekel (whom Freud hated highly emotional circumstances, how to obtain and banished). But what is in a name? “A rose by satisfaction from his genital zones, a satisfaction any other name would smell as sweet” (Shake- which he is then usually obliged to repeat again speare, Romeo and Juliet, paraphrase. No less in- and again” (p. 190). Here the term object is val- teresting is Freud’s observation that infants relate id, for the adult “clever seducer” (p. 191) uses as sucklings to their nursing mother. A child’s in- the child exploitatively, not as a person but as tercourse with anyone responsible for his care an object, a thing, without respecting the child’s affords him an unending source of sexual exci- dignity. But, similarly, “the parents’ affection for tation and satisfaction from his erotogenic zones. their child may awaken his sexual instincts pre- This is especially so since the person in charge of maturely (i.e. before the bodily conditions of pu- him, who, after all, is as a rule his mother, herself berty are present) to such a degree that the psy- regards him with feelings that are derived from chic excitation breaks through in an unmistaka- her own sexual life: she strokes him, kisses him, ble fashion to the genital system” (p. 225). Freud rocks him and clearly treats him as a substitute left unexplored this all-important issue of sexu- for a complete sexual object (pp. 222-223). Here al arousal of the child by adults. Three conclu- Freud is unabashedly interpersonal: suckling is sions emerge: Freud’s total abrogation of the se- primarily dyadic while thumb sucking is deriv- duction theory never happened, it is a collective, ative, autoerotic and masturbatory, “not direct- tribal analytic myth. ed towards other persons but [allowing to ob- There is no either/or between internal sourc- tain] satisfaction from the subject’s own body” es of sexuality and its arousal by others, a push (p. 181), a precursor of the concept of narcissism from internal bodily sources and a pull from oth- narcissistic nine years later. The corollary here ers. Children are not born polymorphously per- is that the interpersonal and autoerotic are not verse: they are polymorphously pervertible [33].

Archives of Psychiatry and Psychotherapy, 2015; 2: 61–74 68 Henry Zvi Lothane

There is nothing perverse about infantile sexual- of a number of cases of neurosis and indeed, it ity, it is a normal phenomenon. would seem, of paranoia in general (pp. 166-167; Freud [34] was explicit about “people who re- emphasis added.“Social” is the lacuna in mon- member scenes of sexual seduction and abuse adic formulations of sexuality at any age. in their childhood years who have never been In 1906 Freud [37] added an essential missing hysterical” (p. 207), “provided only that all the element, interpreting “the language of hysteria” people who become hysterics have experienced (p. 278), pointing to the connection between the scenes of that kind” (p. 209). Note that here child’s language, social behaviour par excellence, ‘scenes’ is about dramatic and traumatic events. and infantile sexuality. In the preverbal period Surprisingly, Ferenczi [35], who had also written the mother teaches the child about language and about such childhood traumas, was bitterly at- love in the interchanges of bodily contact, emo- tacked by Freud at the 1932 Wiesbaden congress tional communion and communication with of the IPA - Psychoanalytical Association. body gesture and vocalisations. Mother and Finally, Freud’s abstract category, “sexual ob- child show a biological, psychological and so- ject”, explains why “the sexual person from cial adaptation to each other to ensure the sur- whom sexual attraction proceeds” is attractive vival of the child. It is thus essential to under- and none other, with all the qualities of body stand the thoughts, emotions and language of and soul. Even though adult love choices re- the child. Here is a conversation between father flect the historical record of past interperson- and child [38, pp. 13-14]: al impressions of childhood turned into habits, which explain “the proverbial durability of first “Father: What do we think with? loves: on revient toujours à ses premiers amours” Hilda: Animals think with their mouth. [25, p.154] and the habitual techniques of grati- Father: And people? fication, personal preference evolve throughout Hilda: With their tongues. life. Therefore, whereas “the pathological man- Father: What does a man do when he thinks? ifestations of the psychoneuroses, from hysteria Hilda: He speaks.” to dementia praecox, I mean expressly, are nothing else than the sexual activity of the patient”, Children do not separate perception from as stated earlier [36, p. 115] and restated [25, p. emotion, feeling from idea, they operate with the 163], its heuristic value remains limited. “primal unity of perception, emotion and action, Moreover, the glaring lacuna in the causality of a unity whose survival in our own processes is neuroses was aggression, briefly discussed in the stressed by the ideo-motor theory. An emotion Three Essays and then shelved for years. Freud may precede an idea, may be vaguely felt be- noted that “the sexuality of most male human fore taking definite shape in consciousness and