"On Stuttering"

*

"On Stuttering"

This is written as a suggestion for those that stutter or for those helping others overcome it.

 On stuttering or now subtitled "On The King's Speech", the movie by the same title just won the Oscar for "Best Picture" of the Year. 

At the time of first writing this, I had not seen the movie. I have subsequently done so. King Edward had much reason to have "shame" and a dose of humiliation in his life and thus lose his "voice." This voice couch gives him his voice back.

 

The Terry Gross interview at the end of this piece is a personal story of stuttering that encapsulates what I am saying without technical language. If you put in the effort to learn the basic theory I am putting forth you will read it with a new understanding and understand the movie at a new level.

I stuttered. I don't anymore. Why? I am not sure how I got over it but now I going to present a possible mechanism of the cause and the cure. (Since the original writing of this these ideas are more accepted.)

I know that since I stopped I have learned a great deal about the emotional life of mankind.

I share some thoughts on my personal view as a physician, patient, and student of psychology on these matters.

The idea is to be practical and help people stop stuttering.

It may seem in some of what I say that this is not what I am doing. That is for anyone to improve through this method it will take an understanding of their emotions and therefore it is not "practical." It is not practical to expect people to take the time.

We have to start somewhere and "break the ice.“ It is my particular sensitivity that we, for the most part, are dangerously in a mindset that unless it comes in the form of a machine or a pill we are not very interested in it. We are not, that is, very self-reflective. That is a lot of us. On the other hand, we are the nation that uses "psychotherapy" more than any other country. I guess we are just a complex lot. 

I want to speak to everyone. So I suppose what I am trying to do is reach and warn those of you reading this that are looking for a solution in a pill or an apparatus or in some kind of new "speech therapy." Please try and look past that kind of external solution. Otherwise, I will be, as they say, "preaching to the choir." There is no claim here that this is the only treatment or the only cause. 

I am not saying at all that this is not at all a genetic or inherited problem. The fact is stuttering may have various causes and that fact is we do not know how to distinguish among them. The literature is still not specific on either the cause or cure. Now, I think that may be precisely because we have not looked into the specifics of what I am about to say But the fact is I do not stutter anymore.

So one might go through various therapies in an orderly fashion. That is try all you can and see what happens. That is an alternative to what I am offering. Or at the same time try this.

It would seem that there is a good chance that any therapy that works in some would partially work in all but of course, there are no guarantees.

I can pretty much guarantee you will feel differently about things if you give what I am offering a try and if so you should feel at least a tad bit better and if so you will probably stutter less. No one can tell me that when they feel "nervous" they don't stutter more!

Some basic points:

* Human beings speak. Far and away this makes us human.

.

* I will try and be practical.

* Human beings can be said to "want" things.

* We "want" to get our "message out."

* Something often "impedes" this message.

This sequence of events happens in all of us, all the time every day many times during the day. When it happens we "feel" something. I have taken to saying that we feel "hurt" and or "confused." There are microbursts of this and macro bursts. I say we put a buck fifty in the dispenser and nothing comes out. Our "want" or interests have been blocked or impeded. We are flying down the highway and turn the curve and see a bank of red tail lights, again our "interest" is impeded.

I hope you see where this is going.

From the first time I caught on to this simple emotional idea that, well, yes my "interest" was an emotional force, and when something got in the way I just felt 'blocked", "impeded", "hurt", "confused", "a 'thud'" it soon brought back to me remembrances of times past when I stuttered.

Right now as I write I "feel" those times. This is why I am writing this. Most precisely because I yet again saw a piece in a news magazine about stuttering and felt that I should not yet again put off putting these ideas down on the cyber screen.

I trust the reader might, again, see where I am going. It is but a short step to thinking that when we speak it is to relate to "other." I do not think that there is any way that the statement :

"When I speak I have an emotional interest in communication to self or other.", can in any way be denied.

Since speech is a flow of something it can be blocked, impeded, or stopped. That process will have consequences. In this case what we call and describe as stuttering or stutters.

What can cause it? This is what this article is about and what I am suggesting and what will take some work and commitment.

Up until now not much has worked in treatment except time. Not until now. This is why I write but the answer is not blatantly on this page. I am saying that in my experience and putting 2 + 2 together this seems to make sense to me. What is "this?" "This" is an investigation of the emotion of "interest" I know you have never really considered "interest" as an emotion and the consequences of tampering with it. I say stuttering is one of those consequences.

