Addendum to a progress note

Question of the moment: If a client is nearly dying (chronically suicidal) because she has never detached in any way – emotionally, developmentally, behaviorally, geographically – from her unloving, torturous and incessantly denigrating parents, is it sensible therapy to ask her to consider that she might have to give up on them? The client believes, in her lifelong bunker of misery, that the only surcease will be if they let her go, not if she lets them go: She has no power to do that. We have worked deep, maybe too deep, into this. I suggested that even if her parents did come clean and state their real feeling – or actually, the feelings she believes they must have – “We don’t love you, we let you go” – this would be a false epiphany: Her parents are so dumb and blind and repressed that they cannot know the truth of their real feelings. Their reality would be in their “inner” child – hurt, bitter, needing love. That corrupt state doesn’t grow into lack of love for their daughter. It grows into lack of all love, any kind at all. So the young woman would hear an abandonment that was the final knife in her soul but that wasn’t even real.

Such a question! I was so certain about this that I had to allow a “logical” contradiction to it – “Other therapists may tell you that somewhere deep inside them, your parents do love you. They just may never know how to show it.” Would this be right? To be encouraged to believe something that was belied by every feeling and sensation in her, every behavior – past to now – in her abortive, solipsistic and passively homicidal parents? Recently, her mother smirked as she said, “I had an abortion before I had you.” The clear message my client heard: I would rather kill babies than be your mother.

I know one therapy – Levenkron’s “nurturant-authoritative” approach – which claims to “re-parent” many young adolescents who have detached – anorectically, obsessive-compulsively or self-injuriously – from their parents. How blasé and fabulous! In a moment of deep care, impulsively, I had offered to be my client’s “father.” This struck her in a terrible way, as craved but impossible. When I said it, she must have had the feeling of all that loss telescoped into a moment, and an impossible moving on. The offer continues to float in the air above us. But it would take a breakdown to accept it. Would it be sensible therapy to work toward that?

Solipsism #2*: A less made-for-tv understanding of teen suicide

I could ask hundreds of parents of clients I’ve seen: Are you lost in yourself? Are you self-absorbed? And they would be puzzled, would say “no.” But they would be wrong, and absolutely clueless. These parents are the solipsists for whom the ultimate meaning of every thought, every feeling, every perception and every consideration is Self. They are trapped in a world of Self and do not know it. It is a trap that pushes reality over the horizon, never to be reached. It doesn’t matter that they have relationships, pet the dog, “love” people, go on vacation and see new sights. They can never throw themselves beyond themselves and land in the arms of the strange world, of deep experience. Their need, their soothing and their value are their only path and destination.

You are their child. They have never seen you, but possibly in their last minute on their death bed. They have never known that you exist as a separate person apart from their demeaned property, apart from their idea. If you were your own person in your own world, who looked down at them like the sad, lost, bunched-up souls they are, they would be all alone, with no one to be better than, no one to consume. They would feel like children. You have never been touched by them, you have never been loved by them.

You have no parent, but this is the parent you crave, the one you cave into. Mother is the center of your life. You pay regular visits to father’s house to look after him, bring him his grandchild. “I forgive, but I don’t forget,” you declare solemnly, but you actually have killed the feeling in the memory, because it killed you.

In your desperation, you are competing with a child to be the child.

It may seem impossible to finally blink these parents out of existence, but I have seen a nineteen-year-old young woman do it. Her parents produced not one, but two suicidal teens, because all the critical years they only had mocking contempt and dislike for the strangers in the room, their own children. She doesn’t need them, really. I don’t know how she doesn’t, but I can only smile sadly with her.

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* A more in-depth look at solipsism: https://pessimisticshrink.blogspot.com/2013/10/normal-0-false-false-false-en-us-x-none_20.html.