beings contains an element of aggressiveness – being ‘intellectualised’” (pp. 16-17). Moreover, a desire to subjugate. Thus sadism would corre- children also think in vivid pictorial images, an spond to an aggressive component of the sexu- activity of their eidetic imagination, and experi- al instinct which has become independent of the ence an “oceanic feeling of an indissoluble bond, erotogenic zones, exaggerated and has usurped of being one with the external world as a whole” the leading position, derived from the apparatus [39, p. 65], felt “by an infant at the breast” and for obtaining mastery” (pp. 157-159). Further- “at the height of being in love, when the bound- more, the “impulse of cruelty that arises from ary between the ego and object threatens to melt the instinct for mastery” (pp. 192-193) is “put away” (p. 66). The child, the poet, the prophet into operation through the agency of the somat- and the psychotic locate thinking and speaking ic musculature” (p. 198); “in the active and pas- in the various parts of the body. The Bible lo- sive forms of the instinct for cruelty, the element cates wisdom in the tuhot (kidneys or adrenals) of suffering dominating a part of the patient’s and emotions in the intestines. Freud cited Fech- social behaviour. It is through this connection ner stating that “the scene of the action of dreams between libido and cruelty that the transforma- is different from that of waking ideational life” [7, p. tion of love into hate takes place, of affection- 48; italics Freud’s]. By analogy, the child’s body ate into hostile impulses, which is characteristic is the arena of the action of representations and

Archives of Psychiatry and Psychotherapy, 2015; 2: 61–74 The primacy of emotions: a continuation of dramatology 69 fantasies of his own body and the incorporated ual pleasure [25, p. 211]. Language [43] and love bodies of others, different from actions and per- bring us back to dramatology. ceptions in the environment. The same is true of the psychotic. Schreber felt connected with the universe and “in contact with divine rays and Dramatology his head, as a consequence, illuminated by rays”; he heard voices speaking to him “not aloud but Emotions of love as agape, caritas, philia: in the nerve language” and he saw visions “with dreams and deeds of love are completed by his mind’s eye, light and sound sensations which dramatology [1, 44, 45]. Narratology tells about are projected in my inner nervous system by the deeds done in the past, dramatology deals rays”. Such sensations he experienced “during with dramatic happenings: encounters, events the first weeks of [his] stay at Sonnenstein (ear- and emotions happening in the present, expe- ly July 1894)” [40, pp. 123, 124]. “In the first year rienced and/or witnessed by onlookers. A wit- of [his] stay at Sonnenstein” he was plagued by nessed happening is a historical fact. The sto- “threatening divine miracles”, actually divine ries created after the fact may be as varied as in maladies visited upon him by God as in the Akiro Kurosawa’s Rashomon, each story show- case of Job, to whom Schreber alludes indirectly ing a different perspective and recollection of the [41], with “limbs or muscles being pulled or par- event. Stories can be shaped by personal needs, alysed, e.g., the most horrifying compression- desires and myths, the last shading into mythol- of-the-chest miracle” [40, p. 151]. Schreber in- ogies and ideologies. Dramatology approaches corporated feelings about his wife’s miscarriag- human encounters, events and scenes as dramat- es and stillborn children and imagined himself ic enactments of characters in conflict and crisis. as a pregnant woman [41]. However, children It comprises two forms: and psychotic people live not only in fantasy, on dramatisation in thought involves images and the contrary, both are exquisitely aware of the scenes lived in dreams, daydreams and fanta- traumatic impact of reality and the difference be- sy scenarios; these are accessible in therapy via tween pretending and perceiving. Thus, no mat- spontaneous memories and free association ter how severe the psychosis, the healthy part of [46]; the personality is never completely extinguished. dramatisation in act involves real-life scenes A person is known by his or her actions, includ- and situations of love and hate, faithfulness and ing unconscious acts, whereas an organ, cerebral adultery, ambition and apathy, triumph and de- or sexual, is known by its functions. Freud de- feat, despair and hope, and living and dying. personalised the person as object and personal- Both life dramas and staged dramas are about ised libido as being “invariably and necessarily action and interaction, emotion and expression, of a masculine nature, whether it occurs in men intention and influence, events and encoun- or in women” [2, p. 219], but said nothing about ters, communications in spoken and body lan- a bi-gender libido. He closed the gap in 1921: guage, in health and disease. The Italian play- “Libido is an expression taken from the theo- wright Carlo Count Gozzi (1720-1806) described ry of the emotions, the energy of all that may be thirty-six tragic situations [47] which impressed comprised under the word love, what the poets