Building an Onion: Alternatives to Biopsychiatry
This essay concerns the relationship between psychiatry and its subject, the lives of persons who are considered to be patients. If psychiatry is to advance, it will need to consider not only the microworld of biology, but many larger worlds, notably, emotions, relationships and social systems. Human beings are not only bodies, but contain emotional and relational systems, and they are connected to social systems. I propose that in order to understand these systems, we need to examine inner and outer dialogue in great detail. Labeling theory, which concerns the social system, may be integrated with a theory of emotional/relational dynamics that occur within and between people. Analyzing dialogue from a single therapy session illustrates how a theory of the emotional/relational world might be developed.
To simplify her task, when God created an onion, she probably started with the inner core working outward. However she could have also started with the outer skin, working inward. Even if you are not God, it doesn’t seem to matter which way you start, as long as you realize an onion is not just the inner core, nor is it only the outer skin.
Biopsychiatry has so far sold the public the line that the inner core of mental disorder is all that matters. The labeling theory of mental disorder that I developed (Scheff 1966; 1983;1990) functioned with the opposite trope (metaphor), that the societal reaction, the outmost skin of the onion, was more important. But the truth of the matter is that most of onion, the great bulk, is neither core nor skin. We need to move beyond both tropes, into the layers and layers that make up a complex phenomenon.
Tom Szasz is one of the earliest debunkers of the idea that psychiatry should be based solely in biology. He is in the great tradition of rebels, those who have attempted to overthrow the status quo. In this light, Szasz has taken what seems to be an absolutely necessary first step, challenging the trope of "mental illness." If he hadn’t existed, we would have had to invent someone like him.
But Szasz has not offered any sufficiently detailed alternatives. Art and science, as Blake urged, needs to deal with "minute particulars." Perhaps the next step is to establish a model alternative to the myth of mental illness, one that encompasses the minute particulars of social, psychological, and biological reality. Most of this essay will concern one such alternative, a theory of the emotional/relational world as it has been described in Retzinger (1991), Scheff and Retzinger (1991) and Scheff (1994; 1997).
The grip that established institutions have even on science has been nicely caught by the philosopher Quine (1979):
The neatly worked inner stretches of science are an open space in the tropical jungle, created by clearing tropes [metaphors] away" (1979, p. 160.
That is to say, it often happens that before science can be applied, an obstructive metaphor has to be overthrown. The history of the physical sciences is full of examples. For example, progress in the astronomy of planetary motion was delayed for over a century because of the trope that the earth was the center of the universe. This idea is a correlate universal ethnocentrism: the conceit that we human beings are the center and purpose of the cosmos.
Astronomers, like everyone else, took for granted that the planets circled around the earth. In the l6th century, Brahe had made a very accurate charting of the transit of Venus. But he could not plot the shape of the orbit because he assumed Venus was orbiting around the earth. Kepler, who inherited and added to the data after Brahe’s death, was equally puzzled for many years.
The idea of a logocentric universe was so ingrained that Kepler hit upon the solution only inadvertently. In a largely irrelevant burst of creativity, he devised a geometric model of the planetary orbits based on solid figures representing cubes, spheres, and polyhedrons. The model was absurd except for one feature; in his playful excitement, Kepler had inadvertently placed the sun, rather than the earth, at the center. But the "error" made him aware of a new way to compute the orbit.
Similarly, Einstein began work on the theory of relativity with a joke concerning persons passing each other on trains, trying to determine their speed relative to each other. He realized intuitively that this situation challenged the ruling trope that time and motion were absolute. Although he had a doctorate in physics, Einstein knew little mathematics. Apparently he had found it boring, and missed or slept through many of his classes. He had to get help to put his anti-trope into mathematical form. Like Kepler, he was a trope-clearer.
Like Kepler and Einstein, Szasz attacked a ruling metaphor in Western society. His target is the idea of mental illness, and its planetary system of concepts (symptoms, patients, hospitals, drugs as medicine, etc.). He was the first psychiatrist to forcefully and repeatedly show how poorly these concepts fit reality. Since our society still accepts the myth of mental illness, Szasz’s attack is ongoing.
