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.