Addictions and trains

 

Most of what you need to know about addiction is contained in the film Trainspotting, which now has a sequel, Trainspotting 2 (the title is the only thing about it that’s banal), which opened here in March after a January UK release. The story takes place in Edinburgh, Scotland, twenty years after the action of the first film. Mark Renton (Ewan McGregor) returns to town after years living in Amsterdam. Mark’s return is half-heartedly redemptive: he seeks reunion with Simon, “Sick boy”, from whom he’d stolen money twenty years earlier, and from Daniel, “Spud”, whom he’d abandoned to continuing heroin addiction. Though seemingly healthy and well-adjusted, Mark is adrift, suffering from a recently diagnosed heart condition and a mid-life crisis: he is jobless and divorced, and still wearing on his sleeves the guilt of his past mischiefs.

It’s as if they never went away. One of the melancholic themes of Trainspotting 2 is the terrible slide of time. It has drained away and yielded nothing that lasts or has meaning. The music they liked in 1995 seems only slightly different now. The nightlife of pubs and clubs looks and sounds more or less the same, only now Mark and the others are older, flabbier and more vulnerable. In some ways, Mark is just like he was in the first film. He is thoughtful, capable of remorse and caring behavior, despite a self-centered core. He saves Spud from a suicide attempt, and agrees to help Simon with his darkly comic scheming, which has moved on from petty drug dealing to more creative territory: blackmailing of Johns with the help of a Bulgarian prostitute (also Simon’s girlfriend); a later plot to pilfer credit cards from drunken patrons of a Glaswegian, unionist pub*.

There are moments that mirror the joy and reckless spirit of their earlier days. Mark and Simon remind me of how I am with certain friends: nostalgic for a past when hair was darker, waistlines were trimmer, and the circles beneath eyes betrayed fewer miles. While fooling the foolish, dashing from danger, inhaling powdery fuels and then slumbering on mornings after in messy bachelorhood, Mark and Simon reenact their twentysomething fantasies (actually, Simon never really left them) and fall into old patterns. Ever looking for quick success, they devise plans to start a brothel, securing an EU loan on the pretext of resurrecting a derelict pub of alleged historical significance. Meanwhile, they overlook predictable flies in the ointment. Firstly, Simon is arrested for his blackmailing exploits, which leads Mark to seek a lawyer on his behalf, which in turn leads Mark back to his old girlfriend, Diane, who is now a lawyer willing to help, but who will charge a sizable fee. More ominously, they proceed with their plans unaware that Begbie, a former nemesis, has broken out of jail and is on the path of revenge, having also been ripped off by Mark in the first film.

The reunion with Diane affords Mark a glimpse into the life of someone from his past who trod a different path. She is someone who grew up, avoided addictions, the emptiness of modern life, plus the enduring bitterness resulting from a diffuse cultural malaise. This is where the title comes in, sort of. The original Trainspotting featured numerous commentaries on vacuous yet consuming lifestyles; on an oblique vision of Scotland in the late twentieth century; on class, gender, sex, and history. Trains and the obscure hobby that is trainspotting are metaphors for life bypassing the mediocre. That reverie continues twenty years later. For the benefit of Veronica, Simon’s Bulgarian girlfriend/prostitute, Mark reprises the “choose life” beat poesy that informed the friends’ once vital and anarchic spirit. This is a fuck-life speech that decries all that is shallow and false in the modern world, and thus posits drugs and/or intoxication as one’s “only friend”. Such diatribes invariably lead to relapse or just continued use, which leaves casualties. Mark gave his friend Tommy his first hit, and Tommy contracted AIDS and died. Simon, more thick-skinned than Mark ordinarily, once sobbed over a crib, staring down at his dead infant daughter—neglected while he languished in a nearby squat, doped-up and out of it. For what it’s worth, Mark has largely managed to stay clean in the years since, unlike Spud or Simon. As he counsels Spud, who is trying once again to kick heroin, and who extols the virtues of another detox as his chosen solution, “it (the addiction) is in your mind, not your body”.

All is going to its sloppy, unlikely plan until a chance meeting finds Mark and Begbie sat in adjacent toilet stalls in a nightclub. The ensuing chase is a mad duel, made barely plausible by Mark’s relative fitness and Begbie’s…well, his plain madness. As a villain, for me, Frank Begbie makes Darth Vader look like Ward Cleaver. He’s right up there with Hannibal Lecter and any one of Tarantino’s baddies as one of the scariest heavies of 90’s cinema. As he recognizes Mark’s voice in the bathroom stall, the theater audience audibly shuddered. The protracted chase takes up the latter third of Trainspotting 2, interspersed with glimpses into Begbie’s sad psychology. Here, actor Robert Carlisle out does himself, adding depth to the violent sociopath whose frothing vitriol in thick Scots dialect makes subtitles necessary. After he breaks out of jail, Begbie returns to his wife and son, a comparatively effete teenager who wants to go to college, and whom Begbie forcibly enjoins into a burglary only to discover that the mild-mannered boy has gentler aptitudes. Ultimately, Begbie is contrite, and delivers a sad farewell message to wife and son just prior to one last showdown with Mark and the boys. It’s one of those I was never raised to show my feelings laments that occasionally inspire patriarchal dinosaurs into therapists’ offices. The awkward scene nonetheless softens him, and elicits sympathy amid his later defeat.

