Monthly Archives: August 2013

Remember the Big No

ImageMasterson criticized Kohut’s theory of an independent line of narcissism, his idea that the self matures from infantile forms to mature forms through the self-object functions of parents (mirroring and idealizing) who, once again, don’t exist so much as separate individuals as much as they represent functions in a strictly vertical line of development. In Kohut’s model, which would appear to have influenced the latter day Strength-based movement which is aimed at kids in schools (and also kids in special needs programs), the individual seeks mirroring and idealization in an effort to correct prior deprivations. These ‘efforts to correct’ reframe the discussion of therapeutic intervention. They de-pathologize the defensive actions of the narcissist, in keeping with a positivist, ‘non-judgment’ ethos, and the reader might consider the shadow side of this bias.

Years ago I created a different kind of drama centered around the so-called unempathetic mother. In The Big No, Jill Evans, my first and only female protagonist, is living a protracted separation/individuation from her mother, a Romanian immigrant now living in Northern California. Jill’s mother is religious, somewhat narcissistic in her own right, and protective of a secret past. From within Jill’s disturbed sleep the reader glimpses a world parallel to her own. Her recurrent ‘Cinderella’ dream plucks beta elements from her everyday life and posits her as a step-child of a controlling mother, and an absent and/or abusive father. Ugly sisters are jealous and venal, and the father is a humiliated failure with sinister, exploitative friends. The dreams, like Chris Leavitt’s shadows from Crystal From The Hills, portend the future, or else they call out the guilty in the present. Like the culpable mothers that informed Masterson’s theory, Jill’s mother has maintained libidinal availability as long as Jill has been dependent. As the story begins, Jill has returned home after a relationship failure and a job transfer, with her tail between her legs. But it’s her dogged unconscious combined with later efforts to uncover family secrets that bristle against the family order: the mother’s comfortable old-maiden-like existence, living in proximity to Jill’s two conformist sisters; the secure knowledge that the past has been stashed, and that everyone is safe. A confrontation ensues, creating casualties out of each character’s false selves, their stifled existence. Society must set limits on some things, and liberate others. Everyone has something or someone they must covet. Everyone has something to fight against.

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The Mirror Defense

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Within the branch of psychotherapy that is self psychology, which is derived from Object Relations Theory, which in turn is derived from classical Psychoanalysis, Heinz Kohut was pioneering. He was the first to emphasize the clinical manifestations of a grandiose self and an omnipotent object representations of a narcissist personality disorder. He also suggested the existence of a ‘healthy’ narcissism, and posited psychotherapy as a restorative exercise in which afflicted patients receive “correctional emotional experiences” through what Kohut termed transmuting internalizations.

He prescribed the technique of mirroring, in which a therapist repeats back what a patient has said, then amplifies its importance to the individual. The therapist doesn’t necessarily elucidate the defensive purpose, which was a problem in places like Thunder Road, the adolescent drug rehab in which I worked for fifteen years, and which I depict in my book, Working Through Rehab.

At Thunder Road, the first order of business was the containment of acting out behaviors, especially destructive behaviors like drug abuse and violence. Mirroring alone wasn’t sufficient to contain this acting out: it failed to acknowledge reality, both of the consequences of destructive behaviors, and also the reality–meaning, the thoughts and feelings– of other individuals, including that of helping professionals. I mean that therapists aren’t fantasy parents. They reject, disappoint, criticize, as anyone does. Sometimes they love, but they don’t really correct. The Kohutian therapist focuses on the inner experience of the patient, more or less ignoring the possibility that what is “needed” may be a distortion, a need with a defensive purpose, such as an expression of helplessness, which may in turn justify apathy. If the therapist doesn’t confront this response (which might be a behavior as well as an internal event) the defensive purpose may be reinforced and treatment may reach an impasse. As a therapist in a residential milieu, it is easy to become overwhelmed, consumed with the day-to-day lives of patients, the hand-wringing, fretful concerns as to whether these individuals will “make it”. This plus the volume of work is the reason that many burn-out, or so management assumes. In my opinion, it’s not. The reason there is high turnover among staff in drug rehabs is the sense of objectification and futility: the experience of being used by patients, and by management, for the mirroring of their insatiable needs. It is the sense that problems never stop, that business never stops, and finally, that some interventions are iatrogenic–not only unhelpful, but also counterproductive. The whole process seems a reenactment of an insidious, circular pattern begun long before treatment started. For the concerned and astute helper this is demoralizing. In actuality, it’s this that leads to burn out.