We do have to review and be clear about this inherited and genetic stuff.

Let us say that there is genetic material in my family for me to get diabetes. Let us say that I get tested and I have the gene for diabetes and you can now get tested for this gene.

Am I going to get diabetes? Not necessarily. There is much you can do to avoid it. You can maintain your weight and there is much evidence that if you take the drug Metformin along with a substantial walking routine you can prevent diabetes.

So let us say there is a stuttering "gene." Ok, we can't do anything about that. Does that mean you are going to stutter? I would say we don't know. I would say some will some won't.

Now what is always brought up about stuttering? It is the teasing, ridicule, and humiliation of the person which inevitably makes the stuttering worse. So, I say it is a clue that is right under our noses. Again, I said above that nervousness makes stuttering worse. Why? It is because it impedes our interest. It seems to me there is at least an indirect connection if not a direct connection. Connection to what? A connection to the neuro-emotional system.

Now comes the hard work.

If you are an adult then maybe you would be willing to consider that stuttering might have an "emotional" basis." To be sure many of you have already done this and have been through much therapy. This would just be a new "twist" to the therapy.

I have no problem whatsoever realizing that my stuttering had this emotional basis and I am quite certain that it was probably 100 percent emotional. In the last ten years, there have only been a few occasions where I had a glimpse of a feeling that I might falter. I now can speak in public without fear. I attribute all of this to my understating of the emotion of interest and what happens when it is blocked. Whatever kind of therapy this consists of it is a deep understanding of that concept. Yes, it is in the mode of relaxation but it is very much an organic relaxation.

I fear to say more would start to, well, block your interest. It would start to give you too much information and confuse you.

You need now, to explore more in dept.

I suggest:

If you can, speak to someone familiar with Affect Theory/Psychology that might agree with this essay. That is have them read this essay. They need not have thought of this idea before if they are proficient in Affect Psychology to help you with your problem. That is they should be able to read it and understand immediately the connection.

There is very little material on Affect Psychology that is readily accessible.

There are two small books:

My book "Knowing Your Emotions".

Which is a general introduction to Affect Psychology (currently out of print soon to be republished).

And "What Babies Say Before They Can Talk" By Paul Hollinger.

This is worth reading as it has a lot of good general material about Affect Psychology and should give anyone some good ideas.

That is about it.

Then you can graduate to Don Nathanson's "Shame and Pride: Affect, Sex and the Birth of the Self", this is pretty much a major undertaking and of masters level material but a beautiful book.

Ok, none of it is directed at stuttering nor do I think you will find the word "stuttering" in any of the texts. The "help" lies in understanding the theory. In understanding that when interest is blocked speech will be blocked. What are the myriad of ways our "interests" are blocked? How do we feel when this happens and how can we improve this situation? If we improve it all the neuro-muscular feedback systems will improve that are impeding our "interest" in talking. Seems reasonable.

I write this because of my own experience and because I know this material helped me and am convinced that there is something to this. I am also convinced we have made so little progress with stuttering because we know so little about this connection to "interest" and its blockage.

The next easiest place to go is my web page Facebook Affect Psychology Group, EmotionalMed YouTube, and SubStack Brian Lynch M.D.

These are "new" ideas in this area but we have to start somewhere. I am trying to pick up the ball. I wish there was some specific literature but there is none.

Hope it might help someone. Let me know.

Note the following:

On the National Public Radio Show, "Fresh Air" host Terry Gross had a guest that is an admitted "stammer." David Mitchell an author who talks in very articulate terms about stammering/stuttering without using the words shame or

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Heard on Fresh Air from WHYY

August 5, 2010 - (Soundbite of music)

TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

My guest David Mitchell is recently described by Dave Eggers as one of the more fascinating and fearless writers alive. Mitchell is the author of the new historical novel "The Thousand Autumns of Jacob de Zoet." ................................

You've written about how as a boy you had a very bad stammer.

Mr. MITCHELL: Mm-hmm.

GROSS: And there's still I guess elements of that left, but.......................

Mr. MITCHELL: It's my life-long companion.

