Chapter Two: Basic Concepts
Interpersonal” is what goes on between people.
Human beings are born and develop in an interpersonal environment. They develop sequentially by living and learning in interaction with other human beings. Unless there are natural or human-made catastrophes, problems or limitations in specific areas of development are directly related to interactions with significant people, particularly in the formative years (approximately the first 10). In addition to these central significant relationships, broader social phenomena such as racism, classism, religious oppression, gender stereotyping and anti-LGBTQ2S+ oppression, war, famine, pandemics, economic crises, immigration, migrations, etc., are also interpersonal, and profoundly impact the growing person. Throughout life, people have the capacity to change in an interpersonal environment. These assumptions are central to interpersonal theory.
Everything we do, as well as most of our biological development, is impacted by the experience of interpersonal interaction. Much of the development of human functioning that we think of as purely physiological occurs in an interpersonal context. For example, in infancy, the need to defecate is a biological function, but its organization is determined by experience with the primary parenting figure(s). Moreover, many infancy functions thought of as purely biological, such as digestion, are impacted by the moods and actions of significant others as the functions are developing.
There is a hierarchy of needs depending upon where a person is developmentally. The satisfaction of current needs is impacted by the degree of satisfaction of earlier needs. Infants require the satisfaction of very basic needs for survival, such as food, temperature control, and cuddling. Functions are the operations an individual learns to satisfy those needs. Initially, the primary caretaker(s) is required to validate the satisfaction of those needs, and is then required to validate the functions needed in each subsequent developmental era. Examples include encouraging the ability to crawl and walk in late infancy and providing the opportunity for interaction with other children during childhood.
In this context, the satisfaction of needs is required at all levels of human development.
Sullivan also defines another kind of need, the “need for security,” in which the defensive structure of personality organizes for the prevention of anxiety but not for satisfaction (Sullivan, 1953, pp. 42-43). If the person is about to satisfy a need that has been forbidden or discouraged in their upbringing, they are in “danger” of experiencing anxiety with its attendant disorientation and terror. Instead, they muster a security operation to ward off that intense discomfort. For example, instead of agreeing to hang out with a new potential friend, they “need” to stay home and watch several episodes of their favorite series. They are, in this instance, delaying or destroying the satisfaction of a more productive need such as intimacy. Or, in a more extreme situation, a person might feel that they have a “need” to get personal revenge or to drive 40 mph beyond the speed limit for the sheer “fun” of it to unconsciously ward off feeling or noticing something about their life that would change it for the better.
However, not all security operations are expressed as “needs.” Security operations are whatever maintains a defense against the anxiety-provoking experience of a forbidden need. For example, being preoccupied with how they look, worrying that they are going to say something “stupid” when interacting with people at an exciting event or aggressively drinking to blackout at a gathering are other forms of security operations designed to limit or prevent satisfaction of the productive need to improve their social life.
The Interpersonal Framework
In the interpersonal framework, human personality is composed of a number of components dynamically related to one another: the self-system, the central paranoia, the integral personality, and the dissociated. The following is a series of definitions of these interacting components.
The self-system is one’s sense of self at any particular moment. It has productive and restrictive characteristics. It is available to grow from experience or to ward off growth from experience by omission or distortion. The self-system is the part of the personality that organizes awareness. If the self-system could be frozen in time at any particular moment, it would consist of what a person has available to consciousness — that is, the awareness of what one can do and who one believes oneself to be in relation to oneself, other people and the world.
The self-system governs the ability to focus attention in order to do anything at all. However, this same capacity to focus attention is also affected by a second function, the self-system’s restrictive apparatus, which uses “selective inattention” to avoid awareness of anything that disrupts the historical emotional connection with the central parenting figure(s).
Some functions move in and out of the self-system, remaining much of the time in marginal awareness but available to be utilized in special situations. For example, a person might be quiet and unassuming, but in an emergency or crisis may assume a leadership position, provide direction to others, or speak out on an important issue when they had not previously done so or even thought they could. Basic physiological functions, like breathing or digesting, are also usually in marginal awareness and only come into focal awareness when there is a problem or a conscious decision to bring them into awareness, as in yoga.
The self-image, as opposed to the self-system, is mostly in marginal awareness, but periodically in focal awareness. It also appears in dreams. The self-image is a person’s symbolic condensation of how one sees oneself: a symbolic encapsulation or representation of what the person believes is or isn’t possible for oneself in life. Statements of self-image might be “I am a good teacher,” or “I am a scaredy-cat.”
The Central Paranoia and Despair
The central paranoia is an organized, complex system of despair about what is possible, which forms the basis of a security system designed to ward off learning from new experiences that would threaten the tender connection with the original primary caretaker(s). At the beginning of life, the infant is dependent on the primary parenting figure(s) for its very survival. If a parenting figure is, for whatever reason, unavailable, the infant experiences discontinuity that results in instantaneous visceral distress, because of the infant’s fragility and dependence. The central paranoia is built upon those repeated threats to existence, functioning, and satisfaction that inevitably occur when an infant is most fragile and dependent.
The primary caretaker(s) provides tender empathic connections that stimulate the infant to thrive and grow. In general, tenderness involves empathically sharing with another to satisfy any need at any time and in any era of development; but this kind of interaction is most potent in the formative years, and particularly in infancy. All caretakers usually have out-of-awareness limitations based on their own upbringing. When the infant, in its newness and staggering potential, collides unknowingly with those limitations, it empathically experiences parental discomfort. For example, when the infant explores putting its fingers in its anus and takes pleasure in the sensation, this can be seen by the caretaker as an undesirable activity. The infant empathically picks up the adult’s mood, and continuity with the caretaker’s tenderness is disrupted. Since the infant is dependent on the continuity of loving relatedness with the parenting one(s) for survival, the ability to function, and tenderness, the disconnection from that relatedness is experienced as a threat to all three needs.
Limitations are different for every caretaker, but whatever they are, they form the basis for the subsequent development of the young person’s central paranoid restrictions. Repetition of this dynamic is necessary to form those restrictions. For example, repeated parental disgust while changing diapers (whether because they are simply disgusted with feces or because they are generally disgusted with their baby) can ultimately become the basis for the child feeling like a disgusting person. This formulation applies to anyone who is the primary caretaker with continuity. One babysitter, well-meaning friend or relative who is disgusted by diaper changing, and then is no longer welcomed by the parenting one(s) as a helper, comprises only a short-time experience among many positive ones and will not form the basis for a person’s self-disgust.
