In-house #2 -- Two mini-vignettes

A client who left

Here I sit in my pity pond, steeping in bile and tears.  I don’t know the answer to a question: Why do some clients, steadfast in their neurotic alacrity and appreciation, suddenly become immaturely irresponsible: a downward parabolic curve to an ugly end?  Why did this woman attend a handful-and-a-half of sessions, mostly her intense soliloquys, then respectfully cancel and reschedule, then “too late cancel” (post-appointment hour) and reschedule, then just no-show no-call?  This may, of course, be her life out of control.  Though that generous theory seems belied by the fact that she recently won her Disability benefits and now sits on a small cushion of money.

This woman was truly self-enclosed, even though she had gushed to front desk staff that she “loved” me.  I had diagnosed her as Histrionic Personality: She was “very, very close” to every former boss (even those who’d fired her) and a bevy of others, including acquaintances and a pimp.  Self-enclosed meant a brand of solipsism,* not the execrable kind that starves one’s child, de-oxygenates his life by absolute blindness and neglect, but a cloying sort that clings to the child as a possession to decorate and fill up with goodies.  The kind that “loves” the counselor, even claims to be re-railed by some simplistic guidelines (a “My Goals”-type listing), but is still daddy’s abject girl and princess, sees and knows only herself.

So, and still, what happened in her inner life to pull her away, without a blink, from the therapy that seemed to matter to her?  I do not know what happens in a Histrionic, whose problems – her childhood life of cluster-crazy dynamics poking holes in her and filling them with sequins – by sheer force could fuel the drama I’d see in that chair.  The only other Histrionic I’ve known would show up two or three times a year with lite regret for the many missed months.  Remember that Narcissists can extinguish the therapist’s existence after leaving therapy; Borderlines may forget what their spouse looks like during a short separation.  Levenkron treated an Obsessive-Compulsive man who admitted the therapist wouldn’t exist in his mind for a long time.**  But I’m sure there’s more in a Histrionic’s hollow core – the convex mirrors to herself, the neglect by both parents – that made her so negligent.  Maybe we could say that such an individual is always tragically negligent, of her own life and therefore everything in it.

Identity and truth

There is a college student too dysthymic and intellectualized to do deep-feeling work, who nevertheless is intent upon grasping his identity problem.  He asked, How do I know my thoughts are mine?  This question is as heavy as the world, because I believe most adults have screen thoughts, ventriloquist-dummy thoughts that defend their pain rather than reflect their health, and are therefore deceptive and “wrong.”  A related question, my client wanted to know how one determines what is the “truth.”  We imagined this scenario: Two ten-year-old neighbor friends come from very different homes.  One, Gil, has parents who are human: grown up and secure in themselves, content, and therefore able to love and accept their child as a separate, individual self.  The other boy, Bill, has parents who are off-human: vessels of unmet needs, never grown up, unable to countenance a child different from and better than themselves.  The healthy boy values life as he is valued; the other the same, and opposite.  On a spring day, a beautiful green praying mantis is perched on a bush.  Bill rushes into his house and returns with a container of Elmer’s Glue, intent on covering the mantis with it.  Gil cries, in alarm, “Don’t do that!  Why would you want to hurt it?”  Bill stops, flustered.

The client and I considered their thoughts.  Gil thinks: The praying mantis deserves to live.  Bill thinks . . . nothing!  He is troubled, confused.  Gil’s question has struck him like unique therapy, in a place where nothing from his parents ever struck him – in his heart.  He is not too old and callused to feel his pain, and probably some memory of compassion.  Maybe if he could think now, it would be: It’s true.  Life is wonderful and deserves to live.  Why doesn’t anyone see mine?  And my client and I saw that if Gil had not intervened and Bill did suffocate the mantis, and was never touched in his heart through his childhood, he would indeed grow thoughts.  Bugs are ugly, they are nuisances.  They deserve to be eliminated.

Who nowadays has truthful thoughts, those that accord with the real self before injury?  Pain screams need and hides; health feels.  And feelings are the inner voice that thoughts find words for.  Question your bent clients who talk about love, their academic or career ambitions, their “guilt,” their assessments of their children, their “anger at life” and hatred for their wife, their politics which believe it’s right to deprive the poor or rob the rich, their moral system, their certainties.  They are stating their defenses, labyrinthine or straight.  You won’t know what real is underneath them, what identity, until you parse them away.

- - - - - - - - - - -

* See post http://pessimisticshrink.blogspot.com/2013/10/normal-0-false-false-false-en-us-x-none_20.html.

** “He laughed quietly and responded, ‘Not really.  People don’t count in my pictures.  It’s only the other objects I have to think about.  Actually, it may take me months to remember what you look like.’”  Steven Levenkron, Obsessive-Compulsive Disorders, Warner Books, 1991, p. 76.

