TIFT #72: Dignity

For us therapists, the most interesting thing about dignity is that it should be a right, but it can be given, taken away, demanded, defended, and even negotiated. In a way it is a dialog between the self and others. In response to a request and because the subject keeps coming up, let’s look deeper.

The dialog of dignity

Dictionary definitions of dignity describe it two ways. It is a right belonging to every human, the right to be treated with respect for one’s individuality. It is also a statement conveyed, without words, by a certain bearing that commands respect. What binds these two definitions together is that dignity is a conversation between the individual and his or her human environment regarding the honor and respect to be accorded to that individual. Dignity can be demanded and it can be given. It can be denied and sacrificed. In every case, it is the prize in an exchange between the self and others.

A woman, transferred onto the operating table and feeling anxious, is jerked harshly into position by the surgeon as if she were inanimate. He has stolen her dignity. A bully seizes upon the vulnerability of a school boy and rips away his dignity. An opposition figure, caged in the dictator’s false courtroom, speaks out and reclaims his dignity in exchange for more beatings. The word is often not spoken aloud, but the commodity in question is the recognition that an individual’s self or soul is a unique and precious entity.

And the dialog can be nuanced. Stories thrill us with the triumph of one over another, maintaining safety because they are only stories or because they are about someone else. In sex, insisting on consent and a negotiated outcome, ritual submission can become an affirmation of power and dignity. Adoption of traits and mannerisms that command respect can be a way to affirm dignity as well as to reclaim that which has been lost or sacrificed.

Ultimately dignity boils down to an idea, a cognitive assertion that a person is to be valued and respected as an individual, or not. In humans, I will argue, the dynamics around this assertion arise out of early child development. Specifically the difficult tension between having one’s way and being loved.

Evolution

In mammalian species, conflict between wanting one’s way and still retaining the other’s love simply isn’t a problem. Dominance hierarchies are established and help organize the herd or pack. In nature, the strong usually come out ahead, but are, in most cases, instinctively guided not to kill rivals of the same species. Pups let out a cry when alone or in danger, and mothers respond as best they can, though the runt of the litter often dies. In the end, built-in drives and restraints serve to select for the strongest, while preserving the greatest number of individuals.

Prior to age two, children are similar to other mammals. When they need something, their demands are powerfully compelling to their adults, but around age two, their demands take on a different, more insistent tone. Around that age, the human mind comes to possess something new, a sense of entitlement. When expectations are “violated,” the response is anger and outrage. I think these responses are qualitatively different from the attitudes we infer in animals. I’m ready to hypothesize that the “pride” of cats doesn’t involve the same kind of cognition, but instead arises from inborn instincts that make them act in a way we lovingly anthropomorphize as a sense of pride and dignity. In contrast, around their second birthday, humans appear to develop a new and cognitively based awareness of what “should be.”

The “conscience”

Dear reader, please note that this discussion is changing my thinking about the origin of the conscience and even the word, itself. Specifically, I think this sense of entitlement is the precursor of the internalized values that traditionally inform the conscience. For some time, (TIFT #9) I have taken the view, first proposed by Allan Schore, that the conscience begins to be active as a result of the myelination of the right prefrontal cortex at about 18 months. I have stated that the conscience begins to function as a protector of social relationships at about age three, when children begin to express wishes to be “good.” I have asserted that the basis of this functionality is the internalization of values by which the mind judges the self and others and that ultimately lead to those special, conscience-based emotions of pride, shame, and guilt, which then influence behavior in ways protective of our place in the social fabric.

Here’s what I would change. I’m thinking that the two-year-old sense of entitlement represents a similar but even earlier internalization. It is a cognitive structure that functions in a way similar to later internalizations of values. At age two, the internalized principle is more like “I am entitled to what I want and you should agree.” When the other is not in agreement, the response is not shame, but outrage. Actually that’s not far from the feeling when others violate our moral values. When we see people trampling on our values, we also feel outrage. Like shame, guilt, and pride, this is one of those special emotions based on judgment and not belonging to the limbic emotions we share with other mammals.

Argument for a change of terminology

This extension of my understanding of the conscience highlights the fact that “conscience” is both misleading and value-laden. It misleadingly orients us towards morality, as opposed to a more inclusive view of how the mind forms judgments and how those judgments influence behavior. As scientists, we should also have a word that is value-neutral. In fact, one scientist has developed a more appropriate term for this mental function. Sigmund Freud called it the superego, meaning that it was independent from the self, but fulfills an overseeing function. I vote that we swallow our pride and re-adopt Freud’s term.

Development of the superego

Age two, then, is a time of power struggles, when myelination of the prefrontal cortex begins to allow children to internalize principles about how things are “supposed to be.” That is also a time when cognition is black and white, without degrees. Two-year-old’s imperatives are absolute. “You must do what I want.” It’s an existential imperative. The caregiver’s will must be perfectly aligned with my will. There is another imperative, the absolute necessity of surviving and growing, which, at that age, means only one thing, being cherished and supported by the primary caregiver. 

You can see the collision coming. The two absolutes leave no room for disagreement. “You must do what I want and You must love me totally.” The classic tantrum is only partly about having one’s way. It is just as much about the fear of losing the caregiver’s good will. That is what makes tantrums so intense. And for those adults who never solve the dilemma, the need for power can remain no less absolute, justifying murder and atrocity on a limitless scale.