And defeat is a core theme in Trainspotting 2. Another one of the boys’ asides is a fond recollection of seventies footballers, reprised from a similarly musing passage within Trainspotting. George Best, the focus of this rapture, is literally the first public figure and athlete I became aware of as a small child. Gifted, with a cartoon hero’s name and Paul McCartney looks, Best was the golden boy of British sport in the early-to-mid seventies, but a taste for night life and too much booze addled his career, which declined over the second half of that decade. By the time I emigrated to the US in 79’, Best had emigrated also, to collect a late-career paycheck playing soccer for Americans who barely knew his name. In the ethos of Trainspotting, Best tops a list of sad, one-time legends whose addictions collapsed talent and fame.

If only the boys could be more like Diane, whose diligence and relative normalcy enabled good fortune, a reaching of her personal potential. Happily, not all of the boys are without hope for something real or normal. Ironically, it is Spud, the likeable loser of the three Scots lads, who discovers a latent talent: he writes. He writes well, and furthermore writes the kinds of stories I couldn’t write, because I haven’t lived dangerously, which is less entertaining, apparently. The price of normalcy, perhaps. People enjoy drunken stories, but don’t necessarily understand addiction. Recently I listened to a loved one suggest that recovering addicts were not so worthy of admiration as many seem to think. Why should we celebrate someone who once caused a lot of damage and pain, simply because they later curbed bad habits so they could live a civilized life, just like the rest of us have all along? The argument presumes the capacity to choose, but choice is elusive for some. Sometimes I envy those with bad habits, because bad habits are fun and generate good stories, like Trainspotting, and Trainspotting 2. The thing is, I chose life and potential, and I’ve got work tomorrow.

  • Unionism: in this context, it pertains to the politics of Northern Ireland, whose centuries old conflicts pit Catholics against Protestants. In the film, Mark and Simon’s impromptu song, “1690” lampoons a hate song about the Battle of the Boyne, in which William of Orange conquered Catholic Ireland

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A statement on addiction

You know, since my site is at least half-devoted to the concept of addiction, I recognize that I’m overdue for a comment on the subject. It’s not as if I don’t have daily reminders, but in case you wondered, this blog is far from being a conduit to the tales heard within my office. The unique stories are indeed private, though the themes are by now well in the public domain. The details vary, but the before and after descriptions have me nodding in recognition.

 First thing is to distinguish the concept of addiction as a cultural one, not a medical construct like the term dependency. The term addiction befits the clinical focus of a private psychotherapist, a marriage and family therapist, because it connotes a relationship (with a substance or behavior) that can be discussed in relational and not strictly scientific terms. Not that I am opposed to science and how it informs the mental health army, but ultimately (and after 20 years I think the following more than ever), an awareness of how substances excite or inhibit the uptake of dopamine or serotonin, or else how mind-altering behaviors target the pleasure-reward centers of the brain is, in the end of the day, not that useful. Likewise, detox, psychotropic medication, or even 28-42-day rehab programs do not expel the ways of the agitated mind. Go read a book on the subject if you must, but recovery from dependency or addiction requires a sincere contemplation of problems, past and present, followed by a firm commitment to not block one’s emotional life.

 Notice I didn’t write the word change in that last clause. That’s because I almost wrote the word change, which in turn is a result of having heard such rhetoric spoken or written multiple times over the years, by many in my field. Such language is not enough. It’s not specific enough. Afflicted individuals—those with addictions and troubled selves—lose consciousness through their habits, of both their thoughts and their feelings. Their lives are beset with self-doubt, anxiety, and tension. They lose their core and don’t notice the loss. They can appear calm, or else they can appear manic and preoccupied—neither is a genuine expression of who they are or could be, yet the feelings that accompany such states feel comfortable, familiar, and often necessary. Confusion sets in. What is normal? Medicating their semi-experienced distress, they use substances, engage in manic processes, abuse not only drugs, but food, sex…money. Don’t think sex is a mind-altering experience? Try concentrating on something while steering towards climax. You’ll lose focus, you might notice, lose continuity of what you want for yourself.

 Sobriety for the addicted can be a drag, sometimes a quiet, unremarkable drag. Depression for some entails tears, crushing guilt, and a compulsion to distract at all costs. For others it is a flat, dull sensation followed by a need for excitement. Stimulation-seeking of this kind doesn’t avoid pain, as it is conventionally understood. It fills emptiness, a feeling few can label, but they can mutely agree when it’s reflected back to them. Craving secretly satisfies envy and hate—feelings people are not supposedly to have—only they do. The task of someone like me is to generate a pre-substance-using, pre-itch-consummating vocabulary for what’s happening, as in what’s reality, versus a fantasy of what people ought to be. Addicts and others who avoid their real, fuller, complex, undiscovered or forgotten selves, need the tools that post-verbal human beings have—words and a recognition of self—to express themselves fully, be physically alive, and connect with others, primarily so they can seek containment of risk-taking emotion, and thus spare themselves some of that alternative shame, guilt, and fear of which they are all too conscious on mornings after.

 There.

Graeme Daniels, MFT

 

 

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A comment on process, shoulds, and oversight

 

If you are new to my blog and reading its motley assortment of essays, short stories and diatribes, you might wonder as to my purpose. After all, the link at the bottom indicates addiction as a central theme, yet that overused cultural term has gotten short shrift in recent months. Indeed, you’d have to go back over a year, to entries running concurrent to the publication of Working Through Rehab, to read my thoughts on that matter.

