Reality dose: Lori Gottlieb’s “Laughter on the toilet”

Lori, New York Times psychotherapist, has written an article* about laughter and life amidst the tears and pandemic traumas her videotherapy clients bring to their sessions. Two clients, she said, have sat on the toilet (presumably seat cover down) while engaging. I have not experienced that. Are my clients too unoriginal, boring? Most have been at a chair and desk, two were in a closet (not even a walk-in closet, just a tiny closet), several lay on their bed, back propped up. Kitchen, patio, walking outside (smartphone in hand) to get clear of family.

Gottlieb said she and her clients share laughter about the technical glitches – “screen suddenly freezing at an inopportune moment.” That’s funny? No, Lori, it’s disruptive and aggravating as hell when the image freezes or stutters, the voice breaks up or reverbs or goes out entirely, often several times an hour. Are these your clients, or your Sex in the City girlfriends?

She waxes gracious about the laughter that can heal, that made a client “feel better than anything I or anyone else had said to comfort her. It had been more than a month since she had laughed, she realized, and she hadn’t noticed how much she missed it. Laughing felt like a return to her former self and also offered a glimpse of herself in a happier future.” I remember writing Progress Notes like that in my intern year: Full of ego altruism, I knew that a magical laugh at a joke or observation would turn things around, blue the skies and bring out the underlying, redeeming goodness of self and world. Bullshit. Poopies galore. It’s nice to laugh, but it will not change anything in the person after, give or take, five minutes.

I don’t like whitewashing our work, clothing it in a chic New York jacket for an op-ed article. And I don’t like exaggeration for effect, which is what I suspect in Gottlieb’s description of the “toxic daily dose of devastating stories of anxiety and loss of every conceivable kind – loss of loved ones, loss of health, loss of jobs, loss of stability, loss of physical presence, loss of touch, loss of daily routines, loss of weddings and graduations and holiday gatherings, and loss of even the ability to smile at neighbors while walking around the block. . . .” What a tragedy it is, oh dear ones, that they can’t smile, damn the Mask of Despond! My clients are as real, serious and complex as Gottlieb’s, but I’ve heard no jeremiads of coronavirus tragedy, not one in two months of daily and weekend sessions. The quarantining at home is boring. “I’m going stir crazy.” Have they suffered any of these profound dramas? A few are out of work, but their spouses aren’t. I’m pretty sure they’d tell me what else.

An offer, for my last article of an over-saturated month: If anyone wants to know what real therapy is like, contact TPS through this blog or by email (teletherapy link). Be aware that the psycho-journalists will not be real with you.

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* https://www.nytimes.com/2020/04/30/opinion/psychotherapy-remote-covid.html?action=click&module=Opinion&pgtype=Homepage.

Lighthearted confab #1: How to diagnose Borderline PD from the face and voice*

I’ve written a few pieces on the nature of personality disorder,** presenting some ideas grounded in Masterson’s theory that traces its formation to a neurotic mother-infant separation-individual phase (age one to three). The personality disordered individual has remained unformed, a child. This would be fairly apparent in the childish or “emotionally primary” Borderline, Dependent or Histrionic, but even more decisively though less visibly in the Narcissist or psychopath. Consider our “man-baby” president, Trump. Has there ever been, in all present generations’ experience, a more obliviously immature incongruity of sick child’s painful feeling and irrationality with the gossamer veneer of adult character? Logic would then take us one more step to see perinatal abortion in the murderous psychopath. This is someone whose heart burned out in birth and infancy. Everything after that became self-medication of pain and therefore a life of agenda and manipulation in the social realm. Clearly this person could never grow.

The Borderline’s face and voice typically exude out-of-place youth. We can’t diagnose based on those signs, but once we’ve determined that the woman cannot parent competently, deals with stress by, essentially, holding her breath ’til she turns blue, feels abandonment extremes, has a rice paper-thin sense of identity, we re-look at the goofy, childlike twisty or coy or vicious mouth, hear the strangely unpleasant lilting voice, and know. There will sometimes be the same phenomenon Lowen noted in the Narcissist: His face is years younger than his chronological age, as narcissism has caused the burdens of life to waft over him.***

Personality disorders can be difficult to diagnose, in part

because defense and immaturity exist on a continuum. We know adolescents and adults who are egotistical but not Narcissistic; immature, impulsive men or women who are not Borderline; subservient, domestic violence victims who are not snugly Depen­dent; someone capable of transient cruelty who doesn’t qualify for Antisocial Personality.**

I think it is acceptable, then, to listen to the voice, observe the face, and get a good first clue. From the ground of that prejudice, we’d then check ourselves brutally for a long time, trying to disprove that impression at every turn until little could deny it.

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* Disclaimer: This is nonsense, though with a smidgen of reality.

** https://pessimisticshrink.blogspot.com/2014/01/normal-0-false-false-false-en-us-x-none.html, https://pessimisticshrink.blogspot.com/2019/01/definition-personality-disorder.html, https://pessimisticshrink.blogspot.com/2014/09/in-house-3-youthfulness-and-personality.html.

*** “Though the story of Dorian Gray is fiction, the idea that a person can present a physical appearance that belies the inner state of his being is valid. I have been struck by how many narcissistic individuals look much younger than they are. They have even features and smooth complexions, which do not show any lines of worry or trouble. These people do not allow life to touch them – specifically, they don’t allow the inner events of living to reach the surface of their minds or the surface of their bodies. This constitutes a denial of feeling.” Narcissism, Denial of the True Self. Alexander Lowen, M.D., Simon & Schuster, 1985, p. 38.

Roots of the Trump follower (aka Take it from a former callous Libertarian)

Trump followers were bent in a bad direction in their childhood. One of a million possible analogies to their plight is the woman who, once an abused girl given no empathy, buried and lost her expansive heart, lived under siege, ran from warmth to sex then to immature abusive men, remained a victim under siege, too emotionally ungrown and too suppressed to defend herself or her children, eventually stumbled upon a man who had a heart, who didn’t keep her chains on her, then her hell broke loose. That’s not the best analogy, but it points to the eyes that could never see selfless warmth again, only possessive warmth; to the child in the adult, to what was dormant and latent all along: hell.

It’s a pretty terrible plight to have to be a person whose formative years merely survived, without love, without gifts, without peace, falling over the Rubicon onto the adult plateau with infinitely heavy baggage and an empty suitcase. I know these people – women and men. All of their feelings are different from more fortunate people’s, though they will seem the same. Their love is different, their loyalties, their distrust, their neediness, their hate which can be murderous in suppressed fantasy, unless they come to therapy and voice it.

I want to make it clear that I’m not talking only about the worst abuses, growing up. I would have been fine, deliciously fine, with Trump had I not found some pieces of my heart later in life, yet I was never abused. Rather, I was silenced by the aridness of my home. I was invisible to everyone, as they were preoccupied with their own prisons and their own escapes. That can be enough to make someone survive but on the wrong nourishment, the fuel of self-medication, superiority, plotting anger.

Could someone on his deathbed laugh at a good joke? Of course: We’re ridiculously layered, with our conscious, preconscious, unconscious (Freud), our basic adherence to the norms of society while there are various hells sitting still inside or running in tiny loops. Because of our complexity, a Trump fan could, like me, feel different if something moved inward. He or she could heal somewhat or a lot.