Despair is a compilation of one’s worst fears. It includes the fear of death, the fear of disorganization, and the dissociation from the need for tenderness. Usually, it is a symbolic statement of why the project of learning something new can’t work, or why one can’t grow. Ironically, it is a formulation people experience most powerfully at the point at which they are in “danger” of growing beyond what was conceivable to the primary caretaker(s). To grow beyond the primary self-system(s) of their primary caretaker(s) would threaten very early continuity with them. For example, nightmares very often occur during periods of crisis and change in a person’s life, when they have reached some kind of turning point toward growth beyond what was conceivable to those who brought them up so far. Nightmares are symbolic statements of despair. They are useful tools in therapy because they congeal or codify despairing assumptions a person lives with all of the time, assumptions that the person is often not aware of.
A person most likely becomes conscious of despair at the point at which they are about to make a breakthrough into something new. It usually appears in the form of moods and dreams, including nightmares. Despair is most effective when it is formulated out of awareness, but can also be quite powerful when it exists at the margins of consciousness: one lives by it uncritically. In situations when the self-system is not challenged, the despairing thought or perception is “It’s just that way.” The person doesn’t think about what “that way” is, and is not critically aware of it. Once despair is exposed to the light of day, it is open to criticism and available to change. Despair is like a distress signal that can marshal unspoken beliefs when the status quo is challenged. It can take the form of inner, unspoken beliefs that happiness, success, or any intense pleasure would be fatal. It brings back the “I’m about to die” (in not so many words) feelings of an infant in distress from losing loving continuity with the primary caretaker(s). “Despair is the watchdog of the self-system” (Pearce & Newton, 1963, p. 408).
Depression, as defined here, is usually a chronic state of a flattening or not noticing feeling. It is a state that occurs to keep out threats to the self-system that would imply forbidden opportunities for growth. Depression is different from despair because, in its apathetic shroud, there is no opportunity for the distress signal to occur. The alarm sounds when the apathy lifts with the intrusion of new experience and hope for change. That produces anxiety, with the attendant experience of the despairing assumptions. But therein lies the opportunity for a critical reassessment of those assumptions, in a supportive interpersonal environment.
A person comes into therapy saying, “I can’t make a friend, find interest in a project, enjoy anything in life. What am I living for?” The individual feels intensely discouraged because nothing feels satisfying, and may even call this feeling “depression.” To get past these pronouncements, the person would have to examine the original relationships that prompted the despair which, at the moment, would be too threatening to their self-system. However, it is an opportunity for the therapist to gently work toward bringing to light the underlying despair and the etiology of it, by taking a history. Whatever words are used to describe problems in living, the therapeutic work is to finally push the self-system to grow and thus challenge despairing assumptions and the discouragement that goes with them.
The dissociated consists of all needs and perceptions, including memories and partially organized functions, that have been exiled from awareness because of the forbidding gestures of the early significant other(s). As discussed below, the dissociated is not a system; it is not organized in any way. It is a repository of forbidden needs and a “chaotic constellation of amputated experiences” (Pearce & Newton, 1963, p. 21) that could not be validated and those moves to satisfy them. Dissociated needs and experiences are drawn upon by the integral personality (see below) in order of urgency of the need and emerging opportunity for satisfaction.
There is a continuum of dissociation. Needs that are less dissociated may be partly available to consciousness, e.g., in marginal thoughts, fugue states, or dreams. This partly dissociated material can be consciously thought about because it is more accessible. Thinking about dissociated material consists of holding it up to scrutiny, perhaps in dreams, artistic work, discussions with friends, and/or in therapy. This work is done in awareness, in the self-system, usually with a supportive person, therapist, or friend; or it is worked on out of awareness, in the integral personality, in the form of dreams or fugue states, which may or may not be remembered, and can then be usefully interpreted by a therapist and/or helpful other. Then the person may be able to meet the heretofore dissociated need, which expands their self-system to include the new experience: that is, to grow.
If a person comes close to experiencing dissociated material, say by embarking on a forbidden expansion of experiences—such as a new relationship, a trip to another country, or by leaving home—they might despair in some form or another. That is, there might be an emerging conviction that life will never be any different, or even that it will be much worse, that they are on the path to destruction. The security system, responding to the emergence of previously dissociated material, may quickly marshal its big guns and resurrect the old barriers. The purpose of this psychic maneuver is to repudiate and re-bury the previously dissociated experience.
When a dissociated need moves into awareness, the productive aspect of the self-system has a chance to expand. If the emergent dissociated need is repudiated, there is a strengthening of the self-system’s restrictive apparatus. Thus, when there is contact with the dissociated, the outcome is either growth or deterioration (see below). Much depends on the availability of other people who can validate the new experience as well as the person’s previous level of development.
The Integral Personality
The integral personality is the total of all aspects of experience, both dissociated and in awareness. All experience one takes in via the sensory organs is contained in the integral personality. It is called integral because it integrates everything: the self-system, despair, central paranoia, and the dissociated, all of which relate to the integral personality in a particular way. It is seen as integrating all experiences, both conscious and unconscious.
Even those aspects of functioning that are forbidden by one’s early experience, which one mostly dissociates, are contained in the integral personality. Because they are unmet needs, they continue to push for awareness. The degree to which they reach the borderline of one’s awareness depends upon the intensity of need versus the strength of the security system.
For example, a child reaches the age of four or five having dissociated the need for relatedness to peers because of one or another unfortunate aspect of their upbringing. When it is time for them to begin going to school, they are pushed much more powerfully to relate to other children by the changed circumstances as well as by the ongoing need to play. At that point, the need to relate to their peers pushes for awareness. It may or may not succeed, depending upon what else is going on. The more intensely felt needs push for awareness. When there is opportunity, and the more the need has gone unmet, the more the integral personality pushes to meet the need.
Sometimes functions that are forbidden in the conscious experience of the child are expressed in dreams or masked in fantasy, but not directly acknowledged. They are fueled by needs, using experiences only deposited in the integral personality because the self-system cannot accept them yet. These can be elaborations of thought, still out of awareness, which are more evident in dreams, artistic expression, fantasy, or slips of the tongue. A person often plans and organizes how to get their dissociated needs met outside of awareness. They might know about it via dreams or creative work, such as writing, painting, music, or fantasy.
As a kid, Jen was essentially isolated from other children, except for a cousin or two. So she had an ongoing fantasy of being with one or two other children. They start building a log cabin, and more kids get interested; together they build more cabins. Then they decide to build a wooden fence around the cabins, like the forts in cowboy movies. Now they’re self-sufficient and no grownups are allowed. It becomes a thriving cooperative community of kids. Jen didn’t grow up in a community of kids, but in her fantasy life she was organizing a life consisting of a community of friendly people, all working together to make something that excluded people they felt didn’t love them. It was a very elaborate fantasy that went on for several years.