More recently, I’ve been in a satirical mode, an oblique, withholding habit. Perhaps it’s the role of therapist which inclines me towards mystery. From my office chair, my opinions are selectively available, but are secondary to those of clients. A therapist evinces some principles, most notably the belief that attaching words to thoughts and feelings is good for people. Beyond that, the pedantry is thin, leaving room for others. What happens next involves listening, or tracking, mirroring, or attunement. More sparsely, it entails interpretation, reverie, and with rarer opportunism, a suggestion or two.

The adventures, diaries, and such of Process Man and Should Woman are mischievous gratifications: of a therapist’s after hours play; of my implied biases; of clients’ wishes for reciprocity, for revelations litter the subtext. PM and SW represent and lampoon contrasting poles of the mental health industry: on the one hand, a faction that is aloof, circumspect, commenting on the how of things, refraining from directives. The opposite wing is plainspoken and unpretentious—it enters the trench more readily and grabs the needy by the scruff. Either side thinks the other misguided, though in collegial circles we smile, shake hands and say there’s a time and place for everything.

Who is in charge of all this? The Board of Behavioral Science? The APA? Anthem Blue Cross? Kaiser? John Gottman? Patrick and Stephanie Carnes? Francine Shapiro? Who determines what style, methodology, or philosophy works with selected populations, or presenting problems?

Not me, but in the fantastic realm of mental health mountain, my psychewriter alter-ego plays reluctant leader. Flawed and vulnerable, he is Hamlet’s father, The Wizard of Oz. From behind a locked office door, he is an able orator and a capable mirror, but also a secret dispatcher, a shadow program director, wielding a desire to influence. Implicitly, he has nurtured his neurotic offspring, the overconfident, cheesy Process Man, who plays the hero, dishing out comic translations and then vanishing like the good witch. Should Woman is a righteous helper, chip-on-shouldered, feeling neglected by patriarchal oversight. With soldierly presence, she intrudes more doggedly, and sticks around, outstaying her welcome because she cares so goddamned much.

I’ve known colleagues who are derivatives of such caricature. I think these figures are more prominent in hospital programs and agencies: places where teams direct services, and an audience for bombast is required. A third psychewriter creation, Thunder Male, is referenced in this vein but not enacted in the stories. The character was triggered (inspired?) by a commercial for a documentary featured Dwayne Johnson, aka “The Rock”. In it, a boot camp for miscreant youths (primarily male) is profiled, showcasing the hypermasculine ethos of tough love wherein tender care for trauma is eschewed, save for the lip service. Ultimately, Thunder Male’s nightmare emergence is averted, as psychewriter chooses to boost the flagging spirit of Process Man instead. Both he and Should Woman will be nurtured further and sent back to their jobs, revitalized. A happy ending, right? All therapists, regardless of the settings they work in, need support to stay in this work. The helped may wonder if we feel love, hate, envy, shame, guilt, loneliness, anxiety, rejection, joy, or even compulsion, as much as anyone else, in and out of our working roles.

You may wonder.

Graeme Daniels, MFT

 

 

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Process Man and the object

 

Process Man arrived outside psychewriter’s office in a plume of smoke because…well, he didn’t know any other way. He was a minute late, regarding a closed door. Psychewriter had taken to heart a critique Should Woman hadn’t actually made, but nonetheless exuded. Process Man stared at the office door, nonplussed. What was he supposed to do? Transport to the other side, enter uninvited, as he usually did? But this was psychewriter. Indecision. Half-heartedly, Process Man closed his eyes—another of his habits just prior to “ghosting”—and summoned the smoke.

Psychewriter swung open the door. “No, not again,” he commanded just in time. “Jesus, just knock once in a while.” Process Man entered, head down, feeling sheepish. Not a good start. He barely noticed the parallels as psychewriter said, “Your colleague implied you weren’t doing well recently.” Sensitively, he turned and amended his statement. “She meant that you’re sick a lot, need some rest, otherwise you’ll go mad.”

Process Man nodded gingerly and looked around. “Rest. Yes. A chance to dream.” Psychewriter gave him an appraising look and lightened his tone. “What’s up? You’re not usually this flat. Where’s that buoyant spirit everyone knows and loves?”

“I’m not sure everyone loves it,” Process Man replied morosely.

Psychewriter chuckled. “That sounds self-pitying, but knowing you, I think you’re referring to me, what you imagine I’m thinking.” Process Man took in psychewriter’s vaguely transparent image.

“Who is Thunder Male?” he asked accusingly.

“Excuse me?”

“Apparently, you have a new guy that you’ve been giving assignments to. I’ve heard he’s called Thunder Male.”

Psychewriter wiped his own eyes, bemoaning the gossip amongst the dispatches. He sneaked a rueful peak out of his window at mental health mountain. Thunder Male was a new recruit, trained in the valley, in secret. Psychewriter liked his energy, but had to admit he was over the top: loud, mesomorphic, shaped like a plinth. He wouldn’t know what process was, and wouldn’t give advice, per se. He was more of an inspirational speaker—liked to raise his voice at groups, talk about being a man, and so on. Psychewriter had Thunder Male earmarked for youth boot camps, wilderness programs where counselors bark at young men, telling ‘em it’s okay to cry, while still barking.