Curmudgeon #2: Forgiveness*

I practically get hives when clients tell me they “forgive” their parents or others who were mentally, physically, sexually abusive to them. I know I’m looking at someone who has not only exited the world to a place of dissociation, but someone who has landed on a fantasy planet and is riding the imaginary rides. And not only that: someone who has bought an empty idea she did not create or critique but learned at mother’s knee.

This is a place where people believe in magic, actual magic. What do they think happens when they say “forgive”? Do they grow a warm, gracious, benevolent feeling from nothing? What feeling do they imagine they experience? Or do they convince themselves that such a gift (to self or other) can exist solely as a thought or a decision, a “commitment” without emotional value? Uncanny to me is that people act for all the world as though the word is the deed: Just say it and it manifests. “My adoptive father forced sex from when I was twelve to fourteen, and my mother actually believed his lie that it was an ‘affair.’ They have never apologized to this day. But I forgive them.” That is the most stupefying feature. Is there any other incantation in modern history that somehow creates the reality it invokes? Does someone despise a person then say “I love you” and it is so? Does someone state “I am cleansed of disease” and it is believed? “I forgive” is unique, I think, because it is the great placebo of healing whenever therapy is not done. These – forgiveness and therapy – are the two continents in the world of the hurting, with forgiveness the preferred home by far by most people. It is a way to imagine we have moved on when the body remains sickened by its poison.

Forgive me, but forgiveness is simply the repression of true feeling, with various thoughts mixed in the anesthesia, and a determination to feel a noble or healthy or moral sense. Some individuals will enrich the thoughts with biblical citations or New Age wisdom or scientific evidence. There will be Cirque du Soleil-level gyrations of delusion and argument that swoop in at light speed, because forgiveness must happen: It is the dream rock that an adult house is built on. But it is a belief in magic and a denial of human pain and injury. Magical deniers have a very sticky time in a therapy that deals with the truth.

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* See Curmudgeon #1 if you dare -- https://pessimisticshrink.blogspot.com/2015/03/curmudgeon-1-thoughting.html.

Pure omniscience

I recently met an 18-year-old boy who was righteously certain that he knew everything about truth, love, the failure of people and the ugliness of the world. His logic of disgust was profound. He claimed scientific proof that human existence is garbage, and was so confident as to be magnanimous: “I accept everything you say, but . . .” A decent therapist should know that there is, on the one hand, angry-hurt attitude, and on the other, fixed, ego-syntonic, pervasive mind corruption. That is, a personality disorder. With such folks – I have seen it in other teenagers – I had never before gone “father superior,” but this situation felt different. Maybe I wanted to jar his mother, too, who had joined the session despite her son’s “adult” status.

“You are 18. I am 65. I have spent forty-two years accumulating neuroses and now for the past twenty-three years, every day, eight to ten to twelve or more hours a day I have studied my and other people’s and your problems and the thoughts and attitudes that are hatched in them. I advise you to park your omniscience. Your belief system is your alcohol, your self-medication, not what is true about the world.”

I am too old for this and just right for this, burned out but with the right simmering burn. I had just established with my therapy group that corporal punishment of children is shit, while they argued with me like good neurotics. With the young man, I had more hidden pleasures: I knew, because the theory is correct, that his personality warp started with his mother’s disturbance. And she, intrigued by my discussion with her son, asked for some leads on studying “personality disorders.” I did not give her any information on a depth approach. But maybe she’ll read further, and find where the mother has “issues” in the first three years of her child’s life, and continues to be an undermining presence.

The Attitudinal One and I got along. I acknowledged being aggravating, and offered my services. I’d like to help someone who wonders about suicide, so deadened to his real self, to the child who could still feel life, not end up painting the world rotting.

Walking therapy

We take a walk through the paths and woods of Park of Roses, Clintonville area of Columbus. The client is troubled. Walking stirs up positive (survivor) energy, contemplative energy, and feelings that have been buried. These energies make us feel viable, maybe more than if we sit on a chair or couch in the therapy room.