GROSS: You write something I thought was very funny and very true. You wrote: The willpower myth maintains that a stammerer is analogous to a newly wheelchair-bound character in a heartwarming American film. The doctor says he'll never walk again, but his gritty determination proves them wrong. This myth, you say, cost me angry years of believing that I stammered because I wasn't trying hard enough not to stammer......................

Would you describe what you tried to do during those angry years?..................................

Mr. MITCHELL: What I went through in those years: sort of a state of civil war with myself. It took a long, long time to understand that a stammer is more like a kind of force field, and the more you throw at it, the more it throws back at you. You sort of have to outwit it rather than outfight it. And, in a way, not even outwit it. You sort of - I think of it now as a kind of a companion. It's a part of me. It has a right to exist as I do and I need to sort of come to a working accommodation with it.

A friend who was an alcoholic once said to me that an alcoholic never stops being an alcoholic. He may - but what you have to aspire to be is a teetotal alcoholic. And in the same way a stammerer, I think, certainly in my case, will not be a stammerer but you have to aspire to become a non-stammering stammerer. And this involves certain strategies and techniques that you can sort of encrypt into how you speak so that I'm able to do this interview, for example, which 20 years ago would've been unthinkable. And in the end, these strategies can become so well integrated into who you are and how you speak that they become behavior and speech patterns rather than techniques.

GROSS: So do you find you should say up front to people yeah, I've got a stammer, so that's the way it's going to be?

Mr. MITCHELL: Oh, much, much more so. Yeah.

GROSS: Mm-hmm.

Mr. MITCHELL: It's a huge weight off your shoulders. Yeah.

GROSS: Was that something you had to hide - try to hide when you were young?

Mr. MITCHELL: Most certainly. All the time. Being a teenager is hard enough at the best of times. But if you're a stammering teenager, then I noticed if it's known, and if you're sort of exposed as a stammering teenager then it's really tough. So I spent a lot of energy and a lot of angst and a lot of stress trying to hide it throughout my 20s as well. But in the long run, it's much, much better for me at least to be upfront about it.

GROSS: It must've been so frustrating because you're Mr. Language. You know, and you're all about...

GROSS: ...language and when you opened your mouth it wouldn't come out smoothly. Yet, I'm sure you were writing even as a teenager and...

Mr. MITCHELL: Frustrating, yes.

GROSS: So people would make fun of you because of your stammer, yet you probably knew so much more about language and were so much more facile with language than the people who were mocking you.

Mr. MITCHELL: In part yes, because of my stammer. This is why I view my stammer now as a companion and not an enemy. ]I might've been a writer without it, but I certainly wouldn't have been this writer. One of the strategies I was referring to, which you meet quite early on in your career as a stammerer, is autocue sentences ahead of time. You see what words are coming up, and say right now I'd have difficulties with words beginning with S. If I, certainly as a younger person, if I saw an S word was approaching then I would try and reengineer that sentence to avoid needing that Sword. And this teaches you how language can be employed in many, many different ways to say the same thing.

GROSS: Now you lived for eight years in Japan and taught English there to Japanese students........................................

GROSS: You don't stammer when you're talking to animals?

Mr. MITCHELL: No. No. You see, it's all to do with...

GROSS: Why is that?

Mr. MITCHELL: Oh, I've thought about this a lot. But I think, and you may have some speech therapists listening to this program who could have a different point of view, but it's to do with what you think is going on in the listeners' heads. If you can have a certain militancy about it, if you can think that, you know, I frankly don't care if I'm about to stammer or not. I don't care if this person thinks I'm weird. I don't care if this person thinks any less of me, then miraculously, kind of the fingers of the stammerer loosen and suddenly, you're more fluent again. Obviously, an animal isn't thinking in these terms. So when you're speaking to an animal you don't stammer.

This is also why it's good to be upfront about it. If there's no question before you start that, hey I am a stammerer, it's out in the open and I may well stammer in this conversation, if that's there before the conversation starts, then as often as not, the stammer will be a lot lighter and looser in that conversation.

GROSS: You know, I'm thinking, you have this problem with a stammer, so speaking has always had obstacles and the threat of failure, right?

Mr. MITCHELL: Yes. Yeah. Yeah.

(Soundbite of laughter)

Mr. MITCHELL: Yeah.

see transcript:

 @ http://www.npr.org/templates/transcript/transcript.php?storyId=128872438

Dr. Brian Lynch March 2008

Brian Lynch, M.D.

