Tag Archives: psychoanalysis

More things in heaven and earth

 

I am watching it. I am compelled, and I should not be writing of this while I know so little, while so much is unexplained. But that is my life, my “subjective” reality: the unknowing. And not knowing doesn’t stop me from writing or doing my job.

I am four episodes into The Leftovers, an HBO series adapted from a novel by Tom Perrotta which is set in the aftermath of a rapture-like event in which 2% of the world’s population has inexplicably disappeared. October 14th of 2011, is a 9/11-style shorthand for a mass “departure” that scientists can’t explain. This results in a social malaise that recalls P.D James’ Children Of Men. In that novel (also made into a film), the world’s population has become sterile for similarly mysterious reasons, and in the aftermath an aging (and therefore dying) population is variously depressed or psychotic. Cultists speculate that mankind is being punished; that its hubris, perhaps manifest as a privileging of science, is to blame.

In Leftovers, the focus is not so much on a failure of science as it is that of mainstream religion. Major denominations are nowhere to be seen. A baby Jesus replica is stolen and later desecrated by the acting out daughter of a local police chief of a grim, middle-American town. Baby Jesus is later returned, but significantly, the response is indifferent, and the police chief ultimately dumps the rejected figure on the side of a road. Meanwhile, cultists are represented by a group call the Guilty Remnant, a name reduced to the letters GR until episode two. This tidbit of withholding is typical of the series thus far, which parallels the air of unknowing by minimizing exposition, thus keeping viewers in the dark, and not just about the headline departure, but also about personal details. I am gripped, but optimally frustrated—the essence of suspense, I suppose. Four hours in, I am yet to understand the following: why do all the followers of GR smoke (an ironic play on ‘don’t waste your breath’?) Have the departed transformed into dogs or birds, creatures of either violence or passivity, as is also suggested? Why do the dreams of some enter those of others, as indicated by the profusion of nightmares featuring strangers and foreshadowed events? Why is the police chief estranged from his kids and his wife? It seems implicit that something happened, and whatever it was, it happened before the departure.

It’s just a story, after all: a good one that promises more about meaning; perhaps how religion, ostensibly exiled, has a defiant, parting comment on humanity. The stories of those who enter therapy are good stories also, and the details are likewise often obscured; divulgence of truth, not to mention meaning, is delayed. It is a feature of projective identification, a primitive defense yet more ubiquitous than most imagine, that individuals communicate in fragments: through play, language that is reduced to slang, idioms and inside jokes; by ‘acting out’ infused with terse revelations; by somatic displays that medicine can’t explain. Symbolic expression, via the articulate, coherent use of language, has broken down, though it may repair and unfold over time. Unpleasant emotion is dissociated, replaced by a standard of flatness and baffling obsession. When something has happened that is traumatic and not understood, life goes on, promise onlookers. It goes on with ritual, structure; with substitute things to do that mark time but also betray, in pieces, an epistemological drive.

The police chief of Leftovers loses his bagel in its inadequate incubator, and he’s not gonna take it lying down. He bemuses colleagues by not giving up on the search: for his bagels, for that baby Jesus. He finds the bagels also, eventually, through a semi-violent dissembling of machinery. They were stuck in back of the toaster, trapped in a secret passage, burnt. As the chief pulls them out, he sits back, moping over burnt food, dead…something. He is mildly relieved, having discharged energy from a nagging mystery. He is also depressed, aware that mysteries will keep coming, and that unfolding reality may yet be horrific. “Say it! Fuckin’ say it!” he later cries towards the wife who won’t speak, won’t explain. But she wants to leave him, she writes, giving an answer. It’s not enough. He pleads to know why. About everything.

 

Graeme Daniels, MFT

 

 

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Interruptus

 

A hypothetical dialogue (believe it or not) about a crisis:

 

“What’s the point in talking about it. It’s not gonna solve anything”

“What’s the point of checking out that person at the gym. You’re married, right?”

“Yeah”

“Well, that’s not gonna solve anything, either”

“Yeah, but…”

“What?”

“It’s different”

“How?”

“Seriously?”

“Seriously, put it into words”

“Well…I dunno, it’s…when I’m looking at someone I’m…I don’t know how to say it”

“You’re blocking. You know but you stop thinking, and you act instead”

“Right. You’ve said that before. I’m…wait, acting?”

“You’re acting on something, a feeling”

“…yeah, you know what it is—this is interesting—I think I am solving something, in a way. I mean, when I do that stuff I’m taking care of business, if you know what I mean. It feels necessary. It’s…”

(pause)

“…you want me to say the rest?”

(sigh) “Maybe, I…now I lost my train of thought”

“Interruptus”

“What?”

“Forget it”

“Oh, I get what you’re saying, I think. Well, I mean—okay—I’m expressing my sexuality, right? Jeez, that sounds weird putting it like that. Finishing, I mean. I’m…(laughs) I don’t know why this is so hard to say. I’m used to…I guess I can’t control myself, or it seems like…I just can’t turn it off, ya know?”

(pause)

“Or on, in another sense. Again, it seems like—”

“Yeah, okay, I get it. You’re not gonna say it for me. I need to use the words, give it meaning because…Gawd, I wish you’d explain again why that’s so important. (pause) Awright, so again, I can’t just turn off my sexuality, right? That’s the problem. It’s there…all the time. Waiting”

“True”

(pause)

“Okay…(shrugs)…so?”

