Weak smile without a self

For unknown reasons, I have seen very few wimpy men in therapy. That was my “diagnosis” of this client, though I believe he wouldn’t have seen himself that way. Instead, he thought he had been long trapped by a master trapper, his incredibly psycho-bitch evil wife. After seventeen years of marriage, he finally left after being slapped and punched and pushed almost daily, verbally knifed and threatened constantly. His story was one of being out-clevered and strong-armed at every turn, fooled, cheated on, stolen from. For years he had thought of leaving, but she used the Borderline strategy of threatening to claim he’d been violent, to take his children. He lost his house – she refused to move out. He couldn’t sell it – she wouldn’t let the agent show it; then after an extreme price reduction, wouldn’t sign. She’d been the money manager, had secretly neglected his car payment for months, so he lost his vehicle. He described her wizardly way of diverting his checks to a hidden bank account with a post office address, so no warnings would come in the mail.

From a five-bedroom house, substantial equity, savings, six-figure income, to a cheap apartment, the clothes on his back, unemployed.

My client didn’t think he had any depression other than the blues that such circumstances would warrant. His character was genial, loose, game, going with the flow, hopeful. And – in a move that has at times made me want to ball a fist and clock the pisher* – he ingeniously slid in this inoculant: “I had two loving parents.”

I was somewhat pleased to scandalize him. “No. You had wimp-making, backbone-stunting parents.”

Actually, I only talked to him about a home where strength is prevented and a child is separated from his feelings, and the facet of depression that is loss of identity, and the attraction to people who recapitulate one’s selflessness.

Before my talk, he hadn’t wanted therapy. After it, I didn’t know. I could say that in a way I didn’t want therapy with him. He had that look and that way that say “depth isn’t a part of me.” Some people shouldn’t cry deep tears to their wellspring: They are just too stunted and tight-circuited for that. I wrote down some book names for him. 

If any readers would like a brief discussion about depression, identity and the absence of strength in dreadful situations, you are invited to write to the email listed at Profile, right column. 

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* “Pisher” – Yiddish, at http://www.brityiddish.com/2016/08/pisher-is-crude-word-or-at-least-in.html.

Narcissism and the pain of reality

The president lies continually because reality is painful to him. Narcissism, as he embodies the personality disorder, is a kind of universe, a global perfection and invulnerability system that begins, like the Big Bang, in a volatile monad. That singularity is an unarticulated sense of failure in the child, a sense of false existence that is most likely to explode into its narcissistic defense when adolescence requires some maturity. Prior to that, the child will still lean on a parent for ego solidity.

We can all be personal psychologists by feeling within ourselves pain that never healed and which we’ve covered with repression, denial, explanations. Even now with our strength, we may find it impossible to admit core flaws seated in our early childhood which would manifest if we didn’t replace them with untruth. A fundamental cowardice. An abyssal disconnect from everyone which actually means the deepest hopeless need for connection. A sense of never leaving childhood. A feeling of not having an identity. Even if we can, wisely and candidly, name our insight into such a flaw, we can only do it by bouncing off it, glancing at a fact then returning immediately to our tower of functionality and ideas. To dwell in that error would be to become it again.

Donald Trump’s brain formed, by “nature and nurture,” the greatest drug to escape from existence pain: the false feeling-belief of perfection. But even he might on rare occasion sense the deepest hollow inside. This is an intrapsychic place where one feels without knowing, and the feeling is that one was never a genuine human being.* Drugs and other self-medications cover, for many people, that abyss. People kill and die for their drug. Remove an alcoholic’s or meth addict’s supply and he will begin to die inside, because he is feeling his early failure. Cause Donald Trump to question his narcissism, which must be a seamless coat of paint over everything in the world, and the plain world would kill him.

We revile Trump for his narcissism. But he is just covering, with gold paint and lies, the pain of reality.

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* “Painful memories once repressed rise and come flooding into awareness with a gruesome, hallucinatory awareness. As if in a trance, he suddenly ‘realizes’ that at no time in his life had he ever been a person who was fully human.” John Modrow, How To Become a Schizophrenic, p. 23. Publisher: Writers Club Press, 1992, 1996, 2003.