3044 North Laramie

Chicago, Ill 60641 HOMEPAGE -

DrBPLynch@aol.com -

773-202-7991

         "Attack Self"

Raising children is difficult on average, and always has been. Little more than a hundred years ago if that, childhood in fact barely existed. The common man’s life expectancy, once one made it past the early years was still short, and was often not past the mid-thirties and women often died in childbirth.

This is to set a stage for some “reality” that life has, yes, been for the most part nasty brutal, and short. Simply a fact that it does not take much to realize that in a world without heat and in the cold it was not too easy to feed a baby, carry it around or clean it. It might be easy to see how babies were seen as the devil incarnate. Evil made flesh now in “our hands” to be made “good.” Ergo the finger pointed at me the evil one that “I” the child am bad.

This has the most profound implications as the child often becomes the bearer of the family’s emotional burdens.

Following logic, I believe what I have stated so far. I also believe that we have a biological glue that holds us together as a family unit and that is “interest” and “joy.” – My goal in these words is to limit myself to the “here and now”, to the tangible, to what we can glean from everyday life. - We need companionship. But the journey to where we are has been rough. We are beginning to recognize in all of the modern psychology the dominance of our “negative” feelings or what Silvan Tomkins preferred to call our punishing feelings. These keep us alive in a punishing environment that, by the way, is still punishing just made more pretty by suspended ceilings and bridges that are just as easily swept away by tsunamis and earthquakes. That is, our punishing feelings tell us what is “wrong” at the moment and that we should take care of. 

As babies, these are what keep us alive. They are the only way we have of communicating with our caregivers that something is wrong but boy can we get on their nerves. We become the “bad” ones.

 We have evolved ever so slightly from this idea that children are bad. The idea persists because it has always been a difficult balancing act to raise children; to make a go of it. 

Lloyd DeMause, a founder of what is called “Psychohistory,”’ delineated six stages of child rearing all of which persist today. They are infanticide, abandonment, ambivalent, intrusive, socializing, and helping mode and he feels the last mode which takes into consideration what the child wants for his life only to have arisen around 1950 and he claims that it is only practiced by a minority of parents.

The mother “has” to emotionally abandon her children or worse for fear of her own life as the father demands that the mother follow his orders or she is beaten or worse. One outcome: “Look what happened to your mother because of you!” The adult result of this is overwhelming guilt and shame.

My point is to concentrate on this legacy of us as children bearing the burden of the family’s emotional pain. The theory goes that it has just been inevitable as the world is not perfect. Things only will get better slowly. Parents “have to” dissipate negative feelings somewhere. Yes, terrible thoughts, and yes not “excuses” just facts. Can we do better tomorrow?

Then what are the consequences of this legacy for all of us? It is that we grow up with many ideas that we are to blame for much of our problems and everyone else’s. Simply “I am a bad person.” Why would I not think so? Since I am been told so all along?

I cannot give many examples here but they come in all varieties. Just recently someone was enthusiastic about getting a job after a long hiatus and focusing on all their attributes and the positive aspects of the job, the good hours and low stress that the job was presented as offering. Unfortunately, the job did not work out, and when they came in the next time some of the very first phrases were self-accusatory phrases such as “I was not ready for that job.” “I was not right for it.” I stopped the person and made them realize this was not at all the case that it was, according to what they had said to me, simply not true.

Or the seventy-year-old who calls me late at night devastated and “ready to die” as she still hears her father’s voice every time she tries to fix something. “You’ll never be able to do anything.” “You’ll never amount to anything.”

This self-blame becomes a way of “fixing” all kinds of problems it “avoids” all kinds of problems and “stuffs” severe emotional pain. It helps us “affiliate” with others so we “at least have someone.” We end up buying too many of the rounds. We are the “sucker” or “mark in the room.” It is a deep belief that I believe I deserve to get “screwed.”  

I once read a small study done on the general population in a Family Practice waiting room and it asked if patients in any way had done something to hinder their care. My analysis of the data was that a good 2/3 had; they had missed an appointment, not changed a bandage, skipped a medication dose, or something, all of these things with some conscious element. We somehow are punishing ourselves.

All of this is to say is what I believe to be the case as a medical doctor is a majority of what I see as “physical” illness is greatly influenced, if not caused at some level, by our “subconscious” affect system diverting “negative” affect/feelings/emotion to places where it cause hare. We end up in doctors’ offices.

