Down and dirty #1: The weakest of men

A little comment (https://nyti.ms/3PWZyRL#permid=122256406) to a recent New York Times article on domestic violence and murder-suicide:

Men are often lonelier and needier than women are. Their plight – their dysfunction – starts in childhood when they are discouraged from expressing – giving to a caring other – their full spectrum of feelings. Because they're supposed to be real men. They become self-enclosed repositories of need for emotional bonds that they are not allowed to have. Men who stalk are desperate children of abandoning parents, but now are big and angry. The same for men who abuse and kill. The irony is that women who are victims are subjugated by the weakest of men: little boys who couldn't grow up.

This is a generalization that you can count on. One, it's hitched to a basic principle of human dysfunction: the ungrown "inner child" which is most of us. Two, boys are still tainted by the culture of macho, the strong, silent type, the less-feeling, the aggressive. This is not to say that girls do not grow up needy for love, and lonely. But there is a difference, the difference between reality- and delusion-based suppression. Girls will be deprived of what their introjected lesson tells them they should have: communion, bond, an emotional life. Their whole is injured, but vital. Boys are deprived of vitality as they are given to assume they should be left out in the cold. The soldierly calm, the soldierly lost. They can't conceive they are merely human.

Men are born, live and die under this delusion. What a fate.

Christmas Eve-Eve warning

I have already written with disgust about the empath.* I am displeased with people who think they're that. Such a conceit advertises different waves of blindness and fakeness. It's usually wounded people who don't know what they feel who believe they know other people's feelings. Even if sensations and emotions were as simple as categories rather than the near-infinite shades of chemistry they are, could a so-called empath pinpoint me somewhere on this?

To expand: A person who purports to "resonate" with another person's emotional state may be extremely repressed and therefore may not feel for the other person. What is empathy without care? In fact, it's "psycho/logical" that deeply buried people will be triggered by others' negative feelings, just as someone might weep at a Hallmark movie but have no feeling for their grieving neighbor or for nameless victims of authoritarian regimes. The inner child is being triggered but the adult is armored, cold and obtuse. We know that some of our most troubled parents of troubled children are "empaths."

At Christmas – though it's sunny and pleasant here in Henderson, NV and mortally cold elsewhere – we feel moments of childlike love and care for others, even strangers. It fades like the morning dew.** Jesus can do that to children, which (I constantly say) we are.

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* https://pessimisticshrink.blogspot.com/2021/01/tps-whats-next-thing-youre-disgusted.html.

** https://www.youtube.com/watch?v=2LWgXIwLKXg.

Dry humor, or wet seriousness #7: I ponder as I wander

1998 or thereabouts, between 2 a.m. and 4 a.m. Emergency Services clinician at Netcare Access, Columbus, OH, to a walk-in homeless man who probably wants a sandwich and an Apple & Eve juice box: “You are feeling suicidal? Do you have a plan?”

No-Eject No-Reject Client: “I’m going to jump off a building.”

 

1998 or thereabouts, between 2 a.m. and 4 a.m. Emergency Services clinician at Netcare Access, Columbus, OH, to a walk-in homeless man who probably wants a sandwich and an Apple & Eve juice box: “You are feeling suicidal? Do you have a plan?”

 

No-Eject No-Reject Client: “I’m going to jump in front of a bus.”

 

1998 or thereabouts, between 2 a.m. and 4 a.m. Emergency Services clinician at Netcare Access, Columbus, OH, to a walk-in homeless man who probably wants a sandwich and an Apple & Eve juice box: “You are feeling suicidal? Do you have a plan?”

 

No-Eject No-Reject Client: “I’m going to jump in front of a building.”

 

Clinician: “That’s probably not going to kill you, but that story deserves a sandwich.”

 

🔩

 

I am in a rancid mood these days, but the above account is true. My shift was 12 midnight to 12 noon, Friday, Saturday and Sunday. With 24-hour crisis availability, nurses and psychologists* would drag their recalcitrant teens to our facility at 3 in the morning, such as the 14-year-old boy wearing high-heels and an evening gown (those were the days when that was OK but not yet de rigueur). When a Borderline threw her colostomy bag at Barbara D__ (the social worker who, admittedly, most deserved it). When a Somali man would make a bee line down the way, knocking all the computers off the long desk. When a Somali woman was seen eating the chair’s vinyl seat in the interview room.

 

Now, after years of doing one-hour once-a-week therapy with variably amenable clients, I can’t quite remember how I would help those folks attenuate – temporarily or even longer – their extreme crises. I was full of depth psychology information, which could then as now help someone see their plight from an understandable, valid and self-compassionate perspective. I was saturated with peak moment solicitous care and respect. But the magic that would make someone immediately stop feeling deathly – that may no longer be in me. But maybe it would kick in again.

 

Looking back to those hours, those years, I wonder if that work was in some ways more fulfilling than individual therapy. I have this sense that that one moment, where a person’s entire life has come to be condensed and twisted into a poisonous tiny ball, like the universe before the Big Bang, is the best time to give her a feeling of hope. It’s as if all of human life is distilled to a symbol: We always need a person to save us, and here he (or she) is. An hour during shift work becomes the perfect Mother, what we will always need, cradle to grave, in the human tragedy.

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* That is, the professionals with the most troubled children.

Infinite regress minus one

If you want to help a client understand herself, be moved and changed simultaneously, you can use infinite regress minus one, which I made up yesterday. It's just a path to Gendlin's Focusing process which, as I said in "Rabbit hole,"* avails the person of "bodily nuanced feeling. One senses inner truths that the here-and-now head, with its brand-name labels for feelings and attitudes as platitudes, is not in touch with." Because "the feeling is the fact," digging down to buried feeling reveals and frees the true self.

The process is simple. State something you believe or feel, then ask yourself "why?" or "what does that mean?" Answer each question, then question that answer and do this over and over until you get past your explanatory thoughts and ideas to the feeling core. Here is an example:

Depressed client says: "I like being a nurse." Why? "Because I like helping people." Why do you like helping people? "I like to be valuable, to make a contribution." What does that mean to you, to be valuable? "It means to be of service." Why is that valuable to you? "It makes me feel good." What is the 'good' feeling? "It makes me feel important." 'Important' is not a feeling. There is no emotion of 'important.' What is the feeling? (At this point, the client is brought to what Gendlin calls a "felt sense" – an actual chemical-emotional sensation that she has possibly never questioned and has never read.) "I don't know. But it does make me feel good." Look. Sink into these felt senses: 'good,' 'important.'

(Long pause.) "The feeling is actually not good, but I think it is. This is strange." A longer pause, during which the client has gone inside the molecules, then: "I'm not actually a helping person. I've never been helped my whole life. I've built this needy shell into a giver. My patients love me for ten minutes, an hour, but they love the persona, the giver, not the real me." Why don't they love the real you? "Because it's not there."

If readers are getting the bizarre, absurd notion that this deep-sensing facility is the key to all human self-understanding, they would not be wrong. It's the paradox where great thoughts, Shakespearean thoughts, are false elements, screens, while the nuts-and-bolts material, our nuanced experiences inward, are the greatest wisdom.

Does that feel disenchanting?

Another example:

Client, with her husband, moved from New Jersey to Nevada and lives ten minutes from her parents' home. Why? "I like the neighborhood." Oh? "Convenience."** There are hundreds of thousands of nice houses and good neighborhoods all over the U.S. Why did you move near your parents? "They're getting old. I'd regret missing their golden years." What do you mean by 'regret'? "I'd feel guilty. You know my mom was abusive to me and my sister. But my stepdad was my ally." Don't you have to have done something wrong to feel 'guilty'? Did you do anything wrong? "No." Sink into the guilt sensation, the regret sensation. The client does, and an underground world of need, of feeling like a "little child," of "pull" to a self-enclosed and never-giving parent, of hope for love, opens up.