Molecular mess #3*

I had come home from work around 6 p.m., watched some news with my wife, then ambled into the bedroom to empty my pockets and found myself, with no forethought, lying down and being semi-conscious to unconscious for the next five hours.  I hadn’t known I was tired – in fact may not have been tired.  So I wonder if it was the turning of part of the subterranean mood – my own personal ocean – to deliver its almost completely recondite truth.  I couldn’t call it depression exactly, or a sense of “end of the road” exactly.  Maybe it was some meaning down there that will always be invisible.  Maybe it was an anticipatory inchoate curtain, or exhaustion, or giving up, in touch with –

I already work Monday through Thursday and Saturday and have now added Fridays.  The weekend looks like paperwork; my wife is moving out west to get a head start for our family; the month’s income has been weak but is showing a nice but futile surge at the end.

Or maybe it was none of this.

At 11:30 I got up and took the dog out for our typical evening walk.  But this time I was in a unique (never-before-known) state: My brain did not engage, had no thoughts, had not given me any mood “program” positive or negative.  There was only the emptiness that felt the breeze, the quiet, the street lights, and the quietest inner state that deserves the name “molecular mess.”

I wonder if that’s who we all are, deep within, when we ditch all thoughts, all assumptions, all wordless attitudes, the silent resting on any laurels, current-events feelings.  What if our psychology equals that undifferentiated mass that consists of first birth templates and discrete things – earliest baby sensations – forming over time discrete impulses, then unspoken conclusions (“emotionalized attitudes” – Axline), fears that become thematic fears, nervous system feelings with unique or proprietary psychic meanings.  And then, as we grow, wider organisms of meaning – jubilant deathless feelings along with dead parts (lost childhood) that feel like needing to die; the scaffolding of adult persona: concrete reinforced and undermined by childish needs – Citizen Kane’s Rosebud – and meanings that we think are adult-mature  but are really our child’s need for love and touch and being-in-itself wonder.  Remember that there was a time, long ago, when our full meaning existed without our determining it, without our deciding that this or that cause or goal or credit was important.  Catching lightning bugs was all the meaning of the universe in itself.  The blinking glows, the summer night – all of meaning.

But then we think.  We think so much.  Haughty concatenations of words, ideas that become the scaffolding, the stilts we walk on forevermore.  These germs become diseases: philosophies and categories that include political ideologies and psychiatric labels, religious clubs and declarative meanings we give ourselves: I’m a failure, or I’m a success, or I’m good, or I’m “guilty” not to want to caretake my cold mother.  We live primarily in our head which declares tin-can truths and eternal truths with every utterance.  We bury in the forgotten past wonder and good ignorance, which would feel-see the molecular messes of people and the world and react with natural subtlety.

I suppose we all must paint everything, must believe that we know.  But I’ve proven, on my midnight walk with Simon the miniature schnauzer, that one can be observant or “experiant,” empty of all questions and feelings, and the world consents to it just fine.  And possibly, in touch with the “mess” by being it, we feel our original good – life before pain, questions and sentences.

- - - - - - - - - - -

* See the earlier two posts, Oct. 6 and Oct. 10, 2013.

Counselor, stifle thyself

How do I write about my quietly subversive and duplicitous relationship with psychiatrists, without jeopardizing my present and future relationship with them? I am not against psychotropic drugs. While I do believe in the potentially higher quality and greater staying power of psychotherapeutic healing, I am no purist. These drugs enable greater functioning, sometimes save people’s lives, and often make them feel different, or feel less, which is usually what they mean by “better.”

Maybe the biggest axe I grind comes out of the conflict between my therapy approach and medication’s and psychiatrists' effect on clients’ attitude about it. Simply put, a number of clients stop coming to see me after they’ve been started on depression or anxiety meds. They don’t ditch counseling when taking antipsychotics and bipolar meds. Why is this?

I will offer to work to mitigate depression and anxiety through depth process. This means digging to the roots and reasons of pain, sometimes staying with and working and crying through childhood agony. Medicine on the brain makes that drastic stuff feel unnecessary, and maybe distasteful. I remember a young man, in 1999, who felt at all times a moribund depression but prepared for therapy – and much of his day – by presoaking in marijuana. By session time he hadn’t the slightest interest in any emotional work: His depression – already a repressive entity – was given a dirty pink coat of paint by the chemical mellow. There was no work to do.

With psychotic and bipolar clients I rarely offer to try to undermine their disturbance, for different reasons. Bipolar is, per Alice Miller, a double-defense package (“grandiosity is the defense against depression, and depression is the defense against the deep pain over the loss of the self that results from denial”*), and so is more deeply entrenched than most mining can reach. Plus, clients are even more likely to believe the biological, not psychodynamic, theory of mania: It looks “chemical.” And while psychosis should, I believe, also be understood to have causes in childhood tragedy,** it is too desperate a problem for community mental health – with its thin walls, concrete Objectives-based treatment plans, easy-listening culture and creamy strength-based mission statements.