Client: I’m talking with you, but I don’t feel that I’m here. Of course I am; it’s nice to be outside, in the trees. But at the same time, it’s a bad reality. I want to grasp something – this branch – but I know I wouldn’t feel it. I want to feel great, adventurous, when I walk solid on the ground. But I’m walking in my mind.

Therapist: (a few more paces.) Let’s stop. Put that leaf in the palm of your hand. Quiet your mind. Feel, don’t think.

C: (a quiet moment.) I did have some feelings. A potpourri. But then a sad one. Why in the name of Crap would a leaf make me sad?

T: What would you feel if it was just you and that leaf?

C: (longer pause.) Oh my. I would fall into it, become green, drown in it. (A bit wistful.) Can’t I do that?

T: I would welcome it. Try it a little longer.

C: (client stares at the leaf.) It brings me back to childhood. (There are silences everywhere.) In all the soup of garbage, a few good moments. . . . It’s not a feeling – it’s being. Kicking a football ten times higher than the houses. Collecting a dozen honey bees in a glass jar then dropping it and running! Everything was crucial: looking at my friend’s face, burning in the summer day, walking to the far foreign end of our street where the strange kids lived. . . . But there was already something in the way, something that pulled me into myself. Anxiety. A kind of depressed fear. It made me pull back and leave things, leave everything, eventually.

This leaf is sad. Or it’s the past.

T: Allow the tears.

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There are times when I think walking therapy is the best way to do it. The client can never be fully with you anyway, because she’s going to be lost in herself. If she’s going to be lost in herself, she might as well be there within the world she has to live in.

Recent observations

-- Several weeks ago a client, 25 years old, asked me if I could be her “dad.” This wasn’t frivolous, regressive, Borderline or romantic. There was a real meaning to it. This week, after a few months of stasis in sessions, I asked a client – also mid-20’s – if she wanted me to be her “dad.” There was nothing erroneous or unsound about this, either. You won’t learn anything in a clinical counseling program about being a client’s father or mother. You will mostly learn antiseptic stuff that, like loaded dice, is weighted with professional propriety: a big bland umbrella, over the client’s head, that has many holes in it. This umbrella is both respectful and a cop-out. It’s respectful to the client’s adult persona, and to her true self’s requirement to breathe alone, to be a separate person. But it’s a cop-out because people need someone. If we’re the helper of last resort, and maybe the only one in a long, long time, then we can’t refuse, or not offer, to be that person.

-- I have reached a next level of distrust in the power of Primal Therapy, though this distrust will rest at the theory level. It comes from a certainty I have about a horrific and blind epiphany that occurred when I was around twelve or thirteen years old. For the first time, and the one and only time in my life, my mother had come into my room, sat on my bed, and asked me if there was anything wrong. Why this had occurred to her now, in a family where nothing was ever right and nothing was ever wrong and where nothing was ever said and all feelings were fake and everything was ruining slowly but inexorably – who could say? But that question, the only intimate words I had ever heard from her, exploded and suffocated me simultaneously. I cried, tears of the deepest unconsciousness, of everything lost in me from the beginning to then. She did not help, had no capacity to hear beyond the din of her life. I almost immediately returned to the prison of “life goes on.” What I know now is that had my mother understood what those tears meant and held me close with that knowledge, I would not have been helped. I would have fallen into a regressive black hole that reached insanity – the traumatized baby in a precarious teenager’s body.

If a boy, with his mother’s history-erasing compassion and love, could not survive regressing, how, Dr. Janov, could that person survive it later, as an adult?