Regressive questions can draw forth the hues, tints, tones and shades of the psyche, the insides of the interior of a soul. But be careful: ". . . when you clearly felt-sense a door, it opens."*

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* https://pessimisticshrink.blogspot.com/2015/01/rabbit-hole.html

** Actual responses!

The Death Bed in life

Script is read to the client, maybe early in a term of therapy, as he lies on the sofa, eyes closed:

Now, I want you to accept the following situation. You are lying on a bed in a hospital and you are dying. You are your present age. You are not in physical pain, but you are aware of the fact that in a few hours your life will end. Now, in your imagination, look up and see your mother standing at the side of the bed. Look at her face. There is so much unsaid between you. Feel the presence of all the unsaid between you – all the things you have never told her, all the thoughts and feelings you have never expressed. If ever you would be able to reach your mother, it is now. If ever she would hear you, it is now. Talk to her. Tell her.

The Death Bed Situation, conceived by psychologist Nathaniel Branden and introduced in his book, The Disowned Self, can evoke the most abyssal, most unearthing, most moment-of-truth feelings in a person's life. When I read it for the first time, I was instantly overcome in the way that I suspect a person is when at the moment of death, their entire life appears before their eyes. Childhood need as deep as time, ages of invisibility, and lifelong loss surged to pour out of me at once, an unstoppable nuclear bomb. But something did stop them: my repression, which I have come to see as one of the most powerful forces in the universe. The infinite juggernaut stopped, and disappeared. Though not the first or only means, this triggering exercise proved diagnostic of my nature in different ways. The first was: It was supposed to open me up to healing, but it couldn't: The repression was too strong. Another: The ephemeral feeling showed me how much fatal hurt was suppressed, a "quantity" that appears impossible at the thought of it.

I have used the Death Bed Situation sparsely, not with most clients, always with the hope that it will evoke a representative epiphany of their life. As it goes, it is mostly diagnostic.

Many clients are tearful, but I've rarely if ever witnessed the anguish that I know is "always there, whirring continuously just beneath the membrane of life."* One can see this deficit in Empty Chair process, too. If the person were really in communion with their father or mother, they would collapse to the floor, or possibly throw the chair through the wall. Death Bed is even more powerful. This is the one moment to be what you never could be, to name your need even before your identity formed.

Some clients prove, by their words, tone and affect, that they cannot really do therapy. These are the individuals who, in that very moment when they could be a person who matters, apologize to their mother for not having been a good enough daughter. Or they praise their terribly deficient parent for "doing the best you could." This is repression and self-sacrifice, alpha and omega, of their entire life, a badge of honor of no dignity, no value.

A woman who had already shown her complete immersion in what Virginia Axline (Play Therapy) called the "emotionalized attitude," a style of tainted consciousness, could feel nothing as she saw her mother standing at the side of the bed. After a long moment of silence: "When I picture the scenario . . ." Detached from self, the world, life.

It's understandable. People come to therapy as a system of defenses and flaws that predominately work. They are Freud's optimal state: "I do not doubt that it would be easier for fate to take away your suffering than it would be for me. But you will see for yourself that much has been gained if we succeed in turning your hysterical misery into common unhappiness." No one wants to be more undone than they already are; so undermined that they lose their ability to talk and reason and rationalize.

Arthur Janov: "Most of psychotherapy is talk therapy or insight therapy, or therapy with words. And Primal Therapy has found that it's not words necessarily that we need to go to. In other words, we need to talk to a brain that doesn't talk, that feels."**

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* Irvin D. Yalom, Love's Executioner and other tales of psychotherapy, Basic Books, 1989. Prologue, p. xi.

** From a short video available at YouTube: https://www.youtube.com/watch?v=_bcOO3JICgY

Progress report

Life has lately gotten more interesting than ever, as I've been fucked over by Anthem Blue Cross / Blue Shield. As described in an earlier post, Anthem has decided to hold onto more dollars by requiring the kinds of nonsense dream descriptions of "measurable" progress that have heretofore distinguished Medicaid as the arse end of therapy quality assurance. Imagine working with a person whose identity is empty and false owing to childhood catastrophe, who therefore has depression, absence of self-esteem, the anxiety of no existential safety net, suicidal resignation, and having to fabricate minutiae of "progress" at each and every session over the course of several months to a year or more, or different reasons for the lack of it.

My most recent paycheck was less than one-half of the typical amount. It doesn't matter to Anthem that I may be homeless if this happens two more times. The remedy would be to dumb down the essence and nuance of therapy – and for that matter, of the client – and create long- and short-term measurable objectives and goals that turn the client into a sixth-grade math word problem. What is so awfully undermining is that I don't know that I can do it, despite real effort. I don't know how to have a terrible imagination and to write the meaningless stupid. And I will admit: I can't stomach asking clients to digitize their distress.

In the meantime, I continue to see thirty-five to forty clients per week, always giving my all, even if half of them turn out to be pro bono. I am very lucky that the presence of a client on the couch is one part of the two parts of my sense of motivation, what wakes my heart from its long dysthymic nap. The other part is the existence of my wife. As new pay periods come and go, I will keep my readers abreast of developments, which I fear may be inevitable atrophy.

📉                  📉                  📉

Addendum two weeks on: Next check, again less than one-half the earned amount. Anthem sends me clients, I do my job, write peer review-quality progress notes, and am refused payment. I am told that the owner of the group practice is working with lawyers, calling officials, confronting jackasses who wield power. Next Addendum may be more interesting.

A little sniper shot to the soul: Variation

I think it's interesting to picture nearly every adult as a person who is "whistling past the graveyard," whose life is a dream dimension, an alternate reality that keeps him away from and largely oblivious to his true self. Several clients today, too, to whom I'd mentioned this notion, also thought it felicitous. What's not pleasant is the awareness of the reality, of what we left behind and beneath us: a child, aflame, falling down an endless black abyss, ungrounded as the universe is large, nothing to cling to in his heart or in his hands. Time does not move on in this real place. A young client knew this was his identity beneath his character of obsessive-compulsive behaviors, all of his sanitary occupations. To stop all the actions would be to immediately be falling and wailing in that black abyss. Nobody wants to picture a child so helpless, ungrounded, no love, no help. But I told him that if he were that boy in this room, on the couch, I would keep my hand on his shoulder until he finally landed, because he would finally land. My hand would be ground, would be the love.

I believe that nobody "copes" with any loss without present love. What we call coping is just stepping into that dream dimension, imagining strength invoked from old storybooks, whistling past the world.

Underneath it is that fragile, two-dimensional plane of the child, always falling.

Real and unreal

A paradox of the human species is that the most immature, grizzly, raging, constant-victim, sulky, Trump-delusional, histrionic and angsty people have more mental health going for them than those of us who live the Functional Adult life. We could add to the Reality List individuals who are inner-driven to power, riches and success. It's the irritant of their childhood, ever poking them, that inspires the building of the pearl (whose value to the oyster is very different from its value to outsiders).

How is this so? The answer is: injury's pain versus the covering of it versus the healing of it. See the child who cries over his dead pet, and the other child who swallows his tears, acts tough. See the seven-year-old boy who is outraged at his father's drunken loutishness and the same boy who, two years later, shows no feeling, has a straight calm face. We know which one is real, which is fake. But as adults, we value the calm face. We value the repression and the soldiering on. The buried person is safe. We value it so much that ninety-nine percent of all therapy and social information exists to keep the pain buried, the person living in his think bubble.

Bleeding is real. Pretending you're not bleeding is unreal. The confoundment is this: When cancer cells are discovered, they are surgically excised. When a person has "malignant despair" (A. Janov) or the "cancer personality" (D. Brodie), she is advised to adulterate it with self-help literature pearls of wisdom and talk with a twenty-eight-year-old social worker who presses her to think different.

