Artículo 22. Auditoría relativa a la calidad del servicio de atención a la clientela
II. OPORTUNIDAD DE LA PROPUESTA 1. Motivación
Ed Tronick
PSYCHOTHERAPY IS ABOUT changing the meaning people make about themselves in the world. Indeed meaning—private meaning—is a core concept in approaches as varied and contentious as psychoanalysis, psychodynamic, psychotherapy, cognitive–behavioral therapy (CBT), dialectical cognitive therapies, dyadic therapies, attachment and relational therapies, and even “alternative” body psychotherapies (Tronick, 2007; Harrison & Tronick, 2007; Ogden, Minton, & Pain, 2006; Modell, 1993). Nonetheless, I believe we have misconstrued the nature of meaning in deep ways that limit our understanding of how humans function, what meaning “is,” and how individuals change their meanings. In essence we have tended to limit and categorize meaning into the domain of the explicit, mostly to the domains of language, symbols, and representations. We do this limiting in part because our cognitive processes tend toward chucking reality into categories, so it is hard for us humans to do it other ways. We also do it because our thinking is colonized by language, which in turn feeds back and further reifies the categorizations. Furthermore, the culture of science and its demand for the explicit also plays a role. Finally, we are very impressed with our ability to name things because it gives us a feeling that we know and control whatever it is we name. This thinking holds much truth about the meaning we make of ourselves in the world. But not the whole truth. Meaning is Biopsychological Meaning is biopsychological. It is made by polymorphic systems operating at multiple levels of the individual. These polymorphic systems create qualitatively different forms of meaning, what Freeman (2000) refers to as actualizations of meaning, which at best only messily fit together. Moreover, meaning is not one thing–one meaning. Meaning is a layered flow over time of the different meanings emerging from the multiple levels and processes that make meaning. Meaning is a laminated polysemic flow or bundle (A. Harrison, personal communication, 2008) that affects itself as it flows into the future. Yet, this flow of meanings has to be assembled by individuals into a coherent sense of themselves in the world, into what I will call a state of consciousness. No simple task.
Bruner (1990) has said that humans are meaning makers. They make meaning to gain a sense of their self in relation to their own self, and in relation to the world of things and other people. These meanings are held in the individual’s state of consciousness. A state of consciousness is the in-or mostly out-of-awareness polysemic meanings made by the totality of an individual’s biopsychological processes. Some meanings are known and symbolizable, some are unknown, implicit but with “work” can become known, and some may be unknowable. More on that later. The meanings contained in a state of consciousness organize individuals’ presence, way of being in the world. For example, it is the comfortable and inexplicable feeling one has in a loved childhood home or the unknown shearing discomfort in one’s body, the feeling of a need to stretch and move, when in a house of an unknown trauma. Meanings are self-organized, regulated internally and private as well as dyadically organized, regulated with others, and shared. When self-organized meaning-making is successful, new meanings are made and become part of the individual’s state of consciousness. When meanings are dyadically organized, a dyadic state of consciousness emerges between the individuals and contains new cocreated meanings, which in turn can be appropriated by each individual into his or her state of consciousness.
Successful self-or self-and-other creation of new meanings leads to an expansion of the complexity and coherence of the individual’s state of consciousness. And successful creation of self and dyadic states of consciousness has experiential and functional consequences. So does unsuccessful meaning making. Successful meaning making carries with it a sense of expansion and positive affects; these feelings cascade and affect themselves, perhaps leading to a feeling of exuberance and aliveness, or an oceanic feeling of wellness. When successful meaning is made with another person, a feeling of connection and synchrony emerges, a mutual sense of being together in a special state. Failure to evoke meaning generates negative affects, fearfulness, anxiety, and a constriction and shrinking. These too feed on themselves, leading to radical qualitative changes in state. We see these shifts in our patients during those moments of new insight or when there is the catastrophe—a failure to make meaning (Modell, 1993)—and we must also recognize that we are participants in these processes.
What do I mean by saying that meanings are biopsychologically polymorphic? Meanings include anything from the linguistic, symbolic, abstract realms, which we easily think of as forms of meaning, to the bodily, physiological, behavioral, and emotional structures and processes, which we find more difficult to conceptualize as forms, acts, or actualizations of meaning. The difficulty arises because these polymorphs are made at every level of the organism, from the physiological to awareness, and also because we are forced to use language to discuss meanings that are inherently nonlinguistic and outside of explicit awareness. However, it is possible to comfortably integrate these ideas about meaning under a principle of singularity. The concepts of mind, body, and brain may be useful concepts or not, but they reflect the operation of the way our cognitive processes cut up the world. As such, they do not necessarily reflect or encompass the way the individual operates. Rather, there is a singularity, a concept related to how all subprocesses in a system not only purposively operate at the local level but also function in the context of the operation and goals of the whole system. All systems making up the whole individual—the totality of human biopsychological processes, including, but not limited to, what we call mind, brain, and behavior— operate to gain information about the world in order to act in and on the world in alignment with their intentions and goals as well as to create the individual’s unique, singular purposes, intentions, meanings, and sense of self in the world.