Accompanying Szasz’s challenge to the idea of mental illness was the work of others in the anti-psychiatry movement: Goffman, Laing, my own labeling studies, and many others. These studies, like Szasz’s, were a step forward. But they were not sufficiently detailed, on the one hand, nor theoretically framed, on the other, to get to the core of the problem.
Although Goffman’s approach is sociologically sophisticated, it does not contain a theory of mental illness. He defines his terms only conceptually, without attention to the problem of goodness of fit to actual instances. Laing’s work is psychologically sophisticated, but involved even less conceptual development. Szasz, finally, uses no concepts; his approach is stated entirely in vernacular words. This approach makes it easy for anyone to understand, even laypersons. But it is much too narrow and simplified to use for analyzing and understanding real cases, each of which is apt to be quite complex, like most human conduct.
Szasz’s reliance on vernacular words reduces his theory almost to caricature. For example, the terminology that Szasz suggests as an alternative to "psychiatric symptoms" is "problems in living." If adapted, this usage might help to de-stigmatize the sufferers. But the phrase is much too broad a tool for understanding, since it encompasses a impossibly vast realm of problems. Unrequited love, over-extension of one’s credit, and the physical incapacities of old age are certainly all commonly encountered problems of living, but they are not the particular types of problems that are usually designated as mental illness.
If Szasz had used the terminology "residual problems of living" (problems which don’t have conventional names), he would have come close to my own solution of the problem. In any case, a social theory requires statements of explicit hypotheses, all of which are couched in terms of conceptual and operational definitions. Labeling theory was a step in this direction, but it was too narrow to grasp the intricacies of emotion and relationship that generate functional and dysfunctional behavior.
One obvious limitation of labeling theory was that it dealt only with the societal reaction to residual deviance, but not with the origins of that deviance. It simply bypassed the question of the biological and/or psychological causes of symptoms. In some ways, this orientation was a strength. In some cases of what is labeled as mental illness, there are no symptoms. When I was observing mental hospitals in the 60’s in the US, England, and Italy, many of the patients were unhoused seniors who wintered in mental hospitals. In Stockton State Hospital in 1959, I found that there were many patients with no detectable symptoms who were being used as unpaid laborers. The vast laundry facility was run almost entirely by these patients, most of whom were Chinese immigrants to the US who had never learned English. Perhaps symptoms had led to their original hospitalization. But, in any case, symptoms no longer played a role in their "mental illness."
But the single focus of labeling theory on societal reaction is also a weakness, a sin of omission. If human beings are going to live in peace together, we need to better understand the origins of symptoms such as depression, delusion, compulsion and obsession, for example. These symptoms can be found not only in mental patients, but scattered throughout whole societies, even among ruling elites. They are an important aspect of the human condition, and need to be further investigated.
Closer to the dialogue that is to be analyzed in this paper, labeling theory had a further weakness: it focused entirely on the formal, official societal reaction to residual deviance. As the dialogue excerpted from Rhoda’s psychotherapy session suggests, there is also an informal process of labeling that takes place within families, before they has been an suggestion of a formal reaction from officialdom. Informal labeling in the family, it would seem, is the next layer down of the onion, right beneath its outermost layer, the formal societal reaction. In his extraordinary paper on the growth of paranoid symptoms in an individual inside of an organization, Lemert (1962) provided an earlier description of the process of informal labeling and its effects. But labeling is but one of many processes that occur within the emotional/relational world.
The Emotional/Relational World
This essay is a proposal for creating a dynamic model of the emotional/relational world, a world that is mostly disguised and ignored in Western societies. A recent cartoon in the New Yorker is apropos. A male client, lying on the couch, is saying to the analyst: "Look, call it denial it you like, but I think what goes on in my personal life is none of my own damn business!" Like much of the best humor, this caption contains a core of truth. We are all trained to ignore the emotional/relational world.
My approach requires integration between the social sciences in general, and between sociology and psychology in particular. It points towards a theory that could lead to the empirical study of actual social relationships, the core subject of all of the social sciences and a crucial subject for the mental health professions. With emotions and relationships routinely disguised and ignored in Western societies, social sciences that also ignore it serve a conservative function, helping to preserve the status quo in the emotional/relational world.
