Tag Archives: addiction

The ultimate risk of addiction treatment

 

In the field of addictions work, so-called, it is common for practitioners and later patients who integrate ideas to cast addiction as a problem of emotion.

The addictive personality is one who is pleasure and novelty seeking, and risk taking, it is said. Risk-taking except in the area of intimacy, wherein he/she is likely avoidant. Psychoanalytic theory, attachment theory, and a host of techniques derived from either, are supported by neurobiological research, which affirms that unconscious process, communication that occurs implicitly, via eye contact, body language, and voice prosody, is mediated via the prefrontal orbital areas of the brain, and nurtured (or not) in human beings during early childhood development. The role of the therapist in our society, not unlike that of the early caregiver in some respects, is to serve as an auxiliary ego, using words, reflection, tone and physicality: to connect.

Addicts and trauma survivors would appear to have something in common: a penchant for disconnection, or dissociation, as trauma researchers indicate. John Bowlby, the founder of attachment theory in the latter half of the twentieth century, offered that psychoneurosis derives from protracted separation anxiety: that children deprived of maternal care first protest, then despair, and then finally exhibit detachment, which is characterized by dissociation, a state of disembodied escapism. What latter day research indicates is that infants and toddlers’ levels of the steroid hormone cortisol maintain elevated levels when a caregiver is either absent or insensitive. If such a child is deprived of all caregiving, cortisol levels stay chronically high and therefore children will develop passive parasympathetic strategies of dissociation. Habituation of the brain to the opioid-releasing state of dissociation thus becomes a “default mode” of affect regulation. The result: a predisposition to addictive behaviors, and insecure attachment in the form of an unresponsive, intimacy-avoidant personality.

This perspective is a paradigm shift for many seeking treatment for problems of substance abuse, sexual acting out, food addiction, and such, because society’s inclination is to externalize the problem of addiction: it is the substances that are addictive, for example—not so much that a predisposition within an individual exists. Meanwhile, sex addiction is a term used by some to exert an alternative, moralistic argument against sexual promiscuity, or alternative sexual lifestyles, rather than an assessment term that draws attention to a mood or mind-altering use of behavior. Food addiction is a label that is likewise criticized for being a thinly veiled attack upon the obese, especially obese women. The problem with labels is that they elicit persecutory anxiety, especially in those prone to what Melanie Klein once termed the paranoid-schizoid position, a primitive stage of childhood development. The benefit is that labels, like any succinct form of communication, draws quick and urgent attention to problems that merit just that.

The reason why the paradigm shift is important is so that preventive measures can flourish. Education is of course important, but education in the cognitive, Socratic sense is only the beginning, not the end of the intervention. We can, as we have for decades as a mental health community, provide appropriate medical care for those whose dependencies (to opioids and alcohol, for example) merit such monitoring and focus; we can concurrently and thereafter dogmatize that the consequences of addiction (jails, institutions, and death, to quote 12-step programs) are prohibitive; we can gingerly (or not) shame addicts into realizing that their behaviors are self-centered and immature, and we can impose various consequences based upon the premise that imposing limits will alter behavior (actually, limits are a good idea, but are mostly beneficial for friends and family—not as an agent of change in treating addiction). But for real change, the following is necessary.

Consciousness. Structure. Honesty. Time. Consciousness comes first. Not consciousness of the problems outlined in the last paragraph. There’s plenty of consciousness-raising about that already. Consciousness of feeling states, beginning perhaps with bodily sensations, as mirrored, amplified, and sometimes spoken to by an observant other, perhaps a therapist: someone who will monitor the moment-to-moment reactions of the patient; modulate closeness, sensitive to the fears that may manifest as withdrawal, whether the person is aware of their defenses or not. Structure comes in the form of routines: go to therapy, 12-step meetings, work and family obligations, etcetera—those necessary things to do to support growth and recovery. Time: the re-building of this afflicted self takes time, patience, and ongoing consciousness, about things like bodily sensations, feeling states that are felt and not—about that which has been driven underground, into the unconscious, and otherwise discharged via behavior.

This recovery process is another kind of risk. The biggest risk of all: to re-attach.

 

Graeme Daniels, MFT

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How do I…?

How do I…?

  A question that emerges after the story has been told, the problem outlined. A man doesn’t trust himself: he has a plan to stop doing what he’s been doing for a long time, perhaps his entire life. He’s determined; the stakes are higher than they have ever been before, which usually means that others will be affected. Guilt will be key. The guilt stems from the prospect of failure, a background of it, and the implicit knowledge that there is something inside that demands expression.

 How do I…?

 As a therapist, I attend to the question on its own terms, responding with an outline’s semblance. First I mimic the crowd, who also knows the story, the history of the problem, and the stakes. Those stakes are reiterated. Regular reminders about the consequences of problem behavior: the impacts upon self and especially others; the damage to health, career, family. To hear some, you’d think that nothing more than such interventions are called for in the prevention of self destruction. I think that therapy supplies the subtext: people care; the man, despite himself, and despite the observations of some, cares also Further, reality can be cruel. Fate is indifferent.

 Implicit is the call for fellowship. The man in question has been isolating, not talking to others, getting lost in himself. Where is the accountability? I ask. I’m quick to explain: I don’t mean he should answer to me, or that he owes anything to anyone. At an early stage of therapy, I avoid stepping into dynamic roles wherein lines of authority are unconsciously laid. I mean something subtler; having something like structure, containment—that there is someone to speak to, to be honest to, when mania has run its course.

 How do I…?