Goethe and Schiller. The idea was continued sing of, sexual love, and also self-love, love for in 1917 by Georges Polti (born in Providence, parents and children, friendship and love for hu- Rhode Island, 1867-1946) who searched classi- manity in general. Psychoanalytic research has cal Greek and contemporary French dramatists taught us that all these tendencies are an expres- and found thirty-six dramatic situations among sion of the same instinctual impulses” [42, p. 90]. parents, children and siblings, with themes such It can also be argued the other way around: non- as expiation of sins and crimes; acts or venge- sexual love derives from the instinct of self-pres- ance; injustice, defeats and triumphs of love; ervation, seeing that the infant is totally depend- victims of cruelty or misfortune; abduction or ent for survival on parental care and love, aid- abuse of women; enmity and rivalry, envy and ed and abetted by the “incentive bonus” of sex- hatred among relatives; incest, crimes and mad- ness; slaying an unrecognised kinsman; self-sac-

Archives of Psychiatry and Psychotherapy, 2015; 2: 61–74 70 Henry Zvi Lothane rificing for an ideal or for fatal passions between onstrated by Breuer in Anna O.’s fantasied “the- lovers and beloved; for others; adultery, dishon- atre of the mind” and in her multiple enactments our and betrayal in marriage; errors and loss of via facial expressions and gestures. Freud fol- love; and last but not least, conflicts with God. lowed by showing representability and dram- Such dramas frequently fill tragedies in life and atisation in dreams: “dreams, then, think pre- in plays, operas, on stage and in film. The most dominantly in visual images, but not exclusively. important subject of tragic drama is the dreams Dreams construct a situation out of these imag- of love, current conflicts of love, fear of loss of es, represent something as an event happening love, depression over love lost, joy over love re- in the present, they dramatise an idea. In dreams gained. Art is an imitation of life and life is the we appear not to think but to experience, we at- source of art [1, 45]. tach complete belief to the dream hallucinations In 1893, after more than two millennia of spec- [7, pp. 49-50]. The transformation of thoughts ulation, Breuer and Freud solved the enigma into situations (‘dramatisation’) is the most pe- called hysteria: their case reports were stories culiar and important characteristic of dream filled with lively conversations about dramatic/ work (Freud, 1900, p. 653), dream symbolism, traumatic events and reliving the past as thera- fairy tales, myths and legends, in jokes and in py, with the help of “associative thought activ- folklore (Feud, 1900, p. 685). ity” and “associative correction” [19, p. 17] and The crucial discovery of Freud is that the key aided by the catharsis (in Aristotle’s theory of to the meaning of the dream is in the dreamer’s tragedy), the purging or abreaction of constit- free associations that lead from the manifest to uent strangulated emotions. Thus, “the injured the latent content of the dream, the foundation person’s reaction to the trauma only exercises a of the psychoanalytic method [7, pp. 100-104]. completely ‘cathartic’ effect if it is an adequate The method of free association also applies to reaction – as, for instance, revenge. But language decoding the manifest and latent meanings of serves as a substitute for action; by its help, an enactments. The German word translated as rep- affect can be abreacted almost as effectively” (p. resentability is the polysemous Darstellbarkeit, 8). The illustrative cases were Anna O.’s paraly- from darstellen, which means to present, to rep- ses [20] and Dora’s aphonia and coughing spells resent, to mimic, to impersonate a character, on [36, 44]. Already in 1893 Freud “asserted that the stage or in life. In 1919 Freud defined dramati- lesion in hysterical paralyses must be completely sation as mimetic, i.e. pantomimic [49]. independent of the anatomy of the nervous sys- Freud’s view of dramatisation was reaffirmed tem, since in its paralyses and other manifestations by my teacher George Engel [50]: as long as af- hysteria behaves as though anatomy did not exist or fects in the form of wishes, ideas or fantasies are as though it had no knowledge of it” [48, p. 169] not blocked by intrapsychic conflict, they may be (italics Freud’s). From the perspective of drama- expressed in spoken words or in action or trans- tology, a so-called hysterical paralysis is commu- lated (“converted”), not into words, but into nicative conduct: it is neither organic nor func- some bodily activity or sensation which suita- tional paralysis, neither genuine nor pseudo-pa- bly represents it in symbolic form. It is a token ralysis – it is no paralysis at all, they are enact- gesture, which substitutes for the real thing. The ments in the form of an embodied metaphor. In conscience is appeased, expression, discharge essence, the hysteric is someone impersonating and compensation are achieved, no generalised a genuine paralytic and, as a result, frequenting unpleasure affect reaction takes place. A useful medical and psychiatric emergency rooms, ad- analogy is the game of charades, translating a mitted to in-patient and out-patient services, or verbal (cognitive) message into pantomime, ges- wandering from doctor to doctor [45]. Dramatol- tures or other movements, into “body language” ogy approaches human encounters, events and (pp. 369, 373). scenes as dramatic enactments of characters in But what does “converted” mean? What is conflict and crisis. Its two forms, (1) dramatisa- converted into what when we decide to lift an tion in thought that involves images and scenes arm? It is merely a façon de parler: a non-hys- lived in dreams, daydreams and fantasy scenar- teric lifting his arm and a hysteric not lifting it ios, and (2) dramatisation in act, were first dem- are both performing an act but nothing is being