Goffman (All of his books, but especially 1959; 1959a; 1963; 1963a; 1967) was the poet and prophet of the emotional/relational world. But his work is only a beginning, since it doesn’t involve an explicit theory, method, or systematic evidence. Another problem concerns his treatment of emotions. Compared to most social science descriptions, his are three dimensional, dealing not only with thought and behavior, but also with feeling (Scheff 2000a).
But with the exception of one essay focused on embarrassment (1967), he portrayed emotions only by implication. There is considerable embarrassment, shame, humiliation and disgust implied in his representations, but it is seldom make explicit. In this respect, his methods of dealing with emotion are similar to the usual treatment of emotion in Western societies, disguising or misnaming.
On the other hand, there are fruitful studies that go much deeper into the minute particulars of human relationships, revealing whole new realms of information about the filigree of human conduct. One such study is by Labov and Fanshel (1977), two linguists. They conducted an exhaustive microanalysis of the first 15 minutes of a psychotherapy session. They analyzed not only what was said but also how it was said, interpreting both words and manner (the paralanguage). They based their interpretations upon microscopic details of paralanguage, such as pitch and loudness contours. Words and paralanguage are used to infer inner states: intentions, feelings, and meanings.
With such attention to detail, Labov and Fanshel were able to convey unstated implications. Their report is evocative; one forms vivid pictures of patient and therapist and of their relationship. One can also infer aspects of the relationship between Rhoda and her family, since Rhoda reports family dialogues. Labov and Fanshel showed that the dispute style in Rhoda’s family is indirect: conflict is generated by nonverbal means and by implication.
Indirect inferences, from a dialogue that is only reported, are made in order to construct a causal model. Obviously, in future research they will need to be validated by observations of actual family dialogue. It is reassuring, however, to find that many aspects of her own behavior that Rhoda reports as occurring in the dialogues with her family are directly observable in her dialogue with the therapist. For example, the absence of greeting, and Rhoda’s covert aggression in the dialogue she reports with her aunt can be observed directly in the session itself (not included in this chapter but discussed in Scheff 1989).
The limitation of this and similar language based studies is the opposite of that of the work of Szasz, Goffman, etc. Where their work was largely theoretical, the linguists, working inductively, had too little. In particular, they had no theory of emotion and relationship dynamics that would help them interpret the family conflict they reported. Here I will show how a theory of these dynamics might be developed from close examination of dialogue.
The Feud between Rhoda and Her Family
Labov and Fanshal (1977) carefully examined an audiotaped dialogue between Rhoda, a nineteen-year-old college student with a diagnosis of anorexia, and her therapist. She had been hospitalized because of her rapid weight loss, from 140 to 70 pounds. When her therapy began, she weighed 90 pounds. At five feet five inches in height, she was dangerously under-weight.
Her therapy sessions took place in New York City in the 1960s. Rhoda lived with her mother and her aunt, Editha; her married sister also figures in the dialogue. The session that was analyzed by Labov and Fanshel was the twenty-fifth in a longer series, which appeared to end successfully. The therapist reported improvement at termination. At a five-year follow-up, Rhoda was of normal weight, married, and raising her own children.
Labov and Fanshel focused on the web of conflict in Rhoda’s life, mainly with her family and to a lesser extent with her therapist. The conflict was not open but hidden. The authors showed that Rhoda’s statements (and those she attributed to the members of her family) were packed with innuendo. They inferred that the style of dispute in Rhoda’s family was indirect: although the family members were aggressive toward each other and hurt by each other, both their aggression and their hurt were denied.
Labov and Fanshel’s method was to state explicitly as verbal propositions what was only implied in the actual dialogue. This method proposed a cognitive structure for the conflict in Rhoda’s family: it translated utterances, words, and paralanguage into purely verbal statements. The set of verbal statements served as a compact, clarifying blueprint for a dense tissue of complex maneuvers that were otherwise difficult to detect and understand.
In addition to this type of analysis, Labov and Fanshel also used another. Following the lead of the therapist, they pointed out cues that were indicative of unacknowledged anger. To reveal this emotion, they used verbal and nonverbal signs: words and paralanguage (such as pitch and loudness). Hidden challenges in Rhoda’s family were made in anger and resulted in anger. Rhoda’s therapist made explicit reference to this matter: "So there’s a lot of anger passing back and forth" (5.27[c] [The numbers refer to the Rhoda transcript, pp. 363-371, Labov and Fanshel 1977]). There were also myriad indications of unacknowledged anger and other emotions in the session itself.