 Continuity. How do you keep it up, your motivation? A woman changes her mind, doesn’t want what she wanted last month, has forgotten what drove her in another mood; what seemed different. The next twisting, turning switch must be explained while the past is denied. A therapist is memory—an aspect of containment. Something changed. Why? The question doesn’t compel answers as much as it does thinking, the protraction of curiosity, and slowing down. Very little has to happen “right now”.

 How do 1…?

Needs. A subset of the why question: why do people do what they do, especially if what they do generates guilt? Why doesn’t guilt itself motivate change? Why doesn’t remorse always do what courtrooms think it should? People do what they do in spite of guilt, in spite of shame, guilt’s less confident twin. Truth—that something within—hurts; it hurts self and others, and it always will. It needs out. It needs to be released, titrated in the spirit of compromise, for if it can be discharged without anyone knowing, then no one gets hurt.

 How do I…?

 Hope. When continuity has broken down; when the relapse once cast as a mere change of mind has returned the individual back to square one, a knowledge of pain lingers. The day after is another appointment. The fellowship, in all likelihood, is still there. People still care. The questions are still worthwhile. Curiosity is resilient. The therapist is in his office, waiting.

Graeme Daniels, MFT

 

 

 

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Memory of skittles

 

Do you remember going to movies as a kid, expecting colorful, fun adventures; a gripping, if not especially meaningful story? And do you recall those films whose lulls in exciting action, featuring longwinded dialogue (by my youngest standards, that meant all dialogue besides the phrases “look out!” or “we’re running out of time”) that left you confused, or bored, or possibly disturbed? Some stories, books or films, deposited ideas that I failed to grasp when I was young, but they left residues that my mind later absorbed, reorganized, and therefore put to different uses. Like…

I’ll eschew a Jungian pretense, a scholarly attempt to know the cross-cultural and time immemorial derivatives of modern storytelling. If Willy Wonka & the Chocolate Factory, the first ever film my parents took me to see (that I recall) is based upon, or is meant to parallel some Biblical or otherwise mythical antecedent, I was and still am ignorant of such information. When I saw the film when I was four, or maybe five, circa 1972 or 73’, I came away from the experience, like many other children I think, delighted by the color and mischief of the story. The rainbow images were childlike psychedelia, and an apt reflection of the candy ephemera I and most kids seem to fall in love with. The characters and story of Willy Wonka seemed fun and mildly comic; I was inclined to smile, laugh or even squeal at the playful action. At the same time, however, I recall feeling oddly disoriented by the menacing character that was Willy Wonka, and vaguely concerned for the sympathetic hero, the “honest” Charlie Bucket.

The morality aspect was not lost on me, even as a four or five-year-old. I was, after all, supposed to be downloading guilt around about this time, so a timeless cautionary tale about honesty or greed was actually, uh, well-timed, developmentally speaking. I recall the theme of gluttony being most impactful at the time. This may have been because I was at a movie theater, where candy snacks will have been (as they are still), with no sense of irony, sold in oversized portions to parents and children. I may have been more conscious, via experience, of greed and gluttony issues. Lying or treachery versus faith and honesty were likely not yet my cutting edge concerns. Maybe for me life was more about what I could do, when I could do it; when it was time to play, to stop playing; when is it time to notice too much of a good thing. The theme of patrimony, of passing down a legacy—notions of continuity and mortality—to a worthy heir, was lost on me.

It isn’t today, of course, but as I watched Willy Wonka recently over the holidays (it somehow seems an appropriate Holiday feature), I considered that the themes that resonated with my five-year-old self, that were implicitly deposited then, and which lingered thereafter, are still the ones that resonate most today. An addict is someone who is drawn by a figurative candy store; is seduced by an anticipation of pleasures: if not color or adventure, then of joyful affiliation, like-mindedness and play. The consequences of eating too much, of being self-centered, entitled or arrogant, are observable, but more so by onlookers, not the actors, save for a hero, the one survivor who will be redeemed, and rewarded with a happy ending. As a kid, I didn’t fully understand Charlie Bucket’s happy ending—that piece about inheriting the kingdom, whatever that was about. I just thought he’d been rewarded for not being too greedy. I might have looked at my mother to see if she were directing my attention, hoping I’d get this message, and thus I’d pick up my empty wrappers and not ask for more.

When people taste freedom for the first time, or for the first time in a while (going off to college, life after a separation), there is a sense of loss, one that may be felt palpably or tacitly, like the original losses. Buried. Not Buried. This is when the candy store opens its doors.

 

Graeme Daniels, MFT

 

 

 

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As dark as it gets

 

“Around ten o’clock, Andrew revealed a surprise: he’d been in therapy before, as in before he’d ever called me. And not even therapy, but analysis: for two years. He left because he didn’t like what he started to feel, a parallel between his drug addiction and emerging sexual compulsion. Though tired, I perked up, sensing something coming. Andrew spoke theoretically, about chasing highs, going back to an original experience. It felt like a prefacing explanation, his talk of addiction, its bedrock principles. Then he told me about his first time, the predictable, clandestine grope with an older girl, when he was eleven, she fourteen. The dreams of that girl, and his lust for teenage girls in general had never gone away, but he wouldn’t tell me more, not while there were legal issues pending, files not yet written. With that stuff looming, I wondered why he’d tell me anything, but then, I am ever struck by the desire to be known, by someone. Andrew’s loneliness gripped my heart, even as he retreated from memory, back to theory. He had an idea about pedophilia, he said, lowering his voice. It related to that original experience, that primal desire to be a child, experience pleasure as a child—natural, he argued. Shortly thereafter, his face broke, as if the pain in his soul had just hit him: that unsolvable clash between ancient fantasy versus the demands of growth.”

