Friday, 28 March 2008

Shame and the Body

There are certain schema of explanation which pretty much define contemporary clinical psychology; schema which are inscribed into the very structure of what 'psychological' has come to mean; schema which come very easily to minds raised in individualist and modernist Europe and America; schema which pretty much trip off the tongue with an ease which itself should make us suspicious; schema which, I want to claim, only provide the illusion of understanding; schema which are hyper-banal; and schema which are bizarrely suited to to many of the phenomena they are used to theorise since the pathological features of the phenomena are (in a way unacknowledged by the theorist) mirrored in the theoretical sub-structure of the psychologist's schema.

Take bodily shame as an example. We know that shame is very much a bodily thing. We go red in the ears or in the whole face, we feel very awkward and clumsy, we look down. Perhaps we are also shamed by our bodies (acne, big nose, awkward gait, small or big breasts, you name it). Sometimes this shame reaches pathological levels (think of body dysmorphic disorder, or certain cases of social phobia and paranoia).

Here's the typical clinical psychological 'explanation' of shame. (No particular theory is being referred to - the focus is on the kind of theoretical substructure which I suspect would be in play framing pretty much any of the psychological theories one might look at.)

1. Bodily shame is understood as a two-part phenomenon. On the one side we will be offered mental representations. On the other side we will be offered bodily reactions.

2. The mental representations will be representations of my body and of the environment (including the representations in the minds of proximal others). My shame will be said to consist in my cognitive representation of my body as being a certain way.

3. The bodily reactions will in some not-quite-specified way (but doubtlessly somehow mediated (oh don't you just love that causal rhetoric in psychology of distinct states 'mediating' one another) by an emotion) be said to be caused either by environmental triggers or (when the problem is more entrenched) by the mental representations of the body. In the latter case we will probably get the beloved CBT-style vicious cycle: cognitive representation causing shame causing bodily reaction causing increased representations etc...

4. We will expect there to be predisposing factors in the body - tendencies to go red very easily, etc. Some kind of evolutionary explanation will be trotted out to account for bodily shame reactions in general, and which will also provide the theoretical resources (unfortunate gene inheritance etc.) for excessive shame responses.

5. And the rest of the explanation will sit with the cognitive factors. If I have body dysmorphic disorder or anorexia then this will be explained in terms of 'distorted cognitions about my body'. Or perhaps I have distorted representations about the extent or nature of my own bodily shame reactions. I'm not really going as red or sweating as much as others think I am. (I'm going to - oh-so-conveniently-for-my-own-critique - leave out reference to hypervigilance, body scanning etc., since these seem to me to be genuinely interesting and theoretically cogent postulates, and irrelevant to the conceptual critique I want to mount.)

6. If I am wanting to make some kind of a name for myself and get on with my career, I will elect to spend years collecting correlational, synchronous and longitudinal, data on the tendency of patients with different diagnoses or different symptoms to have distorted cognitions which have, as their intentional content, (aspects of) the patient's own body. I will also develop a theory which posits that these distorted cognitions have a causal relationship to the symptoms and to the emotions. If I'm scientifically minded enough, I'll spend years and cash performing regression analyses on the data. Hopefully I'll come up with a 'model' of the disorder, and this will probably be representable in a diagram, with component boxes joined up nicely by arrows etc. I'll sleep well when my inputs and outputs and intervening variables all line up right. I'll be able to adapt the model by 'positing' different 'mediators' or 'intervening variables', thereby keeping the research project alive for several years.

And, da-da!, there we have it. This is, I take it, the kind of sleep-of-reason pseudo-theory that passes for real psychological understanding in contemporary psychology. It's surrounded by enough sciencey language and practices (data gathering, model-making, those regression analyses) and formal rhetoric (talk about 'representations', 'cognitions', 'information processing', 'cognitive processes', and all those sharply drawn powerpointish boxes and arrows) to look respectable. We have the lovely old we're-so-post-behaviourist "input - intervening cognitive processes - output" conceit structuring the model. And so on. Familiarity with this way of representing psychological difficulties also gives the psychologist some sense of professional identity - in particular, this way of bringing together the technological (those boxological diagrams and regression analyses) and the clinical (pathological shame or what have you) fills out what the 'scientist practitioner' model might be all about.

So, well, what's actually wrong with it? Here's the bit I'm struggling with: it isn't completely hopeless; and its pundits are clearly sincere. Furthermore, because it all - at the surface - seems to make such perfect sense, there is a strong pull to cleave to it and resist any problematisation of it. And, worse still, because the form of thinking which such cognitive models rely on itself becomes so utterly totalising (I mean: it becomes paradigmatic for what counts as evidence, what counts as justification, what counts as reasonable critique, and so on), objections which come from outside are liable to simply look confused.