The Role of Anger and Shame in Protracted Conflict
Emotions were not central to Labov and Fanshel’s study, but they are to mine. Building upon their assessment of cognitive conflict, and their (and the therapist’s) analysis of anger, I show shame sequences in the session that were apparently unnoticed by both patient and therapist. Labov and Fanshel frequently noted the presence of embarrassment and of the affect they called "helpless anger," but they made little use of these observations. Nor do they comment on the labeling of Rhoda in her family.
My study leads me to conclude that labeling occurs at two different levels—the informal and the formal. At the informal level, labeling is quite symmetrical: Rhoda labeled and blamed Aunt Editha and her mother just as much as they labeled and blamed her. The family members casually insulted each other almost constantly. In some sentences, several different insults were implied at once. As Labov and Fanshel pointed out, conflict seemed to be endemic in this family.
At the formal level of labeling, however, there was no symmetry whatever. The mother and the aunt were just as violent with their insults, threats, and rejections as Rhoda, but it was only Rhoda who was physically violent; she tried to starve herself. In contrast to the constant verbal violence, Rhoda’s overt violence was highly visible; her dangerously low body weight bore ostensible witness to her self-assault. Although the verbal violence seemed to be visible to the therapist and was documented by Labov and Fanshel, it was invisible in Rhoda’s community. If labeling theory is going to lead to further understanding of mental illness, it will need to take a new direction, to make visible what has hitherto been invisible; violence in the micro-world of moment-to-moment social interaction.
I use two excerpts (Labov and Fanshel 1977: 364, 365) to illustrate this point. The first involves Rhoda’s relationship with her mother; the second, with her Aunt Editha. The first excerpt occurred early in the session—it deals with a telephone conversation that Rhoda reported. The mother was temporarily staying at the house of Rhoda’s sister, Phyllis. (Since pauses were significant in their analysis, Labov and Fanshel signified their length: each period equals .3 second.)
1.8 R.: An-nd so—when—I called her t’day, I said, "Well, when
do you plan t’come home?"
1.9 R.: So she said, "Oh, why!"
1.10 R.: An-nd I said, "Well, things are getting just a little too
much! [laugh] This is—i’s jis’ getting too hard,
1.11 R.: She s’d t’me, "Well, why don’t you tell Phyllis that!"
1.12 R.: So I said, "Well, I haven’t talked to her lately."
Rhoda, a full-time student, argues that she can’t keep house without help. Her mother puts her off by referring her to Phyllis. The implication—that the mother is there at Phyllis’s behest—is not explored by the therapist. Rather, she asks Rhoda about getting help from Aunt Editha. Rhoda’s response:
2.6 [a] R.: I said t’her (breath) w-one time—I asked her—I said
[b] "Wellyouknow, wdy’mind takin’ thedustrag an’justdust
2.7 R.: Sh’s’s, "Oh-I-I—it looks clean to me,"...
2.8 [a] R.: An’ then I went like this.
[b] an’ I said to her, "That looks clean t’you?"
(It appears that at this point, Rhoda had drawn her finger across a dusty surface and thrust her
dusty finger into Editha’s face)
2.9 [a] R.: And she sort of....I d’no-sh’sort of gave me a funny
look as if I—hurt her in some way,
[b] and I mean I didn’ mean to, I didn’ yell and scream.
[c] All I did to her was that "That looks clean to you?"....
The therapist persists that Rhoda may be able to obtain help from Editha. In a later segment (not shown), Rhoda denies this possibility.
Rhoda’s Helpless Anger Toward Her Aunt
I will begin analysis with the least complex segment, the dialogue that Rhoda reports between herself and her aunt (2.5-2.9). Labov and Fanshel showed a thread of underlying anger, anger that is denied by both parties.
Rhoda has explained prior to this excerpt that dust "bothers" her—that is, makes her angry. The authors argue that the request that Editha "dust around" (2.6[b]) involves an angry challenge to Editha’s authority, a challenge that neither side acknowledges. It assumes that the house is dusty, that Editha knows it, that she has ignored her obligation to do something about it, and that Rhoda has the right to remind her of it. Although Rhoda uses "mitigating" devices, speaking rapidly and casually, she ignores the etiquette that would have avoided challenge.