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Silence and good questions

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Whenever a counselor or therapist hears that they’ve asked a good question, it’s likely a prelude to an awkward silence or a fumbling speculation. For recovering addicts, in particular, there is a paradigmatic mystery: why do they keep doing the same things over and over again expecting a different result. Definition of insanity. Cognitive dissonance.

In the residential settings depicted in Working Through Rehab: An Inside Look at Adolescent Drug Treatment, counselors like me got to observe not only the complicated relationship drug users had with substances, but their relationships in general. Basically, we got to see how they related, period. Psychoanalysts and trauma experts, allied in their focus upon past experiences, might refer to the internalized object relationships, the ways in which users sleepily attach to the past, and to the absent, through the lens of the present.

And so went treatment. What is it they want? I ask throughout my book. Do they know? Do the kids we work with, the kids in us, want containment; someone to say ‘no’, to parent? We suspect, or rather we hope, that they do; at least unconsciously. Please, we might desperately ask. Do they want insight, an answer to those multitude of ‘why’ questions that they seemingly admire. Possibly. After all, that may be what drugs, or the mileu that surrounded drugs, offer: an experience of being free, seen, and understood. Here’s a passage from Working Through Rehab:

Staff members at Thunder Road, the 12-step or TC Concepts veterans especially, ardently told their stories, but knew they were fighting an uphill battle. They offered the paternalistic perspective of “I wish I’d gotten this at your age” with melancholic airs. They drew attention to physical deterioration as a principal consequence of unabated substance use; others may have cited constant legal difficulties, a series of relationships destroyed by bad decisions, or the tragedy of estrangement from their own kids. Many clients had experienced these events from the other side, as witnesses: they had parents with disease; parents that were separated or divorced. Some knew what it was like to be removed from a home by a social worker, or to have known or even witnessed a caretaker’s death. The platitudinous cautionary tales of staff resonated with some kids, but often missed the mark with others, sometimes because kids were not ready to cope with painful histories, but also because staff caveats aimed too narrowly at the projected results of an unresolved problem rather than the intrinsic problem of a disturbed inner life. “I’ve got problems because I’m messed up,” said the recovering addicts, reflecting on past damage but a chronic condition. “I wanna learn so I can avoid this stuff in the future,” the most motivated kids would answer, missing an important point. The slogan One Day At A Time seemed designed for them, for their myopic ambitions and short attention spans.

 

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Working Through Rehab: Growing out of it

 

In Masterson’s The Psychiatric Dilemma of Adolescence, published in 1967, the problem of treating kids in the psychiatric setting is exhaustively examined. Noting the tendency of clinicians to dismiss diagnoses of clients, saying “he or she will grow out of it”, in reference to a plethora of acting out and mental health problems. Meanwhile, Masterson recounts that social scientists in the 60s were attempting to organize the phenomena they studied, rather like researchers of the physical sciences, and thus methodology changed; so-called objective research, focusing upon variables like validity, reliability, and statistical analyses, were coming to the fore and changing the ways clinicians addressed problems. Masterson, however, grew conflicted about the differences between the social science methodological point of view, and his and others’ clinical observations.

Masterson found after his twelve year study, that 50% of the adolescents he studied did not “grow out of problems” upon five year follow-ups, and that while symptoms like anxiety, depression, and acting out (with sex, drugs, or violence) did diminish, but that which brought the most difficulty, in terms of sustaining meaningful relationships, activating healthy goals, ambitions, accessing creativity and self-care–their pathological character traits–had not been touched upon in treatment…at all.

