Dry humor, or wet seriousness, for the end of the old year

In February of 1958, classical music composer Milton Babbitt published his notorious article, “Who Cares If You Listen?”*  The article expressed indifference, or worse, to the listening audience who had hidebound tastes,** could not grasp the complexity of “serious” and “advanced” music, meaning serialism, and didn't like it.

There are psychotherapists with a similar sense of rectitude, which might be expressed: “We know what you need, what is good for you, and what your best is – whether you want it or not, and what your worst is – whether you want to ‘go there’ or not, and we will promote the ultimate good and cleave to the truth irrespective of your liking it or your improving.”

I know about these imperialists because I am sometimes one of them.  And I hope that very many of my fellow therapists are, too, because I’d hate to think we are pusillanimous dance partners whose definition of “help” is to masturbate our clients’ defenses.

Who masturbates their clients’ defenses?

* Therapists who practice the latest vogue, “strength-based counseling.”  This politically and bureaucratically correct inebriant, according to a University of Miami course outline, “represents a new paradigm in the field: from viewing clients primarily through a deficit lens, to a view that focuses on client strengths.”  “The aim of a strength-based counselor would be to identify and amplify client strengths, not on diagnosing problems.”***  See Appendix for an example of the strength-based approach.

* Therapists who assume that strengths are strengths, when they may be weaknesses.  Hope is a strength, unless someone continues to prostrate herself before a toxic parent, hoping for love that parent is incapable of.  “Hyperfocus” and hard work are strengths, unless you are hyper-avoiding the feeling world within and around you; unless you are struggling to be acceptable not worthless.  Kindness is a strength, unless it is the false self or your perfumey armor over shame.  Reasonableness is a strength, unless it is what grew over the corpse of your emotions, the fire of a feeling self.

* Therapists who believe in “solution-focused brief therapy,” another lobe job**** philosophy that believes pointing a rudderless ship to shore is good help.

Describing my paradigm at the beginning of a therapy – after the psychosocial assessment or a good listen to the client’s distress – I am saying that your problems fall within human nature as I understand it.  You have been hurt and have grown a wounded self.  The past is not the past, but the roots beneath your feet.  Time doesn’t heal – it masks and suffocates, abandons, intensifies, twists, corrodes.  Rarely if ever do clients demur from this benevolent approach.  What they do, sometimes, is request a psychiatric referral then substitute medications for therapy.  But in twenty years the only contrarian position I’ve heard has come from a student of counseling who was averse to the idea that one cannot smart-think one’s way out of mental pain.

And that long experience – that “my” people accept where I’m coming from – makes me wonder: Are there legions of strength-based, and solution-focused, and think-heavy (cognitive) therapists out there?  Clinicians who convince real people that capitalizing on their strengths will banish their ills?  Who convince real people that a new behavior or plan will change their different nature?  Who complexly out-reason their inferior-thinking clients?  Could it be just a reification of an echo – the way celebrities are famous for being famous – that the culture of psychotherapists buys these ideas, popular because we think they’re popular and therefore blessed?  Underground, are we actually authorities, brain surgeons in velvet gloves, Rachmaninoffs in Babbitt’s clothing?

____________________

Appendix: Strength-Based Counseling

A man enters his strength-based Primary Care Physician’s office and says, “Doctor, I think I have cancer.  All the signs are present according to WebMD and my family history going back four generations.”  The doctor reassuringly says, “Don’t worry.  Let’s not focus on the negatives.  I hear you play a killer game of backgammon!”

____________________

* http://www.palestrant.com/babbitt.html – Babbitt's ridiculous article that kills as it bores.

 

** That is, they preferred this: http://www.youtube.com/watch?v=QNRxHyZDU-Q to this: https://www.youtube.com/watch?v=_fkx5IYfiPs.

 

*** umbh.med.miami.edu/.  What terrible grammar!

 
**** “Lobe job.” The term comes from a science fiction story I read as a teenager.  A man in suspended animation wakes up in the far future.  Instead of finding an advanced civilization, he sees a decrepit cityscape, fallen to ruin from centuries of neglect, and nary a soul about.  He comes to learn (if I recall, in a disastrous way) that most of the population has succumbed to the pleasure of fantasy lobotomies – "lobe jobs" – by which they live out glorious lives of adventure, intrigue, etc. while lying comatose on a table.

 

Fantasy in f minor

I wanted to mention that while I sometimes reveal, in these posts, neurotic and dynamic features of my makeup, there is much that I will never say to anyone, that I will carry to the grave.  That content is not indiscretions or other colorful stuff, but what I know about the formative structure of my identity – the seed as it was and as it foretells the rest.  The fact that I can’t be alone in having “places” one does not want to dwell on – or dwell in – is a lesson about the shortcomings of the “primal” approach to psychotherapy that I cut my teeth on and still respect the most.  That is the approach that brilliantly questions the False Self and all defenses, sees Pain as the river that carves our landscape and undermines our subterranean self, and understands that repression is pathogenesis of mind and body.  I believe the best argument against primal purity is, “You can’t go home again.”  Pure openness – defenselessness – would be the untied balloon that deflating, lurches back to its formless, inchoate self.  Even exorcising his or her pain would not be enough.  Even counting on – a paradox the primal folk silently endorse – the “outer adult” to hold the cleansed-by-fire inner child would not be enough, if there was never a foundation to stand on.