(Labov and Fanshel wrote, "The making of requests is a delicate business and requires a great deal of supporting ritual to avoid damaging personal relations surrounding it" .) To avoid challenge, Rhoda might have begun with an apology and explanation: * "You know, Aunt Editha, this is a busy time for me, I need your help so I can keep up with my schoolwork." Rhoda’s actual request is abrupt. (As customary in linguistics, an asterisk (*) is used to denote a counterfactual, a hypothetical statement not made in the actual dialogue.)
Editha’s response is also abrupt: "Oh-I-I—it looks clean to me..." She has refused Rhoda’s request, intimating inaccuracy in Rhoda’s appraisal. The ritual necessary to refuse a request without challenge is at least as elaborate as that of making one. Editha could have shown Rhoda deference: *"I’m sorry Rhoda, but...," followed by an explanation of why she was not going to honor the request.
Rhoda’s response to what she appears to have taken as an insult is brief and emphatic: She contemptuously dismisses Editha’s contention. She wipes her finger across a dusty surface and thrusts it close to Editha’s face: "That looks clean to you?" Labov and Fanshel noted the aggressive manner in Rhoda’s rebuttal: she stresses the words that and clean, as if Editha were a child or hard of hearing. They identified the pattern of pitch and loudness as the "Yiddish rise-fall intonation": *"By you that’s a monkey wrench?" implying repudiation of the other’s point of view. "If you think this is clean, you’re crazy" (202). Rhoda’s response escalates the level of conflict: she has openly challenged Editha’s competence.
Finally, Rhoda describes Editha’s response, which is not verbal but gestural: she gives Rhoda a "funny look as if I—hurt her in some way." Rhoda denies any intention of hurting Editha, and that Editha has any grounds for being hurt: "I didn’t yell and scream," implying that Editha is unreasonable.
Labov and Fanshel noted the presence of anger not only in the original interchange but also in Rhoda’s retelling of it. The nonverbal signs, they said—choking, hesitation, glottalization, and whine—are indications of helpless anger: Rhoda "is so choked with emotion at the unreasonableness of Editha’s behavior that she can not begin to describe it accurately" (191). Helpless anger, the authors wrote, characterizes Rhoda’s statements throughout the whole session: "she finds herself unable to cope with behavior of others that injures her and seems to her unreasonable" (191).
Labov and Fanshel further noted that her expressions of helpless anger were "mitigated":
All of these expressions of emotion are counterbalanced with mitigating expressions indicating that Rhoda’s anger is not extreme and that she is actually taking a moderate, adult position on the question of cleanliness. Thus she is not angered by the situation, it only "bothers" her. Even this is too strong; Rhoda further mitigates the expression to "sort of bothers me."
Mitigation in this instance means denial: Rhoda denies her anger by disguising it with euphemisms.
What is the source of all the anger and denial? Let us start with Rhoda’s helpless anger during her report of the dialogue. Helpless anger, according to Lewis (1971), is a variant of shame-anger: we are ashamed of our helplessness. In retelling the story, Rhoda is caught up in a shame-anger sequence: shame that she feels rejected by Editha, anger at Editha, shame at her anger, and so on.
Helpless anger has been noted by others besides Lewis. Nietzsche (1887) referred to a similar affect ("impotent rage") as the basis for resentment. Scheler (1912) used Nietzsche’s idea in his study of ressentiment—pathological resentment. Horowitz (1981), finally, dealt with a facet of helpless anger under the heading "self-righteous anger."
Rhoda and her family are caught in a web of ressentiment, to use Scheler’s term. Each side attributes the entire blame to the other; neither side sees their own contribution. As Labov and Fanshel showed, one of Rhoda’s premises is that she is reasonable, and the members of her family are unreasonable. The reported dialogues with her family imply that the family holds the opposite premise: that they are reasonable, but she is unreasonable.
The theory that will be developed here suggests that the dialogue between Rhoda and Editha is only a segment of a continuous quarrel. Since it is ongoing, it may not be possible to locate a particular beginning; any event recovered is only a link in a chain. (Watzlawick et al. 1967; 58). Starting at an arbitrary point, suppose that Rhoda is "hurt" by Editha’s failure to help. That is, she feels rejected, shamed by Editha’s indifference, and angry at Editha for this reason. She is also ashamed of being angry, however. Her anger is bound by shame. For this reason it cannot be acknowledged, let alone discharged.