Pessimistic therapy laws #5: Therapy conversations are better than almost all other kinds

All the people in the world stranded outside therapy offices should be jealous of our conversations. Everything they say eventually reveals, in hindsight, its emptiness, its missed truth. Salutations, jokes, politics, religion, art, obituaries. Pillow talk, Shakespeare, prejudices and hatreds, philosophy and poetry. Parental lessons, campfire songs and ponderings. Everything but science. In an absolute way, all of it is breezes flying high above a fire. People are bleeding, lost, blind, stuck, and not knowing it they live lives of noisy desperation, moving their tongues about anything. In therapy we look at our question marks, we look for the buried or huddled in a corner child. We question ‘what is love? What do you really feel? What am I?’ We search with compassion the humanness that others call weakness, failure, guilt, lazy, mental illness, crazy, evil. We stop the ride that is the world we never made and are still, looking both inward and at our widest possible horizon, like a physicist peering through a telescope all night, after midnight.

We give love without needing, we reparent, we respect, we find a truth or two that will support and last to the grave. We find realer and realer layers of the person, sometimes down to the seed that bore her.

After therapy, other conversations are icing on the cake. Without therapy, they are icing without a cake.

In-house #8: The Socratic two-step

Sometimes, in an expansive mood, I will set aside the diagnostic interview and ask a client: ‘What do you think therapy does? How do you think therapy helps?’ I always expect the question to jazz him or her: to urge discovery, to shine a light into an unknown cave. It’s a good question because some people have no clue and come for magic, and now they have to get real about themselves. Or they speak the clichés and memes du jour – “sounding board,” “receive guidance,” “learn coping skills,” “cognitive therapy,” “neuroscience,” “get my feelings out,” or more rarely, “learn about myself.” If so, the next question would be: ‘Do you think that changes a person?’ Silence ensues. I want to put them on the spot. Why shouldn’t they be able to figure out the answer? These questions nearly compel a deeper reality than anything the client’s mind has brought to the room, or that the mainstream of psych or Dr. Phil offers. They will realize their answers aren’t good enough. That “coping” or guidance or talking isn’t dislodging depression; learning psycho-facts and even insights doesn’t whisk away the sludge of identity mal-ease. “Expressing feelings,” as they understand it, can indeed seem helpful. But they’re not talking about anything outside of their adult life. They don’t know that –

“We scream before we cry, cry before we speak, and speak before we can organize conceptions about what we have and don’t have. Each of these stages of expression forms part of the skill of communication. Crying is a language – a primitive one, but nevertheless a very human one. The history of neurosis is the history of misery and the need to cry out this misery. Crying is not only an expression of general hurt; it is also a vehicle that carries us back through time to those specific traumas that were buried long ago by the processes of repression. It is tears that break down those barriers and help us on that voyage through time when we were hurt and could not cry. Tears wash away our pain and unmask the unconscious. This is not a metaphor but a biological fact.

“Tears of early loss are the solution that dissolves the walls of the unconscious and liberates encapsulated pain. . . . .

“Deep weeping as we see in our therapy is not hysteria but a unique new category that involves healing. It is the first convulsive phenomenon to be related to the healing process. Here, the adult brain gives way to the child’s brain, travelling back to an exact feeling, an exact moment and scene where crying should have taken place but did not – tears suspended in time by the agony of the experience. The regression from the adult brain to the emotional brain and then to the ‘pretear’ perinatal brain is the exact reverse of cerebral development.

“Tears, by and large, are uniquely human. We differ from animals in our ability to cry and tear. Crying is a curative process. I do not believe that one can cure either mental illness or a host of serious physical ailments without it. For some reason, however, this natural function has become opprobrious. We shush our children and deride them as “crybabies,” consider it grown-up not to cry, and believe it is a sign of weakness to give in to tears. So we block out this innate, biological process and then pay the price, because along with that blockage goes a host of other suppressions and dislocations. It is not just wispy tears that are blocked, but basic biological functioning.”*

When a serious or exceptional client asks herself the question, she will feel the ominous question mark of her life. She will feel that there must be some form of help, because pain moves like a slow river, like osmosis, beneath the hard crust of personality. She will feel that something has to change deep within her. This understanding may put her in a place to feel the core feelings of her formation. That’s her childhood meaning.

She is ready for depth therapy.

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* Arthur Janov, PhD, The New Primal Scream, Chapter 15, “The Role of Weeping in Psychotherapy,” pg. 318.