— a passage from Venus Looks Down On A Prairie Vole

Several points here, will touch on just a couple for starters. In this chapter, Daniel Pierce, my troubled protagonist and therapist, has serendipitously reunited with a patient he’d A.) thought he’d lost after a bad intake session, and B.) is the man whose privacy he is being pressured to violate by a rogue former prostitute and later, lawyers. Check out my novel and you’ll find out why.

The above conversation happens in the “privacy” of a shared room in a sober living environment–both men’s retreat. What Andrew (alias Derek) reveals here he would likely not have in the structured, orthodox forum of the therapist’s office. The thoughts Andrew shares are of a kind that few, in my opinion, share unless a near-profound alliance has been established. The reference to analysis, as distinguished from therapy, implies the depth divide between models of care, and further suggests what Daniel and Andrew tacitly have in common: they both tend to leave before the going gets tough.

 

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Sexual Narcissism

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“I’m in porn.” He’d said it quickly, in a clipped voice, while looking away, like he’d wanted the words off him, shooed away. I gave him a stilled look at which he grinned teasingly, masking unease. “Well, alright. I’m getting into porn, I should say. I’ve been in one clip so far.”

“Uh-huh. What film? What’s its title?” Rick laughed again, and shook his head. I felt like an idiot, stalling with questions to conceal my blushes.

“What film? I don’t know, man. Who cares…what film? Big dicks. It’s called ‘Big dicks’. There. I just gave it a title.”

“I’m sorry. I don’t mean to—”

“Nah, it’s cool. I don’t know why I’m giving attitude, actually. I’ve got a name, if that means anything. Kane—Kane Able. How do you like it?”

“A play on…I suppose.”

“Sure.”

“That’s good,” I lied.

So I asked about plot. About the film with no name: I asked if his clip contained any plot, or acting, or even theme. Surprisingly, Rick, or Kane—was pretty sure I’d not make the shift on this one—said there was. Firefighting, he said, not surprisingly. His part, as in his role, was that of a firefighter who has entered a burning building to rescue a trapped woman, who is feebly crying out (I imagined the acting) until the hero arrives, ready to spare her. The room is very hot, about which the performers comment wittily, and then the room gets hotter, and soon they don’t care so much about the fire and…well, you get the picture.

“Any dialogue?” I asked. Rick looked at me as if I were reading from a book of stupid questions.

“I ad-libbed this one line as I came: ‘fire in the hole, baby’, I said.” This time I said nothing. “I know, don’t tell me,” Rick lamented. “Pretty dumb, huh?”

“Did she say anything, have any lines, ad lib or scripted?”

Rick shook his head, uttered a dismissive noise, like I’d asked whether the props spoke on set. I blew air through my teeth, and thought of Lira.

“That’s typical. It goes to show there just aren’t enough good roles for women these days.”

— a passage from Venus Looks Down On A Prairie Vole

An example of parody in my mischief novel: the name Kane Abel is a play on words, of course, common to porn actors. My favorite from the real world of porn? Peter North. Subtle, right? Anyway, Kane is otherwise Rick, a young man whom Daniel Pierce meets while living at a sober living house, wherein he’s in retreat from a fraught personal and professional life. Rick’s day job is in a seafood restaurant, as a chef. There he causes trouble, disturbing his boss and Daniel’s temp boss, Jimbo, by stirring unrest, harassing female staff, flirting with nubile customers, doing very little cooking, it seems, while strutting his sex like a farmyard stud. Rick likely thinks his place in the service industry has layered meaning. He’s the kind of man who feels entitled to promiscuity, who feels offended, let down by another man’s diffidence, thinking that humankind benefits from the indiscriminate sharing of seed. He’ll try to re-ignite something in Daniel, provoke a libidinal return in the grieving, wilted psychologist. That last line, Daniel’s teasing of a feminist complaint, glides over Rick’s head, not so much because of stupidity, but rather self-absorption.

The role of women. What indeed is the role of women?

**image by Philip Lawson

 

 

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The Trauma Currency, Part Two

(Continued from part one)

Cermak’s intent was to present codependency as a legitimate focus of clinical attention, applicable to a variety of contexts. And so we have the Co-Addict Model, which draws attention to problematic behavior as a function of an underlying, pervasive disorder. While RT adherents may agree with aspects the co-addict corollary, their clinical focus downplays the pathologizing accent. Coping strategies, such as keeping busy with tasks, are instead normalized, cast as affect regulating under exceptional circumstances. Certain behaviors such as indiscriminate sharing of a sex addict’s behavior with friends or family, including children, are discouraged; however, these behaviors are framed as products of social isolation and episodic trauma brought on by an addict’s behavior, not an underlying or even associated pathology. The notable literature that represents this position includes Your Sexually Addicted Spouse (Steffens, Means, 2009), and Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts (Carnes, et al., 2012): the latter, in keeping with recovery tradition, outlines a healing process in stages: a pre-discovery stage, followed by phases of crisis/decision, and repair. In the crisis/decision stage the partner asks, “how did I get here?”, and comes to realizations like, “nothing in this marriage has been real”. Note the emphasis upon present or recent past events, not family of origin, early developmental or even adult developmental material.