Brian Lynch

h 1994)

DISSMELL

*

Something you never knew about your Emotions.

Brian Lynch

If we go through life not thinking much about our emotions, which is the ax I am continuously grinding, then it is for certain we do not think about our five senses much.

Our senses are sight, hearing, touch, smell, and taste.

These are the portals by which we experience everything. Each is a type of feeling we are not meant to notice so much as they are to integrate us into our every moment seamlessly.

Stimuli enter through these portals. We know of famous people who lack in significant ways some of their senses but have succeeded. One of the most famous is Helen Keller. Born a normal infant, she lost both sight and hearing at the age of 19 months, and so from that age; she could only know the world through touch, taste, and smell.

The Psychologist Silvan Tomkins teaches us that we become conscious of something only when we feel something about it. And by feel, he means something emotional. But in a more direct way, we feel through our senses. All senses share a type of feeling in that they are based on nerve endings reaching out and interpreting the world. So taste is a feeling, as is smell, but then we must "feel" something about those feelings. We can be interested in touch, fearful of it, or disgusted by it, and so too a smell. All this is by way of introducing you to or as a review of a specific feeling discovered by Silvan Tomkins. That feeling is part of an innate or "born with" emotional network.

He first hit upon these ideas with his newborn son and then confirmed them by studying the anatomy of the human face in detail and taking thousands of pictures, and videotaping thousands of hours of the face. In this process, he observed what no one else seemed to have observed, and that was a new expression. That was the head drawn back, and the upper lip drawn upper ward symmetrically curled up as we see here, which he called "dissmell:."

But let's back up a moment. Initially, along with Paul Ekman, Tomkins thought "contempt" was a separate emotion, but further research found it was not. If it was, it should be symmetrical on the face like other emotions, but contempt is asymmetrical, with one side of the mouth curled up. He decided contempt was a combination of disgust and his newfound emotion of dissmell. Disgust and dissmell then go hand in hand and would seem to have their origins deep in the reptilian brain. It is well known that we are naturally protected from most poisonous food due to our sense of smell(dissmell or bad smell), and of course, taste and smell do a great job of saving us not only from other poisonous food but from rotten and spoiled food. Disgust is protective in that if we ingest something harmful, it is the way we can eject it from our body. Dissmell is a pre-emptive warning to not even consider ingesting it.

This all sounds good as disgust and dissmell can save us and, in fact, they are efficient, useful, and beneficial. There is, however, a big downside. As time went along in our evolution, we started to generalize, abstract, and project into the future and anticipate what would be dissmelling and disgusting to us and thus began to make errors. This is the case with all of our emotions. It is the case, say, with anger; we can start to get angry at all kinds of things that, in the end, make no sense.

With dissmell and disgust, they are a bit more complicated and interwoven with our senses. Focusing on the sense of smell and the emotion of "dissmell" we are reminded that we have, then, the sense of smell and that to experience that, we have to "feel" some emotion about it, and one of our emotions is directly related to the sense of smell, and that is dissmell, "to get away from a smell." We don't have an emotion related to "to get away from" touch or to get away from seeing something. Of course, all of these "to get away from feelings" would come under "disgust" or "fear" such as "what I see is disgusting." But "dissmell" is directly related to smell, and disgust is directly related to taste when we are talking about food. To be clear, I am simply saying "dissmell" and "disgust" would seem to have a special place in our emotional network as they are specially anchored, having roots not only in our senses but also in our hunger drive, and yet have their unique facial expression.

All emotion in humans has been generalized in "thought" We can apply all emotions to anything or anyone. The emotion becomes abstract. We can, that is, treat another person "as if they smell bad'" or "taste bad." We can also have come to have thought of ourselves as smelling bad. This is a quite common problem in general medicine. People become convinced that they smell bad. There are, of course, real physical problems that cause body odor, but there are situations where there is no problem other than the patient convincing themselves that they have an odor.

Disgust and dissmell are important to recognize in relationships. It is recognized by many, for example, that once disgust enters a relationship, it is usually impossible to repair, and there is a separation. All of this becomes much more complicated as we are so unaware of the concept of "shame." It is this vague and poorly understood concept that we are just now becoming articulate about. But until we are better at recognizing shame, and even when we do, it will just be the beginning of untangling the linkage that builds up between shame, dissmell, and disgust.