More and more, I see my clients' need to reach the core, epiphanic, disastrous feeling that altered their lives, and pour it out. Most of them probably couldn't go there, but then the healing waits. The closer the person gets to that dark place, the more she is herself. She is a healthy person who is injured, not a sick person who is disordered. Because she approaches the fire, she is ugly, she is out of control. Pain and destruction in childhood are messy. Therapy should not be neat.

Intervention tidbit #11: Compliments

What would cause someone to feel bad, in a most inscrutable way, upon receiving a compliment? A lot of people get a strange negative sensation when they are complimented or appreciated. In fact, I do. And I believe the reason is always the same. The reason is not a thought, such as "I don't deserve it." "Don't deserve" is the mental misattribution to a feeling, not a belief or a fact, and is born in each individual's life history. What is the feeling behind "don't deserve"?

We are one with our childhood heart injuries, which in some way could be considered fatal, the end of something precious and essential. (I cannot find the quote, but I believe Alice Miller wrote that a therapist ‘needs to know what it is like to have been killed in child­hood.’) But many layers of time have grown over these injuries. Thought and distance have covered our irre­coverable losses. The pain that is revisited, that our present resonates with when we are complimented, could be described: "It's too late. I was not appre­ciated, loved, when I needed it, and I've been floating above grief since then. And now in your words you've shown me the intolerable “what should have been.” The fundamental expla­nation is that the deprived “inner” child is still present and needs her mother or father to appreciate her, not you.

Almost all of us could fall a thousand miles inside ourselves if we allowed that negative feeling to be there, to engulf us. But then we'd need our parent there, the perfect mother, and we'd need all the time in the world to weep in her arms. The feeling would be the utterly unique fusion of bereavement and hope, and we wouldn't know which would be present at the end of it. We wouldn't know until it happened.

(This is why therapy is so "cognitive" today.)

Pelosophy 101

Maybe we liberal folks need to rethink sociopathy, the lack of conscience and the crude humor of the overgrown "callous and unemotional child." There are so many of these people now, and they are out-winning us. We could determine that there's best human nature (kindness, dignity, future-thought) and there's actual human nature -- spontaneity, frustration, id-thinking, pain and its projection. Maybe the Republicans are simply being the base and basic truth of humankind, our prepotent nature. Which would explain why they are legion. It would be more difficult, more fragile, to be decent. https://nyti.ms/3UoL520#permid=121334505

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Image from a Trump rally.

A little sniper shot to the soul

You're lucky I'm writing this in a casual, low-intensity mood. I have had many clients whose life ended in childhood, but that their body went on, numbed by sudden pain-killing anesthesia – a "defense mechanism" – and pushed forward by the expectations and demands of their parents and by futile but necessary hope.

That statement is not dramatic or exaggerative. It would be obvious truth if you (many therapists, many clients) cast your eyes back on a moment when love from your parent burned up, when the feeling was only: security turned naked, connection disappeared, implicit assumption of love became a cold place in your brain and you now were heavy with emptiness and distress. In my case, I was around five years old when my mother, in immature pique, rejected me because I was angry with her. In clients' cases, it was when father said to them: "You'll never amount to anything," or mother said: "You were supposed to be an abortion," or when mother missed their birthday two years in a row (and then ever after) because she was a tax preparer, had finished her work by the April deadline, then took her well-deserved vacation with her boyfriend.

Cutting to the chase, if life ended then, if the impossible happened, and that impossibility is the reality behind our hologram adult identity, how can therapy ask us to do any childhood grief and loss work? To sink into the feelings of abuse or neglect? Aren't we likely to feel that old obliteration of our self?

Clients cry often. But I've noticed that those who grieve the most drastic, who "primal scream," are pulled away near the bottommost rung by anger or by thought. They cannot collapse in their total tragedy. To do that would be the final dimension of psychotherapy and healing: the child in mother's arms, going back to the beginning, redoing time.

They resist that eventual calm.

No diagnosis

I am sure I have seen many clients whose diagnosis I could never discern, who I'd say in an "official" way had no diagnosis. Some I worked with for months, some for years. These clients fit no categories except for a baseline of depression, which I believe exists in practically every human being on earth. Here are some recent examples:

Is Mack, the CPA, depressed or is he alexithymic? He knows he has no empathy (except maybe "crisis empathy") for human beings but gets very sad if an animal is hurt or abandoned. Does Allen, the young adult I've worked with for three years, have Asperger's, birth trauma, dysthymia or catastrophic depression buoyed by intellect? Is Maverick's nearly-invisible autism embedded with Antisocial Personality? Should there be a name for autism fused with Complacent Personality Disorder and somatic anxiety, all grounded in childhood serial trauma perped by a Witch Borderline mother? Is Dar, sales executive, an Antisocial Personality or a complex trauma victim with a "deformation of character" that resembles sociopathy? She steals and cries, cares and lies. Wealthy Julia is a Sphinx. Highest functioning, a Martha Stewart-quality bountiful and involved mother, enmeshed and selfless, regressed and terraformed by her solipsistic mother's pure entitlement. Does teen Julio, fey and wan as a leaf skeleton in the breeze, have anxiety, or has his parents' indifference made his gayness so passive? Elderly bodyworker Staci dims and tints all of her feelings and emotions with self-help literature platitudes that layered upon the normative insanity of her childhood escapism, to where she may never fully land on reality. Each session, she unleashes one flowing hour-long paragraph with no awareness of Prolix. Diagnosis: Blind child in a woman's body? Lamar, 16, has a global cynical view of "all friendships" except the girls whose affection he craves like cocaine and a teddy bear. He is as rich and wry as an adult, vastly overestimates his talents, acts unruly and explains it like a pundit. Personality disordered already? Or just realistically reactive to his mother's poisonous immaturity and contempt? Is Daniel a selectively Avoidant Personality, or is he socially anxious, or developmentally out-of-sync and thereby uncomfortable with human beings?

The point is that these people are welcome, rich fields of exploration because we are not limited to "disorders." They don't conform to them because they are too complex and hidden, because their true diagnosis, Enigma, has hegemony over any label. We may listen to their stories for weeks or months while each session ends with another question mark. We come to know in time, possibly, the main qualities of their nature. There is one fact that joins them all: They need to know their origins and weep out their pain.

A delusion is a feeling

https://www.washingtonpost.com/investigations/2022/10/29/david-depape-blog-pelosi-fairies/?commentID=e6db2f43-1ebb-422f-a6be-6e1fd896f730. Before the time of Trump, "delusional" meant you believed someone else's internal organs had been transplanted, without scarring, into your body, or that every car, bus, bicycle, helicopter, pedestrian in the environment was surveilling you. The word had a poignant, red-blooded meaning. Now, "delusional" means you think Donald Trump is a good person. (Comment to a Washington Post article.)

I wish people would understand this, vastly undermining though it would be: To believe in the goodness of a bad person, someone who thrives on dehumanization not benevolence, is to have walled-off the most human part of your heart. This is something that I think even many MAGA-blind people could see about themselves, because their heart was once whole, in early childhood. They would be able to see the difference between love and revenge.

I've known grandparents who "love" their four-year-old grandson but ignore their five-year-old granddaughter. This is one of the most brutal facts that human beings will remain blind to: Much professed love isn't love, it isn't a different "language." There is just the one feeling, the one fact.

To feel affection for Donald Trump is to feel pain, but to rename it.

The Mask of Sanity* (elaboration of a late-night, late comment to a slate.com article)

Maybe the greatest weapon the MAGA deranged wield against the rest of us, but are unaware of because they cannot suffer it themselves, is that they have forced us to live with their hegemonic insanity every day, and every hour of every day if we're especially tuned in. We cannot avoid observing that a toxic juggernaut of willful delusion and sociopathic agenda is moving through the country with few obstacles in its path. To normal individuals, this is as hallucinogenic-like surreal and nightmarish as if we woke up one morning to find that nearly half the country were cannibals who eat their neighbors as a matter of course, without the pang of compunction. In the early-mid twentieth-century schizophrenia literature – before the psychopharmaceutical industry tried to convince us that emotional problems are simply "chemical imbalances" – researchers were aware that parents' contradictory messages and injunctions – called "crazymaking" and "double-bind" – could over time drive their children insane. Young minds would slowly turn from reality to escape the psychic pain of their parents' nonsense. I hope something similar is not happening to us who know that the smaller inaugural crowd is not the bigger, that election results are not deniable because you want to deny them, that an insurrection is not a walk in the park.