The framework of RT appears to contraindicate a neutral therapeutic stance, becoming partner-centric, especially upon discovery of sexual betrayals, because the proposed de-pathologizing shift only applies to partners. There’s nothing in the RT paradigm that contests the assessment of sexual addiction. Indeed, the scope of questions for the revised version of the Sex Addiction Screening Test (or SAST) has widened in recent years, to address not only changes in technology—the broader means of acting out available to sex addicts—but also the impact upon partners of sexual betrayals. Notice, for example, a question on the 1989 version of SAST, “Does your spouse ever worry or complain about your sexual behavior?” (Carnes, 1989), versus a question on the revised 2008 version: “Has your sexual behavior ever created problems for you and your family?” Notice the slant has shifted to query problems identified by the would-be addict, instead of that which is externally identified by a partner whose perspective might be denied by the would-be sex addict, or distorted by a co-addict disorder.

The RT model calls for sex addicts or acting out partners to be identified as perpetrators of trauma, and this term—“perpetrator”—seems close enough to the connotations of “offender” that observers may be surprised that APSATS hasn’t called for the inclusion of more sex addicts on public sex offender registries. In the RT model, partners are validated as victims of a relationship-specific betrayal, and thereafter supported to integrate this experience in a way facilitates a healthy re-emergence in life, comprised of self-care, fellowship with a strong support system, realistic observation of sex addict behavior, but also renewed trust in humankind. The approach suggests that observation of predisposing pathology and validation of traumatic experience are mutually exclusive goals, which may lead to facile, short-term interventions, tailor made for practitioners presenting brief, intensive programs of care. While this may be an appropriate shift in the paradigm with respect to many partners or with all partners of sex addicts in the immediate aftermath of discovery, I wonder about the pathology that will be overlooked in the service of trauma validation, especially amid follow-up treatment episodes wherein identified-patient premises collapse over time.

In cases of sexual betrayal, a therapist working with acting out and non-acting out partners functions as a container for memories and emotions that cry out for expression, or disavowal in the case of those struggling to cope with the past. This Winnicottian task dovetails with reparation efforts—a Kleinian concept before a sex addiction treatment strategy—which hinges upon individuals’ capacity for mourning. Klein (1975) wrote that grievances we harbor towards parents for the wrongs they have committed, and for having denied those wrongs, elicit feelings of hate and desire for revenge. Durham (2000) has argued that the capacity for making reparations in the internal world is the basis on which empathy for others is established. When individuals defensively split, they attach to a narrowly defined narrative: therefore (borrowing the RT Model identifiers) a victim’s anger and hatred is rigidified in the face of a perpetrator’s denial, which represents an evil system built upon a primitive intrapsychic structure. A working through of splitting, into mourning, requires the perpetrator to own his destructiveness so as to experience mourning; then, if the victim is sufficiently open to an awareness of “good enough” qualities in the perpetrator, a re-internalization of that individual as a good object might occur, which in turn enables the victim’s own work of mourning.

Whether or not labels of victim, perpetrator, addict, or codependent are necessary, harmful, or inhibitive of this process seems ambiguous. Assessment and diagnostic nomenclature informs psychiatric intervention; enables the placement of individuals in appropriate levels of care, including hospitals when necessary; generates short and long-term treatment planning goals. Informing patients of their diagnoses gives informed consent to treatment based upon an understanding of conditions that are the focus of clinical attention. At the same time therapists know the stigmatizing risk associated with assessment and diagnostic labels, particularly those whose prescriptive measures are not clearly defined, or subject to a range of treatment alternatives, despite the attempts of some who promote protocols in response to diagnoses. The advisability of informing a patient or client that he or she has a substance dependence, for example, seems predicated on particular factors well understood across professional disciplines, and by the general public: that the problem can be accurately assessed in a short time frame; that prescriptive measures can be readily understood by those potentially receiving services (such as recommendations of abstinence, or attendance at 12-step meetings); that a person may be at grave risk of illness, injury, or even death if immediate intervention does not occur.

Are these factors true with respect to sex addiction, or codependency, or personality disorders? Maybe in some cases, but of the forty five questions on the revised SAST, for example, only one pertains to behaviors that place afflicted individuals in dangerous situations. In my training I learned to refrain from using diagnostic or assessment labels when addressing clients about their problems, unless the applicable term or terms seem critical for intervention, or unless prescriptive measures based upon the nomenclature can be articulated succinctly and concretely. Otherwise, confusion and/or resistance typically follows, with clients left thinly understanding conditions, floundering to make sense of new identities imposed by expert opinion. I often experience this when clients meet with me for the first time, having been diagnosed by a previous practitioner with, say, Narcissist Personality Disorder. They’ve been given an article to read, or a DSM criteria sheet to examine. Afterwards, they exhibit disorientation, manifest with awkward attempts to describe their freshly assigned disorder. When devising a plan, they offer that they need to learn to empathize with others more. Woodenly, they report feeling instructed, and branded, but not understood.

This is often true with individuals who are told they have a sex addiction, or a codependency problem, and while many can wrap their minds around the concept of sex addiction, the assessment still bears much explanation and holding of emotion. As for codependency: from an object relations point of view, that umbrella term represents a whole multitude of dynamic relational configurations, replete with intersecting projections and introjections. So no wonder partners of sex addicts are flummoxed and invalidated by the term, regardless of what betrayals they have felt. Aren’t many or even most shocked to hear that they may have enabled another’s addiction? Won’t many be confused to hear they may have contributed to another’s disorder by an overly close, or conversely, a distant involvement? Doesn’t it jolt the senses, the unconscious, one’s entire being, to hear that one might have a sex addiction, and that an important aspect of that concept is its impact upon intimate partners? Ultimately, what seems important is to hold the idea of a complex problem, brought to light by acting out behaviors, but not reducible to those habits, necessarily. Might it not render the divide between rival models of treatment moot to consider that our clients deserve to not be hamstrung by labels, or denied what is useful in our nomenclature? Rather, they should feel held by our open minds and fuller understanding.