Editha may be in a similar trap. Rhoda is irritable and disrespectful, which could lead to shame and anger in Editha. She could experience Rhoda’s hostility as rejecting, arousing her own feelings of helpless anger. Reciprocating chains of shame and anger on both sides cause symmetrical escalation.
The Impasse between Rhoda and Her Mother
Excerpt 1, as reported by Rhoda, may point to the core conflict. It is brief—only three complete exchanges—but as Labov and Fanshel showed, it is packed with innuendo. My analysis follows theirs, but expands it to include emotion dynamics.
Rhoda’s first line, as she reports the conversation, is seemingly innocuous: "Well, when do you plan t’come home?" To reveal the unstated implications, Labov and Fanshel analyzed understandings about role obligations in Rhoda’s family. Rhoda’s statement is a demand for action, disguised as a question. They pointed out affective elements: it contains sarcasm (1977: 156), criticism (161), challenge (157, 159), and rudeness (157). The challenge and criticism are inherent in a demand from a child that implies that the mother is neglecting her obligations.
Implicit in their comments is the point I made about Rhoda’s approach to her aunt. It would have been possible for Rhoda to have requested action without insult, by showing deference, reaffirming the mother’s status, and providing an explanation and apology. Rhoda’s request is rude because it contains none of these elements.
Rhoda’s habitual rudeness is also indicated by the absence of two ceremonial forms from all her dialogues, not only with her family, but also with her therapist: any form of greeting, and the use of the other’s name and title.
Does Rhoda merely forget these elements in her report of the dialogues? Not likely, since they are also missing in the session itself. Labov and Fanshel tell us that the transcript begins "with the very first words spoken in the session; there is no small talk or preliminary settling down.... Instead the patient herself immediately begins the discussion." Rhoda neglects to greet the therapist or call her by name. Since Rhoda is junior to the therapist, her aunt, and her mother, the absence of greeting, name, and title is a mark of inadequate deference toward persons of higher status. Rhoda’s casual manner is rude.
The mother’s response is just as rude and just as indirect. According to Rhoda’s report, her mother also neglects greetings and the use of names. Like Rhoda’s aunt, she neither honors the request nor employs the forms necessary to avoid giving offense. Rather than answering Rhoda’s question, she asks another question—a delay that is the first step in rejecting the request.
Labov and Fanshel stated that the intonation contour of the mother’s response ("Oh, why’") suggests "heavy implication." They inferred: *"I told you so; many, many, times I have told you so." (When Rhoda gives a second account of this dialogue [4.12-4.15], she reports that the mother actually said, "See, I told you so.") What is it that the mother, and presumably others, has told Rhoda many times? The answer to this question may be at the core of the quarrel between Rhoda and her family.
Whether it is only an implication or an actual statement, the mother’s I-told-you-so escalates the conflict from the specific issue at hand— whether she is going to come home—to a more general level: Rhoda’s status. Rhoda’s offensiveness in her opening question involves her mother’s status only at this moment. The mother’s response involves a general issue. Is Rhoda a responsible and therefore a worthwhile person, or is she sick, mad, or irresponsible?
Labeling, Shame, and Insecure Bonds
At a superficial level, the mother’s I-told-you-so statement involves only Rhoda’s ability to function on her own. As can be seen from Rhoda’s complaints at the end of the session, however, this implication is symbolic of a larger set of accusations that Rhoda sees her mother and sister as leveling at her: she is either willfully or crazily not taking care of herself, starving herself, and she doesn’t care about the effect of her behavior on her family. Her family’s basic accusation, Rhoda feels, is that she is upsetting them, but she doesn’t care. Rhoda formulates this accusation at the end of the transcript.
T. What are they feeling?
5.26 R. ...that I’m doing it on purp—like, I w’s- like they ...
well-they s-came out an’tol’ me in so many words that
they worry and worry an’ I seem to take this very lightly.
To Rhoda, the mother’s I-told-you-so epitomizes a host of infuriating, shaming charges about her sanity, responsibility, and lack of consideration. Note particularly that the labeling process to which Rhoda refers here is not explicit; it occurs through innuendo.