There is always pressure from the integral personality to admit dissociated needs to awareness. A simultaneous struggle occurs between the integral personality and the self-system’s security operations, forged by the central paranoia, about whether to allow those thoughts in or keep them out. People sometimes act on the basis of dissociated needs without realizing it or, on the other hand, by setting up situations to meet their needs, governed by their integral personality. At the same time people can, in a dissociated fashion, set up structures to block themselves based on dissociated despair from the central paranoia. It is an internal dialectic that moves forward and backward in the integral personality’s struggle to grow and change the self-system. There’s always pressure from the integral personality to admit needs into awareness — that is, into the self-system. In the dialectic process, there’s always pressure from the security apparatus to keep those thoughts out.
Other Explanatory Concepts
“People who ride on roller coasters will pay money for being afraid. But no one will ever pay money for anxiety in its own right. No one wants to experience it” (Sullivan, 1954, p. 95).
Anxiety is emotional and perceptual—a state of mind when confronted with something that will disrupt the self-system as one knows it. It involves a serious drop in self-esteem—or an anticipation of devastation, of separation from those significant people in one’s life whom one depended on or still depends on.
Anxiety is the disruption of consciousness, which has been organized according to the rules of the self-system. It is seldom experienced without the immediate response of the central paranoid system, so that it is an emotional state where one experiences, or anticipates experiencing, a threat to oneself, a threat to one’s very being—intense fear.
Since it calls up the central paranoia, it involves an utterly devastating feeling, which, in later life, can be identified as the fear of death, of complete isolation, and/or of insanity when a person has words for it.
In short, anxiety is the emotional and perceptual experience of combined disorganization and terror.
Anxiety occurs when dissociated material begins to intrude into awareness causing disorganization of the self-system, the sense of self as one knows it. The subjective experience is disorganization and some form of distress, whether it is terror or low self-esteem. This very powerful and intolerable experience can be headed off by the security apparatus, which may be efficient enough to stop this intrusion so that anxiety is barely noticed. The result could be an increased tightening of the security apparatus to avoid the most devastating experience of anxiety.
Anxiety is a transitional state, ending either in the further tightening of the limits of the self-system or a reorganization of the self-system to include the dissociated experience from the integral personality in order to satisfy previously unmet needs.
Developmentally, intruding needs may date from any time in a person’s lifetime. But since they have been previously dissociated, their intrusion into the self-system calls up the infantile terrors of the central paranoia. For example:
A young man who comes from an extremely sheltered and restrictive family has had a very hard time staying at a job for more than three days, because of an increase in fears that he is incompetent and disliked. He gets a new job and, with encouragement from his therapist, begins to talk to co-workers and enjoy spending time with them. As he accepts an invitation to happy hour, he is seized with feelings of dizziness and nausea, and the intense conviction that he is not wanted there despite the invitation. He instead goes home (he lives with his nuclear family) and spends the night tossing and turning with nightmares. The next day he comes to work, but loses his way and gets there late. He finishes the day but feels he’s done a slipshod job and feels guilty about being late. Feelings of disorientation and self-revulsion continue. But with help from his therapist and co-workers, he doesn’t quit after three days, and it is possible that he will finally keep a job. The uncomfortable feelings may dissipate over time with enough reassurance, and particularly with the knowledge from his therapist that there have been no reported deaths from anxiety itself.
It is said that most people dislike change and would rather not even try. However, it is not change that is repugnant. The reluctance is comprised of the original reasons for not disrupting the status quo. If change were so scary, as the culture would have it, we would never get past infancy, because from infancy through at least adolescence every moment is something new. The problem comes when the assumption of the original caretaker(s) is challenged. At that point a new change, divergent from that context, can arouse anxiety with accompanying disorientation and terror, because it represents distancing from the original significant relationships. The phenomenon particularly arises as the growing person becomes involved with environments psychically farther away from home. The occurrences of psychiatric crises and panic increase markedly in adolescents, coinciding with their increased potential for independence, mobility, and sexual desire.
In this context, “stress” is differentiated from “anxiety.” Stress may be related to a realistically or unrealistically overwhelming situation and does not necessarily come from an expansion of one’s self-system. Anxiety results when the person attempts to expand how they view themself, which is now being challenged, to include previously inconceivable perceptions and functions. It is the difference between worrying about getting to a meeting on time (stress) and uncanny feelings of disorientation and dysphoria (anxiety) that come when one is successful at organizing for the first time not to be late.
Security operations are perceptions and behaviors designed to avoid anxiety. They function to limit the awareness of needs that have been dissociated; that is, they prevent the emergence of the dissociated experience of needs. They can limit experiences that may lead to anxiety-provoking expansion of the self-system.
Thus they promote the status quo, the way the self-system is organized. They may function in anticipation of the point at which a person might experience anxiety.
Security operations are extremely varied. They could be anything and are very creative. For example, the young man described above sits at his desk and ultimately avoids going to happy hour because, “My co-workers are just being nice and don’t want me to join;” “I’ll have nothing to say because I’m not very interesting;” “I have too much work to finish;” “Besides, it’s supposed to storm tonight.” Experience to expand his self-system has been successfully headed off.
Paradoxically, in some circumstances, productive capacities can be called in to prevent expanding experience. For example:
Harriet, a gregarious young woman, decides to get her Ph.D. and enrolls at a university. However, each time she decides to devote herself to her studies she finds herself embroiled in social activities: throwing a party for her friend’s nephew, hosting old friends, and showing them around town. These were productive activities, but now they are used to avoid needed study time. Obtaining her Ph.D. would challenge her view of herself as a good-natured gal but somewhat intellectually limited. She’s gregarious enough and organized enough to be accepted to graduate school, but God help her if she ever actually obtained a higher degree and realized she was even more capable of using her productive skills.
Security operations can take the form of functions, behavior, thoughts, perceptions, beliefs, and moods called up at crucial moments. Or they can be comprised of ongoing delimiting patterns running nonstop in the background of one’s mind. For example, one thinks of oneself as “I am always depressed. That’s my personality, my diagnosis.” Some people walk around as if under a dark cloud, another kind of security operation.
In the process of learning a new function, new security operations may crop up as obstacles that may be more or less successful. For example, a young woman with low self-esteem finally forces herself to make it to a party but then acts like a wallflower once she gets there.
A few more examples:
A person feels the need to perform their latest song at an open mic, to share their creativity with others. However, on the evening of the event they decide they had better write a new song, and so going public is delayed. Each time, on the evening of the weekly event, they decide they’d better write a better song, which keeps on delaying their going public.
This next example illustrates the expression of a need and its undoing:
Bill, who had been psychiatrically hospitalized, finally decides to go to a party. In his subsequent session he says he had had a horrible time, that no one wanted to talk to him. The therapist asks him to start at the beginning: “I walked in, had a drink; a woman talked to me, asked me my name, and I said, ‘My name is Bill and I have been in three mental hospitals.’ I was being honest.” He had successfully fulfilled his deeply embedded expectations about the outcome of such a bold social endeavor.