-- Are you schizophrenic if you hear voices? Hardly. Very anxious people, drug-addicted people, childhood-traumatized people sometimes hear voices. They may hear several, and often. But they are fundamentally down-to-earth and are not insane. Psychiatrists, though, will typically diagnose them with schizophrenia or another psychotic disorder. Stupid. There has to be a certain character that is predominantly and helplessly off-reality. The same, possibly, with visual hallucinations: seeing people, fleeting dark images, shadows. And with delusions. There are a lot of fragile folks who believe absurd things – about conspiracies, demons, energies, self-reference (e.g., strangers’ attention is focused on them), but they are not psychotic. And yet there is a gray area on the continuum where we’d have to say the person is more unreal than real. But who can always say who is there? Not the medically minded psychiatrist! A client with sculpted-wild hair said: “Life sure drags me down. I’m having a problem with radios, tv’s. People’s conversations are altered toward me. The demons are screwing with my eyes. Three years ago I began to believe that people could read my thoughts.” I was mostly certain that he was as sane as you or me. But he had come to be invested in psychotic incompetence.

-- With twenty-three years of almost daily psychological work, I have found some of myself and answered some of my questions. Two questions, though, I have never been able to answer, as simple as they seem: When a person asks: How are you? or How are you doing? And: Am I a good person?

I despise bromidic truths. They are emblematic of the blindness that made my childhood invisible and that makes people’s – including my clients’ – lives largely irrelevant to their truth. We live with answers with little depth, often those that live only in our head or on the surface of our tongue. With access to a fairly open history and to Dr. Gendlin’s “felt sense” – the body’s molecular treasure chest of emotional history – I am still dumb to any sense if I am “wonderful,” “fine,” “ok,” tragically bad, or even unhappy. I am not deeper than you (I think we are all made of the same earth). But I can get no answer to this question.

It’s the same with: Am I good? A handful-and-a-half of hours in a day I enjoy helping people. But I’ve had only two friends (with a few “friend-clients”) in the last forty years, and distance more acquaintances than I preserve. I don’t give to charity. Right now I’m growing a contemptuous disgust for a coworker who is an entirely decent chap. I don’t have a moral code, and my spiritual core is limited to Einstein’s sense of mystery during a look upward. Only in moments of their need do I feel caring toward people, with the complicated exception of my wife. I would give no one the shirt off my back, but would give them money or my best and most loved books. I have no family – something that probably angers and may hurt them. I believe my articles can be helpful to an honest person’s mind, yet they are disquieting. I know I never received, from a parent, what a person needs to feel wholly benevolent, complete: I remain a paragraph that ends with an ellipsis.

Am I good? You tell me.

License to diss

In Ohio, you’d scour the Help Wanted section of the newspaper and see jobs for hospital mental health workers. I’d eye these little plums offered at Riverside Methodist Hospital and OSU in Columbus. But at your second glance, you’d notice the hospital is only targeting licensed social workers (LISW), not licensed counselors (LPCC). And you’d learn that they really mean it. Another one bites the dust. Once, momentarily infuriated (panties in a bunch) not to be given a high load of clients (as a per-unit independent contractor), I made a solicitation to a different group practice in the neighborhood. This was for a psychotherapist position. But I was informed that only social workers would be considered. Who informed me of this? A licensed counselor.

Here in Nevada, while working at a good clinic, a nice job, I nevertheless put my name in at a hoity-toity-sounding group practice (the website features principals’ head shots that look like airbrushed stock photo beauties). But there was a glitch. While in Ohio, every Master’s-level clinician and her brother was either a Social Worker or a Counselor – the marriage and family therapist license (LMFT) was brand new there – in Nevada, every brother and his half-step-niece is a Marriage & Family Therapist, often courtesy of University of Phoenix® Online. The coin of the realm, whatever its value. So at Pretty Place, no counselors admitted! I’ve seen the same with hospital ads here. Imagine – an ER or med-surg or psychiatric unit needs a clinician to do crisis intervention, brief intensive counseling and resource referral, and it desires a Marriage & Family Therapist! How sweet! The Borderline is screaming like a harpy with a turbine up her ass, vomiting charcoal and waving her oceanic ridges of red arm slices, and she needs Systems Therapy!