I’ve said “I will offer to work to mitigate” depression and anxiety. Often, admittedly, the process will in time moonwalk from sublime to pedestrian if the client proves unable or unwilling to “go deep.” When it does, counseling remains acceptable, does not goose the sleeping giant of medication effects. But it’s in the interim zone, when he or she is in a place of disturbing discovery – first efforts to peel the onion – when the allure of chemical amelioration can turn heads, and leave me an empty chair.

I can’t and don’t confront the psychiatrist about this wrong done to a client. Obviously He, the doctor, is master of the mental health universe. And, She is so lofty not to be ruffled when I occasionally mention published cautions about Paxil withdrawal, or the need to monitor one’s own medicated feeling, or in a reckless moment cite Breggin’s “chemical straitjacket” or “involuntary intoxication,” a concept that has exonerated perpetrators and punished pharmaceutical companies in criminal cases. And yet . . . walking this line, after so many years I have finally come under fire. A perfect storm occurred where my loose lips, the client’s impressionability or ambivalence, and a doctor’s disdain for depth psychotherapy, all collided.

Out of the blue, good therapy clients would consult with the doctor and come away condemning child focus or Empty Chair or my tendency to give information, sometimes at length. Disclosing painful stories of their mistreatment by parents, they would complain to the nurse practitioner or psychiatrist that I had determined their parents were faulty. The weeks or months of complex, heartfelt, empathic and eye-opening process would disappear, replaced by their lamentation about therapy. I could not understand how people I had served with intense effort would, in a sense, betray me – until I discovered the three-fronted storm.

I feel, wanting to be powerful and therefore to have agency, that I brought this on myself. A minority of people want to fight their human nature, which is to be solved and soothed quickly. Psychiatrists may allow but not embrace psychotherapy whose implicit requirement is – be open to feeling, not medicated against it. In the future I will suppress my meds talk but for some basic theory that says “feeling is healing.” And if I ever challenge the doctors again, it will be after I win the lottery.

- - - - - - - - - - -

* Alice Miller, The Drama of the Gifted Child, 1997 edition, p. 34.

** See Modrow, Breggin and Harry Stack Sullivan, R.D. Laing, Theodore Lidz – the old guard.

My philosophy changes my psychology

I am getting the nerve to write some very fluffy stuff here, so my apologies to those who do me the kindness of reading these posts.  My reason is, however, as solid as I am able to get: My thoughts about ontology and psychology coincide, as I get older.

"One of the chief results of the effort of the last hundred years of European philosophy is the final establishment of the necessity for abandoning the quest for the reality behind the appearance."

James F. Sheridan, Jr., Ph.D.

Once More From the Middle, A Philosophical Anthropology

Ohio University Press, Athens, 1973, page 1*

The universe is a question mark.  It can’t tell itself what it is, obviously.  And there are no answers for us, because knowledge is simply our word for how we react to our perceptions.  That is, how we react to ourselves.  It is a different kind of ignorance.

The universe is blind and knowledge-less.  So instead of looking at it in wonder, or looking at it in weariness and poetic disgust – You are too far away to do me any damned good – we can look at All as permanently asleep.  Will it ever wake up?

Now, in our newness, we can destroy things or rearrange our planet.  Maybe in some billions of years we will rearrange the galaxies or the universe as a whole.  But it is still there: One can wake a person up.  One can’t wake the bed up.

It’s very sick to hurt people.  I wonder what the equivalent, the source of this is in inanimate matter, a rudimentary quality of mood or destruction in matter.  Is there some basic futility in the fundamental cosmos?  Does energy feel unfulfilled?  Does it feel free – think it is free – while actually being determined by its nature, like us?  And is that self-contradiction inherently painful?  Is Everything in depressive terror to be stuck, unmovable?  The universe can’t move, it is fixed.  As is God, who would be the exact size of everything.

The universe is the bed asleep, and we think we can see it, and feel it.  To me this is very sweet, a sweetness that undermines the legitimacy of hate, violence and destruction.  We are somewhat, a little more awake than the rest of entirety and this is such a great boon.  We should be happy.  And when we fail – when love dies or we are hurt by another – we should make some justice or collapse in pain, feel it.  To create havoc seems to me to be an error: assuming we are uniquely awake, different and better than the universe.

We are part of everything, yet violence is lonely-making: It is to reject the pain we are in, striking the hand that we need to soothe our forehead, raging to drown out or kill the hurt which can’t be drowned out or killed, because it exists.

I wouldn’t be surprised if many people have this sense that they would like the universe to wake up, tell them the meaning.  But just look at it, and see the question mark.  And if some alien race, or God appears to you in his superiority, point out the question mark to him.

- - - - - - - - - - -

* My favorite philosophy professor, Allegheny College, Meadville, PA.