I suspect this is what happens in any totalitarian country before the people have become lobotomized to be shells of themselves, laboratory animals with no dignity. They may wonder, How is it possible that hatred and insanity can take over, that masses of people can love a blundering psychopath, that the air can become poisoned and we're supposed to think it's clean?

As a therapist, I can see that one child whose life is undermined may grow up to swallow errant, ego-syntonic ideas, like my middle-aged client whose rage never diminished over two years, who talked about his fantasy to kill random women walking on the street. He had a kind of insanity, twisted away from love and reality in his childhood and teens, that unfortunately didn't feature florid hallucinations, command voices, bizarre delusions of aliens, body organs and impossible surveillance. Had those been his problem, we could all identify his sickness and see how abnormal it is. But there are different kinds of insanity, as Hervey Cleckley understood in his study of psychopathy. We are faced with the fact that half our population had a different life than we had, maybe only slightly different, leading them to trap helpless – unhelped – pain in their bodies, pain that must be impacted then projected into the world because they won't believe in help. They are children who continue to be undermined by their past, and the nation is their poison container.**

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* Hervey Cleckley, The Mask of Sanity -- https://www.amazon.com/Attempt-Clarify-So-Called-Psychopathic-Personality/dp/B000WTUKP4/ref=sr_1_7?qid=1666667455&refinements=p_27%3AHervey+M.+Cleckley&s=books&sr=1-7&text=Hervey+M.+Cleckley&asin=B01BPMZTTI&revisionId=f4ecc417&format=1&depth=1

** Lloyd de Mause, "The History of Child Abuse" -- https://psychohistory.com/articles/the-history-of-child-abuse/

I announce my idiocy*

I walk down the hall of our group practice office and occasionally peek in other counselors' rooms (when their doors are open and they are not present), and notice bookshelves holding counseling and self-help books. Most often there will be the contemporary ones on the latest memes, like "gaslighting" and "trauma bonding." One must, after all, keep up with what money-seeking experts think of these phenomena. Quite by contrast, my bookshelf looks like a sad street gang of consumptive urchins out of Dickens' novels. The two dozen or fewer are all in pieces, so I may cite a passage to my client by extracting the one needed page. They are old – hardly any new purchases since the early 2000's – and their subjects are old, musty fogies that would embarrass the "with it" culture of TikTok and Instagram. So today's question is: How can someone do twenty years of five-day-a-week therapy, seven to ten clients a day, having never read another book (and only a smattering of articles)?

Since I obviously do a lot of therapy, maybe the better question is: What do we learn from psychology books after we've absorbed the basic known principles and behaviors of human dysfunction? My first scandalous response is that I have never found a therapy technique that is useful outside of the feeling- and memory-evocative ones, the Gestalt and Primal ones. This rejects all Cognitive and Silly processes such as RET, DBT, ACT, NLP, tapping, eye wobbling, mindfulness, which just tease-and-feather the topmost thought-neurons or, Lord help me, brainwash "new cognitions" into the person. The books of yore taught me about radical feeling-is-healing work, the regressive identity of domestic violence perpetrators, emotional incest, causes of OCD and anorexia in "underparenting," infant-stage origin of Borderline Personality, the almost natural incompatibility of couples, "bad objects," children's attachment needs, the "as-if personality," soul murder, brilliant and not-brilliant ideas about the "real self," solid parenting principles that also apply to marriages, the psychopath. After those, which traveled with me through some years of hard-trekking and sometimes wayward adventures in different offices in different states, I tried to find new ideas, new principles, new insights. But the later books didn't have them. They often had errant and superficial claims. Instead, I found that clients' own descriptions of their distress, their memories, their assumptions, sparked in my mind new questions and understandings and possible solutions. It seemed that at a certain point, old and new facts fighting among themselves and fusing together – like couples arguing then having sex – begat newer ones. So far, they've begotten quite a few children, as seven-hundred blog articles will attest.

I am describing, I don't mind admitting, a perspective rooted to a theory: what could be called holistic depth psychology. It assumes that people are dysfunctional because they have been hurt, and they must be freed of pain which may be buried fifty years, five years or five minutes deep. This foundation will look at almost every concept of psychology and psychotherapy and see hidden notions. "Codependency" proves to come from the child's lack of self and self-esteem, her depression, and will need to be addressed at the "inner child" level. The same with angry and power-hungry men, who are such dependent little boys that they disintegrate without their mommy-wife. "Trauma" loses its billboard-type identity and is seen in the child's eyes when his father spends too much time at work. Depression is loss of the child's true self in benign or abusive homes. Anxiety is the later smoke from earlier fires of fear and apprehension. And the past proves not to be the past at all, but the poison which remains locked inside and which changes the nature – every molecule – of the person.

I noticed, at the very beginning of my work, another problem with the books. When I read into a good one, my therapy the next day would be inferior. A good book would give me ideas which would replace my feelings, my own eyes. I use that phenomenon as a lesson now to clients. If I suggest a powerful book such as Alice Miller's The Drama of the Gifted Child or The Body Never Lies, or Arthur Janov's The Primal Scream or Steven Levenkron's first book on anorexia, I say: If something epiphanic hits you, put the book down. Don't continue reading: It will keep you in your head and out of your body, your life. Do what I do when I read a client or myself: Let the shock open doors within you, showing you molecular truths that had been buried by time and adult escapes. Anyone can be the best therapist, because all the answers are within.

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* The original title of this article was “Books, shnooks.” I decided to change it after reading a July 23rd article in The Guardian: “Want to quickly spot idiots? Here are five foolproof red flags." Red flag number one is: “Beware of anyone who describes themselves as a ‘proud non-reader of books.’” While there are likely many bright people who don’t read new or old books, and who don't say "describes themselves," the flag of idiocy is raised when one admits to being a non-reader. To save myself from stigma, then, I promise to pick up a Colleen Hoover. Or maybe Jordan Peterson's 12 Rules for Life, (though at age 72, it's probably too late).

I found a penny / on the ground (Peter, Paul and Mary: "Rocky Road")

At 71 (in a month), I'm seeing more clients than ever before: usually forty or more per week. But I've captured very few new insights (blog material) lately, and when I find one, I don't write it down. It just passes quietly into the time flow. I do remember an interesting one. A client told me that when he recently experienced joy – a once-in-decades rare mood that followed his reunion and weekend with an old girlfriend – he became scared to feel so happy, and "in that rare state, found himself 'wondering if I have a sense of self.'" Hearing this, I remembered once experiencing an incandescent lightning-shock emotion and finding that I'd lost my self. I discovered this explanation: Essentially, most of us lose our true, organic self – feeling – in childhood, from gradual repression, and then make an identity from our head. I am the strong one. I am the coin collector. I am the piano player. I am the smartest. My father is a policeman and can beat up your father. I am an attorney. We become a thought which we bend a positive feeling to, to feel solid, meaningful, "good," to be something. But when some time has passed and this new Self has become burnished and universal, then, if a child-rooted raw feeling floods us, it dissolves that thought-identity. In becoming solely body feeling for that moment, we become disembodied: light without its candle. We become for a moment what we should have been had our childhood survived. Loose in old age, I lobbed this personal tidbit to my client. And guess what? "Yes, that's me," he said.

There will be a few other insights, I'll wager, and yes, they are important to me. Knowing the self more is to, in some way, become the self which was, as I said, lost long ago.