Brian Lynch

                      It is not about you.

Time and again, I go over a simple thought for myself and others: Do not take things so personally, and do not think you are special in a relationship, especially in terms of negative attributes.

If you see someone that is your friend, or you think is your friend, doing things to people that you do not like, do not make the mistake and say to yourself, “Oh, I am special; Tom won’t do that to me.”

We all have been, and are, abused. We all make the above mistake. We all “disavow” the truth. The truth is right under our noses, but we would rather not see it.

The more we take off the blinders, the more we might be able to keep those friends as much as possible and help them and ourselves. We will reduce our trauma as we will less and less be blindsided and stop saying why, why me?

We will be able to stop saying it because we will have the great insight that it is so much not about me. It is about them. You see, if you observe their behavior, they are doing these things that bother you to everyone in the same fashion. This is what we call a script. It is like a computer program. Yes, sorry to say, humans in many ways are like this. If we were not, we could get nothing done. Scripts are “good” and “bad.” I get up and start brushing my teeth, and don’t even realize it, and while brushing, I am in the process of composing this essay. That is the usefulness of a script. It “frees up thinking.”

Unfortunately, humans can get “scripted” in all kinds of ways. Due to early experiences, we generalize certain dislikes, subtlety unconscious or even conscious we have about people. These are the root of great pain and fear that people harbor their entire lives unless they get help. A very common fear is one of abandonment because the person was abandoned at a vulnerable time, and they now project that on every relationship. They might have some sort of “disgust” for people in general that they really have no understanding of, but it is there, always interfering with things. They need to get to the root of it. So, we think it is about us. Why don’t they like me? What is wrong with me?

Often, people with severe problems have overcompensated in other parts of their personality. They are, that is, for example, very seductive. They conquer us. They have the same need for attachment as all of us, but let’s say they have this lingering disgust. They would be at war with themselves, would they not? So they seduce, and even fall into a kind of love, but then it has to end. So, it is that we often blame ourselves.

What I have noticed in my own life, and what has been so convincing and so remarkable to me with several people in several types of relationships, be it family, dating, or friendships, the person has been greatly abused, but now, when the person is in a safer saner environment, not only due to me but to various other factors, it seems to make such little difference. Again, the point is, it is not about you or even the environment but about them, at least at first, and often for a very long time. Unfortunately, this can be a setup to blame and shame the person for not “taking advantage” of a good situation, or “not wanting” to, or being “lazy,” or “wanting everything handed to them on a platter.” It can all be frustrating.

Nothing that is Human is foreign.

This is an old therapist saying.

 Terence was on the money.

The therapeutic community is on the money for claiming it.

Now several years ago it came up in a discussion with a colleague and he pointed out how unfortunate it was that so many in the community only give it lip service.

I can certainly say that is so often true in my experience in medicine.

I often say that I am quite sure that I would not be alive today without the understanding of the material I came across 13 years ago which gives me a clear understanding of why even healers give only lip service to Terence's saying. To go to the extreme why one of Osama Bin Laden’s lieutenants can be a physician? Or why even a colleague of mine, that supposedly understands seemingly the same material, can refer to young girls that are caught humiliating a classmate on video as less than human? 

To be clear about what Terence is saying it is this, the therapist should not be surprised by any human act, and I take it to mean that we should treat all comers. Jeffery Dahmer was a human being, he is not, not human, no matter how greatly he “disgusts” us. He is not “foreign.” Of course, Terence knew nothing of “therapists” having lived c. 3 BC to 65 AD and it is therefore all the more remarkable the statement.

The answer as to why we give lip service to his statement is simple, human beings know squat about their emotions and thus often mostly miss the mark about what is causing behavior no matter how bizarre. 

We are humans living in what Western humans call the twentieth century at the end of only a few hundred years of using what we call a scientific method that has been looking at our species. Then add to that the man that saw us as we are only lived 150 years ago. That man was Charles Darwin. Darwin knew a lot and knew a lot about emotion but not many others did then or now.

We had to wait a while to advance. It was not until the 1950s and 1960s that Silvan Tomkins picked up where Darwin left off and started to tell us about ourselves. It was then people could start to understand why humans talked so clearly out of both sides of their mouths; could talk of accepting all comers but in practice always discriminate.