“Is that your problem? You think I’m replacing you.”

Process Man stammered while contemplating the most difficult of process comments.

“Your opinion. It means a lot to me. I worry that I’ve lost my focus, my direction. Tell me psychewriter, I can’t stand secrets. Am I past my sell-by date? Am I out of touch?”

Psychewriter swayed in place, suggesting a need to be elsewhere, not dealing with a sea of troubles, but rather dying.

“Ugh, I don’t know—not really. Or maybe, I don’t know.”

Process Man’s eyes widened, absorbing psychewriter’s equivocal response. His heartbeat danced a beat as he replied, “Wait, you don’t know? You can’t decide?” Modeling—primitive and containing—that’s what some call this.

“Well…okay, you could lose a few clichés: the cape thing, plus phrases like ‘sell-by date’. Plus, the smoke: you don’t need it. It freaks more people out than it impresses, and it’s screwing up your health. Also, your ‘tell a friend’ soundbite: it’s a bit cheeseball, or yesteryear. This is 2017, not 1957.”

Process Man gently nodded with dawning recognition. “Yes,” he said, exhibiting his toothy smile for the first time in days. “You’re right. You know, some of that stuff hasn’t felt right for ages. Thank you. Really, thank you for being honest with me. Geez, all this time I thought the toxic feeling within me was the smoke. Now I know it’s not literally the smoke. It’s that I think I need things like smoke. Ha!”

Process Man looked at psychewriter like he wanted to kiss him. Psychewriter stepped back, half-recoiling, but secretly relieved. “Wow,” he said, affecting pleasure. “I’m glad this little talk helped. Well, anyway, we’re at time. That was quick. Thanks for coming by. I assume you’ll be walking out instead of…you know.”

Process Man gazed at psychewriter. Now he was appraising the great leader, wondering about his hasty withdrawal. “I’m having a ton of thoughts right now. You were scared to meet with me, weren’t you—with Should Woman also? And I’m getting a hit on something else: Thunder Male is a back-up, isn’t he? Someone you have in case one of us leaves you, which would mean you’d fall apart, lose yourself. I think I understand now. We are you. And the process: it makes more sense now than ever before.”

Psychewriter was tongue-tied. “I…I…don’t know. It’s…” he uttered, falling apart. Fragmentation: that’s what he called this in others. For him, there was no leaving the shadow of the mountain. Process Man strode towards the exit, only to halt at the threshold. Reality was before him with a thousand natural shocks. He turned and looked over his shoulder at the slumped creator, who was peering out of his window, appearing fallen and tragic…needing a kind of magic.

“Don’t worry. I’m here to stay, friend,” Process Man announced triumphantly. “And your secrets are safe with me.”

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Should Woman enters therapy

 

Psychewriter’s office was on the top floor of a four-story building, in a corner, with a window that looked out towards a mountain, not down from atop a mountain. Still, it was a perch of sorts. His followers were figments of his imagination that were starting to separate. Among other things, they were seeming real, which was confusing. Worse, they were individuating, or in plainer terms, were having attitudes, growing. This spelt trouble for psychewriter, for this meant he was losing himself.

“Come in, Should-Woman, I’m ready,” he invited in bored voice.

Should Woman had been hovering about his open door, half-peering inside, half-waiting with affected reverence.

“Are you sure? Our appointment’s not for another five minutes. I don’t mind waiting.”

“I know what you’re thinking. In a minute, you’ll suggest I create better boundaries around time, though you’ll be more polite than you usually are.”

He was right about that last part, though as Should Woman entered and saw him edge behind a screen, she bristled at his presumption.

“What makes you think—wait, you think I’m rude?”

At this point, psychewriter moved away from the screen, but still had his back to her. He was fussing with something. Talk about rude.

“Hmm…okay, not rude, necessarily. Direct, maybe. Blunt. Some people like that. Anyway, how can I help you? Why did you want to see me?”

He stepped towards a black leather chair and beckoned her to sit upon a couch that was opposite. His eye contact was fleeting. Should Woman drew breath slowly, realizing she was more nervous than she had been when this idea came to her. His aloofness was dimly familiar.

“Well, I’m having a problem with my character.” My character. Should Woman had never used that term before. Her expression stilled. Memory left her. In an instant, she observed that she didn’t know much about herself: she didn’t know what her job was, who she was to other people; how old she was, even, or who she was before she became Should Woman.

“What’s the problem?”

“It’s your bias against me. Everything I say transitions into a directive, whether I want to give one or not.”

“Well, if you don’t want to give instructions, then don’t”

“That’s not the point. I…I do want to give directives. When I tell people what to do, I’m making meaningful suggestions, trying to help people.”

Psychewriter shrugged. “Okay, fine. So again, what’s the problem?”

“You! You’re the problem, up here in this ivory tower, passing judgment.”

“It’s Adobe, and I’m not passing judgment. You are. You do that a lot, actually.”

“Whatever. You’re making fun of me, using me to make a point, and making Process Man seem like the better…” she trailed off and frowned.

“The better what?”

She stopped and went blank. At that point the scene changed. Psychewriter transformed into a Victorian-attired figure, wearing a tunic and a floral necktie. Below his ears, handlebar sideburns suddenly appeared, framing a cunning grin. The room illuminated with warm light while a painting beside him evoked fire alongside a dungeon. Behind her, a small terrier dog appeared and started yapping, like it was giving her warnings, telling Should Woman what to do.