Vague generalizations can also be used to maintain the status quo:
An isolated boy tells his therapist that all the kids in school pick on him; all the kids misbehave, and he gets blamed. The therapist says, “Okay, tell me about a particular time that it happened.” But the child wants to keep the generalization, keep this image that “nobody likes me.” The devil is in the details. The generalization prevents him from being clear on what goes on between him and other children: their role in blaming him and his role in keeping other children at arm’s length. 
All security operations operate via manipulation of consciousness defined as “selective inattention.” Selective inattention is a major factor in the organization of consciousness necessary for a person to function (such as not attending to the grinding of a refrigerator motor). As such, it is a vital ability without which a person cannot think. However, in the service of avoiding anxiety, selective inattention can be used as a security operation to misdirect conscious experience or dissociate it, thereby protecting the status quo of the self-system to its detriment.
For example, one can focus on the things one dislikes about another person and not notice those things one might find attractive. Or, in a different style of security operation, the obsessive person might not be able to stop thinking about a lost lover or a failed course, effectively blotting out constructive thought that could lead to improving their life.
In the process of learning a function, a human being needs an audience, at least one other significant person when they are very young, or simply another person when they are older, who responds to the functioning, consciously or unconsciously. The ability to function is dependent on the quality of that response and is impacted accordingly. For example, in early infancy, the response by the parenting one(s), in muscle tone, mood, or voice pattern (to name a few) is validation for how the infant is able to digest food or develop skin integrity. If a parenting one is comfortable and enjoys cuddling while feeding the baby, its digestion will probably go smoothly. If there is irritability or worry, that mood will also be communicated to the infant, with subsequent disruption of whatever function is being learned, including, in this example, skin integrity and digestion.
As discussed above, functions that are often seen as purely biological processes require learning via validation, even though learning must go on within the framework of the given physiological structure. Ribble, in The Rights of Infants (1965), and Spitz, in a series of studies (1945, 1946a, 1946b), showed that infants, given adequate sustenance in the most sanitary conditions, went into apathetic states and died unless they also received human contact, i.e., holding and cuddling. Survival rates improved with human touch, whether or not the holders and cuddlers were the biological parents. This is a very clear example of the need for validation of basic physiologic functions at the beginning of life. As people grow, the audience for various functions can be real or imaginary (i.e. fantasized), depending on the life experience of the developing person. Some people experience a great deal of validation from fictional characters, TV personalities, athletes, or social media, to name a few.
Optimal validation occurs when one or more significant people take pleasure in another person’s experience. The negative reaction of a parenting one is also a kind of validation. For example, a person has a close friend, but their mother constantly bad-mouths their friend or friendships. It is validation with a negative skew (e.g., “Friends are ok, but they always have ulterior motives”). The key is the acknowledgment of the existence of the friend. If there is no response at all to the expression of need in the child, then there is even greater difficulty learning how to meet the need for friendship.
Phil was an “army brat”: His parents moved every year or two when his father was reassigned. They sent him to the local school wherever he was, but always with the orders that whatever went on in the home stayed within the four walls. Phil’s mother was an alcoholic and his father was a severe disciplinarian. Phil was punished severely for small infractions like not doing chores or talking back. He would either be beaten or grounded, sometimes not permitted to see anyone socially for months. No one was to know anything about family business. His father encouraged school achievement and discipline, but both parents remained aloof from the local town. Phil was encouraged to play sports and to win at any cost, but not to whine. Despite always being the new kid in the school, Phil did well academically. He was also successful at sports and became a star on whatever team he joined. But he was always a loner. He never confided in anyone and never had close friends. He was able to engage in activities with other children and even work cooperatively in team sports, although he was extremely competitive and intolerant of teammates who were not as good as he was. Completely forbidden was any kind of closeness or identification with his peers. No one specifically told him intimacy with others was bad. However, his life was organized to avoid intimacy with a peer. He remained aloof and did not experience loneliness. There were times when other kids made overtures to him, but he usually saw that as some sort of weakness or seductiveness on their part and treated them with disdain. When he reached puberty, he approached sex with the same competitive orientation he had toward any other activity.
There may be all kinds of limitations in the quality of available validation. It could be loaded with envy, disgust, competitiveness; it could be almost anything, but in some way or other if the validator at least recognizes the existence of the need with accompanying derogation, there is validation with accompanying limitations. That is, to the degree that there are significant outside alternative validators, the person has an opportunity to learn, but perhaps not without some misgivings about the process.
Validation is rarely perfect. It usually comes freighted with the limits of the perceptual framework of the validator, along with whatever opportunities are available to the individual. As the person grows, there are more opportunities for experience and alternate validators.
A very well-known political prisoner was incarcerated as a teenager for stealing a bicycle. He was in prison for seven years and suddenly began to write, starting with a brilliant political book. The book is like a journal talking about his life week after week. It starts out monosyllabic. He’s angry; he’s depressed; he’s barely talking, and one gets a sense of an extremely paranoid, closed down, depressed person. Then he meets a lawyer and falls in love with her and she with him. She begins to talk to him. And he suddenly starts writing long essays, formulates theoretical concepts and poetry. Where did it come from?
It is not that she taught him. She didn’t. His capacities had been developing inside him out of awareness until someone came along and said, “You’re brilliant; you an important political prisoner, a political figure,” and it came flooding out of him. It is quite incredible. It is evident in his book.
The above is an example of the movement of a function from the dissociated to the conscious because of alternate validation. Sometimes that movement happens when a student has been sitting on a lot of potential and then a teacher recognizes it and simply comments on it.
There are varying levels of responsiveness to validation for various reasons, based on a person’s readiness to respond to validation, depending on previous experience. If validation in later life is effective, it has the potential to increase the momentum for change in wider and wider areas of living. No matter how old, a person can change with validation.
Envy is an unconscious forbidding response by a significant figure to a burgeoning function in a person that would satisfy that person’s need. The recipient of that significant other’s envy starts moving towards satisfaction of the particular need but hits a brick wall. An example might be the significant other’s ridicule of the early adolescent’s attempts to explore sexual expression. The significant validator is uncomfortable with frank sexual expression and so there is negative validation for that particular function. Instead, the envious person is scornful of or disgusted by the behavior, and the young adolescent’s burgeoning function becomes fraught with embarrassment and feelings of shame or self-revulsion.
