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The Trauma Wire

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Emotional amnesia. That was the term that flashed in my mind as I read Donnel Stern’s “Witnessing Across Time: Accessing the Present from the Past and the Past from the Present”. Starting with a familiar idea, Stern writes that for survivors “the past of trauma cannot be understood in the present”; that it is drained of vitality, and that memories lack “plasticity”. As practitioners, we experience this in the affectless way in which trauma patients recall life events. Of course, this article refers to several sources and therefore Stern is not the author of each idea. I won’t attempt to credit them all, but rather represent them as best I can.

A second kind of effect: that of contemporary trauma upon capacity to experience the past is the focus of much of this paper. The three clinical examples, one drawn from a fiction, feature situations in which a character or a real-life individual has experienced a contemporary trauma, and that trauma robs the past of any goodness. This is seen in the example of Michael, the character from The Wire. A positive memory of his saving a child from a gang, uttered by Dukie, the boy Michael had saved, is denied. The positive is forgotten. That life is gone, and goodness is dead. With Menachem, the child who is smuggled out of Krakow, we learn of another kind of trauma: the reunion with a mother who has been beaten down by war: sick, emaciated, barely surviving. Menachem’s experience of his mother violates the memory of her vitality, as preserved in the picture he’d kept of her and even prayed to—a witness of Menachem’s creation. Upon reunion: “Something accessible becomes inaccessible”. Meaning, the former memory is tainted. Thirdly, we read of Darryl, the amputee Vietnam veteran who enters therapy, but continues to act out violently after previously suffering a psychotic break while in combat (he fires his weapon at home, terrifying his family). Darryl seems good natured and quiet in sessions. He came from a family of origin that was warm and related, but trauma has soiled nurturing, and only in therapy can a good relationship be preserved.

So trauma distorts an experience of the present, spoils an anticipation of the future, and even robs the past of its once seeming integrity. Witnessing, the article suggests, holds the key to “retranscription”. I am reminded that secret-keeping, if sanctioned, is so because many assume that secrets (not speaking of the past) will protect individuals from pain. Stern’s article more or less echoes this, but adds that the absence of witnesses sends the message that no one cares. “Nobody ever gets over anything,” Stern quotes from a contemporary novel referenced as House of Meaning. The line is despairing, suggesting an absence of hope (or meaning?) for those living in the wake of trauma. Incidentally, the reference in his article contains a mistake. I happen to own the Martin Amis novel in question, which is about a love triangle in a Russian Gulag. The actual title is House of Meetings.

 

 

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Talkin’ about Crystal

A discussion of the novel, Crystal From The Hills, and readers’ reviews

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October 11, 2013 · 5:18 am

Why Read Crystal?

 

That’s a marketing director speaking in my brain. Or, it’s an agent, sitting at a table in a hotel conference room, playing speed-date with scores of writers pitching ideas–trying not to look jaded. I’ve written several blogs on the subject of my novel, Crystal From The Hills, and have yet to really make my pitch for why you, the reader, should give it a shot. Here goes:

Are you interested in psychology; I mean, really interested, as in you read on the subject, are familiar with its language? If I spoke of things like chronic trauma, addiction, the ambiguously-termed mental illness, might you be intrigued? Probably not. Not enough, I hear you saying. Topical though, isn’t it? With episodes of mass shootings, ‘disturbed’ individuals entering school yards or driving their vehicles into capitol buildings, you might think it timely for someone to create a drama around a protagonist whose perspective is, shall we say, not quite reliable. But there’s that word: drama. You need action, don’t you? After all, there are lots of stories about ‘crazy’ people. You want something to happen, or else you need a reason to care about my protagonist. Is he a good guy, you’re wondering? A hero? Or, if not those things, is he funny at least?

What? He’s a loser? WTF? That’s the internal voice of that fidgety agent, that business-like marketing director, saying, “destined for indie!” Well, maybe I haven’t lost you yet, indulgent reader. My “loser”, protagonist Chris Leavitt, is…ya know, special. So are his friends, Sweet and Weed. Even his girlfriend, Jill, has something of interest to offer: something dark, yet compelling.

It’s something to identify with, or better yet, empathize with. See, that’s a psychology word for you: empathy. Can you empathize with feelings not expressed, but rather those that might be inferred from actions. Can you interpret? in other words. Difficult, psychologists say, because we are a telelogical society (judging that which we can observe–behavior), a scientific society (looking for that which is ‘evidence-based’). Judging the traumatized, the mentally ill is a challenge, because they do not express, or even experience their feelings, ordinarily. Rather, they act, and that ‘acting’ makes them enigmatic and sometimes dangerous.