“I don’t know. That’s why I came here. Tell me what I am. What am I supposed to do?”

Psychewriter’s face twitched, betraying doubt. The plans of the creator had strayed, it seemed.

“Aren’t you doing what you want?” he asked experimentally. A stuckness hung between them for a few moments. Psychewriter gazed upwards, directing his thoughts into a dimpled ceiling. “See, I can’t tell you what to do, though you might have developed that side of yourself because I neglected you in that way. I don’t know. I haven’t figured that part out yet. It’s interesting though, isn’t it?”

Should Woman felt a surge of anger. “No, it’s not. This isn’t a game. This is my…life? Jesus, what am I saying? This totally is not what I came in here to talk about.”

“What did you want to talk about?”

She fell silent, was dumbstruck again. Though she couldn’t draw from memory, she was sure this was what talking to fathers was like.

“Someone else, huh? Process Man, maybe. Well, it didn’t take long for that agenda to fall by the wayside, did it? That’s okay. That’s the way it’s meant to be, I think. Do you want to sit down and talk?”

Should Woman dithered and looked about herself, disoriented by all the changes, inside and out. The door to psychewriter’s office was still open, and the carpet outside was suddenly yellow and stretched out towards a distant horizon. “I don’t know. I think I want to go home.”

“You’re a long way from home now. I say we sit down and figure this thing out. There. I made a decision, told you what to do. Feel better?”

“Yes,” she said, though her feelings were actually mixed, which was a new experience. “No,” she then said. She plopped herself down on the couch.

 

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Process Man and Should Woman hang out

 

“These blog entries are sexist,” Should Woman muttered bitterly.

“What?” Process Man’s face was an irritable grimace. Hanging out with Should Woman was a drain upon his energy and cheer, which was already dragged down by a stubborn cough and burning eyes. When not out intervening, he spent time in the break room of mental health mountain, waiting upon assignments. The only nourishment available was through a vending machine. Should Woman was often there too, giving attitude and, as ever, telling people what to do.

“Psychewriter. Your story is called ‘Adventures of Process Man’—typically male description, making you a hero. I get ‘Diaries’, like I’m a housebound teenager, stuck in my bedroom, being a whinny little girl doing something ordinary.”

You probably were a whinny little girl. As Process Man kept rejoinders to himself, he dabbled water upon his red eyes, and chose to air a complaint of his own.

“At least you don’t have to enter and leave in a ball of smoke everyday. I swear, I’m gonna get lung cancer or asbestos poisoning doing this job. You don’t know the pressure created by that kind of act. People expect golden insights every time. People want magic.”

Should-Woman was not initially sympathetic. “Well, that’s what you get for performing an act. It’s not magic. You should try being real for a change. Try helping people in a practical way: establishing structure, holding people accountable—being there, day after day, instead of coming and going like a ghost.”

“Jesus, here we go. You just can’t help yourself, can you? You know, you almost did something different for a minute there.”

“Excuse me, what are you talking about?”

“Your analysis of adventure versus diaries. That was interesting, and correct, actually. If and when we have an audience with the great psychewriter, we should ask him about the subtext of our characters, see what’s on his mind.”

Should Woman scoffed. “What’s on his mind. Yah, that sounds like a good use of our time.” Sarcasm aside, Should Woman had often wondered what was on psychewriter’s mind. What was her purpose versus that of guys like Process Man? What did he expect of her?

“I’m being serious. That was an interpretation you made earlier. It’s in you, if you try.”

“Don’t patronize me. Just because he gave you a cape and the gift of disappearance doesn’t make you superior. If anything, that makes you unreliable. You probably trigger people’s abandonment issues.”

“See, there you go. You did it again, making a point about the unconscious reaction people might have towards me. I often sense the ambivalence when—”

“Oh, shut up.”

“Look, I didn’t mean to—” This time, Process Man’s words disappeared into a coughing fit, not an interruption. Should Woman softened.

“You should get that looked at. It doesn’t sound good.”

“I know,” he said finally in a quiet sputtering voice.

She walked over, took him by the hand. “Here, come with me.”

“What are we doing?”

“You honestly don’t know, do you?”

“Uh…”

“First, stop drinking soda. It doesn’t help with…well, with whatever’s wrong with you. Next, you should gargle. It will dislodge any obstruction, rid you of bacteria.”

“Obstruction? I’m not choking.”

“You don’t know that. Or it might be phlegm buildup. Regardless, you should take some time off. We should tell psychewriter that you need a lot more rest than a few hours in that miserable break room. In fact, if you want to just rest, I’ll go to him. I’ve got a few things to say anyway. So…”

Should Woman stopped as she glanced at Process Man’s hangdog expression. It seemed he didn’t have strength to fight her anymore.

“What?” she said. “You want me to stop talking, don’t you—stop telling you what to do? Is that what you’re telling me? Is that look your process comment?”

Process man chuckled and shook his head. “No,” he said wearily as he looked deep into her. Should Woman dropped her shoulders and sighed. A wave of fatigue claimed her as she realized one more thing.

“We both need rest,” she said.

In the cuts, from a slightly aerial vantage point, psychewriter looked on, thinking his characters had something in common.