 

 REFERENCES

 American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA. American Psychiatric Publishing.

 Bergner, R. & Bridges, A. (2002). The significance of heavy pornography involvement for romantic partners: research and clinical implications. Journal of Sex & Marital Therapy, 28, 193-206.

Black, Claudia (2009). Deceived. Hazelden. Center City, Minnesota.

Carnes, P. (1989) Contrary to Love. Hazelden.

Carnes, S., Lee, M. A., Rodriguez, A. D. (2012) Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts. Gentle Path Press.

Cermak, T. (1986). Diagnosing and treating codependence. Minneapolis, MN: Johnson institute

David J Ley (2012, September) “Abusing the Term Trauma”. Retrieved from https://www.psychologytoday.com/abusing-the-term-trauma/

Durham, M.S. (2000) The Therapist’s Encounters with Revenge and Forgiveness. In “Psychological Repair: the intersubjective dialogue of remorse and forgiveness in the aftermath of gross human rights violations”. Journal of the American Psychoanalytic Association. Volume 63. Number 6. December 2015

Glass, S. (2003) Not just friends: Protect you relationship from infidelity and heal the trauma of betrayal. New York, NY. The Free Press.

Klein, M. (1975) Love, Guilt and Reparation and Other Works, 1921-1945. London: The Free Press, 2002.

Steffens, B. A., & Rennie, R. L. (2006) The traumatic nature of disclosure for the wives of sexual addicts. Sexual Addiction & Compulsivity, 13, 247-267.

Steffens, B. A., & Means, M. (2009) Your Sexually Addicted Spouse: How Partners Can Cope and Heal. New Horizon Press.

 

 

 

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About reviews, popularity

Ever get the feeling someone’s trying to tell you something by not telling you something? Psychotherapists (that identifier feels awkward for some reason) have to learn to interpret the unsaid, by thinking about non-verbal information: everything from muted sighs to averted glances at a hidden clock, to I’m-running-late text messages, belated vacation or business trip announcements; e-mail terminations. Relationships in some people’s lives end with tumbling regularity. Exchanges are transient. Promises are easily given, and more easily withdrawn or better yet, forgotten. If you wrote it down, good for you. Kudos for the documentation, signifying that something meaningful happened.

I don’t spend a lot of time documenting psychotherapy, largely because it makes for dull reading, the type of notes one is meant to write for nosy overseers. It makes for good stories however, not that I can lift them directly from my clients’ shares. Instead, it’s an exercise in grabbing at pieces, tossing them at a blank page, worrying later about the links. For my first four novels I’d picked sketchily from my clients’ backstories, preferring to represent moments, unidentifiable fragments of individuals’ lives, maintaining everyone’s confidentiality. Except mine, of course. It’s several years since my first effort, the much somethinged Living Without Blood, about somebody named Eric Metcalf and his friend Richard something else, coming together after years of gradual estrangement in order to…actually, I’ve forgotten what they did together. I loved LWB at its time of publication—2009. It was my first-born: a sloppy, muddled beginner trying to find its legs after a nine-month labor, but occasionally standing tall, inspired by a self-consciously prosy flow. Skip to 2012: the release of Crystal From The Hills, a picaresque adventure that I’d conceived as a 600-page novel, only to split the story in half, releasing its follow-up, The Situation, two years later. Crystal took three years to write, in sporadic bursts in between semesters of my post-graduate training program at the Masterson Institute. Written three times, suffered over like a still-birthed thesis, it was my best effort thus far I thought, and I was confident enough of its value to submit a manuscript for review, with Kirkus magazine, a reputed den of literary cognoscenti.

Kirkus didn’t like Crystal From The Hills, calling it “sprawling”, “meandering” (a reference to its many flashbacks, childhood background material to make John Bowlbyesque sense of my protagonist’s disturbance). I got my first real taste of a reviewer’s, and presumably an average reader’s distaste for disrupted narrative, impatience with detail. I learned that some might find my prose difficult to read, for it was “ponderous”, “stacking of clauses and syllables”; containing way too much minutia. Gee, had they ever read David Foster Wallace? There wasn’t much complaint (from Kirkus) about the plot as such, or about character development—rather a suggestion that readers prefer heroes to be heroes, or at least charming, as opposed to being self-absorbed underdogs, or as one reader put it, losers. Ironic, for the novel’s underlying theme was empathy, so I did indeed fail in my task. I absorbed the criticism graciously, I think, noting that for my modest investment I’d received more honest feedback in two paragraphs—indeed more feedback, period—than I’d received from most non-paid (friendly or not) readers over the previous three years. Seriously, outside of the odd sympathetic review posted on Amazon, my readers, which include one loving family member, plus a rough crossection of my friendship circle, have given me little interest over the years. Some of them don’t care for psychodrama, preferring sci-fi, fantasy, non-fiction, or pleasant yarns about dogs or foreign travelogues. I think some struggle with the opening pages of my books, are left sucking oxygen within minutes having regarded my prose as if it were like the text of vacuum cleaner manuals. Most think that theme is subordinate to plot, which I agree with to some extent, except that some just don’t register ideas, only action. And some just don’t read. Period.

Oh well.