Nevertheless, I want to claim that these kinds of cognitive models: i) chronically distort the phenomenology (Response: "no I'm not, I'm just saying what really must be going on underneath the naively described experience"!), and ii) deploy unawares an indefensible philosophical framework (Response: "what, no I don't, this is a purely empirical model"!). i) and ii) work together symbiotically, the distorted phenomenology fitting together perfectly with the philosophical framework, thereby disguising the ultimate wrongness of the model. iii) fail to even consider what we could call 'existential' concerns - i.e. the person's changed relationship with the world. iv) correlatively, fail to theorise at all, the personality or self. v) accordingly, theorise any phenomenon which we would naturally understand in relational or self-oriented terms as due to underlying cognitions, and thereby get the cognitive horse before the existential cart.

These are big claims, and I'm not going to justify them all in one post. Let me start, though, with the first two. (The phenomenology of shame I deploy here is I suspect largely drawn (in memory) from Thomas Fuchs' excellent paper The Phenomenology of Shame, Guilt and the Body in Body Dysmorphic Disorder and Depression.)

The experience of bodily shame is, surely, an intrinsically bodily experience constituted by my embodied feelings. I feel - not, at first, think or believe - that I am the object of other people's gaze. Furthermore, my whole relationship with my body becomes disturbed. I no longer inhabit it unreflectively as a living centre of my experience, attending outwards from it to the world. Rather I become alienated from it, I become clumsy, I start to try to control it. I am beside myself.

Moreover the experience, whilst intrinsically rooted in the embodied self, is itself an experience of disembodiment. I become alienated from my lived body, a body which becomes an object of attention rather than the medium of my relation to the world. I start to experience myself as another might experience me. My entire existential relationship, both to the world and to my bodily self, is turned in on itself.

The meaning of this experience is carried in the experience itself, and not in associated beliefs about it or about the body or the gaze of the other. Any such associated beliefs get their distinctive meaning not from thought but from the embodied experience.

The cognitive theory theoretically pulls apart the normal body and mind, in order to set them up again as two causally interacting phenomena. Thus the thinker is theorised as a combined representer of their own body and as a cause, via the biomechanics of the emotions, of certain bodily reactions (picture certain bodily shame as a runaway reaction cycling between body and mind). Yet this isn't how we normally experience our bodies. The whole phenomenon of our actual embodiment - the fact that we are our bodies is missed. Our essential animality and corporeality is lost. The intentionality of the body - the way we are directed bodily towards our environment, in our skills and habits and postures - the way in which our bodily skills and habits disclose a world to us - the way in which the affordances of this world, the basic way it strikes us as holding significance, are fundamentally bodily in nature - the whole praxical fit of the embodied self with its lived environment - this is all lost in the theory. We instead become disembodied representers, all meaning being created in the mind out of the deliverances of the senses, deliverances which might happen to include the subject's own body.

But what is most striking to me, in the present instance (and in many other cases such as psychosis - as Louis Sass has demonstrated), is the way in which the underlying existential presuppositions of the cognitive theory (the disembodied mind containing all the meanings, the body left out as a kind of dull mechanism) so nicely map onto the psychopathology. For this is just what happens in shame: the body becomes un-lived, the mind becomes dis-embodied, and a merely causal self-reinforcing feedback relation can get set up between the two. What the cognitive theory hides from us are the very conditions of possibility (i.e. the disembodiment of the bodily self) of this happening. These conditions are abnormal by their presence. It is through an understanding of these conditions of possibility that we actually start to understand shame. But the cognitive theory ignores these, since it brings them along in its general and in-apt alienated theorisation of human nature.

If we just automatically deploy dualistic frameworks in which meaning and intentionality are relegated to an interiorised mind containing mental representations which picture the world for the subject, and the body is relegated to playing a merely mechanical part in a natural world, a body under the motor control of the representations in the mind, then all sorts of lifeless pseudoexplanations of psychopathology appear possible. Lets take a look at how it happens. First we theorise normal human nature in terms of this framework. Then we reduce a psychopathological condition (chronic misplaced bodily shame reactions) to that of normality, albeit normality tacitly theorised in the alienated terms of the standard model. Then of course the psychopathological condition starts to look as if it makes sense. It looks like a perfectly intelligible response a person would make if they were unfortunate enough to be given (at the bodily end) the genetic starting point and (at the mental end) the mistaken mental representations that are posited to obtain in the pathological case. Yet once again pathology is reduced to mistaken cognition or to bodily hypersensitivity. We fail to understand the logos, the real meaning, of the psychopathology. It eludes us because human nature itself has eluded the underlying theorisation of normality within which the psychopathology is understood.

Once we grasp how the cognitive model distorts: the unity of the healthy lived body, the environmental meanings and bodily understandings, the lived intentionality of the subject who at one with their lived body attends comprehendingly with their reactivity, feelings, dispositions, to the saliencies of their lifeworld - then we can start to recover a sense of what our normal existence consists in. And once this is in place, psychopathological conditions can be understood as disturbances of our normal existence, abnormal forms of relation to the world, to the self, to the body. Disturbed cognitions can in turn be understood to arise out of the prior disturbances to the intentional field in which they are rooted. The banal pseudo-understandings offered by the cognitive models can be set aside. And the logos, the meaning of the symptoms, can finally be understood.