And so, here is the challenge of following Chris Leavitt, a guy who has experienced an ‘accident’ about which he is alternately coy, misleading, or just unresponsive. He’s lost his truck and a friend–Weed–in an accident, and gives a short, unconvincing story to friends, who wonder, is Weed dead? Chris wanders aimlessly in the streets before being discovered by his girlfriend, who then returns him to her home. Though he is ostensibly clean from a previous methamphetamine habit, his life, in terms of his work and his relationship with Jill, is falling apart. And that accident? It is a mystery, but also a culmination of problems that have dogged him throughout his life.

Ok, so he’s not funny, not a hero, and not even a nice guy, necessarily. So what gives? Why should you care about him and his drama? Does he have a conscience, even? Or, is that trauma thing getting in the way of that too?

Sort of. Get ready for the paranormal element, incorporating aspects of Jungian psychology, spiritualism, near death experiences. Chris has shadows: ghosts in human form who appear fleetingly next to either victims or perpetrators of unidentified crimes, existing either as harbingers of future catastrophe, or representations of guilt. Chris sees shadows. He’s one of the gifted. But now they are dogging him, whispering cryptic warnings in his ear, steering him towards a mission that he must first understand, and then, act upon.

Do you care yet? Or, have I lost you. He’s looking at you, by the way, on the side of this blog. He’s an everyman, I guess, and his drama is an aphorism for something important. He’s someone to love at times, despise at others; perhaps, like most of us, he’s someone that elicits only passing interest, even attention–like Crystal’s shadows.

 

 

 

 

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Living Without Blood

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When I think of trauma, I think of heuristic notions that I’ve fashioned in my mind in recent years and then spoken in sound-bites to clients and peers. My favorite—largely because it seemed catchy when I first thought of it—is one in which I address the saying, “time heals all wounds” by saying, “no it doesn’t. It is consciousness followed by honesty that heals wounds”. This was partly a reflection of reading (though I cannot cite the sources), partly a result of clinical observation, and largely a result of private experience. I’d simply known people (including myself) for whom thought, behavior, and feeling seemed frozen in time; memory fossilized as opposed to preserved—inflexible, and more importantly, not open to discussion.

            In recent years I’ve tended to think of trauma more in terms of feeling, of affect, rather than thought, memory, or behavior: listening to drug addicts “war story”; that is, recount the details of their drug use and the accompanying problems with flatness in their voices, or sardonic inflections as they spoke of the “crazy” aspects of their lifestyles. I reflect on my grandfather, a veteran of WWII, and more specifically, of the famous British evacuation of Dunkirk in 1941. As a kid I once innocently asked him to tell me about “fighting” the Germans (I didn’t realize it was more about the defeated—and likely shameful—running away from Germans). Granddad, as he was called, was curiously reticent about “fighting”, and was even more curiously without anger, excitement or sadness when speaking of his memories. Most curious was the specific memory that stood out for him: his anxiety about losing his weapon on the beach, mostly because that would have annoyed his officious sergeant. Years later my father explained that Granddad’s anxiety was compounded by the fact that he couldn’t swim. He had a dilemma on the day of the evacuation: attempt to swim and likely drown, or stay on the beach and get shot. His life was saved by that officious sergeant pulling him to a boat.

            Through reading and discussion, I learn that trauma manifests chronically with problems of hyperarousal and dissociation, and while symptoms of hyperarousal (such as panic attacks, nightmares, or startle response) may draw clinical attention more commonly, our attention should also be drawn to flat affect, inattention, so-called “shutting down” responses such as the dissociated client’s “I don’t know” or “I’ve gone blank” statements. From our reading of attachment research, we learn that the Hypothalamic Pituitary Adrenocortical Axis is a significant barometer of an individual’s response to stress: that when activated, a process follows wherein the Autonomic Nervous System is activated, and from that, a dissociation pattern which disengages the individual from stressful stimuli, rendering them “safe”, if maladaptive.