The effort to engage strangers moved on. The Situation received a warmer review from Kirkus, as in lukewarm, with concessions that it contained less of its predecessor’s flaws, as in less background material, less “meandering” plot. This was a somewhat hollow non-criticism, as the novel was a sequel and therefore did not require much backstory. However, other elements, like theme, the relatively fast pace or crisp prose, plus what I thought were clever plot devices (For example, Crystal’s opening, “He’s dead”, regarding a referenced character named Weed, is mirrored by Weed’s opening line of Situation: “I’m alive”. Reaction from Kirkus: nothing). Clarion/Foreword reviews didn’t notice this and other plot tidbits either, but otherwise offered a glowing review of The Situation, giving me four stars out of five, and remarking that my text was “captivating”, my writing assured; the story humorous, adventurous and fast-paced: gratifying, if not quite redemptive of the story as a whole. Kirkus’ reticence continued to irk me. I held the impression that their reviewer was holding something back, thinking my novel worthwhile but not wanting to say so.

This idea was reinforced earlier this year by their latest (and likely the last I’ll solicit) review, for my new novel, Venus Looks Down On A Prairie Vole. I was cautiously optimistic this time, half thinking my third submission would be the charm, otherwise simply believing my latest novel is pretty damn good. Alas, it was not to be. Upon providing a typically competent synopsis of the plot and a begrudging recognition that I was “drawing attention to an important issue”, Kirkus then complained that my protagonist, the sarcastic, at times pathetic Daniel Pierce, is not likeable. No kidding. According to them, he is pompous, contrarian (like that word, actually), and anti-feminist—a problem, apparently. Actually, as a therapist he’s resolutely neutral: a Bionion depository, as he puts it, “lacking memory or desire” (a famous Wilfred Bion quote). Outside his office he’s not so much anti-feminist as anti that which co-opts platitudes for self-serving aims, which is why he might be unlikeable. I suppose that negativity is not likeable, which I further suppose depends upon point of view. Anyway, it should tell me something, this reaction: something I’ve known at least since high school: in this world, in nearly all endeavors, it’s not enough to be good. BTW: my novel is damn good! But here’s the thing: you have to be liked.

 

 

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Introducing Venus

 

Time to fulfill a promise. Last year, about nine months ago now, I previewed a novel I had then nearly completed and which now has been available for about three months online. At the time it was called Blocked, not that names matter, and I wrote that I’d comment on the novel, its various themes and other elements, leading up to and beyond its publication. Alas, that didn’t happen. Sorry. I know you were waiting with baited breath. Anyway, I got distracted, like my protagonist Daniel Pierce often does; became sarcastic, as I still am, though he is less so. Among other things, my object relations explicating Tommy article got accepted for publication in an academic journal (I’m quite proud of that, in case you can’t tell), and random events occurred, concerning dogs, graphic novels, the politics of evidence-based psychotherapy: all happening with Bionic (as in Wilfred) meaning.

So the novel’s called Venus Looks Down On A Prairie Vole, which is a meaningful title, but you’d have to read the novel to learn fully its point. I know. What a typical, asshole-self-important author thing to write. Well, I’ll give a heads up on a couple of things, hopefully make this labor of my last two years interesting for you. Venus is a reference to women, which shouldn’t surprise. A prairie vole is a monogamous rodent. There. Figured it out yet? Oh well, let’s take it one step at a time, one day at a time, which should clue you into one theme of the story, at least. So, the first chapter (about five pages, I think), will introduce you to Daniel Pierce, a lonesome psychologist (actually, the reader doesn’t really learn his name and vocation until chapter two) who is talking to an insurance representative, seeking payment for a claim that’s gone awry, but also flirting somewhat. There’s some foreshadowing in this comic opening, but mostly I’m introducing a voice—one that’s flippant, like this blog entry—and a theme of subjugation to a system or machine. Daniel suffers and doesn’t “forgive” systems, but he latches onto individuals, like his clients, and also like the angelic-seeming, barely English speaking helper on the line. She’ll listen to him, he hopes. She might really listen. No one else does, he explains sourly.

There isn’t much to help a reader feel sorry for the self-pitying Daniel Pierce, but a troubled, flaky son, and a deceased wife give some cause early on. Later, as he becomes dogmatic, contrary, awkwardly humored, if self-deprecating, liking him might get even harder. But try, won’t you…he needs help. As to his crises, the reader first learns about Ryan, his early twenty something son: absconded from Daniel’s home after completing a stint in rehab and winning from him the reward of an inherited car—a bad move, Daniel concedes. You’ll learn that it’s one of many mistakes he is making in his life, though hereafter they will relate mostly to his working life: his poor boundaries, and at least questionable ethics. In the early pages, Daniel’s wife, Lisa, is introduced as “sleeping”—a figurative trick, for she is really gone. She and Ryan are spectral figures in this tale: oblique motivators, sources of regret, or in Lisa’s case, an overseer of sorts.

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The Reading

I was ready for my reading. The first of its kind was to take place before a private little gathering in a semi-lit room, with an overhead projector not working because my friend, a confirmed techno-specialist, didn’t have the right cord to fit my computer, my less-than-a-year old computer. We could head down to the Radio Shack to get the VRG-DHR cord (I don’t know—I can’t remember its actual name) cord that we needed, he offered with enthusiasm.

“Forget it,” I said with mine draining from me.