One domain of meanings that we often find difficult to conceptualize as meaningful purposive elements of our state of consciousness is that of emotions. Freud spoke about primary and secondary processes, and though not fully clear about how they served as forms of meaning, he implied, and it has come to pass, that it is the secondary processes that are instantiated as meanings. Witness only
that insight—an explicit, symbolized, linguistic form of meaning—was crowned the king of the change processes—whereas primary- process meanings constitute the domain of the unwashed peasant. Emotions were disorganizing, disrupting, disquieting, or even without organization. They were infantile, immature, and had to be grown out of, if one were to come to know the world and oneself.
Other perspectives are not so demeaning of emotions. Emotions have been seen as the intensifiers of meaning or catalysts of meaningful actions, a kind of unidimensional gain-amplifying process, in a manner similar to the way Philip Roth amplifies reality in his novels. Alternatively, they have been conceptualized as adding qualia (value) to experience, in an afterthought kind of way, via an appraisal process comparing the individual’s goal to the outcome (Izard, 1977). Emotions are also almost always seen as existing in a small fundamental set in the individual, and though the core set may be elaborated into more complex blends, it does not show qualitative developmental changes (Ekman & Oster, 1979). Further, emotional processes are viewed as separate from cognitive processes, though in some views they are linked to bodily processes.
In these and other conceptualizations, I think we have misconceived, or at least missed, perhaps the most critical features of emotions. For me, emotions have meaning. Emotions are elements of meaning, being perhaps even the foremost and principal elements assembled in humans’ state of consciousness. And though emotions are elements within the individual (the essentialist or individual psychology perspectives), I believe that they are both internally created in new emergent forms, as well as dyadically cocreated in new emergent forms with both externalized others and internalized objects. Thus, emotions are not fixed elements. They evolve over moments. Old ones change, new ones emerge, nuanced forms abound. They change and develop through emotion-organizing processes, and through the interaction of those process with other processes (e.g., cognitive processes). Further, when emotional meanings are self-created or cocreated in a state of consciousness, their creation has consequences for the formation of relationships, ongoing emotional experience, and the growth of the individual: how the individual thrusts him-or herself into the world (Freeman, 1994).
Infants and Meaning Making
My view of emotions developed out of my work with infants (Tronick, 2007). From Freud onward infants had been viewed as disorganized and/or only responsive to internal processes and/or without intention or contact with reality. Freud shared this view with William James, but notably, not with Charles Darwin or Melanie Klein. This view persisted well into the 1980s and still lingers today, with the related ideas that infants lack language and explicit memorial or cognitive processes. Piaget (1952) saw the infant differently. Though he was not particularly concerned with emotions, he was deeply concerned about meaning and adaptation. He saw the infant as making sensorimotor meaning of the world. Things in the world were what the infant could do to them. Objects as different as bottles, breasts, and rattles were the same to the infant because the infant sucked on them. The meaning of these objects was the action that could be performed on them—they were categorized as suckable. The meaning would change as the infant developed new motor capacities, such that rattles and keys were shakable, but not bottles or breasts. Later in development other processes would supersede motor processes and, eventually, in adulthood, there would be language, symbolization, and abstraction. However, given our adult symbolized, abstract, language-and narrative-based view of the world (e.g., this chapter), it takes a special effort for us to think that a thing is not a thing, but is the action done to it; the sense of the thing to the infant is, in Bruner’s phrase, a literal act of meaning. Emerging from this perspective was the notion that the infant was competent, but the competence was primarily in the perceptual and cognitive domains. As part of this effort, and based on Gibson’s (1988) theory of affordances, I carried out a study of infants’ reactions to impending collision with a virtual object (Ball & Tronick, 1971). The stimulus was an expanding dark optic array—a looming shadow. Infants as young as 11 weeks reacted to this display by putting their hands in front of their face and turning their head away—a defensive posture. As indicated by these actions, the shadow was something they experienced as threatening, and they ducked away from it. Though it may also have been novel or interesting, it had meaning about their relation to the event—it was dangerous to them. In saying this, I do not think that the infants had a sense of their own self or of the object qua object, and I am sure that they could not reflect on the event or their reaction. And though we don’t truly know the infant’s experience, nonetheless, they gave evidence of an organized state of consciousness in which the looming shadow had meaning, and critically this meaning was made without language or symbols. It is hard to move into the experience of an infant, but try thinking of other cryptic examples, such as individuals with apperceptive visual agnosia who move among objects and handle them in the visual world, but do not see them. Yet we know by their avoidance of objects and how they handle them that these individuals have a state of consciousness in which the “visual” world has meaning for them, but it is as radically different from the normal adult’s state of consciousness as is the infant’s state of consciousness. That is, both ways of knowing the world are beyond our ability to put into words.
FIGURE 4.1
Infant’s reaction to mother’s anger indicates a state of consciousness.