The labeling of Rhoda by the other family members and its emotional consequences underlie the whole family conflict. Yet it can be detected only by a subtle process of inference, understanding the meaning of words and gestures in context, in actual discourse. Both the theory and the method of the original labeling theory were too abstract to detect this basic process.
Rhoda responds (in 1.10) not to the underlying implication of her mother’s evasion but to the surface question, ""Why do you want to know?" Because, she answers, "...things are getting just a little too much..." The key element in Rhoda’s response is the affect. Labov and Fanshel stated that the paralanguage (choked laughter, hesitation, glottalization, and long silence ) is an indication of embarrassment (171). Rhoda responds to her mother’s accusations by becoming ashamed. The shame sequence that is described is a marker for stigmatization that is otherwise hidden behind polite words.
Rhoda’s shame may indicate that she feels that her family’s charges have some basis, or that the implied rejection leads her to feel worthless, or both. Since no anger is visible at this instant, it is either absent or bypassed. The verbal text, however, suggests that Rhoda is feeling shame and guilt. She is acknowledging that she needs her mother—a need she has repeatedly denied in the past. She may feel that she is at fault for this reason.
Labov and Fanshel contrasted the force of the mother’s response with the weakness of Rhoda’s comment (at 1.10). The mother says, "Why don’t you tell Phyllis that?" Labov and Fanshel stated that the hesitation and embarrassment that characterize 1.10 are absent from this response. It is a forceful rejection of Rhoda’s claims and, by implication, a criticism of Rhoda for even making the request. The mother’s emotional response to Rhoda’s embarrassment is not simply unsympathetic; it is aggressively rejecting. From the emotional standpoint, Rhoda’s back is to the wall. She is trapped in the helpless role of the blamed, with her mother as the aggressive blamer.
The analysis of shame in this dialogue points to an otherwise hidden issue. At this moment we can see that in her family, Rhoda has literally no one to whom she can turn. She is at odds with her aunt. We know from her reports of her sister’s comments that Rhoda and she are also in a tangle. No father is mentioned. Rhoda and her family are in a perpetual war, a war hidden beneath the surface of conventional discourse. All of Rhoda’s bonds are threatened, yet she has no way of understanding her complete alienation.
The stage is set for violent emotion and/or violent behavior: for mental illness (Rhoda appears to be delusional about her eating and body weight), murder, or suicide (in this case, self-starvation). That the potential for suicide arises when individuals have no one to whom they can turn was conjectured by Sacks  on the basis of his analysis of calls to a suicide prevention center. The repression of shame and the bondlessness that is its cause and effect can give rise to primary deviance in the form of mental illness, murder, or suicide.
In Rhoda’s response (1.12), she continues in the role of the one at fault: "Well, I haven’t talked to her lately." Her mother has defeated her on all counts. She has refused Rhoda’s request without the ritual that would protect Rhoda’s "face"; she has implied a victory over Rhoda ("I told you so") that undercuts Rhoda’s status, and she has criticized her for making an inappropriate request to the wrong person.
Rhoda appears to feel too baffled, upset, and helpless for an angry counterattack. Her anger at her mother may feel too shameful to countenance. It is reserved for lesser targets: her aunt, her sister, and the therapist. Her mother’s rejection, with the implied threat of abandonment, could be the basic source of Rhoda’s shame.
Even to the casual reader, the mother’s tactics are transparent. Why is Rhoda so baffled by them? Why didn’t she use a response like the one suggested by the authors: *"Oh, come off it, Ma! You know it’s really up to you when you come home, not Phyllis. Get off my case!"
Rhoda’s ineptness may be due to her intense shame, evoked beginning with the first question, asking her mother for help. In this instance the massiveness of the unacknowledged shame is befuddling almost to the point of paralysis.
In the overt form of shame, one is so flustered that speech is disrupted, with inaudibility, repetition, stuttering, and fragmentation. Even though she is only reporting the dialogue, Rhoda’s speech shows many of these markers. Bypassed shame, on the other hand, may disrupt one’s ability to think clearly, forcing one into a holding pattern, repeating set responses not particularly appropriate to the moment (Scheff 1987). This dialogue suggests that Rhoda is overwhelmed with both kinds of shame.