Whenever I invite friends or family to show up for me, whether it’s for a public event or not, I find that I have to fight impulses towards the negative: a sour, ill-humored cloud that creeps over me, threatening to douse energy and kill joy at the first sign of a setback. It wasn’t so much that I needed the damn laptop presentation anyway. It was leftover from the workshop I’d given six months ago, and was a supplement to a reading of about half a dozen passages from my non-fiction, Working Through Rehab, which I am occasionally hawking to would-be readers through…anyway, I didn’t need the laptop. That was the point. So I had to coach myself to breathe, or more specifically, to issue forth a gust of breath that would dislodge the wad of resistance that would soon form a mass and block my voice. I had to, as they say, get over it. “Whatever,” I said aloud to no one, dismissing early interpretations: that this was a harbinger; a symbolic alert, signaling me to stop what I was doing, sneak out the back door, leaving a note with apologies for everyone’s inconvenience. For the next few minutes, the lull prior to my beginning, I fought gravity’s tug upon my lips, that smile that was turning upside down. People started to arrive, greeting me with pleasure, eager to support this writing thing I did on the side.

“How’re you doin’?” asked my best friend, seeing a cloud over my face.

“Nervous,” I said.

“Drink water,” he advised.

I did. Throughout the talk, whenever I paused to field a question or a comment, I stole a sip from my bottle, and felt buoyant, if nearly drowned after an hour. There weren’t many there—maybe a dozen people, total. But it wasn’t so much how many were there, or even the fact that I was speaking before an audience, sharing passages from my book, and breaking to make comments in between. It was the who that mattered. Speaking to family, friends, plus a crossover of collegial knowing, I imagined deeper judgments, more fraught investment, and a more rigorous, concerned critique: speak louder, someone whispered ironically after five minutes. “You should look at your audience more”, someone else remarked afterwards. I nodded politely and took it in. How do I do that and read? I thought churlishly. The positives made it through the blockade, however. Gathered around me in a circle, the assembled uttered their “good job” pronouncements, their gentle congratulations and other good wishes. One person left early, without comment, which nagged at me for the rest of the evening. “Sorry I had to go,” he texted later. “Had to pick up my kid. Good job.”

You’d think the event was about me, and it was. The book is about drugs, adolescents, their parents, and the people who work with those suffering from drug abuse and addiction. If you check out the image which is the cover of the book, take note of its artful rendition of drug treatment, milieu therapy, and community mental health. Up front there’s me, the author, sat on a time-out device, having left the field, but now raising a thumb in accordance with an old protocol of rehab expression, indicating that I have something to say. To my left is a doctor, or psychiatrist, holding a clipboard, observing from an aloof position the goings on, wondering what prescription(s) may be best. Over my right shoulder, there’s an officious-looking floor counselor, a fledgling member of the mental health army, not yet working with kids in the manner of his/her choosing, monitoring an affectless, acting out, poorly attached and difficult young person who will nonetheless touch hearts. With his back to all of this is a man busy at a console, producing a report, maybe of numbers. But he’s not an accountant. He’s a therapist, or a case manager, as they are euphemistically called in such places. Tellingly, his back is to the scene, thought it’s not by choice. It’s by necessity. This is the business of mental health that I’m talking about, and writing about, and reading aloud. In public.

Meanwhile, that review came, the one I moaned about in my last entry: it arrived finally, and it was pretty good, sort of. The reviewer read between the lines, observed the melancholy, and something of the humor. He or she (it’s not clear) wrote that I was cynical and bitter, though the comment was not a complaint necessarily. This reminds me of something I heard recently and have recycled for patients: if you don’t complain how do you know there’s pain? I don’t mean it to sound like a rap, but there is pain. That’s the melancholy truth of Working Through Rehab. From my point of view and that of other veterans of drug treatment, there isn’t a happy plan in place for the consumer; no all-conquering model for the professional to embrace. Once, there was a working idea: treat the adolescent more or less as an adult, and certainly as an addict. Operate as if a compulsive pattern has gained a foothold, and that strategies for using other human beings in a human way were profoundly offline. Those who thought this weren’t wrong, and most agree the attachment disorders of those in treatment seem pervasive. But disagreements abound as to solutions. Containing the drug user’s behavior is one thing; aiming for motivation, and assessing capacities are the other great tasks, and this is where drug treatment with adolescents–with everyone, frankly–has gotten tricky.

Why? Because increasingly, kids, old and young, think that using drugs, sex, video games, and cell phones are acceptable tools for soothing the attachment disorders which they may agree are present and ongoing. Don’t see this? At least as far as drugs are concerned, read the latest statistics released by The National Institute of Drug Abuse (NIDA) about the opinions of high school seniors. Only 16% consider that use of drugs constitutes an unhealthy risk, compared to 27% who thought this just five years ago. Wake up: self medication is being normalized. This is why treatment centers like Thunder Road are at risk of being closed down; it’s why places like it have already closed down, and why public officials are reaching out to the media, bemoaning the impending lack of options for at risk youth. It’s why drug treatment as it once was may be a thing of the past, except for the wealthy. It’s one of the reasons my book is a little melancholy, and just one of the reasons my reading of it might stir the nerves.

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The Submission

When I first submitted Working Through for review at the The Therapist, I waited. I waited patiently. Over the previous year, I’d been writing prolifically, completing two books, one a novel whose basic plot I strain to describe in less than a paragraph, but whose themes cover the bases of a therapist’s sphere of influence: addiction, depression, psychosis, and most crucially, the good news: empathy. My other book, my expose of drug treatment and adolescents, fully entitled Working Through Rehab: An Inside Look at Adolescent Drug Treatment, is an ambitious, sprawling memoir cum essay that has been variously thrust at agents, publishers, and indulgent peers, though getting people to read it feels a bit like peeling wet leaves off a driveway in the dead of winter. I take my readers one at a time.