Envy has its roots in the unsatisfied and often unrecognized, unconscious needs of the envious person. While the envious person is not conscious of their own unsatisfied need, they might instead feel and express, for example, some form of rejection toward the articulated need of the other, such as disapproval, disparagement, discouragement, or disgust. This is expressed, accordingly, in a variety of ways. Or in its most subtle form, envy may be manifested by simply (although it is far from a “simple” operation) not noticing the need of the other or by responding in a way that is unwittingly—but accurately—aimed to be antagonistic to the other person’s need. In all cases the unconscious message communicated is: “If I can’t have it, think it or feel it, neither can you.”
Henry won a coveted award in the movie industry along with two friends. After he and his co-editors received an Oscar, he called his mother to tell her. “Me and Hannah and Jack got an Oscar!” His mother’s response was, “Hannah, Jack and I!” With that response, Henry finally understood what he had been hearing in therapy about parental envy.
Envy is a powerful disruptive force in all relationships in which it occurs; it moves to stunt personality growth by promoting the dissociation of a particular need rather than its satisfaction in both the envious person and the person who is the object of the envy. Parental envy of the developing infant or child is particularly damaging because it is taking place in the earliest stages of growth and learning, thereby limiting the child’s experience in some fundamental way. A depressed, envious primary caretaker, for example, whose restrictive self-system will not allow that person to be curious, will not be able to take pleasure in the child’s investigation of the world. Instead, the caretaker will move to prohibit the child’s exploration of their body, or the child’s friendliness toward strangers, or the child’s pleasure in the mastery of a project, for example, because the caretaker’s perception—a consequence of envy—is that such behaviors are wrong or bad or undeserving. These perceptions were developed in the caretaker’s own early experience with significant adults and had not been reevaluated by alternate interpretations. They are not conscious, and the envy is not purposeful. Envy can go on between any two people. It is frequently a phenomenon that goes on between a parent and offspring. In the case of “parental envy,” it does not permit whoever is taking the role of parenting to validate in the child that which is inconceivable for oneself.
To prevent a rupture in connectedness to the parenting one(s), the child confronting such envy has no choice but to dissociate the need and/or specific functions which make up the need and to, thereafter, experience that need with the same original perception of the caretaker. A rupture in this life-sustaining relationship would be experienced by the child as chaotic and terrifying. There is no other option for the developing, dependent child but to preserve whatever goodwill is available from the child’s most important human contact, no matter the cost.
Those needs which collide with parental envy will, until corrected through the expansion of experience and intimacy, continue to push for recognition. This push by the integral personality to get the dissociated need (and/or its associated functions) into awareness and belatedly satisfied is a struggle, no matter when it occurs later in life. To the extent that the threat of disconnectedness from the early envious caretaker, with accompanying anxiety, confusion, and (temporary) disorganization of personality, is re-experienced, the struggle for satisfaction and consolidation of a necessary but prohibited need is in full force. It is therefore essential that along with making use of alternate validation, one works to understand the effects of envy from significant adults in their early development on their continued growth throughout life. To the extent that a person is in the process of experiencing the original anxiety, they are probably involved in a crisis, struggling to get an essential need met. To succeed in getting that previously forbidden need met, they need help in the form of alternate validation in addition to a historical understanding of how envy from their significant adults limited their continued growth.
In interpersonal theory, envy is different from jealousy, which is when a person consciously wants something the other person has that they do not have. In jealousy, the person may go after it too, as if inspired, or on the other hand, might be angry at the other for having what they want and might use it to feed their own low self-esteem. Jealousy can be inspirational and useful to the jealous person. It’s then possible to organize to have something they didn’t up until then think they could have. In contrast, in interpersonal theory, envy is out of awareness on the part of the envious one, and if confronted with it, the envious person would, understandably, strenuously deny it because it is out of awareness or attempt to destroy the very concept of envy with a cover story such as “It’s disgusting!”
AB is jealous because their friend, CD, has enrolled in a theater group at school and is appearing in class plays. AB feels left behind and inadequate. They can’t be popular and talented like CD. Somebody friendly tells them that if they want to do something that shows off their talents they can join the school band, since they are such a good trumpet player. AB had never thought of that, but they timidly audition for the school band and get in. They stop being jealous of CD.
On the other hand, if AB were envious of CD, having dissociated the possibility of belonging to anything, they might not welcome the suggestion to join the band, but continue to mock CD for being a show-off, and proclaiming that their friends were phony, etc., without realizing that they were unconsciously, out of envy, trying to destroy their friend’s enthusiasm for belonging to the theater group.
Point of Fixation
Development occurs in an orderly sequence, one function building upon another (Pearce & Newton, 1963, pp. 56-57). That is, functions are learned in order based on previous learning and maturation. One cannot learn if there is no basis for learning—without required antecedent validated consolidated experience (one needs to crawl before one can walk, for example). In terms of the orderly sequence of development, there must at all times be, in every individual, a zone of experience not already consolidated which would be the individual’s expected next area of development. So it is just these experiences that should be incorporated into the self-system with a minimum of acute anxiety. This zone is the focus of the integral personality in its push to growth. The integral personality is focused on this zone of developing functions in the individual in whom growth is proceeding optimally in sequence and timing. The term fixation is not ordinarily used to delineate where the focus of attention is. The concept of fixation applies when the situation is not ideal. That is, usually some necessary functions are, to varying degrees, inconceivable to a person and thus blocked by the self-system’s restrictions.
Fixation is when progress in the ability to relate stops expanding because of earlier prohibitions operating in that area of functioning. As a person continues to grow in other areas, there may be learning that also occurs in the forbidden area, and so the point of fixation may advance, but with a skew. It’s like a stream, flowing around rocks in its path, but continuing to flow forward, propelled by the force of a person’s needs (Pearce & Newton, 1963, p. 58).
The point of fixation moves along as the person manages to accumulate more learning. In so far as someone is continuing to grow, the point of fixation moves along up the hierarchy of functioning toward greater complexity. The integral personality, which operates based on the pressure of the most urgent need, provides the pressure to move past early prohibitions. That is sometimes seen as the push to growth, which may or may not be strong enough to overcome the security system. So in understanding the concept of fixation, one needs to look at what a person in the sequence of development has next to master (Pearce & Newton, 1963, p. 58).
For example, a person chronologically reaches the age in which they are called upon to be a functioning member of a team, the Juvenile Era. The person is now encouraged to cooperate, compromise, and compete for the sake of the team. However, while learning some of the political aspects of group dynamics, the individual might still be focused on being the star, that is, still operating within the Childhood Era, which is more self-centered, as opposed to focusing on the goals of the team as a whole. In short, the individual is uncomfortable about actually belonging as a member. That person’s point of fixation is at the beginning of the Juvenile Era, with some aspects of it continuing to be developed, but the preoccupation regarding interpersonal growth is stopped at the forbidden function of belonging to and caring about the team or group (Pearce & Newton, 1963, p. 58).