I write the contradiction

My entire weekend was ruined – not a smile and only a frown on my old face – because one of the major insurance companies, Anthem Blue Cross / Blue Shield, has decided to establish the jackass, cringey pseudo-scientific documentation requirements that Medicaid has always specialized in. The client feels bad. Why? Her entire life was bent and broken from as earlier as age six, and nothing since then feels right, secure, happy. And it won't, there, at the very bottom. As soon as – age six, age ten, age three, age birth – we have to repress our pain, we lose touch with our self, and we never get it back. It's water under the bridge. We start living from our underground crushed pain and in our disembodied head, but never again from our one human energy source: our body and its feelings. The phrase "too late" identifies both the dysfunction and the nature of its therapy. I've said it before: Good therapy is too-late love.

So insurance companies pay for our efforts to return innocent feeling (along with its children: promise, curiosity, love) to the client. But we can't return her childhood and all the missed, unfelt experiences. So people, after a hundred years of substantial failure of therapy, reconceive the problem. We are sick because we think the wrong thoughts. Here are the right ones. Or because "trauma" dented the brain and we have to undent it by . . . TED Talks and EMDR voodoo. The problem is that we became a different person. Healing our soul ache would be like performing surgery on Jill when Jack had the heart attack, or like retouching childhood photos to make us happy.

Poor insurance companies. They don't want us to spend time trying to find the apocryphal time machine. So they need us to soothe our client: to be a friend, a parent, a teacher, a guru. They want us to convince our client that thinking different in the here-and-now can change our life. Some of us, though, know about changing the past a little. It involves Candace Pert's "molecules of emotion." It has to do with tears that, when they fall from our adult promontory to deep beneath the earth to the earliest pain in childhood, "dissolve the walls of the unconscious"* and enable life-grieving, grieving of our earliest losses. It can happen, sometimes, in a few sessions.

But 100% of the time, 7 days a week, 24 hours a day for the next 100 years, and at 10 on the Subjective Units of Distress (SUDS) scale, that's not what the insurance companies mean by "brief, solution-focused therapy." To them, the client is: "I can't drive on the Interstate."

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* Arthur Janov, The New Primal Scream, Chapter 15, "The Role of Weeping in Psychotherapy"

Yours truly

How should a therapist work with a client who is floating in life and in his life, who feels bad or just not good, who has forever ignored all matters of his personal psychology, who may have never thought there may be "causes" of his plight – "it's just who I am" – and who comes to therapy as if to a witch doctor, hoping not for "answers" necessarily, but for a magical fix?

It is probably hard to believe there are people this cosmically obtuse. But that was exactly me in my twenty-eighth year when I visited a psychiatrist-therapist, feeling something that I could not understand. And a new client, 23, presented to teletherapy with such stark opacity that I was reminded of myself of forty-three years ago. This led me to think, for the first time in my career, about how a therapist should approach someone so blind that he does not know the unknown exists.

When, however, I picture my own abjectly living-dead persona in therapy, I have to wonder if that may not be so different from other people, people who know the labels of psychology, and that they have "symptoms," but don't know they were made this way, that their childhood was wrong, so wrong that it made them to be wrong. I wonder if being told that "you were not always like this" or "no, your depression started much earlier than ten years ago" might be awe-fully disturbing: the knowledge that they are not an entity, not an identity but a disease process.

If I had been my therapist those many years ago, knowing what I have learned since, I would have been extremely careful, exquisitely dainty in approaching the subject of existential disease. I would start by addressing the now:

Can you think of anything in your life right now that may be contributing to your bad feeling? I would not ask for a "cause" as that would send him into thinking not feeling.

Young me: I don't know. A woman – my girlfriend and her two daughters moved into my apartment. I moved to Roanoke a month ago. I wouldn't have said "girlfriend" first, as that would have had the feel of commitment, and I was a man in space.

Therapist me: How long have you known each other?

Y.M.: Three weeks. I would have felt nothing, and I mean absolutely nothing amiss about this.

Th.M.: (Very polite pause.) Did you feel ready to move in, to live together, after three weeks? I would have been pretty sure that this would be a shocking question, as the client didn't blush or look confused when he said it.

Y.M.: (Stirred quietly, like the butterfly's beating wings that cause reverberations reaching to the antipodes of the world.) I don't know. (Trying to be dryly humorous, not to drown): I don't think I registered a feeling. I'm sure I was a contributing part of the decision.

Th.M.: (Realizing that this client may not have a Self and therefore no capacity for decisional feeling, but that his desiccated persona of cleverness may be what speaks to me.) We may have reached something useful already. What do you feel about your girlfriend?

Y.M.: (Very troubled, somewhat out-of-body trying to find my way in.) She's vivacious, and quite a beauty.

Th.M.: Do you know what you feel about her?

Y.M.: (A pause in which I try to look deep.) That's a difficult question. Should it be?

Th.M.: (Realizing that this wasn't mere "alexithymia," an inability to recognize one's feelings or to have them. This was a lost person, one of those who was a child lost in an adult body. Knowing that to say, "You don't know who you are," or even "You are not in touch with your feelings," would likely cause him to not return for another session, that it would be best to meet him where he was.) I've noticed that some people are very thinking-oriented. They may try to understand things by analyzing them. Do you think that's you?

Y.M.: Well, I thought that was everybody.

The great challenge that would strike the therapist: Introduce the client to the world of feelings and to his felt history. This couldn't be talked about. It would have to be experienced. A person blind from birth couldn't be told about sight. He would have to open his eyes to a world he'd never known. The young man would have to feel the meaning of his life in an epiphany. This would return his heart to him and cause it overwhelming pain at the same time. This did not happen to me in my sessions, as there were only three, and the therapist was as blind to my need for reincarnation as I was. It happened fourteen years later, now alone, as I took a walk in a strange town.

Th.M.: Talk about your childhood. And as you do, try to remember how you felt. Sit back, or even better, lie down on the sofa and just talk. Remember. Remember.

A mother's quandary

The last insight, wisdom tidbit, fact, reveal – whatever we shall call it – that I named for the mother of a teenage client is the first one that some other therapists would, I suspect, have offered. Her son, whom I hadn't seen in three months, had only attended four sessions total. The last one included his mother. The boy and I quietly ganged up on her: Please tell your husband, the stepfather, to stop shaming, ridiculing, criticizing him. Recently, the mother returned, alone, to give me the backstory of her son's problems that included depression, depressive personality (where he preferred feeling miserable to feeling positive) and suicidal thoughts. Three years earlier, he had pushed a sexual behavior at a non-rape level, that may or may not have been consented to by the other person, that may have led to legal involvement but didn't. He was kicked out of school, went to a different school, was assaulted by another "behavioral" student, sent to a third school where his reputation followed him. He got a job but was harassed there, and quit. Many stresses, and they came home to an environment that was shaming since he was a toddler.

He was not motivated to get to school on time, or to do his homework, or to do his chores. We're all familiar with the term "old school." That means: It doesn't matter how you feel or how serious your problems are: You must toil and toe the line. Mother described the punishments levied to motivate him: remove his electronic devices and social media access. I said that may not be great at two levels: Punishment, in general, will make a child feel worse, and these are punishments one might administer to a 13- or 15-year-old, not to a young person about to turn 18.

I cited Thomas Gordon's concept of 'who owns the problem?', which could also be called 'who owns the child?' If a little boy's friend dumps him, it's his problem, not the parent's. Help him get his feelings out, respect and validate his feelings, help him brainstorm through Active Listening, but don't drive over to the other child's house and strategize with the mother about how to resuscitate the friendship. The principle that says 'the parent doesn't own the child' is a very difficult one for many parents to grasp. This is easily seen in another of Dr. Gordon's examples: A teenager is ditching important classes, a potential crisis that would activate the proprietary instincts of most parents. But should the parent force him to go by threat, have him monitored, stand over him as he does his homework, make him think? The child owns himself. See what his grievance, his pain is, which might go back years. Care about him more than the grade.