Empathy.

Graeme Daniels, MFT

 

 

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The Should-Woman Diaries

 

Should-Woman was a more down to earth figure than Process Man. Should Woman didn’t believe in magical appearances or a quasi-heroic vanishing. Should-Woman rang doorbells, gave plain greetings, was stern and humorless, but compassionate. Reality and presence. Day-to-day, for discreet periods, Should-Woman would sustain a role in people’s lives. She would focus upon the practical, that which could be seen, heard, and proven, and she would insist upon continuity.

“I just can’t seem to figure it out,” complained Larry, laying on his couch late morning. Ostensibly, he’d been awake for several hours, but his energy was half-hearted. His days were ever half-activated.

“You should make a plan. People like you need a plan. We should make a to-do list. Now, what shall we do today?”

Larry shrugged. “I don’t know.” He looked around, gazed out the window. Like Ishmael from Moby Dick, he regarded an oceanic elsewhere as if it contained an elusive self and imperceptible limits. “There’s so much out there, you know? The world is like…it’s like a giant, beautiful harvest.”

“Yes, well, let’s try to focus on something real, like a resource list, a list of people to call today, or a goals inventory.”

“A goals list? My goal is to just be myself, and let others be—know what I’m sayin’?”

Should-Woman shook her head faintly and turned away for a brief moment. Collecting herself, she remembered her training and purpose. Tough cases like Larry might ever deflect with meaningless reverie and glib pronouncements. Her job was to keep her mind clean: to not accept deadness but rather model the positive and move forward.

“That’s fine, so let’s start by completing the household chores, then we can go out and work on the community garden.”

“I don’t wanna—”

“I know you don’t, but let’s just take it one step at a time.”

“What steps? Aint no steps?”

“You have laundry, last night’s dishes.”

“There aint no dishes. I ate out of styrofoam. I’ll just throw it away.”

“Well, you shouldn’t eat from styrofoam, and you shouldn’t just throw it away. It’s not good for the environment. Anyway, what about laundry?”

“This aint laundry day. I do that on…Sunday.” He was lying. Larry had no regular laundry day.

“What about that shirt? You were wearing that when I came here last week. It needs to be washed.”

“It’s fine, it don’t matter,” Larry said absently. He got up from his couch and started moving towards his bedroom.

“Where are you going?”

“I’m gonna lie down. I’m tired.”

“Tired. You just got up. Anyway, if you’re done in here, you should unplug your appliances, the TV and the computer. It wastes electricity.”

“Man, why don’t you go tell someone else what to do, Should-Woman?”

Tough case indeed. Should-Woman held faith, for she knew that people who didn’t know what was best for them would learn eventually. Solemnly, she followed Larry to the edge of his room, knowing a hard lesson was near. Across the threshold, he stepped amongst belongings that littered the floor and aimed a sloppy lurch towards an inviting bed. As he made a last torpidly decisive move, his foot tripped over a solid object beneath a sheet that had slid across the floor. From under that cover, Larry felt the smooth yet sickly texture of liquid swim over his toes. He looked down to see the emerging brown stain of coffee being absorbed into the sheet.

“Shit,” he exclaimed as he kicked the fabric aside, only to see a cracked cup laying above a page of handwriting. Larry scrambled to rescue the last letter he’d gotten from Mary, the woman who had left him a month earlier. He’d taken that letter to bed with him every night, having not wanted to let it—her—out of his sight.

“I told you that drinking and eating in bed wasn’t a good idea,” said Should-Woman, looking down upon the scene. Prostate in grief, Larry crumpled the irrevocably stained letter into a ball and said, “You’re right, Should-Woman. I should be more careful with my things.”

 

Graeme Daniels, MFT

 

 

 

 

 

 

 

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The Adventures of Process Man

 

Rick sat on a stool adjacent to his parents’ kitchen, indulging his father’s Sunday night oratory. Tonight, it was about the latest kitchen renovation, proudly completed just in time for his adult son and his wife’s latest visit. Across the way, Rick’s mother was bending Amy’s ear about something which left Rick’s spouse glassy eyed and feigning rapt interest. Rick’s father was a more insistent speaker. To properly placate him, Rick would need to affirm every sentence with a nod, an appreciative hum, or an occasional query indicating sustained curiosity.

“See how it opens up the space and you can look out into the living room, speak to your guests if you want, carry on a conversation while you’re preparing some food.”

“Yeah, it’s great, dad. Really. I can see how it’s gonna work for you.”

“Well, you might wanna think about it for your own place. I could give you the number of my guy. He’d give you a good price, or if you like, we could help you out. Call it an early Christmas gift.”

“It’s April, dad”

“So what. It’s a very early Christmas present.” This was Rick’s mom chiming in, and releasing her daughter-in-law for a moment. Rick and Amy exchanged a furtive glance.

“Yeah, I don’t know,” Rick said with diplomatic caution. He wore the kind of placid smile that he’d been sporting with his parents since his late teens.

“What’s to know. Look, it’s up to you, but see how it opens up the whole place. I’m thinking about your kitchen. You’d be crazy not to do something like this. Look, you can…” Rick’s dad basically repeated everything he’d said three minutes earlier, only now Rick made less effort to oblige him. It was an old pattern, an old diminishing set of returns. While he hung his head, his father continued. Opposite him, his mother resumed her monologue with Amy. Rick sighed.