As much as anything, my reflections in Working Through Rehab: An Inside Look at Adolescent Drug Treatment, are derived from Masterson’s implied warnings about the costs of a superficial treatment approach. I recall working with a young lady in my private practice–a late teen–who was supposedly drawn to relationships with boys “from the wrong side of the tracks”. Much thought, encouragement, argument, and time had been put into making her see reason, re-think her “choices”, and make “rational” decisions. The cognitive dissonance was pervasive: she wanted safety and “respect”, but was drawn to men inclined to hurt her. She wanted independence, but ended up feeling anything but. She was drawn to the bohemian, the pull of rebellion, and found separation in rejection of her family’s fears. Little did she know how conflicted she was with herself, not others, and how long the conflict would last if she did nothing about it. In my first novel, Living Without Blood, I presented the consequences for a family living by the rule, “time heals all wounds”. The Metcalfs  discover that time passage without conscious intrusion does little more than fossilize understandings, generating alienation.

In Working Through Rehab, I depict therapeutic environments that are either forgetting, actively disregarding, or plainly ignorant of Masterson’s now forty year old caveats. Programs working with kids are operating upon the assumption, “they’ll grow out of it”, seeking to emphasize kids’ positive traits in the hope that their deficits will fall away under the power of love. Or, they’ve taken a subtly defeatist tact, thinking the wounds are too great, the fossilization too hard and too widespread, such that the roots of problems are impenetrable.

Do you think this, my would-be reader? Are you a mental health practitioner? A consumer of services. Who are you that you might be interested in this topic? Who do you need to be? Who am I to make pronouncements on trends that flit in and out of fashion, some sticking, some not. Who do I need to be?

 

 

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August 13, 2013 · 8:57 pm

Alice down the rabbit hole into a madness without tea parties

 

This disappearance I keep writing about: it is a misleading singularity. There are several disappearances in Crystal From The Hills. Honestly, there were one or two disappearances in my life that informed my writing. Actually, I think absence is the truer word to apply here–not so much disappearance–for it is the lingering absence that haunts those stuck in either grief, or trauma. Some readers have commented on the relationships in CFTH, wondering which pairing is most pivotal, who is most important to protagonist Chris Leavitt. Is it the awkward coupling with Jill Evans, which manifests conflicts that touch upon sex, money, and adequacy? Is it his obedient bond with Aunt Jenny, the autocratic, aspiring matriarch of the dwindling Leavitt clan? Is it the dawdling friendship with Sweet, his fellow slacker, and likely drug addict. Loser?

Despite the convictions of some, it’s none of these. The most important relationships in CFTH are between Chris Leavitt and the absent: his doppelganger, Weed, the recently disappeared; with his father, a self absorbed, elusive man, now deceased; with his mother, exiled to the east coast, ambigously disgraced and then punished for once leaving Chris’ father and following her heart. The heart was broken. The loving man who replaced Chris’ father was killed in the 9/11 attacks, leaving her catatonic in grief. Chris wanders through the narrative with all this background swirling about him. He strains to make sense; he strains to relate while others gaze into the mystery of his life.

In this way, CFTH is a mystery, though not a conventional one. Its writing coincided with a drama that quietly played out in my working life; the much-delayed publication came from a position (and feeling) of absence, one I have felt keenly. Overlapping the writing of CFTH for about a year was the more driven, didactic non-fiction entitled, Working Through Rehab: An Inside Look at Adolescent Drug Treatment. I worked in this business for fifteen years, after which I was quite ceremoniously, if cynically, marginalized from the workplace until finally dismissed. It would be unfair to call it a disappearance, as it all happened with considerable notice. In concrete terms, there was a month-long and therefore (by my then employer’s standards) unprecedented grace period. In reality–that is, in the murky underlying world of the unconscious/that-which-is-right-in-front-of-me–the signs had been there for over a year. The clues about my feelings are on the front cover of the book. The readers sees a rendering of a youth sitting in between an officious sergeant of a therapeutic milieu, and a distracted case manager, busy with documentation. In the foreground there is a thumb thrust upwards and outwards, in a gesture that will lack meaning until about a quarter into the text. The thumb is connected to a figure who is cut-off, absent. It is me. My fuller self is on the back, leering, seemingly relaxed and free, with a friendly, dedicated doctor standing over the scene, clutching a clipboard. The medicine men of this industry: ultimately, they’re much better postioned (though not necessarily best-positioned) than I am to effect change. 