In a related example, we have seen an infant react to an angry facial display by his mother as she attempts to get him to let go of her hair (Figure 4.1). The mother’s angry facial expression and vocalization lasts less than half a second, but the infant detects them and immediately brings his hands up in front of his face, partially turns away in the chair, and looks at her from under his raised hands. Her angry face, perhaps the first he has ever seen, is not just interesting or novel. He apprehends it as a threat; something dangerous is about to occur and he organizes a defensive reaction to protect himself from what seems about to happen. And the mother almost immediately realizes it too. She changes what she is doing and using cajoling actions tries to overcome the rupture and to change his experience. At first he stays behind his hands but over the next 30–40 seconds begins to smile, and then smile and look at her.
The infant’s defensive reaction to the angry face is an obvious state of consciousness, organizing the infant’s way of being in the world, as is the change and shift in his state of consciousness as he begins to smile and look at her. However, as with sensorimotor meanings or apperceptive visual agnosia, we have to be cautious about what we think the infant knows. In this case, I don’t think the infant knows what the danger may be, as might an older child, but the angry face makes him feel threatened by what is happening. He experiences (let’s call it) threat, but we do not know what he might know, if anything, about what or where the threat is. Perhaps the infant’s experience is analogous to a sense of doom people experience when no doom is obvious; it just is. And when the mother smiles, he smiles back, knowing that his world is again safe, but he does not know what makes for the feeling. It is important to note that the infant reacts as a whole system. Arms, posture, facial expression, gaze, and (we were measuring it) his physiology changed in reaction to the threat, and then continued to change as the disruption was repaired and the threat changed to safety and pleasure. The reactions were not only reactions of mind, body, and brain, but of many processes at multiple levels of meaning making, which were organized into coherent whole system reactions. Further, though we failed to talk to the mother about her reaction to her infant’s reaction, we know, based on her actions, that she picked up on what was happening, changed what she was doing, and worked to change her and her infant’s states of consciousness. In particular, we do not know if she was aware of the angry face she had made. Indeed, when we first saw the infant ducking, it took several viewing of the tapes for us to become aware of her angry face.
Emotions, much like the infant’s sensorimotor actions on things, are one of the polymorphic meaning-making systems for the infant. Moreover, given the precocious sophistication of infants in responding to and expressing emotions, compared to their ability to act skillfully on the world, emotions may be the foundational form of their sense making (Tronick, 1980). Perhaps too mechanistically, infants can be thought of as emotion-meaning-making devices. They do not simply differentiate one emotion from another, or respond to the novelty of an emotion. Rather, emotional input has meaning. The meaning is inherent in the emotion processing and does not need to be translated by the infant into some other form. It does not have to be appraised or evaluated by other (e.g., cognitive) processes, though it likely becomes part of those processes. Perhaps an analogy is that the digestive system (emotion-meaning system) takes in nutrients (emotions) and makes them into useful energy and building blocks (meanings), and some things that are not nutritious (lip smack) cannot be digested (lack meaning, are senseless). As adults, we try to capture the world with language, which makes it difficult for us to even fathom what it would be like to have states of consciousness that were primarily emotional. Just think of the emotion of joy that is the
glorious meaning of a grandchild coming at you with arms widespread, jumping into your arms.
It may help us to appreciate emotions as a form of meaning about our relation to world by considering the ways in which they are similar to, and different from, cognitions. The meaning adults make upon being alone in a dark, shadow-filled, unknown city is fear, anxiety, and creepiness. This meaning exists, side by side, with other forms of meaning conveyed in words and symbols by self, friends, and guides who say that the city is completely safe. Yet often adults remain stuck in the emotional meaning; it determines their sense of the world—danger. Things and people no longer are what we explicitly (cognitively) know them to be; now they are frightening, be they garbage cans or people. In fact, even when a person knows that the thing in the corner is a garbage can, it often still only means—only is— terror. The meaning is inherent in the person’s scared state of consciousness.
The emotions do not carry meaning about episodic time, about digital yes/no categories, or boundaries, as do cognitions. Though they come in sequences, they do not have a narrative structure and they do not have a grammar. They also motivate the individual to action, whereas cognition can occur without action. Emotions also may motivate acts, though the target remains unspecified. Fear without knowing what is fear provoking can still lead to flight. Rage when one does not know what is provoking the rage is still rage. Paradoxically, it is almost as if emotions have no connection to the external world, though they move us into the world. In these ways, they are like Freud’s view of primary process, and they share the timelessness of the unconscious, but they are not primary processes in the way Freud and James spoke of them.
Meaning as a Polysemic, Polymorphic Flow
Emotions are only one of many meaningful elements in a state of consciousness that are part of the hierarchically multileveled organization of individuals’ way of being in the world. A state of consciousness is a dynamically changing biopsychological state integrating biological and psychological meaning, purposiveness, and intentions made at every level and site of operation in the organism, from physiology to awareness. As Freeman (2000) puts it, all organismic processes have purposes. The meanings from different sites at different levels emerge over different time spans (milliseconds to minutes or even longer), such that there is a temporally laminated flow of