A flash appeared in the center of the room, accompanied by a plume of smoke but leaving in its wake a muscle-bound, toothy and earnest figure.

“Hi!” said the ephemeral, masculine image.

“Process Man! What are you doing here?” asked Rick

“Who? Who’s this?” asked Rick’s dad, dumbfounded.

Rick quickly collected himself. “It’s Process Man. He’s a legend. He helps people with communication problems—tells them what they’re saying to each other beneath their content.”

“What?”

“That’s right, Rick,” the figure affirmed. “I am Process Man and I am here to help you understand what you’re REALLY saying to one another.” He turned to face the awestruck women. “What you all are saying to one another”

“Wait a minute, what’s going on here?” protested Rick’s dad.

Process Man began his sage lesson, unperturbed. “You see, Rick, what’s being offered here is a parental gift. Your father has money and advice to give you, and will only be satisfied when you allow him to make this gift.”

“I know that, Process Man, but—”

“But what you don’t know or realize fully is that this conversation isn’t over until you give unequivocal support for the idea. That’s why your father is prepared to repeat the information, and will keep repeating it until you agree. He’s the one who decrees when the communication is over. That’s what he’s saying.”

“You know, you’re right,” Rick enthused.

“Wait. I—”

“And Dad, you probably understand that your son’s gotta consult with his good woman, who’s over there listening to your good woman, loyally absorbing the mother-in-law’s words. But what you don’t fully know is that Rick needs to make up his own mind, and the more you repeat your lessons, the less he’ll take in what you have to say.”

“The law of diminishing returns,” Rick’s dad intoned soberly.

“That’s right. You understand.”

“Thanks, Process Man,” said Rick.

“Tell a friend,” said the figure as he and the smoke disappeared.

 

 

 

 

 

 

 

 

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Personality Disorder: the other way (part two)

 

I want to blame someone. James Masterson did also, I think. He will have argued with many over what comprises a real versus a false self, or a personality disorder—whether such a thing exists with some. Were he alive today I think he’d argue with proponents of trauma model, and possibly with authors of novels like The Woman in Cabin 10. Not that these people don’t think that personality disorders exist. They simply call them something else, because mental health services, like any commodity, ultimately, is not just something to be validated by research, or—sorry—evidence-based research. It is something to be sold to the public.

For the average consumer of psychotherapy, a diagnosis of trauma, whether that trauma is episodic, chronic, the result of fatefully aberrant events or an aggregate of quaintly termed little ts that shape development (the theorized etiology of personality disorders) is simply more palatable. The word connotes victimization by an external agent, and thus a diminished responsibility for the sufferer. Treatment encourages a present identity of a survivor (very popular), with a possible future of healing. It’s a meet-them-where-they’re-at-thing. Regarding etiology, the accent is upon recent, precipitating events, with an intellectualized nod towards distant antecedents, that complex internalization of others which blurs a simplified reality.

Trauma model practitioners pay lip service to the antecedents of trauma. Prominent authors even co-opt object relations theories without crediting them, and repackage (reframe in the jargon of the field) personality disorder as something like developmental or relational trauma. A good example is featured in Barbara Steffens’ Your Sexually Addicted Spouse, whose target readership is evident by the title. In her text, Steffens describes PTSD as “something that can last a lifetime”, and that relationship trauma entails “painful coping mechanisms ingrained in personalities” Study the work of Klein, Fairbairn, Mahler, Winnicott, Masterson or Kohut and you’d hear the echo of their theories in such pop psychology literature: that psychic pain is integrated into personality over time, generating a disordered self in which such pain is habitually defended against in relationship.

But again, while trauma model educators pay lip service to old patterns, they mostly ignore it in treatment. The reasons are two-fold: A.) Treatment doesn’t last very long in this model. It’s a two week stay in a group home of some kind, or an eight-week course at your nearby hospital. B.) Discussion of problems is intellectual, academic—therapy as education. You’re given homework, even, to solidify the association with school. This is organizing, some say. Stabilizing for the unsafe person who cannot, it is presumed, manage complexity, the uncertainty of not knowing more deeply why something is happening. They are unable to weigh or contemplate their own mind alongside those of others, which are similarly complex, and implicitly dangerous. This danger is cast as objective reality, and anyone who says otherwise is “gaslighting”. Thus, treatment prioritizes affect regulation techniques and procedures, not the contemplation of self and other; it advises the practice of coping skills, self-care activities—all of which is worthy, actually, as adjuncts to growth. Meanwhile, the model’s adherents suggest that the afflicted let go of the actions, opinions, even the feelings of difficult others, while attaching labels. Fuller contemplation is put off until some ambiguously later time, when the person may be deemed ready. I think that readiness is seldom achieved. Time passes. It doesn’t so much heal as fossilize thoughts about self and other. What’s difficult to let go of are the pat understandings imparted by practitioners who recycle the same lessons in one short-term treatment episode after another.

In a longer-term therapy model, individuals inhabit their adult roles and live their lives as opposed to dropping out of society and going to school. They are challenged to do more than learn how to self-soothe or calm down, or take time-outs when mad, or to leave that bad relationship that your friends all think is wrong, only to start another one that’s similar because you haven’t learned what you got from that bad relationship. Instead, some learn (or are challenged to learn) to hang out with confusion, the grey areas of day-to-day life; to tolerate discomfort, stay with the difficult, as Masterson was once quoted as saying. Reality is learning about one’s own mind and being open to those of others, especially those that are not so easy to detach from: bosses, spouses, children; the memory of those absent but still profoundly influential.