Though physicists launch their minds into the universe while standing on a self-swallowing base of quantum uncertainty, free will determinism and ontological anarchy, I find my work slightly, and my writing significantly, braked by both the dark gooeyness of my foundation and the question of best psychology.  Sometimes I think of a person as an egg, whose shell is the defense system (drugs, denial, intellectualization, depression, workaholism, masturbation, violence, ad infinitum).  He is imprisoned within the shell – can’t really see out, can’t really live – but is not viable without it.  I wonder, sometimes, if best healing – by God and psychotherapists – would be to hold the hurting person in your arms while covering their eyes against their deepest truths.

A bigger problem for me is my own unsayable, which obliquely conforms to Yalom’s insight that in group therapy, so long as the members avoid discussing the elephant in the room – whatever the big issue is – nothing else of importance will happen.  While there are different subjects I may have a useful perspective on – such as anger management versus resolution, or client loneliness, or the narcissistic-sexualized front of my 21-year-old client – I often find these issues eclipsed by the dark sun of my own existence mystery.  And as my typing is invariably gravitationally drawn to the darkest forces, I’m pulled away from these livelier planets.

http://www.youtube.com/watch?v=5s2mtaQZQn0 – and Merry Christmas.

Tics

I’ve just returned from a very brief vacation with in-laws and young nephews, where the subject of tics did not come up.  As I am “the therapist” in an extended family with problems, I was struck by a distressing historical parallel which I helped create, but may now deconstruct, slightly, by this article.  In the late ’50’s and early ’60’s, I was a youngster with anxiety, tics and other nervous behaviors including a hideous blight of trichotillomania – hair-pulling.  I regularly chewed holes in my tee shirts, churned my neck, bit my lower lip bloody down to the nerve, sewed with thread patterns in my thumb, well callused by continual gnawing.  The bald was a massive, irregular continent shape.  No one said a single word to me, ever, nor was any therapy or other treatment ever provided.  My uncle, formerly an obstetrician and at the time a bona fide psychoanalyst who saw patients at his Park Heights Avenue condominium, never talked to me, and maybe not to my parents.  And they said nothing, but eventually took me to a hairpiece maker who fabricated a custom toupee.  A mediocre story writer couldn’t have come up with a more obviously condemning symbol for “cover up the problem.”

A psychotherapeutic throw-back or curmudgeon – take your pick – I pay indifferent homage to genetics’ likely implication in some psychological disorders, and generally consider the notion a cop-out that deserves to be laughed then kicked out of court.  Much more active than genetics are influences of powerful forces that are in the hands of parents or others.  Following is the abstract of an article, “Relationship of maternal and perinatal conditions to eventual adolescent suicide,” published in the March 16, 1985 edition of The Lancet:

“In an investigation of a possible relationship between falling perinatal mortality and rising rates of adolescent suicide, 46 risk factors from the prenatal, birth, and neonatal records of 52 adolescents who committed suicide before age 20 and 2 matched controls for each subject were analysed blind.  The results showed statistically significant differences between the suicide victims and each of the controls and no difference between the controls.  Three specific risk factors were shown to have a powerful capacity to differentiate the suicides from the controls: (i) respiratory distress for more than 1 h at birth; (ii) no antenatal care before 20 weeks of pregnancy; and (iii) chronic disease of the mother during pregnancy.”

Respiratory distress at birth along with an impaired mother, and mothering, leads to suicide thirteen to twenty years later.  Psychology is biology the younger we are, a fact that sublimates (I mean this more as the chemical definition of refine or purify, not the Freudian take) “blame” of parents to non-blame, but leaves “responsibility” undisturbed.  And the responsibility is: Don’t blame the goddamned genes.

I can tell you what happens when tics, and the person, are ignored.  At age 30, working as a typographer in Sarasota, Florida, I kept in my wallet a handwritten list of approximately twenty tics that I both cherished, perversely, as my identity neurosis and desperately determined to abolish.  Included were thumb-deforming squeezing and clicking; snapping upper and lower rows of teeth together; neck churning; brusque sniffing; finger stretching; foot churning; flicking back of teeth with tongue; sliding, in dreamy patterns, tongue over teeth; intensely compressing nostrils by muscular contraction; swallowing air; chewing skin off fingers and flicking it across the room.  Though the tip of the neurotic iceberg, these acts were essential to my identity, like skin, as they kept submerged the ghosts that, paradoxically, were the dreaded real self, the ungrown child.  In time, I mastered most of them by brute and depressingly vigilant force.  But right now, thirty-two years further on: The thumb is squeezed, and clicks.

Picture this truth: Tics are the compressed energy of impossible silence in the face of insane loss.  A father who does not talk to his son is the world gone wrong, essentially killed.  Say goodbye to that world, but without words, without sympathy.  Dull or divert your eyes from this grandest of all sights, because nobody cares.  And many years later, see the tic as the history of all the unsaid, un-had, ungiven.  How mute it is!  And because it should never have been mute but instead the language of meaning, color, life, it is awe-fully eloquent.