The child still exists in the early Juvenile Era, but has not yet learned to be a true member of a cooperative group. Whatever political success the child has achieved using some juvenile functions has not become the basis for the next stage of development after the Juvenile, which is the development of “warm personal relationships within the group” (Pearce & Newton, 1963, p. 58), that is, the move toward interpersonal intimacy in pre-adolescence. If the person does not feel like a member, further growth beyond the Juvenile will be much more difficult because whatever functions are learned in the group, such as the political arts of cooperation, compromise, and competition, are already skewed. It is a large barrier in the flow of the person’s life.
All new functions are based on the degree of consolidation of previous ones. The close pre-adolescent relationship with a best friend is eventually not possible if a person has not yet learned how to comfortably feel like a member of the group (Pearce & Newton, 1963, p. 58).
Regression and the point of fixation usually go together. In the face of anxiety, a person regresses. Regression is a disruption of functioning back to an earlier function, the last learned function. The point of fixation is what one hasn’t yet learned. But the latest learned function is what falls apart under anxiety. A fixation is a point, and regression is a process backward to that point.
Growth and deterioration depend on the processes of hope and despair. On the hopeful side is the integral personality, the repository of all experience, conscious and dissociated. It operates on the pressure of need, constantly pushing for more satisfaction, responding to any potential validation of one’s need to grow, always searching for new validation of the continuous pressure of need and oblivious to the limiting warnings of the security system. Pearce and Newton eloquently describe the alternatives:
Hope represents the integral personality. It is the inner knowledge that one could be more than he is, that life does not have to be as bitter as it has been. Hope is the reflection of the impact of love and freedom on the forces of life in the individual. It is the response to the unexpected but convincing validation of unpredicted performance beyond the confines of the self-system. (Pearce & Newton, 1963, p. 408)
On the other hand, “despair is the watchdog of the self-system” (Pearce & Newton, 1963, p. 408).
Adult growth, while still dependent on tenderness and validation, is different from growth in childhood. The societal expectations for adults are different from social expectations for a child. To continue to learn how to relate past one’s point of fixation as an adult, one needs to explore solutions that may seem unusual or unconventional (Pearce & Newton, 1963, p. 61).
Joe was so phobic about touch that he experienced only pain during attempts at sex. He began exploring ways to learn about cuddling. Drawing on the early positive experience in owning a cat, and only after a great deal of effort, he adopted a cat that reminded him of the one he had as a child. In the process of cuddling with the cat, he was able to finally experience pleasure and comfort. Many of his friends who witnessed his desire to rush home and be with his cat thought his behavior extreme and inappropriate for a man in his 30s. He felt foolish and developed fears that the cat was going to die. He ran up high bills with the veterinarian because of his excessive concern for the cat’s welfare. Nevertheless, despite the social awkwardness and expense incurred, Joe was able to slowly experiment with touching people, albeit with a great deal of trepidation.
The adult has more opportunities for growth and to make changes than the child because the adult is more mobile and less dependent upon the original caretaker(s). However, because of the increasingly complex web of social relationships, functionality, and responsibilities as one moves throughout life, the self-system becomes a more rigid adversary to the push for new growth experiences (Pearce & Newton, 1963, p. 62). So much more has to be shifted.
The adult needs the experience of affectionate, validating relationships which make it easier to tolerate anxiety when the self-system is reorganizing. Tender validation reduces anxiety and the fear of isolation from the original caretaker(s) and, therefore, from the world one has known up until then (Pearce & Newton, 1963, p. 62).
That is, if there are more friendly people in one’s adult life than there were in childhood, anxiety is more tolerable.
In adult experience, there is a constant struggle between the integral personality and the self-system. The integral personality uses the accumulated new experiences in living to build for new learning; the security apparatus of the self-system twists or dissociates the new experience to justify maintaining its already functioning restrictions. The opposing forces push each other in a hopeful or despairing direction, depending on how much validation for change exists in the adult’s life. The point of fixation, therefore, is in a constant state of flux.
There is also momentum. One thing leads to another. That is, when a person incorporates a new function, thus expanding one’s self-system, the next attempt to grow is easier, based on that success. On the other hand, if the new experience is rejected or repudiated in some fashion, the next opportunity for growth will be more difficult and fraught with even more anxiety (Pearce & Newton, 1963, p. 62). That is the beginning of deterioration.
For example, one may or may not be aware of the failure to integrate the new experience. Awareness of one’s setbacks is on a continuum. A person may be aware of trying to make a friend but fails to do so. In such an instance the person might say, “You see? I could never make a friend. I’m a loser.” In other situations, a person might simply repudiate a friendly gesture, but not be aware that more despair has been created about the possibility of getting closer to someone. If pushed, say, by a therapist, the person might retort with reinforced despair, such as, “I knew what I was doing! Don’t be naive. It’s a hostile world. You can’t trust anyone.” The person has moved from making timid attempts at getting closer to a more entrenched position that rationalizes the distance already existing between that person and others.
The process of deterioration, like the process of growth, is cumulative. If a person is not getting their needs met, they deteriorate. Absence of or the inability to accept tenderness is the primary condition for deterioration, first for the erosion of the interpersonal and then for the intellectual capacities. In the case of deterioration, when people start denying and rejecting experience, they also deny and reject their own perceptions, and they begin to think less clearly. They think in a more paranoid, restrictive way.
Regression, as opposed to deterioration, is the process of temporary disorganization of the latest learned functions under the impact of anxiety and the return to earlier modes of functioning (Pearce & Newton, 1963, pp. 63-64).
James, infantilized by his parents well into adulthood, lives at home even though he can afford to get their own place. Because his job requires relocation, he very reluctantly moves to a new city, and for the first time has to learn to set up his own household, cook his own meals, meet strangers, and explore a new environment. He suddenly finds that he has difficulty driving and needs much more help navigating the new transportation system, although he once prided himself for being very well-oriented and mobile when traveling for work or as a tourist. He is temporarily disorganized because of the anxiety of leaving his parents. As he begins to integrate the expansion of his world of new people, places, and situations, the ability to navigate and orient himself improves. Once the new experience is integrated, he begins to be able to drive and to orient with more confidence.
In other words, he temporarily regressed to a more dependent, less mobile state of functioning when he had to leave familiar childhood surroundings and put down roots in a new city, as opposed to being a tourist. The mechanism of regression is the disorganization in the presence of anxiety about the last learned function.
Regression and deterioration both consist of disruption of functioning, but deterioration is about decay, about the repudiation of function. The person is not learning anything new and is getting rid of what has already been learned. If it keeps going, one gets rid of more and more, and they become more and more limited in intellectual, perceptual and emotional capacity, and less and less functional.