At the heart of the quarrel is a series of threats between Rhoda and her mother. As in all interminable quarrels, it is not possible to identify the first link. I begin with Rhoda’s basic threat, without signifying that it came first: *"If you don’t stop shaming me, I will starve myself!" Her mother’s basic threat: *"If you don’t stop shaming me, I’11 abandon you!"
The abandonment threat in this case is literal: the mother has left Rhoda to stay with her other daughter. Normally, the threat of abandonment would be largely symbolic; carrying out a threat of abandonment is probably rare. But whether it is real or symbolic, threats of abandonment may be the key link in the causal chain.
This chain has potentially lethal force because none of it is visible to both participants. There are four links: (1) Rhoda’s shame in response to her mother’s behavior toward her; (2) her threat to starve; (3) the mother’s shame in response to Rhoda’s behavior; (4) her threat to abandon Rhoda. Rhoda is aware of none of these links. Nearest to her awareness is the mother’s threat to abandon her, and next, the shaming by her mother. Rhoda is unaware that her mother is shamed by Rhoda’s aggressive and self-destructive behavior, and she denies that she is starving herself. The mother is aware of only one link: Rhoda’s threat to starve herself. Because of this awareness, she talks to and about Rhoda in code, not daring to mention Rhoda’s threat. Her shame over Rhoda’s behavior, her own shaming of Rhoda, and her threat to abandon Rhoda apparently are not experienced by her.
The driving force in the quarrel is not the anger that was interpreted by the therapist but the shame in the field between Rhoda and her family. The anger in this family is both generated and bound by shame. Rhoda experiences her mother’s threat of abandonment and her mother’s anger as shaming. The mother experiences Rhoda’s threat of self-starvation and Rhoda’s anger as shaming. The symmetry is complete: each side is threatened and shamed by the other, and each side can see only the other’s threat.
The system of threats and hidden emotions is comparable to that preceding conflict between nations (Scheff 1994). Each side feels its credibility would be diminished by backing down in the face of threat. Each side therefore escalates the level of threat. The resulting emotions have no limit, unless outside mediation occurs or shame is dispelled. "War fever" may be code language for collective shame-rage spirals.
The theory advanced here attempts to explain the emotional sources of mental illness, and the excessive force of the societal reaction to mental illness, the roots of primary and secondary deviance. Rhoda and her family are caught in an interminable conflict that is driven by triple spirals of shame and anger within and between the disputants. For brevity, I have not included my (1989) analysis of the transaction between Rhoda and her therapist, but because of its relevance to the argument, I provide a brief summary.
Although Rhoda attacks the therapist surreptitiously, using the same tactics she uses against the authority figures in her family—her mother and her aunt—the therapist is too wily to become enmeshed in them. She gets angry, but she doesn’t attack Rhoda back, as Rhoda’s mother and aunt do. By avoiding emeshment in the family conflict, the therapist is able to form a secure bond with Rhoda, leading ultimately to a successful course of therapy.
Research in the labeling tradition suggests that therapists like this one are probably rare. Therapists and other agents outside the family often become enmeshed in family conflicts, usually aiding with the family against the patient. Bowen’s (1978) seminal analysis of family systems implies this course. Several earlier case studies illustrate the emeshment of the outside agents on the side of the family (Retzinger 1989; Scheff 1966, 1987).
This paper has proposed a dynamic model of estrangement within the emotional/relational world. I have analyzed dialogue from a therapy session that suggests how Rhoda, the patient of record, became estranged from her mother and other members of her family. The labeling of Rhoda as the problem was based, it seems, on unacknowledged shame. Rhoda and her family failed to acknowledge the cycle of rudeness and rejection that created shame for all sides. Rather than acknowledge shame, the mother and the aunt resorted to verbal violence against Rhoda. But Rhoda responded not only with verbal but also with physical violence against herself, self-starvation.
Applying two unrelated theories (labeling and shame/anger theory) to a single case illustrates how some of the interior layers of the emotional/relational onion might be constructed. Biopsychiatry, on the one hand, and discourse analysis, on the other, can work from the bottom up to create further layers. Labeling theory, perhaps combined with other social/political/economic analyses, can work from the top down. We have a long way to go if we are to create a whole onion, but we must give it a try.
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Antip1 6, 816 words April 6, 2003