Tomkins taught us about how our emotions were seated in our bodies and biology. How we felt things. How we tingled with excitement, shuddered with shame, and were seized with fear. Stuff we all knew anyway but seemingly needed to be told.

But we did not know about shame being so ever-present in our lives and how it could be commingled with fear to terrorize us into being seized with guilt. Nor did we have, nor do we have, much understanding of how our sense of taste and smell can be bastardized as children, to again, enslave us socially and sexually so that we are forever handicapped to exclude people, places, or things from our lives for no articulate reason other than “I don’t like that?” “That disgusts me.” “That is contemptible.” “I never liked that.” “I feel uncomfortable around those types of people.” “I wouldn't see those people in my practice.” “I'm not one of your junkie patients.” 

Our emotions are not much talked about. We grow up knowing something about Joy(happiness), anger, fear (being scared and a sissy), being sad, and that is about it. Somewhere along the line, we learn to say oh that is “disgusting.”

We are just all ignorant of where it all starts. Where the cultural norms came from? Why do they eat dogs in the Orient and nowhere else? So it is with thousands of likes and dislikes and the basis for cultural norms and laws and canons all coming from the deep human recesses of stored memories linked with unpleasant feelings. If you will “affect”(the bodily potential to feel, just like we have the apparatus to have the potential to feel our heart race or have “goose bumps.”) We have never had the occasion of being introduced to recognizing precise emotions such as disgust, distress, and shame. 

We can chant Terence's wonderful ode to humanity until hell freezes over but unless we have had a pretty special and liberal childhood. An upbringing that has taught us to be open to the world and its people we are going to have a hard time making it through without developing strong dislikes, even hatreds of others through no fault of our own. 

This is going to cause much confusion in our lives especially as professionals as we are going to find ourselves rejecting people and feeling terrible about it, disavowing it, and “acting out” about it. This even despite strong liberalizing experiences in later years that might end in many torturing private moments that end reinforcing our ‘beliefs.” We may be tortured as we simply feel we are “all wrong” but as we still do not understand the confusion we feel we must persist as we always have. We may become even more salt-wort in our actions. 

The most persistent place I see this is in the treatment of the “drug” addict Across medical specialties where there persists great personal dissmell and disgust for the “drug addict.” Now despite emergency medicine being a “specialty” for more than twenty years, they are poorly trained to deal with the phenomena. Or let us say individual doctors are poorly trained and this is the point of the essay in part, individual emotion is brought to the table, is not brought to consciousness, and is carried through and into practice despite exposure to dramatic experience and training. They are our own dissmell and disgust and shame that sabotage our reason. It is as if an invisible hand is pushing against what our better angels know to do. It is still not uncommon to hear reported: “Get out of my fucking ER, you fucking drug addict.” Yes, that is a direct quote of course, by a physician. 

Of course, number one, addiction is a medical problem with treatment options and the patient has many reasons to be there. They are all legitimate despite their drug-seeking lying and manipulation. They are all legitimate as they are all part and parcel of being human and therefore are not foreign to the experience. Everyone that walks into the emergency room, pretty much short of firing a nine millimeter at you, which happens, is your patient. 

It is our job to develop the interest you can in them. It is the doctor's dissmell and disgust and shame that she or he does not know of. Nor do we, in our daily lives, when we reject another human out of hand. So if we are lucky we might stumble across some knowledge of what deeply motivates us. But we should go easy on ourselves, always, as we could not have known about these deep complex emotions and their intertwining until now.

And unfortunately learning about precise emotions and becoming aware does not suddenly make things easy. It seems not to be the whole picture or answer. It can, at times, take years of digging to unravel the tapestry life has woven. Many hours of thinking and practice to undo the program; is very much like rewriting the code to the software. “At the time ‘x’ conditions occur ‘y’ will take place and not ‘z.’” 

We have to truly “get ahead of the curve.” That means understanding that I Brian Lynch truly think and believe that it is worthwhile and beneficial for me to understand what I call my “disgust” in and my “hatred” of all members of the religion of Ordeu and what I find dissmelling in their practice of sucking each other's little fingers is precisely because I feel something based in unpleasant feelings that are based in my past that I am projecting forward on them and not in some “pure” preordained “logic.”

So, we begin to understand that, for the most part, there is a “logic”. A logic of deep seeded culture and individual and group likes and dislikes. 

Brian Lynch