I hope you join me in this literary walking-through of my fifteen year career in rehab; this protracted diary and essay about kids, drugs, mental illness, and the mad attempts to do something about it all. Like my novel, it’s something of a rabbit hole, this world, but the two books dovetail, I think, and teach–if you read…if you really do read.

 

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A Disappearance

 

So, as some of you know, I’ve been presenting Crystal From The Hills, my psychological fiction, as a story about an accident, a disappearance, a trauma, and a mystery. On one level (perhaps the only important one), these descriptions refer to an incident in which Chris “Crystal” Leavitt inadvertently drives his truck into a lake; the result in which he emerges from the quietly lapping surf but his friend Weed doesn’t; the fall-out that is his dissociation, wandering avoidance of life, preoccupation with so-called shadows, and faultly memory of the event; finally, and plainly speaking, the mystery of what really happened with the accident at the lake, and why.

But, if you’ve been paying any attention at all to these pages, or if you’re one of the handful of people who have managed to sit through all ten or so minutes of my YouTube videos, you’d be gleaning that the accidents, disappearances, traumas, and mysteries of my novel are not only multiple in number, but multi-layered. The dissociated syndrome of Chris Leavitt unfolds over the course of the story, and his supporting cast–his friend Sweet, his girlfriend Jill, and the autocratic Aunt Jenny, are his would-be therapists, or life coaches, if you prefer that sort of thing. Meaning, they confront, encourage, advise, boss him around, and witness. But they don’t see him, not really. They miss his sensitivity to abandonment. Then there’s Costman, a wildcard character inserted about two-thirds into the action (or inaction, as Kirkus reviews would have readers believe). I haven’t written much about Costman prior to this point, haven’t said much. He is, as my drive-by readers might suppose, something of a random character whose meaning is elusive; possibly enigmatic, if one was feeling sympathetic. To review the plot point: Costman is a gardner who works for Aunt Jenny. He’s sort of a societal drop-out, kinda like Chris, or maybe like what Chris might become if he gets his drop-out act together. Thing is, he and Chris have known each other for several years, which is unusual for Chris, as most of his relationships have been short-term or peripheral. Costman is in the latter camp, but nonetheless knows stuff about Chris and his past–he knows enough, at least.

Chris figures he knows enough about Costman also. Like myself, he imagines the gardner is someone who can be taken for granted; can be overlooked and not spoken of, or written about. He further imagines that Costman is undisturbed by such things. Above all, Chris believes that Costman is no threat to him, that he is enviably disinvested in others’ lives. Costman won’t reveal any of Chris’ secrets, neither to Aunt Jenny, the police, or to anyone else who might be interested. He will listen to Chris’ soliloquys, his delusions about shadows, paranoia about authority, and respond with an indulgent chuckle. But ultimately, Costman, whose name is a play upon his one-time job in a money market, will offer little of substance in terms of advice, encouragement, or straightforward provocation. Surprisingly, however, Costman offers what few have given Chris so far in his life: at once a jolting yet mirroring experience, one that helps him feel not alone in feeling alone. How does this come about? Well, Costman, it seems, was once a most unlikely consumer of psychotherapy. Turns out he knows something about others’ disappearances. Read:

“Alright, so he wasn’t always professional. That part was bullshit. The last time we met—our last session—he fell asleep on me. Actually, I think he’d been holding back for some time, I’m not sure. For a while I thought he had this sleepy look in his eye—this lazy kinda drooping—in previous sessions. Then on our last meeting, I was talking, don’t remember about what—probably about my wife’s cheating—and I guess I didn’t look back at him for some time. In fact, it wasn’t even his eyes that gave him away, come to think of it. It was a snort—ya know, like a snore?” Costman let out his latest burst of laughter; a release following his punch-line, designed to preempt reaction. Unflinching, and without any pretense of matching the gardener’s effortful jubilation, Chris ventured another question:

“What happened after that?”

“Nothing really,” Costman replied, quieting his amusement. His tone and his body settled, like a raucous wave being gradually stilled. “I think I waited for a bit,” he said quietly, frowning. “Then I got up and left,” he then said chirpily.

“What? You just left without saying anything?” Chris intuited the latter piece, having pictured the scene.