            If clinicians are to address these problems and help people, then psychiatrists and therapists must either interrupt the consolidation of memories, or else provide the safe context for the symbolic (as in verbal) expression of feelings. In terms of psychiatric intervention, we learn that pharmacology may have a role in the reduction of PTSD symptoms, which may in turn pertain to the consolidation of memories, the “freezing” of memories in tandem with emotional states. In terms of therapy, I recall Jude Cassidy’s 2001 article, “Truth, Lies, and Intimacy”, and her speculations upon trauma as a phenomenon that is exacerbated by the distortions that caregivers impose on memories, what I have fancifully termed “Hamlet syndrome” (It’s not just the murder of his father that is traumatic. It’s that no one’s speaking truthfully about it). This is bolstered by attachment research suggesting that those whose past traumatic episodes have been acknowledged truthfully (such as Holocaust victims) are more inclined towards secure attachments.

            In the Masterson model, we hear the broad suggestion that a clinician focus on deficits of the disordered self prior to working directly with trauma: meaning, the containing of acting out behaviors through the establishment of a therapeutic frame, the containing of transference acting out in the therapy, as well as destructive behaviors outside of therapy; the creation of a therapeutic alliance (TA).            What else do I want to know? Not sure, but the following quote from the Barbara Short chapter in Masterson (2005, P. 102) stirs my thoughts: “During times of strong affective arousal or dissociation, the therapist can reestablish contact with the patient best by not calling attention to the projective aspect of her experience. That has to come later, when the patient is in a more differentiated mental state.” This statement would appear to have significant implications for a model distinguished by attention drawn to defense, albeit in a sequence that proceeds from an empathic opening.

 

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Your Cashier Today Was Self

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Christine did a double take as she looked at her receipt from the grocery store. Your cashier today was self, it read. A mistake? Little did she know that it was an indicator of the newly installed self-service check-out stations. Was it a joke? she wondered. Otherwise, everything was more or less as she expected: the milk, the beans, pinto and green, the chicken and the eggs, all cost about what she’d expected. Her coupons hadn’t worked on some items; they had expired already. She’d have to take the bananas to the express check-out, wherein there was a moment of self-disgust as one of the coupons  was again rejected. Stupid oversight, she thought, turning away briefly from the surly teenage girl at the check-out stand. Christine flashed on the girl’s face as she left the store. As she passed the receipt, there had been a stifled yawn, preceded by a slight grimace. Surrounded by food, this girl exuded contempt for the product. She was tall, enabling her to look down at people; and she was thin, painfully thin. The glance she made at Christine’s over-stuffed basket was fleeting. She passed the items over the screening device like someone holding their nose as they held at arm’s length a soiled diaper.

Christine showed the receipt to her mother as she returned home. Christine’s mother, also bemused by the phrase on the receipt, made a gruff, bemused sort of noise. “What’s that supposed to mean?” she asked incuriously. Mother’s questions often seemed like that: dismissive, judgmental rather than interested. “It’s…never mind,” sighed Christine. “She reminded me of Erica, though”. Mother was nonplussed. “Who did, dear?”. “The girl at the check-out stand,” Christine replied with a hint of impatience, thinking her mother obtuse; “The cashier, see?” Mother mouthed perfunctory acknowledgement, and then set the receipt aside. The two of them began planning for the evening meal. Christine’s sister, Fatima, was coming over, mother said, so they’d have to watch what they said about Erica, Fatima’s daughter. After finishing an inventory of ingredients, Christine said, “Actually, I think we should say something. After all, it’s not getting any better.” Mother gave Christine an evil eye, and performed her idiosyncratic motion wherein her forehead appears to recede to a lower angle. It was an effective illusion; a warning of imminent disapproval. “I don’t think so,” Mother decreed. “I do wonder what happened between her and that nice young man, Derek,” she instead proposed. Christine rolled her eyes. “Please, I think he decided to date someone who fed themselves properly.” Mother disputed the premise: “No dear, it was Erica who didn’t want to call him back. “Whatever,” said Christine rudely. “Sorry,” she immediately said afterwards.