Archives of Psychiatry and Psychotherapy, 2015; 2: 61–74 The primacy of emotions: a continuation of dramatology 71 converted. The vague term conversion has died warm personal interest in her – a course which, hard and in psychiatry and psychoanalysis but even after allowing for my position as her physi- is as empty as the term pseudo-paralysis. cian, would have been tantamount to providing It retains some legitimacy in psychosomatic so- her with a substitute for the affection she longed matisation disorders, e.g. vomiting, diarrhoea or for? I do not know” [36, p. 109]. He had not har- constipation, or similar observable reactions of boured such doubts with the people he treated the body to stress. Only such transient reactions in 1895: the patient has to “be capable of arous- can fairly be called symptoms, as they can also ing human sympathy” in the doctor [20, p. 266], occur in organic disorders: these are the bodi- the doctor “tries to give the patient human as- ly manifestations, or symptoms of stress. A pa- sistance, so far as this is allowed by the capaci- tient of mine habitually reacts to interpersonal ty of one’s own personality and by the amount stresses and crises with gastrointestinal upsets, of sympathy that one can feel for the particular or falls, bruises and cuts, with multiple visits to case” (pp. 282-283). doctors. Otherwise what we call symptoms, un- In 1906, in in his second letter to Freud [51], der the sway of the medical model, are conducts Jung reported that he was “treating a 20-year-old and actions. As defined by Freud, “symptoms of Russian girl student” (p. 7) to which Freud re- psychical (or psychogenic) illness – are acts det- sponded in his fourth letter: “As you know, I suf- rimental, or at least useless, to the subject’s life as a fer all the torments that can afflict an ‘innovator’; whole, ‘being ill’ is in its essence a practical con- among my own supporters I pass as the incorri- cept, we are all ill – that is, neurotic – since the gibly self-righteous crank or fanatic that in real- preconditions for the formation of symptoms can ity I am not. I can subscribe without reservations also be observed in normal people” [6, p. 358] to your remarks about therapy. Essentially, one (italics added). But symptoms in normal peo- might say, the cure is effected by love (Liebe)” (p. ple are nothing but symptomatic acts: quod erat 12-13). In therapy, a real-life situation, the Aristo- demonstrandum. The woman called Dora [36], in telian unity of action, place and time is both lit- real life Ida Bauer, who was born in Vienna and eral and real, not just a theatrical convention, as died in New York, dramatised her emotions in in Dora’s duels with Freud [36]. As “a girl of in- bodily acts in coughing and loss of voice. Dora telligent and engaging looks” and “sharp-sight- was a spirited 18-year-old whose family drama ed” (p. 34), she fired “arguments”, “rejoinders”, was replete with scenes of unwelcome seduction “objections” and “contradictions”; Freud, just as by a married man; adultery, promiscuity and ve- sharp in his rejoinders, while not feeling justified nereal disease in the father; love barters and be- “to attack” her thoughts, repeatedly bombard- trayals between her parents and a couple called ed Dora for acting sexually repressed with Herr K.: “she had been handed over to Herr K. as a K., instead of helping her to fall in love with a price for his tolerating the sexual relations be- young man her own age. This was a discrepancy tween her father and his wife” (p. 34), material between the theory of disorder and the theory of fit for a novel had Freud been “a man of letters treatment. Retrospectively, Freud realised to his engaged in the creation of a mental state like this surprise that “the factor of ‘transference’ did not for a short story, instead of being a medical man come up for discussion during the short treat- engaged upon its dissection” (pp. 59-60). Freud ment” (p. 13), that “the transference took him had already admitted this in 1895: “it still strikes unawares” (p. 118), that Dora’s purpose was to me myself as strange that the case histories I show up the “helplessness and incapacity of the write should read like short stories and lack the physician”(p. 120), that “she took her revenge on serious stamp of science” [20, p. 160]. Instead me as she wanted to take her revenge on [Herr of being loyal to Dora, Freud used her merely K.], and deserted me as she believed herself to as material to prove the sexual theory of hyste- have been deceived and deserted by him. Thus ria. When Dora abruptly terminated treatment, she acted out [agierte] an essential part of her rec- Freud had this sad reflection: “Might I perhaps ollections and fantasies instead of reproducing it have kept the girl under my treatment if I myself in treatment” (p. 119; italics Freud’s. But Agieren, had acted a part, if I had exaggerated the impor- from the Latin agere (to act) and agir in French, tance to me of her staying on, and had shown a was indeed reproducing in treatment, enacting