ESA letters: Dogs on a plane

There was once a wild pet hair, and it made me respond to an Indeed.com ad for therapists to write Emotional Support Animal (ESA) letters. I’m a therapist. I love my dog. I enjoy writing client advocacy letters (to support a woman’s returning to college following a breakdown; to support a man in a visitation case, etc.). Apparently these factors combined were enough to spark my profit motive. I sent my résumé with a cover letter:

Curious. I was a therapist in Ohio for 17 years, Colorado for one year, and now Nevada for the past two years. At no point prior to Nevada did I see a client who requested an emotional support animal. In Nevada – everybody and his half-step-niece wants one. As you – I hope – know, the need for an emotional support ‘other’ is obscure and potentially complex. I knew a Child Protective Services manager who brought her teddy bear to and from work every day. Did she ‘need’ that support? Might therapy have helped against this dependency? Valid questions.

I have written more ingratiating cover letters than this, but it was right enough to elicit this response:

Here at [Emotional Support Animal Letter Company], we’re always looking for more great people, so we’d like to get to know you.

Your application for the Licensed Mental Health Professional position stood out to us and we would like to invite you for a phone interview.

You will meet with our founder and CEO, _______. The interview will last about 20 minutes and you’ll have the chance to discuss the remote contractual therapist position and learn more about our company.

Later that night, I may have dreamed about pope-therapists blessing dogs in restaurants and in apartments sans pet deposit; and about therapists betting their license that clients are so feeble and unbalanced as to need furry courage to go places and be places. When morning came, I read a few psych-based articles on the problems of these letters, then wrote back:

Following my short wave of curiosity, I must bow out of your candidacy process. It took little contemplation for me to realize that while a ‘self-medication’ is often important or even necessary – whether it’s alcohol, chocolate, intellectual pursuits or the company of a dog – it is not in the interest of depth therapy as I practice it to prescribe them. However, I appreciate your interest.

For humor’s sake, here are the two rejoinders I received approximately half-an-hour later:

We received many applications for the position of contractual licensed mental health professional. We reviewed your application and decided not to invite you in for an interview with the hiring team.

We appreciate the time and energy that go into submitting a resume, cover letter, and application. Thank you for investing the time to apply to _______.

We wish you success in your job search and in your future endeavors.

Within minutes, from a different principal of the company:

Good luck to you . . .

Have to admit, just two emails from you . . . and you wore me out.

I rounded it out with –

I appreciate your dis-inviting me to interview after inviting me to interview. This, along with my letter to you declining your initial offer of interview, provides me documentation that my name and license will not be used by [Animal Letter Company] for purposes pertaining to your business.

The issue of Emotional Support Animals and clinical letters is a qualmish one, an arena of misuse and abuse by both client and clinician. In my imagination I picture hundreds of people, thousands of them, everyone going about with dog on a leash or Shih Tsu in a handbag, cat in a basket, guinea pig in a pocket, parrot or iguana on a shoulder, fly in a matchbox because they are lonely or nervous to be out in the world. I am perplexed, or actually, paradoxed. On the one hand, it can seem like Monty Python therapy (“Pardon me, my good man, but is that an especially obsequious ferret on your head?”). On the other hand, of course almost all of us need some dependency object or person, or thought or hope, or music or résumé, or food or money, or prestige or job, or narcissism or therapist. Why shouldn’t we lean on an animal friend? The crux for therapists is that “First do no harm” and be no enabler: We should question addictive needs, not cave in to them. Rehab questions alcohol, therapy questions codependency. Shouldn’t we question the claimed need to attach an animal to one’s bosom? I believe therapy should see a continuum of help toward a continuum of goals. Best would be “healthy happiness”: promoting autonomy not dependency and victimization; intervening for self-esteem based in one’s core feelings and needs, not on external rewards. If the person is not able to reach autonomy, has a dependent nature, we may still help her create self-supporting boundaries, some limits to a parent’s or spouse’s incursions.

In one article, a normally nay-saying psychologist explained her decision to write an ESA letter. The tragic woman had “no reason to live” but for the companionship of her pet. That was a situation that I believe any clinician would agree with. For the old woman, it was gold-standard therapy, the best and necessary to be done. In less dire cases, we should ask the brutal question of self-medication via dog or cat or peacock versus psychiatric medications, therapy, catharsis and teddy bear. Not to mention confronting a client who is twitchy, likes Bowser and is trying to pull one over on us.