Fatima arrived just as the meal was ready. As usual, Christine and her mother had prepared too much, and both had the habit of dashing back and forth between the kitchen and the dining table, ever looking to perfect the eating experience. “Want some more chicken?” mother kept asking of her daughters, despite the repeated refusals. “We should have added sour cream to this,” Christine would moan halfway through. Fatima, the cheerful younger sister, indifferent yet indulgent of her family’s obsessive ways, just smiled as she placed an obstructing hand across her plate. “How’s Erica, darling?” Mother asked, following the main course. Christine was “dear”; Fatima was “darling”. Why? Christine always wondered, thinking “darling” was preferable. She never said so. “She’s fine,” Fatima replied pleasantly, yet with deliberate shortness. Christine’s knife hovered above her plate; she was behind in her meal, having barely sat down in the last hour. She looked tentatively in her sister’s direction, and peripherally caught the eye of her mother. “Is she going seeing that Derek again?” Mother asked. Fatima paused, and was about to say something when Mother interrupted. “He’s such a nice young man, quite good looking.” Fatima’s face flattened slightly; her head tilted to an angle, as it often did when she was about to say something a bit patronizing. “That’s not what’s important to her, Mother. I don’t think she found him that interesting.” Mother’s eyes widened, like she was incredulous. “Well, I don’t understand. He seemed like a perfect choice to me. Maybe she should speak to Father Lopez.” Christine nodded, but touched her hand to her Mother’s wrist. “Maybe, but I think an expert may also be a good idea.” Mother’s expression narrowed. Confused, she thought: what did Christine mean by an expert?

“She’s not seeing anyone,” Fatima said succinctly. The placid smile remained, along with her shortness. She looked at her plate, which was empty finally, after several attempts by either her mother or her sister to re-fill it. She felt stuffed; fighting back nausea. “What’s for dessert, dear?” Mother asked. Christine licked her fingers clean of gravy, and skipped into the kitchen. In the freezer was her prize, the item she’d spent the previous day baking, and which she’d most looked forward to sharing: an almost two-foot wide, four-inch thick apple pie. “Looks great, dear,” said Mother as Christine delivered the pie to the table. Fatima inwardly groaned. Then Christine lovingly sliced two over-sized pieces, and set them down on plates for her mother and sister. She left her own plate clear. Fatima, with her fork dithering over the crust, asked “what about you, aren’t you having any?”. Christine rubbed her stomach, gave a beatific smile, and said, “Not for me. I’ve had enough.”

**photo by Helnwein

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Crystal Surreal: Revisited

 

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I’m not sure what an example of surreal fiction is. When I think of surrealism, I think of painters like Salvador Dali, or filmmakers like Jean Cocteau, or Luis Bunuel. I’m told Jacques Lacan is the man for those following the unconscious. Not sure that’s true. The author Polizzoti writes that Freud and the surrealists were nonplussed by one another, especially Andre Breton, who reportedly met the Viennese physician and was underwhelmed.  These writers were poets, stylists of the 20s and 30s, contemporaries of the absurdist Dada movement, and men who reported interest in the unconscious, and went about the task of creating images that simulated dreams. For what it’s worth, I’ve tried a modest and similar tact with Crystal From The Hills, having read some of Lacan and Breton, and then staring at that remarkable painting by Magritte: the one that frame a woman’s naked body within the contours of a feminine hairline. ‘Le Viol’ it’s called: the rape. Simplicity and genius.

Mine is a story that begins dreamily on the streets of Oakland, with an ambiguously aged man holding a sign that reads, “Hungry White Trash” as he panhandles by the side of a freeway. You might get the idea that it’s a joke, but it’s not entirely flippant. In fact, there’s a history to the joke: a serious underpinning. Chris Leavitt has suffered an accident. That’s the pitch, the beginning of the story and the forerunner to a back-story. There will be a few accidents depicted if you read on, as well as deliberate action, malevolent and kind. There is no hero per se, just a hapless everyman riding a string of bad luck, making several wrong decisions, struggling to act like an adult. He’s playing with life. He has a girlfriend, sort of. It’s Jill Evans, ten years before her stints playing support character in Living Without Blood, and almost twelve years before she takes the lead in The Big No. Jill gets around, and here she goes back in time, getting younger, lucky girl. I have a villain of sorts, a guy who’s not around, but who gets talked about a lot. He’s Weed, a drug dealer, video game aficionado, con artist—bad guy. His dark influence is balanced by Sweet, Chris’ other friend, who is even more childlike than Chris, yet affable and easy to have around. He sticks around. There’s an aged yet autocratic aunt—Chris’ only surviving relative, an endearingly caustic woman. Others in the story are lawyers, doctors, police, employers, street thugs, ghostly figures (dubbed “shadows”) that hang around with hallucinatory menace: not all bad people; just people with seeming power and a willingness to use it.