My client's mother had a solid rebuttal: She would get in trouble – Child Protective Services – if her son didn't go to school. A powerful argument as long as you leave out the "care" factor. Her old school mind also explained the removal of the boy's television from his room.

I recommended Gordon's book, with a "warning" that it may be hard to take, this notion that the child should be respected as much as the parent.

As the session ended and we were about to exit the office, something occurred to me by sheer, stupid luck: Stupid, that I had almost missed it in the fervor of psychoeducation and the mother's polemical intransigence. I said: "What it comes down to, the essence of everything, is that your son needs to feel loved." She paused for a fraction of a second then said: "Yes, he does. I wish I knew how to make him feel loved."

Best and worst clients

Maybe it's a peculiar way that clients are supposed to be reactive in therapy. It's not just mutually interactive – a conversation of surface and deep thoughts and feelings. It's not just where the client receives information and has an adult-plane emotional reaction to it, though an adult-plane understanding of the insight may trigger deeper understandings and feelings. It's not just the client's inner dwelling, his awareness of his problems and feelings, that is expressed in sometimes-long narratives and a few tears. None of these behaviors will shake anything loose at the core of his disturbance, of his self. The adult cannot heal the child.

Our worst clients will be those who remain on their adult plateau and who believe that's who they are. Many clients, then, are our worst. I believe this is mostly a factor of the modern psychology culture with its "here-and-now," happiness, mindfulness, everybody-knows-their-psychiatric-name conceit. Back in Freud's day, the rallying cry was "id." Serious men in suits and high positions (who were probably raping their daughters) lay on the couch and free-associated about their bizarre fantasies and sexual fixations. They descended to their symbolic and literal bowels and their dormant, itching psychoses. But shallow is deep today; feeling is commodity today, as Cole Porter might have sung.*

Our best clients are those who collapse in memory and tears and who, in that place, join with us in their worst, give us their pain. Bruno Bettelheim, who blamed "refrigerator mothers" for their children's autism, knew this: "I speak here of the child's private world. . . . Each of us is implying in his way that one cannot help another in his ascent from hell unless one has first joined him there."

I have a few good clients.

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* https://www.youtube.com/watch?v=r7NJ9ylAhos

Should I suggest that she get numb?

"Sixteen-year-old girl remains in a steady-state of disconsolateness, silent, glazed-eyed and bereft looking for much of the hour. This sometimes ruins to silent heavy tears. 'Carly' spoke more quietly than a whisper, said that she's been 'telling myself things that aren't true.' Initially not interested in disclosing what these things are, she later said: 'I tell myself that no one cares about me.' She knows her star-crossed girlfriend Runa cares about her, and can't deny that I care about her. But she believes (not merely 'feels') that neither her mother nor her father cares about her. Carly said that she skipped dinner and no one inquired after her. I talked with her about the challenges of making friends under the shadow of depression and fatalistic assumption. She acknowledged that at school she may wear an 'I want to be left alone' look. After all, she doesn't want to be there and might project an off-putting air to potential friends.

Challenge of the day, this young person. I have twice invited her mother to have a parent-only session. Her response to the first request was "busy," not even "maybe." Her response to the second request was silence. I've seen her father once in my office, once in the waiting area. This is one flaccid walking coma. He does nothing to challenge his wife's solipsistic childishness and meanness. "Perfunctory attention" should be his middle name. I believe my client: Her parents really don't care about her.

Her kind of negativity redoubles itself, though she comes back week after week and must sense my effort to mitigate her doom feeling. I wonder if a young female counselor would be a better interactor with her. Girl talk, collages, maybe a more delicate and discreet way of approaching her parents. I am delicate and discreet, benign and gracious, practically courtly, when it's a matter of keeping the child in therapy, not directly angering the parents. In the 1990s when I worked in rural Logan, Ohio, I might walk downtown (five buildings, maybe) with my teen clients to the book-snack store. The ambience of walking, caring, getting air had power and strength. In Pickerington, Ohio, the teens and I could walk in a miniature meadow -- a couple trees and a gentle grassy hill. These ways get us out of the box of therapy. Where I am now, we could only do the parking lot circuit of a medical park. So we are stuck on a chair and a sofa feeling and questioning the worst feelings.

Nine years ago when I started the blog, I would have ended this piece with a pessimistic or optimistic statement. Now, there's no reason to.

A working through with Dr. Herman and beyond

Why do some clients remain extreme forever? Extreme in their thinking and their emoting. Words of rage, lamentations of tragedy. Vicious voice, continual bawling. Actually, I don't know how common this is. I had a client, a man, who was apoplectic – furious tears and hatred – nearly every session. Another, a woman, who couldn't stop weeping about her father's abuse and mother's neglect. She was angry, too – wanted to strike her mother – but essentially she was tragedy and maudlinness apotheosized. I believe I know why the man was fixed in his rage. He had never reached the dimension of grief, the helpless and needy place where I could join him like a healing, repairing parent, beneath the powerful but escapist anger which I could not join. I would say that the woman was in the same boat, despite her "Hoover Dam of tears" each session. She mixed her grief with her rage, which buoyed it and kept it from landing in its deepest dimension: pure pain. She was a teenager but resisted being a child.

This explanation, though, doesn't address the matter of extremity. Most clients can cry or express anger. What made these two different, so "dramatic"? Was it the power of their trauma? The man had suffered continual sexual and physical abuse from two generations of family. The woman's father nearly broke her back. But we know that Post-Traumatic Stress Disorder manifests in triggered symptoms (flashbacks, hyperarousal, rage), not a seamless cataract, not a unitary "theme" of them. And that PTSD requires some symptoms of numbing – amnesia, the deadening of sensation and emotion. These two clients were never numbed. The answer, I believe, lies in the deformation of character described by Judith Herman in her "new diagnosis," Complex Post-Traumatic Stress Disorder.

These individuals' characters, their personalities, warped in an atmosphere of traumatic oppression in their childhood homes. Depth psychology is aware that children always change in homes where there is no empathy – the primary ingredient of physical, sexual and mental abuse. They become repressed, then depressed, the substrate of their eventual problems. They become symptomatic. But this will not transform their outlook on life, their personality, unless no escape of any kind is possible, no help for pain, no light appears. My multiply-abused client was never noticed by teachers, never helped by other family members or by the kindness of strangers or by the police who would sometimes knock at the door. The woman wrote a letter to the middle school she attended twenty-seven years ago, excoriating it for ignoring signs of her abuse, a suddenly crippled child. I can look – now – at these two adults and see beneath their behavior a pilot light of warped, alarmed personality. This is the wrong coloration of attitude that one wakes up with and falls asleep to, the eternal dark energy background of the person. It could never change over the years, the decades, because they could never grow. Growth requires ground. It may be rocky. It may be poor of nutrients. But it can't be a monolith of poison.

These clients, and people in the world like them, should be understood to have personality disorder. Though we must see them differently than we do those whose personality deformed in the crucible of the separation-individuation phases.

Pocket principles: Self-esteem

 

Self-esteem can be defined simplistically as “feeling ok about oneself without having to prove anything to oneself or to anyone else.” Or more vaguely and reconditely as Alice Miller did: being comfortable with, accepting of all of one’s feelings. It can’t be defined as Nathaniel Branden, “the father of the self-esteem movement,” defined it: a sense of personal efficacy – feeling competent in the world. That can’t work, because feeling competent assumes being competent (otherwise the person is delusional), and competency suggests activity extrinsic to the self. Children who are loved, valued, accepted for who they are by their parents will have self-esteem. They will feel ok in their own skin, “in their bones,” will in a way feel complete, “arrived.” They’ll be comfortable in social settings, won’t be intimidated by – or feel less than – bullies or powerful adults. They may experience fear in dangerous situations, but they won’t have anxiety: Anxiety comes when a child can’t unload his fear and confusion to a caring parent and becomes a repository of pent-up apprehension, like breathing in and not being allowed to breathe out.