What is the solution? Ultimately, under good conditions, black and white become grey. At the end of prolonged raging, the need for connection prevails and the child accepts being comforted. I believe the moment of switching between rage and need is precisely the time when a new principle is internalized, an understanding that the child can feel hate and outrage, yet still be lovable.

The experience of disagreeing without destruction of the other or loss of love creates new knowledge supporting greater confidence, confidence that the child is inherently worthy of love, even in the midst of unacceptable wishes and anger. The more thoroughly we internalize that reality, the more confident we become. This is the earliest origin of resilience, the ability to weather adversity, also known as “basic trust.”

Weakness in basic trust

There are degrees of failure to negotiate the transition from black and white logic to the nuanced reality that disagreement can coexist with love. Not everyone who stumbles at this point of development becomes a full blown narcissist. Milder forms involve vulnerability to being triggered into some form of black and white logic, where a conflict of wills must end with a winner and loser. In adults, there are many versions, but all involve some distortion in reciprocity. Some become overbearing or self-centered while others may be weak and fail to provide reliable structure to a child’s environment. The child will experience an imbalance of give and take, resulting in difficulty internalizing a healthy sense of the child’s own dignity.

In contrast, where basic trust is firmly internalized, disagreement no longer has to imply a winner or loser. “Sometimes I get my way and sometimes I don’t.” Neither is a reflection on the child’s value as a human being.

The Stockholm Syndrome

In situations where the victim is overpowered, the only way to survive is to capitulate. Survival is an imperative. Children are programmed to put survival above all else, so, faced with overwhelming power, they sacrifice their rights, including dignity. When the pain of defeat is frequent, a long-term solution is required. The answer is to identify with the aggressor, that is, to side with power against the self. That is the Stockholm syndrome. When such a toxic view is internalized, it becomes integral to the child as an attitude of low self-worth. Once that principle has become part of the superego, any attempt to behave differently is met with shame. I call this an “internal electric fence,” protecting the child from any temptation to challenge the overbearing adult. In this way, the sacrifice of dignity becomes a part of the individual.

Thus, failure to achieve basic trust in the parent can be transmitted down to the next generation through distortions in power balance that eventually become structuralized in the child and continue to cause distortions in the ability to claim dignity.

Dignity is an attitude

So finally I can say that dignity is a commodity that can be given, taken, exchanged, bartered, sacrificed, and reclaimed. Where dignity should be a constant, a right possessed by all of us, in fact it is not. Too often, it is a variable, a commodity to be negotiated. The commonness of failures to acquire confidence in one's self-worth is what leads to the widespread need of individuals to diminish others’ dignity or to sacrifice their own.

Why do parents and caregivers abuse and neglect children? It’s because the parents’ two-year-old absolutes still hold some sway. As a result, parents’ own needs take precedence over those of their children. Life feels to them like a zero-sum game where survival overrides caring. Parents either dominate or neglect their children. The children then fail to build their own belief that opposing desires can coexist with love. The children internalize a degree of basic shame instead of basic trust. From there, they either reject their own entitlement or exaggerate it. Their dignity has become a variable, a commodity, instead of a right.

Transference and countertransference

The therapeutic space is ripe for re-enactment of complex issues around power and dignity. Here is an example. Perhaps the therapist has resolved a personal fear of being overpowered by preferring to treat clients who display weakness and lack of power. That can work well, but what happens when the client begins to overcome internal shame and reclaim power. Without consciousness, that could trigger the therapist to reassert dominance. “Well, it looks like you are doing well, so let’s talk about termination.” Given the fragility of a client who has tentatively begun to claim dignity, what looks like a clinical decision may actually be an expression of dominance, a threat of rejection. The result is a transference storm, resolvable only with conscious acknowledgment on both sides.

Interestingly, the common factor is a prediction by one or the other that their needs will outstrip the available resources. The therapist is afraid that his or her fragile sense of safety will crumble under the weight of the client’s needs or newfound power. The client dares to make the implicit prediction that showing some power might be safe, but retains a hair-trigger readiness to capitulate if the therapist insists on dominance. The less they possess basic trust, the more susceptible each is to non-conscious self-defense at the expense of the alliance. The commodity whose weight is shifted for the sake of maintaining balance is dignity.

The “internal bean counter.”

Richard Schwartz, originator of Internal Family Systems Therapy calls it the “Self.” I have referred to it as the “internal bean counter.” Either way, while the superego imposes its own self-shaming attitudes and values, some other part of the mind remains aware of what is truly fair. The proof is that those who habitually capitulate to power or dominance also harbor anger and a sense of unfairness about having to sacrifice their dignity. Somewhere they know that they are really worth as much as anyone else. Similarly, those who have internalized a sense of entitlement and superiority, harbor a deep awareness that their worth is not what they claim. As therapists, we need to ally ourselves with the part of our client that holds or is ready to hold a correct evaluation, the knowledge that one person is as worthy and lovable as the next.

What can we do?

In the face of attacks on dignity, the effective way to respond is with open acknowledgment of the fragility of our own basic trust and confidence in personal dignity. The more we deny that fragility, the more we are internally compelled to use coercive means to maintain safety. In contrast, openness about our weakness and vulnerability gives us the freedom to use “thinking slow” to evaluate and affirm that we can thrive together as equally dignity-possessing individuals, able to compete and disagree without hate or denigration.

Jeffery Smith MD

Photo credit,  Manja Vitolic, Unsplash