Deterioration, the repeated repudiation of experience, involves repeated paranoid formulations that increasingly restrict functioning. The pull to paranoid reformulation destroys a person’s capacity to organize perceptions in relation to direct experience. Thus, the attack is not only on one’s closeness with other people, but also on their perceptual-cognitive functioning.
Mary, an only child whose parents lived a very reclusive life, dropped out of high school and joined the Peace Corps. Soon after entering the barracks where she had been forced to live close to large numbers of strangers her age, she became agitated and delusional, saying that her dreams foretold the future and that she was destined to be a prophet who predicted disaster. She was admitted to the hospital. After her initial agitation, she calmed down and was soon placed in a residence and given a job through a day treatment center in a somewhat sheltered setting. She seemed to enjoy her job, which involved record-keeping and casual interaction with patients and staff at the residence. However, in her therapy sessions she complained about being better than her co-workers, the other residents, but that she was underestimated by her supervisors, who, she felt, lorded it over her because of her “patient” status. In her estimation, she would reach her true potential once she was discharged. Discharge, in this case, meant a return to her parental home and work in the wider world.
Because Mary’s overt symptoms were relatively mild, she was discharged to her parents. In subsequent therapy sessions, she expressed increasingly negative feelings about people she came into contact with outside the home, such as job interviewers and strangers in the street. She no longer had a good word to say about anyone she met and was increasingly discouraged about finding work or any other kind of social interaction. She was also increasingly silent on the subject of interactions between herself and her parents. She declined to talk about her parents’ and her own isolation and phobia about the outside world. She began to focus more insistently on her belief that she was a prophet whose dreams allowed her to predict the future. Her belief in her prophetic abilities focused more and more on how special and important she was and how unappreciated she was. In her increasingly grandiose mood, she was unable to negotiate any job interview or any other kind of simple social interaction.
Mary’s deterioration, which in this case is a paranoid resolution, started with the derogation of her peers, but because of the pull to justify her alienation from people, her judgment and ability to think began to deteriorate as well. Her curiosity withered as her interest in learning new things about the world around her diminished. She was at the same time less able to communicate with others. The loss of function became cognitive as well as social.
Empathy is the capacity to feel what another is feeling. In the words of Trevarthen, a clinical researcher of communication in infancy, “the core of human consciousness is the potential for rapport of the self with another’s mind. This potential is immediate, unrational, unverbalized, conceptless, and atheoretical: A delicate and immediate [being] with-the-other” (2006, p. 121). He is talking about empathy. For Sullivan (1953) and Pearce and Newton (1963), empathy is the main means of communication between the infant and mothering figure(s). They describe it as crucial to the infant’s survival and cite studies by Ribble (1965) and Spitz (1946a) to show that without that empathy or empathic identification, the infant will die, even with the provision of basic food and shelter. Trevarthen’s research provides even more empirical evidence of the ongoing responsiveness of the infant to available human beings (1979, 1993).
The capacity for empathy exists throughout life. It is the ability to perceive and communicate to another via non-verbal resonance so that one person identifies with the other and feels what the other feels. It exists only to the extent that what the other person feels is conceivable to oneself. It is a significant method of communication between people who are close to each other.
The infant relies almost completely on empathy for all communication. As it grows into late infancy and childhood, when the child depends more on dramatic gestures and language for communication, the reliance on empathy recedes but does not completely go away. The capacity for caretaker(s) to respond tenderly to the infant’s empathic communications is in part dependent on the mood of the caretaker(s), which can range from responsiveness and validation of empathic communications in the offspring, to intense anxiety in the presence of its communications. It can go from intense pleasure in responding to the baby’s needs to the apathy and unrelatedness of, for example, post-partum depression.
Throughout life, empathy, as the underlying method of communication, emerges as reflections, disconnected associations, memories, and intuition. People experience it, for example, in concerts, rallies, and when stuck together in an airport; it becomes intense during states of personal and communal crisis, as well as in day-to-day adult interactions. It forms the basis for communication in the myriad ways that occur when people are relating (Pearce & Newton, 1963, pp. 52-53).
Primary Relationships, Productive and Restrictive
Human beings develop within an interpersonal context. In other words, we become human by “being raised by people” (Pearce & Newton, 1963, p. 13). In the beginning, the parenting figure(s) is the preeminent relationship, the first audience for any action or thought. People continue to think to that particular audience, present or imagined, although their importance may diminish over time. It isn’t possible for perception and thought to exist without interaction with another, current or remembered.
This strong connection to the parenting figure(s) continues until preadolescence, when, if all goes well, the person becomes emotionally intimate with a peer, in the chumship, the person’s best friend, and hopefully goes on to establish important relationships with an expanding number of people. Thus, the audience for thought continues to be expanded. Theoretically, these relationships are called primary relationships. They are the ones who make life meaningful to a person, who make up the primary audience in thoughts and actions (Pearce & Newton, 1963, p. 191).
Primary relationships govern all patterns of interaction, whether they are with the early primary figures or not. So a person’s way of relating to the rest of the world is limited by the fear of losing continuity with the primary relationships. As with a parent and child, any new experience that would expand the self-system in ways that threaten the connection between the person and their primary relationships will be met with inner resistance and anxiety (Pearce & Newton, 1963, p. 191). Since there are always primary relationships by necessity, if a person is unable to form significant relationships with anyone beyond the parenting figure(s), they remain the primary relationship(s), whether they are currently present in a person’s life or geographically removed or deceased. When a person can go beyond inner resistance, new primary relationships are possible. New relationships are easier to integrate if they bear some similarities with the relationship with the parenting one(s). The issue becomes: are the new relationships merely repetitions of what went on with the original parenting figure(s) or are they expansions beyond what a person is used to? As a person continues to have new experiences (such as in school, the workplace, social groupings) and develops new relationships, the expansion beyond the original, parental, primary relationship(s) can increase indefinitely. In other words, a person can expand indefinitely in one’s range and depth of functioning in the world depending on the range and depth of their relationships. Then the person is able to reevaluate earlier assumptions and retain, alter or reject them. This is true no matter how productive or restrictive the original parenting relationships have been. There is always room for expansion.
At the same time, if establishing relationships with others is deficient or non-existent, there is an intensification of resistance to new experiences in the service of maintaining parental continuity, with an increasingly limited ability to relate to the rest of the world. Depending on a person’s opportunities for interpersonal interaction, this can have a crippling effect on a person’s satisfaction in life.
Any primary relationship functions to varying degrees to validate or invalidate perceptions, to provide tenderness, cherishing, and respect, or their opposites. Briefly, validation is the confirmation of the other’s experience.
If there is no validation for a given experience, a person can become anxious and disoriented. If there is validation, a person may be anxious but will have the means to weather the storm.