Archives of Psychiatry and Psychotherapy, 2015; 2: 61–74 72 Henry Zvi Lothane

ter-transference” [1, p. 40]. Furthermore, before was just as important as talking, as had been transference there is a transfer of traumatising Anna O.’s tragieren, or dramatising before. feelings and emotions, of aggression, anger, and The suspicion is that ‘transference’ is Freud’s anxiety, streaming back and forth between the sour grapes feeling, a weak alibi, and a lack of two participants. No less real than dramas of empathy for her dilemma, an action that spoke aggression are those due to temptations of the louder than words: she rejected both men be- flesh and the danger they pose for both protag- cause both disappointed her [52]. But even if onists in the theatre of therapy. Freud’s ethics are Dora’s action contained an element of irrational Hippocratic: “[The analyst] has evoked this [sex- emotional transference, Freud redefined the ther- ual] love by instituting analytic treatment in or- apeutic encounter as a dramatic agon or combat: der to cure the neurosis he must not derive any “this latest creation of the disease must be com- personal advantage from it. For the doctor, eth- bated like the earlier ones. This happens, how- ical motives unite with the technical ones to re- ever, to be by far the hardest part of the whole strain him from giving the patient his love. The task. It is easy to learn how to interpret dreams, treatment must be carried out in abstinence. By to extract from the patient’s associations his un- this I do not mean physical abstinence alone, nor conscious thoughts and memories, and to prac- yet the deprivation of everything that the patient tise similar explanatory arts: for these the pa- desires, for perhaps no sick person could toler- tient will always provide the text” [36, p. 116]. ate this” [55, p. 169]. In the end Freud differenti- Combat makes sense because “all the patient’s ated sexual gratification from love writ large: as tendencies, including hostile ones, are aroused” affection, as agape, caritas, and philia: “the doc- (p.117). In this way, “transference, which seems tor, in his educative work, makes use of one of ordained to be the greatest obstacle of psycho- the components of love. In this work of after-ed- analysis” yes became a crisis, a danger and an ucation, love is the great educator; and it is by opportunity, a challenge and a chance. The idea the love of those nearest him that the incomplete of combat was continued in Freud’s 1912-1915 human being is induced to respect the decrees of papers on technique, where military metaphors necessity and to spare himself the punishment stand for dramatic confrontations: “This strug- that follows any infringement of them” [56, p. gle”, writes Freud, “between the doctor and the 312], i.e., tender love, the “affectionate current” patient, between intellect and instinctual life, in the Three Essays, a concept explored by Balint between understanding and seeking to act, is [57], Ferenczi’s [58] executor and follower. played out almost exclusively in the phenome- Psychoanalysis as a science comprises theories na of transference. of disorders and methods of their treatment. The It is on that field that the victory must be won life of the emotions, i.e. emotional reality – the – the victory whose expression is the permanent heart and soul of love – should apply to both. cure of the neurosis. For when all is said and done, it is impossible to destroy anyone in absen- tia or in effigie” [53, p. 108], in absence or in ef- References figy, for “as the analysis proceeds, the transference becomes hostile or unduly intense [with] 1. Lothane HZ. Dramatology vs. narratology: a new synthesis acting out… The patient brings out of the ar- for psychiatry, psychoanalysis, and interpersonal drama therapy (IDT). Arch Psychiatr Psychother. 2011; 4: 29-43. moury of the past the weapons with which he defends himself against the progress of the treat- 2. Freud S. Psychical (or mental) treatment. In: The Standard ment – weapons which we must wrest from him Edition of the Complete Psychological Works of Sigmund Freud. Volumes 1-24. London: The Hogarth Press; 1905. one by one” [54, p. 151]. But with this caveat: “in Vol. 7: 283-302. the dramatic here-and-now, transference should not to be applied a priori as an explanation of the 3. Lothane HZ. On: from psychical treatment to psychoanalysis. Int J Psychoanal. 2014; 95(5): 1007-1008. patient’s actions which can only be ascertained after a careful mutual exploration, since both the 4. Freud S. The Ego and the Id. Standard Edition. Vol. 19; patient’s resistance and transference may pro- 1923. voke the therapist’s counter-resistance and coun-

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