            CFTH is a story that concerns itself with many ideas. It’s a quick read, but one that depends on a certain momentum. Not many big words: nothing like “importunate” or “solipsism” in this one. I promise. But it relies on continuity and the experience of ideas, fragments that have been indicated previously in the text. If you read a few pages then put it down for three weeks, then I’m sorry if I bored you. If that’s not the case and you’re just dilatory in your reading habits, then I’m afraid you may miss out. A good read is like good therapy. You don’t go once a month, like it’s a check up. You’re supposed to remember bits and pieces, like it’s embedded in your experience, and just know where you left off—no bookmarks are necessary if it works. There are associations to be made along the way. Don’t look for patterns, just experience the sense of revisiting as you note terms, phrases that appear to get repeated in the novel; themes that seem to link to one another. This is a story about accidents; personal, physical, even sexual, and habitual. It’s a story about rejection: also personal, and also institutional. There is trauma involved, and the problems related to poor memory and dissociation. You might feel what my characters don’t: that’s the point. Chris doesn’t remember much in the beginning, but builds his story along the way, and tells others, and you, what’s happening in his own time, on his own terms. His friend Sweet has an even worse memory than he does, but low and behold, it is he that becomes the chronicler of events in the end; the witness. Trauma victims need witnesses. That’s written somewhere. Above all there is a problem with reality. Characters aren’t sure what’s happening. They lack real perspectives, real goals. They don’t even use their real names. Despite all this, CFTH is actually not a confusing novel; at least, not in this author’s opinion. It’s not all in Chris’ mind: things actually happen.

            Bad things happen. Evil lurks, as in any good action movie or pulp mystery novel. Darth Vader types hover, and towering infernos exist. If you read the novel some of these cheeky references will make sense. Meanwhile, like the “shadows” of Chris’ imagination or psychosis, the author and reader are witnesses to all that goes down. CFTH is a novel that may move you, or it may leave you cold, or I suppose—just to cover all bases—it may leave you feeling something (?) in between. Though, I suppose if you’re a Russian huckster or a peddler of dating sites looking to hijack a random blog site, none of this will mean anything to you. My art is an object and you are like rapists to me. Jean Luc Godard said of Weekend that it was like a film discovered on a scrap heap. Lucky scrap heap, I say. Perhaps, like the secrets of my protagonist’s past, CFRH may be found in a box one day: set aside, rejected; an obscure allegory by an obscure writer that aimed for the unconscious.  

 

 

 

**photo by Helnwein

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Everything We Love Vanishes

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A quote from W.B Yeats. In The Silent Past and the Invisible Present, Paul Renn writes about the traumatized, the pathological mourning of those whose ambivalent yearning for and anger with attachment figures becomes dissociated; split off and embedded into personality. Through Renn’s case examples, the reader learns that those with attachment difficulties, personality problems, are beset with distorted representations of self and others, and that time is lost; meaning, past and present become conflated experiences: the past denied, but acted out in the present. In Crystal From The Hills, protagonist Chris Leavitt (nicknamed Crystal) is an itinerant trauma victim, suffering from (among other things) post-acute withdrawal resulting from (you guessed it!) methamphetamine use. He is unconsciously playing out a conflicted identification with absent caregivers: a distant, self-absorbed father, and a protective yet similarly detached and secretive mother. The backstory has yielded his character and thus the first two-thirds of the novel, his “acting out”. Chris tries to be “nice” in life, but as often as not his attempts are disengenuous, especially when dealing with authority. His mentor, Aunt Jenny, advises, “there’s nothing nice about being nice”, articulating the demand that he be real. And he has acted out upon anger: Chris’ problems at work–his “suspension” for insubordination–reveals his impulses, his sporadic rebellion against authority figures and systems. More sinisterly, his present-day drama contains a mystery: the disappearance of his friend, the malevolently reptilian Weed. Chris is noticeably evasive. If attentive, the reader must consider some dark possibilities as the mystery unfolds: is Chris psychotic? a killer? a rapist, even? Meanwhile, ambivalence thwarts Chris’ other ambitions: sleep disturbed, his dreams are interrupted, and his perceptions are marred by visions, his so-called “shadows”. His ideas, such as his strange and somewhat silly diaper invention (an indicator that his dreams entail regression) are tentatively delivered, but easily withdrawn or dismissed with self effacing humor. Back in the day, he once tried to be an actor, and still does affect the odd scene here and there (incongruous quotes from film or literature), but surely the best actors must first be grounded in reality, and reality, through no fault of his own, actually, has also been elusive.

Above all, Chris has failed at love, just as his father had. That is, Chris has tried to sustain love and relationships, but the truth is that parents, friends, women, have all left. And so the story begins upon a two-fold leaving: the disappearance of his doppelganger, Weed, followed by Chris’ disappearance into the anonymous milieu of Oakland.

 

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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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