What’s your pain today? Who or what do you want to blame, talk about instead of understand; focus on instead of yourself? Do you really know what your pain is about, what it’s backstory is—it’s underpinning? Do you think you really know the story of others? I know. It’s not what you (I’m) thinking.

 

Graeme Daniels, MFT

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Personality Disorder: the other way (part one)

 

Musing on a recent concatenation: my annual trip to San Rafael to teach intern therapists something about the late James Masterson and his Disorder of Self model; a reading of a novel that reminds me the zeitgeist is elsewhere, teaching a more palatable lesson. A student in the training, an intern in a private practice model, asked me about the fame of JM, or more specifically, about his lingering relevance. Though she’d heard of him before, she’d only known about him from others at this particular agency, she stated. The comment was a muted, polite critique, suggesting an eclipsed influence of a one-time star in the psychoanalytic pantheon.

What a start, I thought. It was the beginning of a six-hour training, so I’d be up against it, hoping to disabuse this woman and others of some chestnut assumptions, biases reinforced by institutions, medical and cultural, as well as academia to some extent. The pressure wasn’t great–mostly self-imposed, I think–but subtle. What is my obligation or prerogative to instruct about the Masterson model? To advocate for an outmoded, if (in my opinion) far more thoughtful take on the concept of personality disorder? Not much, actually. And six hours is a lot, you might think, to shed light on a few things, offer a different way of thinking about an old problem.

Anyway, Disorder of Self is a term Masterson coined towards the end of his career, to provide an alternative to the embattled Personality Disorder label, which is described via a medical lens in the diagnostic standards manual (DSM-V) of the American Psychiatric Association. The term references a syndrome of characteristics, ‘pervasive’ in nature, cutting across contexts and time. For many, it’s not a popular term. It pathologizes, stereotypes, and reduces, mostly because of the way these terms are used, which indeed pathologizes, stereotypes and reduces. The most commonly used terms, Borderline and Narcissist, have seeped into commonspeak like rain spilling over a dam. It wasn’t meant to be, but it’s not surprising  given the flood of opinion. I remember when I was in graduate school, when I was first introduced to the nomenclature. The word Borderline was a byword for difficult client; it denoted (and still does) someone who is volatile in mood, and therefore in relationship; it means someone who is often suicidal, or otherwise self-destructive. They make demands, flood the boundaries of novice therapists. They overwhelm. Narcissists do something similar, only with more self-importance, so-called grandiosity, and conceit.

James Masterson followed the psychoanalytic tradition, cast PDs not so much as a syndrome of behaviors or glibly-described personal styles as a complex map of self and other representations–a dynamic between self and other, not self versus environment per se, as DW Winnicott opined. Following the lead of Melanie Klein, WRD Fairbairn, and Margaret Mahler, Masterson cast Borderline and Narcissistic disorders as derived from intrapsychic structures comprised of interactions between projections and introjections, those experiences of self and others. He mapped out these experiences in object relations units, states of mind activated by splitting defenses, representing false ways of being, strategies of how to operate in relationship, on an unconscious level. My task in these introductory trainings was to read passages from cases, snippets of exchanges between myself and clients, illustrating these states of mind. The utility? To show how a mind works in commonplace ways, basically.

The students were struck by how familiar the exchanges seemed, and by how apt the conceptualizations ultimately seemed as they were described and then depicted in case scenarios.

Someone asked about trauma, a word often used to combat the notion of PDs in some circles, and subtly join with the paradigm in others. We note the ubiquity of the word trauma to denote victimization, the externalization of problems, attributable to fate or social forces and not so much an aggregation of developmental phenomena. It suits us to connect dots, but to do so expeditiously, to indicate identifiable, as in consciously understood and remembered events. And it is a familiar, almost comforting idea, especially for those who don’t know what projections are—who might find it maddening to ever wonder whether thoughts and feelings come from the self versus another, or between an elusive self and other.

Fiction, not so strange fiction, can reinforce this facile prejudice. Ruth Ware’s latest thriller, The Woman in Cabin 10, for example, features a main character who has suffered a home break-in at the outset of the story. This event serves as a backdrop for the subsequent misadventure, in which she sees and hears evidence of a murder, but is gaslighted by a pernicious crew of a luxury cruise-liner, who are protecting a villain in power, and discredit her because she is shaken, prone to depression–on medication, it is discovered. For some portion of the book, the reader is teased by the possibility that the protagonist is an unreliable reporter, filtering her drama through both recent events and a plethora of self and other representations, accumulated over time, and manifest in a reactive personal style.

Alas, the story abandons the tension of such an unknown and quite readily sides with its designated heroine, linking her terror to her recent misfortune, and only thinly to anything pre-existing. Disappointing, I thought, though the story was still gripping. Oh well, I’m back at work tomorrow, and thankfully not dealing with anything as serious as murder, but still following stories with protagonists that will grip my interest beyond a taut 75,000 words. I just have to figure out who the people are that I’m sitting with. That’s their job, ultimately.

Graeme Daniels, MFT

 

 

 

 

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