The bad – or deterministic – news is that if the child isn’t given, or can’t receive, the gifts of love and respect and full acceptance in her early formative years, she won’t develop self-esteem and will never have it. This is her fate because the suppression and repression of feelings is the loss of self. With no self, there can be no self-esteem. She then must grow, as time passes, a non-self that is an adaptive persona. The only way to prevent this de-evolution would be to immediately, seconds or minutes or maybe a day after the emotional shutting in and shutting down, open up to someone and let the pain flow out. Once time passes, and the persona becomes the person, the real feeling self must remain buried. In his teens he will say: “I don’t know what I want to do after high school; and thirty years later, “I don’t know who I am.”

My sixty-three-year-old client feels “melancholy” because after her retirement she no longer identifies herself as a productive, contributing member of society. It is not enough, she feels, to be just herself, a person who enjoys her life. Good things – her garden, her grandchildren, an old friend – will be pleasurable for a few moments, but they cannot overcome the empty feeling of a self lost sixty years earlier. I want her to feel it’s all right to live, to be a "human being not a human doing," but that would require having compassion for herself, and that would require knowing what she’s feeling compassion for: the hurt, buried child. Few people would want to regress to that depth, return to the beginning of their life and grieve the worst grief possible.

Of course, human beings want to feel good about themselves and unconsciously run away from this critical loss. So they define self-esteem in shallow and magical ways. I can positive- and rational-think my way to feeling good. I can “follow my bliss.” I can accomplish good works. I can love myself and help others. None of these manipulations will touch the core wound.

I suspect that real self-esteem may be so rare that humanity will always need second-tier definitions of it. It's not a real self that has conjured them.

Make my day

There is a very unpleasant but solidly, comprehensively reasoned op-ed in today's New York Times that advises dropping all prosecution against Donald Trump and "allowing the political process to run its course." This could enable, we know, the greater chance that Trump will be president again. Here is the piece:  https://www.nytimes.com/2022/08/21/opinion/trump-fbi-republicans.html. I believe that only those of us whose extremely strong feelings (which we call principles and moral outrage) willfully blind us to reality will dismiss the sorry validity of Linker's argument. I am one of those willfully blind individuals who would prefer crash-and-burn and civil war to letting that sociopath run free again.

But is there any other way that wouldn't lead to war or prove that evil holds all the cards – and the asylum keys – and will hold them forevermore?

This question, not easy to answer, leads to some free association. (Freud's seminal technique requires all verbal diapers off.) The problem comes down to our sick Republican population that admires a sociopath because of its sickness. These millions control their party's politicians, people who seek power in low places. See what we are up against. Normally, the "man in the street," if asked, would say there is something slimy, probably evil, about a person who loves Hitler, Bonnie and Clyde, Bernie Madoff. And yet that same man, and his family, and his community, and his state, will smile upon Trump, the diagnosable sociopath (Antisocial Personality Disorder) and narcissist. These individuals are therapy patients without a couch, and they will never lie down because they have the most soothing and masturbatory defense mechanism in creation: rage sanctioned by their fellow partisans and leaders. They will never want or need to look beneath their rage to the hurt and pain that fuel it. It's their child, their childhood that has always been hurting, and they will never want to collapse to its tears.

The irony is that failing to go to the child leaves it in the seat of power.

Can we reach them? I've seen many men in anger resolution therapy (what "anger management" counseling should be). It's valid to say that since they have come to my office voluntarily, they are not those self-justifying narcissists and psychopaths whom therapy will probably not help. My clients know they have a problem with anger, that the cause is not essentially their wife, their boss, their genes, the universe, or the Democratic Party. They are willing to feel. I have yet to treat a man for anger who did not cry about the brutality of his father or about the barrenness of a life "grown up too fast."

Can we get these millions to understand themselves? No. There is no couch wide enough, no microphone loud enough to turn their attention – inward. If there's to be hope, it will be that the internal weather changes in them. Their scar tissue feels too hard. Their boiling subsides. And their heart wants to come out after a long storm.

Until then, I will hope that Merrick Garland drives a mountain-sized steamroller over their sorry asses.

Debunkeries #1: You are not protecting them

There have always been, there will always be, adult clients who prohibit themselves from indicting their parents, from naming the abuses done to them in their childhood. After "fear," the main reason given is that this would devastate their parents. It would crush them, they would be mortally injured, their heart would collapse and die.

I want to disabuse these clients of their excuse, their delusion. Your parents could not care about your feelings then, and they cannot care about or be wounded by them now. Their response to your truth will be anger, self-pity, contempt and mockery, minimization, projection or denial. None of these reactions will kill or even hurt them. But they might kill you. Your real reason for refusing to name your pain and injustice is that somewhere inside you, you maintain hope for the love that never came, the being seen by them that never happened, and you fear that being yourself, being real, will destroy that possibility. But to continue to hope is to still be the child. To be an adult, you must become hopeless that they will know and love you, even with the possibility that they may someday find an epiphany of healing, of transfiguration.

I know that being the child in that sweet and melancholy dream feels better than leaving your internal home forever. But you have always been homeless.

Kids these days

How can a therapist help a teenager get out of her head, the prison of self-consciousness and thought?

"So basically today was the first day of school and I think I have targeted the number one issue I have and why I'm unhappy at school (or why I was last year). I feel like the reason I am unhappy is because I don't really feel like I have a strong sense of self and I feel like my personality changes based on who I am with. I am really exhausted after today because I honestly always feel like I am a chameleon, and I change how I act depending who I am with. Also I feel like my friends aren't the perfect match for me and it's hard for me to make friends who I more relate to. What can I do to develop my sense of self and stop feeling so empty at school? I also feel like this feeling is why I attach so obsessively to other people who I get along with because I like the way they make me feel and I never feel like that, so I get obsessed. I also notice ever since last year that I always feel 'unsatisfied' after school and I feel like I'm always missing out on other people or places I could be, but when I talk to the people I want to talk to I just feel like super uncomfortable and out of place and socially anxious. How do I get past this?"

This wasn't a new client, soon to be 18. I'd been seeing her for three years. She was as in-her-head now as she had been at the first session. By now, you could say "Sarah" was a favorite, and, in time, a mild source of frustration. We had worked on her depression, social anxiety, self-esteem. Many sessions were like girl conversations, had I been a 16-year-old girl instead of a 70-year-old man: what to do about this acquaintance, that friend group that seemed to be ostracizing her, a problematic mom. While I grew in sophistication about early identity emptiness and its manifestations in the teen world, she could never undo her inner-dwelling, extinguish it, black out and wake up outside the prison walls of her head. I got a bit exasperated:

"Dearie-Pie Sweetie-Potato, I think that if I were to print out all the progress notes from your sessions over the past three years for you to read, you'd say: 'All this worry and anxiety and social uncertainty and depersonalization and parent problems and awkward friendships and neediness and super-neediness and boredom and inferiority and superiority -- Enough! Let me just live and get out there and feel bad and good, and let me cry when I need to (which will probably be a lot) and feel more able to deal with my problems at 17 then 18 (". . . Everyone is fighting a great battle") and let high school then college carry me along and find really interesting things to learn and do (and maybe lean on old Fred when truly lost). Good is better than bad and I can find it because I want to.'"

She took that fairly well: "Thank you, I am trying to work on making me believe it and not feel like the world is ending all the time lol."

There was a young man in the same state. The other 16-year-olds thought him "icky" and he didn't know why, but I thought he had a fair idea. He was not 16: He was 5 and 30, a cynical sophisticate carrying a starved little boy. Nothing was more important than finding a girlfriend. He didn't have teenage feelings, only neurotic ones. I found him easy to talk to, but not for the best reasons: He was open to listening to me because he felt heard, and we were both comfortable being in the realm of thought. I tried to get him into the world, to "black out" and come to, to where an interest was more important than his need, his global prejudices. A lot of this was silly. I sent him Gary Larson cartoons, the old "Son of Fountain Pen" ad, music for an adolescent to choke on like Barry Manilow and Vaughan-Williams' Loch Lomond.