Tenderness involves empathic relatedness to the other’s need for satisfaction, to expand one’s self-system; if tenderness is not present, the one trying to change has a much harder time, feels isolated and in pain. The person might in fact give up trying. If, in infancy, tenderness was to varying degrees lacking, to that degree the person will be unable to accept tenderness from another later on even if it is offered (Pearce & Newton, 1963, p. 192).
Cherishing has to do with relatedness to the other’s physical survival. It ranges from great pleasure in the existence of the other to slight interest in the other’s survival (Pearce & Newton, 1963, p. 192).
Respect has to do with loving feelings towards the other’s integral personality (one’s potential) and a tender disregard for the other’s security operations, or those aspects of the other person that limit that potential (Pearce & Newton, 1963, p. 193).
A loving, or productive, relationship is distinguished by a high degree of mutual validation, tenderness, cherishing, and respect; all push for growth. It involves an intermingling of integral personalities, which mutually force into awareness heretofore thwarted areas of growth into their self-systems (Pearce & Newton, 1963, p. 193).
A restrictive relationship is characterized by the opposite. Now the dominant integration is between the two central paranoias.
The relative stability of these relationships, productive or restrictive, is dependent upon the meshing of either the integral personalities or the central paranoias (Pearce & Newton, 1963, p. 194).
Most primary relationships start with a mix of growth and restrictiveness, but as the interaction progresses, a dominant pattern emerges which is either productive or restrictive. Loving integrations can grow, dissolve, or deteriorate into restrictive ones. Restrictive relationships can become increasingly entrenched, dissolve, or even shift for the better with a change in circumstances, usually when the partners reevaluate their situation (such as, a mother-in-law moves out of the house; they decide to move from a studio apartment to a larger space; they allow each other to have more friends). The value of a relationship is not determined by its longevity, but by the degree to which it promotes growth in the partners. Unfortunately, a relationship may last long after the merging of central paranoias, way after the relationship has outlived its usefulness. Just because two people live together for a long time doesn’t mean the relationship is satisfying to either person. They could be deteriorating together, convincing each other that the world is a dangerous place and becoming more entrenched in an isolated way of life. On the other hand, if both people continue to expand in their relatedness to other people and to increase their creativity and productive work the relationship might be mutually validating over a long period. Either is possible.
Human growth involves a complex and ever-changing interaction between people, in a developmental sequence from infancy onward. This chapter briefly introduces the basic concepts of interpersonal theory as elucidated in this volume, including the self-system, integral personality, the dissociated and central paranoia, as well as other concepts, including anxiety, envy, depression, despair, deterioration, point of fixation, empathy, tenderness, cherishing and validation. Personality is the interaction between the self-system, the integral personality, the central paranoia, and the dissociated, utilizing the mental phenomena described above in repetitive patterns.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders V. Washington, DC.
Pearce, J., & Newton, S. (1963). The conditions of human growth. New York: Citadel Press.
Ribble, M. A. (1965). The rights of infants; Early psychological needs and their satisfaction (2 ed.). New York: Columbia University Press.
Spitz, R. A. (1946b). Hospitalism. A follow-up report. Psychoanalytic Study of the Child, 2, 113-118.
Spitz, R. A. (1945). Hospitalism: An inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic Study of the Child, 1, 53-74.
Spitz, R. A. (1946a). Anaclitic depression. Psychoanalytic Study of the Child, 2, 313-342.
Sullivan, H. S. (1953). The interpersonal theory of psychiatry. New York: W.W. Norton & Company.
Sullivan, H. S. (1954). The psychiatric interview. New York: W.W. Norton & Company.
Trevarthen, C. (1979). Communication and cooperation in early infancy: a description of primary Inter-subjectivity. In M. Bullowa (Ed.), Before speech: The beginning of interpersonal communication (pp. 321-348). Cambridge: Cambridge University Press.
Trevarthen, C. (1993). The function of emotions in early infant communication and development. In J. Nadel, & L. Camaioni (Eds.), New perspectives in early communicative development (pp. 48-81). London: Routledge.
 A person born with a congenital malformation or in the midst of a catastrophe is still profoundly influenced by their interpersonal environment in exactly the same way. [return]
 See discussion of life-threatening infantile apathetic states below. [return]
 As discussed in Developmental Eras, differently abled people require empathic relatedness to their needs. An individual who does not have the physiological ability to crawl and then walk (for example, because of cerebral palsy), requires tender and proactive relatedness to its need to learn alternate methods of ambulating, including providing people and devices to facilitate mobility. [return]
 Sullivan coined the term “self-system” (1953). Pearce and Newton coined the terms “integral personality, “central paranoia” and “the dissociated” (1963). All are discussed and elaborated upon in this volume. [return]
 The use of the word “paranoid” in this context is not entirely what is commonly accepted as a diagnosis in the DSM (Diagnostic and Statistical Manual, 2013). It is meant to define a despairing conviction that is a departure from what is true in reality. It is on a continuum, from a false assumption that regulates one’s life (like “I’m a loser”) to the florid paranoid psychotic belief that aliens are in control of one’s mind (as described in the DSM). [return]
 See Chapters Ten and Twelve for full discussions of the self-system, self-image, and perception. [return]
 Grief is a realistic pain, also within the more general definition of depression. [return]
 A forbidding gesture is a non-verbal mode of communication that expresses dissatisfaction or disgust with what another is doing or saying. For example, a significant parenting one signals dissatisfaction by stiffening when their toddler tries to climb on their lap, or puts their hands on their hips and walks away when the child tries to show them something they drew. Often the gestures are spontaneous and, although keenly felt by the child, are not in the adult’s awareness. In early infancy, when empathy is the mode of communication, a forbidding gesture might be the adult’s rough and hurried handling of diaper change. A person cannot remember the actual gestured message of disgust from infancy, but now, as an adult, they might be able to get in touch with the mood-memory of self-disgust and be able to connect that mood-memory to stories about their infancy. [return]
 A fugue state is a period in which experience of dissociated material is in awareness. It may be accompanied by powerful feelings of paranoia and terror, or blankness or depression. It may or may not be remembered. It is like being in a waking nightmare or dream. (Pearce & Newton, p. 347) [return]
 An overwhelming uneasy feeling accompanied by strenuous dissatisfaction with one’s life. [return]
 There are also situations in which the child is accurate. For example, they are in a racist school, or others are demeaning their emerging gender expression. Adult actions may be necessary to change the environment, such as official interventions, a change in schools, if possible, or guidance on how to deal with the situation. [return]
 See discussion of empathy below. [return]
 This example is an oversimplification in order to illustrate the point. In many instances, there is more than one significant other, and the child might in fact receive conflicting messages, some of which might not be envious. The child might be confused. To the extent that the child depends upon the approval of any particular adult, to that extent the envious responses might in the end be successful, partially successful or of little or no effect. [return]