Folks: All of you who hire. Please know the right positive and the right negative. Each one of us (positive) is his own person, with qualities and experience inimitable. No social work, psychology or counseling program (negative) makes a fine psychotherapist. Please know that most, probably all of us in this field come to it because of our garbage scow of neuroses. The question will then be: Who of us knows it, who of us has done ultra-serious acid Ex-Lax work on our problems, and has lived to tell it. This is what matters, not your judgment of my license.

A new hire here, a Marriage & Family Therapist, does not want to see schizophrenics or other psychotics. And she will not have to. Treat the fragile Phoenix gently.

Socratherapy

I believe the best therapy is holistic therapy that is feeling-heavy and thinking-light. As I (and other primal and primal-related clinicians) see it, people become false lives in their heads. This is because we had to give up our child life, our “blueprint,” when we were hurt or otherwise directed away from it. We become blinkered People of Thought, seeing ourselves and the world high above the quicksand in which we’re rooted, so out of touch with our birthright and essence that we may as well be someone kidnapped early and thrown in a prison tower for the rest of his days.

I once treated a woman who was a living caricature of analyzing intellectuality. After months of sessions, I still didn’t know if this was Asperger’s or a facet of psychosis (it well exceeded “within normal limits”), but I did know there was a childhood of grief. It was bemusing how her mind cerebrated diligently at every second about everything, like Spock on crack, even when I tried to put the brakes on. In the midst of one of her labyrinthine études, I had her sit in my chair and look at a brief scenario in Vereshack’s on-line book, as I read it aloud:

“ – I don’t know why I should have that feeling every time I enter my mother’s home.

– Please just stay inside the feeling without asking the question why.

– But it doesn’t make any sense, why should it happen like this?

– Please just enter the feeling, image your mother’s home and you walking into it. Stop asking for reasons before you feel the feeling. It keeps you in your head.

– All right. I’m standing just inside the door of my mother’s home.

– What do you feel?

– I feel that I want to run away.

– Please allow the feeling to deepen. Don’t think and don’t ask questions.

– Please don’t hit me again mommy. Please don’t hit me again (crying).

– So now your question has been answered.

– Yes it has.

“When we drop our ornate intellectual questions and our need to know, feeling the feeling will allow us to experience our truth.”*

The moment I completed the reading, my client fell into the longest and deepest bawling that the thin walls of my mental health center could abide. Afterwards, a surprised person, she felt different. And better.

Feeling is the sine qua non of life-changing therapy. But most clients don’t crash through to a breakthrough place. They can’t, for a number of reasons. And many shouldn’t. This is why I’m a therapist “of the people” rather than one of the sometimes more effective Primal therapists who treat the radical and scarce elite. I face and accept the frustration of having to be adults in a world made of our defenses. And yet, my work is strongly founded in the ultimatum of feeling and in the holism of mind, body and time.

Most often there is talk, not exactly Socratic, but challenging. I challenge the present self.

- A twenty-four-year-old woman with a deep suicidal splinter, what may be a birth-body feeling that is a certainty even with her smiling and gracious manner, is shown her exact birth trauma in the psychological and medical literature. The trauma is associated with adolescent-stage suicide. We picture it. This in a way disenchants her sense of being, alpha and omega, a person who is meant to die. It is only alpha: the first pain, and the meaning it contained. “We are more than this first seed.”

- One of a fair number of clients in Las Vegas who had once been well-off but was now homeless or on rent vouchers, on a bus or on a bike – he recognizes that “anytime my life is going well, I seem to let it all go to crap.” What’s the feeling of that? If a childhood is sour, empty, where parents and brother and sister are strangers to each other, where there is no bond, how is “success” ever going to be strong, true? There will always be a downward pull to a place and time where there needed to be love.

Conversation rides in a sea of history. Everyone on my couch is a child, but of course also a hurting adult or teenager. Even when it is a parent who feels guilty, devastated, about years of cruelty and intolerance to her little children, we say “You may try to run a marathon with a knife in your back, but you will fall.” We say “It is almost impossible to see beyond your own unmet needs, to feel warm and generous when you were starved. You need care, finally.”