A colleague, a good friend whom I do not shame into reading my material, suggested I take advantage of membership in the statewide association of Marriage and Family Therapists, and submit my non-fiction to its flagship journal, The Therapist. The magazine, which is published quarterly, or thereabouts, features a section in which members can volunteer to read submissions and then provide a review. It seemed like a good idea to take advantage of a service that is a privilege of membership. My friend is good at having ideas that obscure his lack of effort. Anyway, what could I lose? I thought, especially after I’d just waiting six months waiting fruitlessly upon a publisher to study WTR, express enthusiasm for its content, but ultimately reject its content. They don’t publish memoirs of non-famous people, said an executive editor, gratuitously pointing out that I wasn’t famous. Fair enough, I thought. However, he could have told me this earlier, rather than having me wait with bubbling hope that a fantasy writing contract was forthcoming. In the end it was a flat e-mail that delivered the publisher’s verdict—an afterthought, really—by a deputy editor who had forgotten to reply to my last message. A flattering response, “well-written and compelling”, was quickly followed by the word, “unfortunately…” rendering the compliment a consolation.

So I submitted WTR to The Therapist in January 2014, thinking it might be advertised in the next issue, and possibly reviewed in the issue following that (as suggested by the editor). March was the next issue, and my fresh-looking book was there in print, alongside several other titles, looking eager like playful children, but also like bags on an airport carousel waiting to be collected. I was pleasantly anticipating, thinking my book an important work. As far as I could tell, no one else was writing about what really happens in drug treatment, and I feel in my gut that there’s a readership for subject that’s slightly off-center: it’s comprised partly of parents concerned with the impact of drugs upon kids, which is what publishers might presume the book is about. There’s a faction of society that is more broadly concerned with mental health, and with the problems of poorly attached individuals, the famous and non-famous, who are collapsing around us, killing themselves with addictions, violently attacking others in schoolyards and movie theaters, or just plain killing themselves. And there’s a faction of workers in this field, who aren’t necessarily readers, who are slated to work with all these people and somehow help figure out all of their problems: they are therapists, social workers, drug and alcohol counselors, for the most part, and they—not the adolescents or their families, actually—are the heroes of my story.

At least some of them are, and that’s what’s potentially controversial about my book, because it’s not exactly a tribute. You see, I write about some of the things people expect to learn about drug treatment: like what leads kids and their families into drugs and addiction, and how treatment and therapy can help claw them out. But I’m not writing a how-to guide for parents, or any other consumer of the industry. I’m more of a critic of the process; the only kind of critic this business could really have: that of an insider, versus, say, a peripheral insider, such as a policy maker, or even most physicians. I’ve worked several positions within a hospital-based treatment setting, as a counselor and later as a supervisor of therapists. I was a manager of a six-bed group home for teens for three years; a leader of an intensive outpatient program for another three, and have seen patients across several divides in private practice for about twenty years. I’ve tracked the dialogues between the addicted and their families. I’ve been a part of and witnessed the back and forth arguments between patients and helpers, administrators and clinical professionals, and I understand the context of treatment’s limited resources, the conflicts many do not understand. I know the Gordian Knot that is drug addiction and the continuum of drug treatment, and the strained efforts to untie it.

As for the feedback process: I’d written the book, had it appear in black and white, and learned that it was selected by a volunteer to read. Again, I waited. When it didn’t appear in the next issue I sighed and reasoned that the book was long (350 pages) and dense, and was perhaps demanding more time and effort from a committed reader than I’d accounted for. But when a review didn’t appear in the issue after that (another two and half months on), I wondered what was happening. I e-mailed the magazine’s editor, a man who had cheerfully written that WTR had been selected six months earlier, and asked the question. Seeming like the deputy editor of that unnamed publisher, he wrote back that he hadn’t yet received a review from the volunteer, and didn’t know why. With curious incuriosity, he added that I might re-submit a copy such that the book could be advertised again as available for review, and that I might implicitly begin the cycle of waiting all over again. It was: oh yeah, I forgot, followed by an attempt to sweep the matter aside. Waiting and writing: years ago, when I started practicing this pleasing craft, I had no idea there would be this much waiting. What was I submitting myself to? Coolly, I replied to the editor, modeling the curiosity the situation compelled: Was there a problem? Is the volunteer no longer willing or able to provide a review? Did they get bored after reading a chapter and burn the copy? Or were they so engrossed that they couldn’t take their eyes off the material, even when driving, and thus died in a fiery crash. The sheepish editor, to whom I did not share these fantasies, wrote back that he’d pursue my inquiries. A week later, after I again solicited information, he replied that he still had none to give. He vaguely apologized on someone’s behalf, perhaps his own, for being inattentive. He excused the magazine by pointing out that this event—this phenomenon of neglect—seldom happens, and once again invited me to re-submit a copy.

Which I have done, and I am waiting. It is June of 2015: enough time for topical subjects to come and go; happily, or not, addiction isn’t one of them. And as I wait, I will continue to ruminate on my work, and perhaps inflate its importance, thinking that someone is out there waiting to snatch up another copy for review, but then blocking its exposure by abandoning the task. Or maybe I’ll be rewarded for my patience, and my raw message on this subject will be read, perhaps even in numbers, and a fair critique will come back at me finally. In the meantime, I will remind myself that while the culture continues to seek and develop tools for immediate gratification, the writer must endure the slowest, most excruciatingly elusive feedback system ever known.

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