I believe there is a psychological capacity where a young person can partially dissolve his inner sanctum-sanctorum by being disturbed by something in the real world, startled, then stuck in it. If a flying saucer were to land in front of him, would he disappear in and become the amazement, or would he think: "Just some other alien who doesn't want to be my friend"? If she goes to college and finds Oceanography, Theater, or Japanese history and culture, would she become transported by them or just circle back to her room and resume her text-message search for connection?

I have thought that terminating therapy might be the answer. Quit leaning on me for answers and soothing. Sink or swim out there in the ocean. But I can't picture leaving the young man without an empathizing source, the only one he has. He'd be alone with wolves in the desert.

Sarah is in the National Honor Society and Key Club. And she has no interests. What she really needs, or needed, was a mom and dad.

Borderline part 3: Justice vs. truth

 

“Betsy,” mid-30’s, with diagnosed and acknowledged borderline personality disorder, named a “principle” of justice that she adheres to. She was in angry contention with her boyfriend, “Frank”: He did not accept the principle. By use of that term, Betsy wasn’t meaning the colloquial “it’s the principle of the thing,” the quietly indignant expression of a personal feeling casually assumed to be a consensus standard of morality or behavior. She was certain that she was citing a law of human nature. The test case, here, concerned the parking space that was assigned to her apartment. An elderly neighbor had been parking his car in that space. In his disability, it was a real convenience for him. The interesting matter was that neither Betsy nor Frank owned a vehicle and did not anticipate acquiring one into the near or even distant future. Nor did they have guests who might avail themselves of the space. Betsy’s position was as adamant as intelligence and fury fused could make it: It was her parking space. She demanded that Frank confront the neighbor and order him to remove his vehicle and keep it the hell out of their rightful slot. Frank couldn’t see the point in doing that. As with any number of similar situations where Betsy found injustice in mundane places, she made this threat: Do it in your own way or I will do it with guns blazing. I believe he complied.

Over several months of weekly sessions, I had listened to Betsy’s accounts of people’s incompetence and bad character. And I will admit, the logic she conjured and the evidence she cited were consistently cogent to me. Nurses who couldn’t find a vein. Botched surgeries. Doctors’ failure to successfully petition insurance companies for alternative treatments. A landlord who screwed her over. Friends who betrayed her. Though she had been fired from several medical offices in recent years, the reason always seemed to be that she had discerned real malpractice and had gone doggedly (if not rabidly) after it.

One session, by chance or ripening insight, the scales fell from my eyes and a right idea occurred to me: “Betsy, it is not a ‘principle’ that the parking space is yours. It’s your personal ‘principle’ that has no objective correspondence in reality. It is your feeling of injustice, a feeling deeply embedded in your life, in your extremely unfair childhood. You see the world through the lens of this pain. Other people have not had your life or your bent.” She agreed, at least for a moment, and in that window I suggested that she take this fact to her couple’s therapy, where it would help her see her boyfriend as a separate person with his own valid perspective on life. Without this insight in hand, she and he would continue to fight viciously. She would never respect his personhood. She would never have a borderline personality weathered by reality.

Nincompoops, Borderline, Part 2

I once explained to a 43-year-old client that he is still a little boy, has never ascended to the adult plateau. One might think this would be insulting to him. But my explanation was so discreet and strategically euphemistic, hovering, like an angel, above bullshit by a hair's breadth, that he accepted it with equanimity. (Mildly confused equanimity.) My client was the embodiment of what I would call Radical Borderline Personality: the rudiment of all personality disorder, the person whose Inner Child has remained so prepotent over time that the adult costume is powerless to contain it, to teach it adult falsehoods.

He panicked to go to work and be around the other workers. So he took several months' leave, abandoning his wife to carry two jobs plus management of the household. This barely fazed him. Much more important – he told her – were his needs for understanding, support, hugs and love.

When the therapist meets someone this pure, he discovers that the person genuinely can't understand his error, can't grasp the validity of maturity until the therapist attacks with assiduous directness, depth psychology, and inescapable logic. That is what I did, though as said, this was clothed in gracious language.

I don't know how many clients remain too much the child. It's possible that all of them do, even the high-altitude sophisticates. I mean this. Therapy speaks, then, to a fundamental sabotage: The adult's defensive persona must be strong enough to return to childhood pain and failure without drowning in it, without becoming it. But that means that the false self must ultimately predominate.

And yet there is this diametrical contradiction to futility: It is necessary to express our losses, to grieve. It is good to cry. It is helpful to rage, as long as the rage crashes through to its founding grief. It is human nature to need to give our pain to someone and to be held.

So which is it? Is psychological healing deceptive and illusory or real? Is therapy curative, palliative, or a fantasy? Can we, should we, approach the speed of light, but never reach it?

The nincompoops want to eliminate Borderline?

It seems that the existence of the Borderline Personality is being questioned.* Let me clear it up for all the PhDs out there. Borderline is dissimilar to the other personality disorders where there is a primary identifying quality and its ego-syntonic attitude. A Narcissist has perfection. A Dependent won't make decisions, requires the symbiotic feeling. Antisocial personalities have no conscience. A Histrionic person is shallow and dramatic and must be the center of a crowd. A Schizoid is detached. Each of these disorders can be revealed to have an attitude that is in harmony with the identifying feature. A Dependent is fine to be that way and may not even understand independence, may feel torturously uncomfortable with thoughts of separation, initiative and autonomy. A Narcissist finds the notion that he may be imperfect ridiculous, angering, unthinkable. A Schizoid is overwhelmingly complacent in his detachment. All these personalities have an endorsed tangible dysfunction.

Borderlines are thought to embody the stigmas of bitchiness, manipulation, of being emotional projectile bleeders. But many are not this way. They may not have a conspicuous brand. They may be assiduous (my first wife, Borderline, was a high school science teacher for many years) or infantile (unable to keep any job for more than a few days or weeks). They may brandish their primitiveness like a sword or badge of honor, or they may be sophisticated and cerebral. They may be suicidal and self-injurious or safe. They may be desperate for a relationship, or not. What makes these divergent presentations all Borderline? What is their underlying unity? A separation-individuation-stage developmental immaturity and its resultant out-of-sync-ness with the world of its time. It's the abort of psychological growth beyond infancy. This is a lost child in an adolescent's or adult's body. To be an adolescent or adult having to manage the world from an infant's inchoateness, confusion, emotionality is to be sane while insane, disintegrative but perforce held-together, a helium balloon of "thought" pulled under by an ocean of sharks.

Borderline Personality is not in the same trait category as the other personality disorders because it is the fundamental flaw at the base of all of them. The other personalities start from Borderline's failure to pass the starting gate in infancy. They all will reveal, in therapy, an essential immaturity, a "man-baby," a radical dependency on someone. The psychopath is completely dependent on victims, the narcissist on human ego supplies, the histrionic on an audience. "The creative work of these apparently detached individuals" – Schizoids – "may perhaps provide a round-about way of finding some form of social attachment."** Borderline is the skeletal structure of wrongness – the first mother-child breach – that will in time require global defenses, the pervasive, inflexible take on self and world, to maintain continuity in its second-by-second, day-to-day existence. As the other disorders will show this primordial "failure to launch," so Borderline will contain features of narcissism, alienation, dependency, sociopathy, eccentricity.

Sometimes I have diagnosed Borderline but have not recorded it in the client's chart. She might not meet official criteria, but there will be a fundamental incongruity, the prepotent impotent child competing with the adult, an immaturity that she is blind to. She will be smaller than her children, alienated from and rageful at them. She will speak and be triggered by her own words to tears because she is primarily pain. The therapist will have a feeling that says: She is not really here. She is in the past.

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* https://www.psychologytoday.com/us/blog/fulfillment-any-age/202207/is-it-finally-time-eliminate-the-borderline-diagnosis

** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840255/