“I didn’t wanna disturb him,” Costman offered, incredibly. Chris’ jaw dropped perceptibly, eliciting yet another round of laughter from the gardener. “I know,” he uttered amid chuckles, “I guess I should have said something, huh?” Before Chris could respond, Costman stretched out his arm in a gesture of self-defense: “But can you imagine the look on the guy’s face—what he must have been thinking—when he wakes up and sees that I’m gone? Can you picture the ‘Aw shit!’ expression on his face? I didn’t pay him for that session, either.” Costman lay back, continuing to douse the memory with comic emollient. Chris let his head drop.

 

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Where there is hierarchy there is violence (part two)

 

…Which means there are casualties. They are victims, if you’re feeling sympathetic and outraged. They are losers, if you’re not. Chris Leavitt, my protagonist from Crystal From The Hills, is not much of a victim, but he is much of a loser. And I write that with love. In a way, I prefer losers to victims, though they are in some respects the same. Losers lack the hubris of victims, mostly because they haven’t the fortitude to call themselves victims. So Chris Leavitt is a traumatized individual; a casualty and a loser, not a victim: he is privileged, free for the most part but wary of his onlookers–his shadows, both real and not. Ironically, he pays more attention to the less than real shadows, which render him paranoid yet oblivious to what’s right beneath his nose. He is innocent in so far as he is uncalculated, uncensored and anarchic. Whether too impulsive enough or just lacking in political savvy, he is unequipped for any tight, hierarchically-driven order.

There are hierarchies all around: some are tacit structures, governed by race, class, gender, philosophy, religion–prejudices of various kinds. This is not original, but then neither is the hand-wringing that surrounds public controversies. It’s not nice to judge people for being different, people say on camera. But they do. Of course they do. It’s the correct thing to aim for the center (“the center holds” our President tells us), but all around us (and him), splitting, the thoughtless, triage-like division of life into “good” and “bad”, right and wrong, is occurring, and meanwhile, we are all shepherded into cliques, nurturing our prejudices and providing succor within echo chambers. I was once clique-bound at Thunder Road, the workplace that employed me for fifteen years, and which I depict in another book, Working Through Rehab: An Inside Look at Adolescent Drug Treatment. Contrary to my younger observations, Thunder Road is just another typical hierarchical system governed by shadows who determine who fits and who doesn’t; whose turn it is to be in charge, and whose turn it is to go…what works and what doesn’t. Leaders use corporate tools for the most part: manuals, handouts, HR policies, lawyers and spreadsheets, to create order. Meanwhile, the world they govern is an inchoate mass driven by an oral tradition, and the unconscious.

My turn on the rollercoaster lasted longer than most, though it was never my goal to merely have my turn. It was my pretension to do more, and now I have, only from the outside looking in. The point of my book is that taking a turn is not enough. Being politic, fitting in and censoring dissent may suit a hierarchical system, but it is psychological death to the conscious individual, the growing professional. I could avoid hierarchies, mess with hierarchies, dissent and maneuver only so much until shadows converged and told me that if I was to continue avoiding the trappings of leadership and compliance, then it was my time to leave. Cohesion: it means togetherness, which is good, sort of. But coherence, which is like music, is superior. I remember being told once by someone in charge that if I was to really take a turn being in charge, then I’d have to assert just that, regardless of what is right. The decisions were mine, I was told: ultimately, what I said prevailed, not because I was right, but rather because I was in charge. Reluctant leadership. I nodded compliantly but remained slippery, thinking this a dangerous, undemocratic idea, this thing about being right because it was necessary to be so. The problem with equating rightness with being in charge is that being in charge doesn’t last.   

One of my favorite passages of literature reminds me that the exiled exist in numbers, are neither contained nor containable, even if they’re not in charge. Even if they’re not right. This is John Self from Martin Amis’ Money:

“I hate people with degrees, O-levels, eleven-pluses, Iowa tests, shorthand diplomas…and you hate me, don’t you. Yes you do. Because I’m the new kind, the kind who has money but can never use it for anything but ugliness, to which I say: you never let us in, not really. You might have thought you let us in, but you never did. You just gave us some money.”

 

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