Conversations are nearly universally moving, because of a sort of parental empathy that stirs the emotions: it strikes major and minor and complex chords that have been waiting to be touched since childhood. The adult feels a mild air of being parented, of acceptance for her whole self. We challenge a man’s present anger and he sees that it comes from the quicksand of his childhood. We “argue” the messy reality of children and a woman admits enjoying sex with her father when she was an older teenager. Shame mitigates in the dialogue.

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* http://www.paulvereshack.com/, at http://www.paulvereshack.com/helpme/chapt20.html#6b.

Meds and personality

“Medications should not be used as the primary treatment for BPD as the benefits are unclear.” -- https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml

Today I’m going to talk psychiatric medication from a position of full ignorance about meds other than the elementary facts a counselor absorbs. Logic, of sorts, will co-opt knowledge. A client with Borderline Personality Disorder has been medicated for the past thirty days with a mood stabilizer and an antidepressant. Their effect has been injurious, she says. What had always been verbal aggression transformed into physical violence. Micro-dissociations and amnesias occurred throughout the day – locking her keys in the car three times in one afternoon; forgetting to go to work the entire day, thinking it was the weekend. More “borderline-ish” extremes than usual. The client had come to her Psychiatric Nurse Practitioner with two diagnoses – Bipolar II (from a doctor) and Borderline (from a family member’s Internet research) – along with my first-glance diagnosis of the personality disorder. Looking for the quarter beneath a street lamp rather than in the dark alley where it was lost, the NP prescribed only to the Bipolar and hoped for the best.

In session, we worked a thought experiment. Give a baseline “normal” person a mood stabilizer and Xanax – or two beers, for that matter – and he may react more benignly toward a slow or unsolicitous waiter. Give the same drugs to a Narcissistic Personality. Would he react so temperately to the waiter’s behavior? I suspect the Narcissist would be as entitled and arrogant as ever. He might even be worse, with his feeling of intrinsic “unique specialness” – critical to inflate his prosthetic ego – chemically flattened.

Or – Imagine giving Jeffrey Dahmer an antidepressant to deal with his ‘anger’ (catch-all term for the bad, monstrous feelings of a psychopathic Antisocial Personality). Do you think this would stifle his cannibalistic urges and the view of life that supported them? The logic of a personality disorder says the serial killer’s moods are not simply chemicals in his brain, but chemicals embedded in his formative identity – the “psychological birth of the human infant.”*

From a progress note on my Borderline: We looked at possible reasons for the difficulty of medicating her personality disorder, based on the understanding that Borderline has its origin in the dys-formative mother-child bond and creates a “full-body chemistry” that supports the global warp of the personality. From this perspective, it seems likely that there would be greater difficulties in medicationally addressing symptoms that have an “identity basis.” We considered an example: Her mother was aware that as a child, her daughter had to create chaos (which might be seen as a cry for justice or help – to unmask the “cover-up” of rightness and OKness): When things were going smoothly, she would invariably “scrape the needle across the record.” Forcibly numbing or “chemically lobotomizing” (Breggin) the feelings behind this need would create a psychic turbulence that was even more uncomfortable – the equivalent of putting a straitjacket on someone running from a wolf.**

We all know that psychiatric medications have different effects on different people (no perceptible effect, to life-saving, to suicidal and homicidal, to the stripping of one’s emotions or one’s conscience) just as alcohol does. Here I’m saying that one reason for this difference is the chemistry of personality, which could be considered the global, seamless defense that has become the Self. To medicate the person is to change this radical survival Self into – it must be said – the non-self. How could that feel right to anybody?

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* Borrowing the title of Margaret Mahler’s seminal book that deals with “separation and individuation” of the self.

** Borrowing from the title of Theresa Sheppard Alexander’s book, Facing the Wolf – Inside the Process of Deep Feeling Therapy.