“But so is the rest of you”

 

Graeme Daniels, MFT

 

 

 

 

 

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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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The old scripts

 

A man sits in a conference room, chatting collegially with a pair of co-workers, ostensibly leading a meeting. Technically, the man is in charge, but he prefers to keep things informal, not throw his weight around. Soon they will be joined by another man—everyone’s boss—who appears to not have such reservations. As a kid, he will have been a problem, this man: if not an out-and-out bully, then maybe just a nuisance; tagged as having attention deficit disorder, and needing a good dose of meds in order to follow directives, play well with others. Today, an observing psychiatrist might say he has poor audience; meaning, a blind spot keeping him from knowing where he treads. A less generous opinion would be that he doesn’t care. He walks into a room and simply expects people to drop what they’re doing and focus on him. It’s how he got to where he is, he might say. His turn to give directives, direct play. That is, if he notices.

The first man has had a different life. Until now, his once subordination to either bullies or the inattentive has been dormant. He’d worked hard, quietly achieved a certain status within the organization, and earned his graduation to civil society, mostly spared the obnoxious company of autocrats whom he’d suffered plenty enough as a younger man. When the boss walks in he begins talking louder than anyone else, instantly turning the heads of everyone present. That other collegial exchange is now relegated in importance, which immediately stirs in the first man a dreadful anger. What is this feeling? the man wonders…later. In the moment, his thoughts go blank as his adrenaline surges, followed soon by a chill sensation. Bad, implicit memories. Anxiety. The resultant compromise between states is a halting, passive, as in barely discernible complaint: “I guess we’ll postpone our talk until later.”

In models of psychoanalytic psychotherapy, espoused by the likes of James Masterson, treatment proceeds with the following assumption: that individuals develop self and other representations, based upon an accumulation of experience of ourselves in relationship with others, which in turn forms a psychological structure that is activated in times of stress. Our explicit (conscious) and implicit (unconscious) understanding of ourselves and others is an aggregate of our object relations (experience with caretakers), derived from early development, and nurtured over time. The task of therapy is to make sense of one’s own mind and that of a therapist, even though manifest content tends to eschew focus on the therapist, especially early in the process.

Self identities—meaning, strategies of being in relationship—are often fixed and rigid by the time therapy begins. They constitute a way of getting by, but not of growing, or of being happy. A kind of quantum phenomenon collapses time, disorienting the distressed patient, who experiences new stressors with an old psychological structure, and therefore people are dimly reminded of unfinished business, though presented with fresh choices. Though I am few people’s idea of an autocrat, I might tread on toes this day, and look into fleetingly bewildered, scared eyes; hear the opening strains of quickly defended selves. I wonder what they’ll say.

 

Graeme Daniels, MFT

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Sex addiction stigma debate (part two)

 

She spoke haughtily, which has a peculiar effect on me: I start questioning my right to think. “You’re speaking of men who acted out with their sexuality, and society is pushing back against that kind of privilege.”

“Acting out? Wait, are we now talking about something different than when you spoke of female sex addiction?”

“The men you indicated are compulsive philanderers, porn addicts, acting upon an exaggerated sense of entitlement. Women are no longer willing to tolerate that.”

“Whereas female sex addiction is…different?”

“Women are stigmatized for simply having sex before marriage. Men aren’t!”

“Okay, but women are not being assessed as sex addicts for simply having sex before marriage.”

She waved her hand in an expansive fashion. “No, but that’s part of the context, that generally lesser tolerance for their sexual freedom. It just makes it harder for women who do have problems to come forward and get help.”

I tilted my head, affecting skepticism.

“I can see you’re having a hard time accepting this.”

“You say ‘accepting this’ like you’ve already landed a truism, and I’m like a holocaust denier or something.”

“Seriously, you don’t think society has traditionally been harsher, more devaluing of women’s sexual behavior than men’s.”

“Traditionally is a key word there. Time’s change. Not sure I accept the conclusion based upon your premise.”

She shook her head. “You lost me,” she said.

“So let’s go back to the earlier point. You say that women feel a greater stigma around their sexuality than men, right? And this stigma, which is a societal phenomenon, is internalized by women, causing extra layers of shame?”

“Correct,” my colleague said cautiously.

“Well, consciousness leads to change. That’s the basic promise of our profession, after all. Now again, we’ve had at least two generations since the so-called sexual revolution, which sought to liberate men and women from sexually repressive values. I think many women now externalize the problem of that stigma you reference. They resent society’s traditionalist constraint of their sexuality, and therefore push back against institutions, including schools of thought like sex addiction treatment models, that would pathologize that newfound sexual freedom. It’s like when political outcasts used to get diagnosed with schizophrenia and other mental illness labels: I think some people think the term sex addiction is a sex police invention, and I think it at least one alternative reason why women especially, as well as the gay community, might reject sex addiction treatment.”

My colleague offered a soft utterance, one aimed at neither agreement nor concession, but merely diffused conflict. I think she wasn’t sure if we were saying different things.

“Interesting,” she said neutrally. “Still, I think the women that I see and talk to retain that traditional internalization, and they hold other women to the standard they believe in.”

“With respect, most of the women you speak to are over fifty, and their husbands are John Wayne-types.”

“Maybe. But I just don’t think men judge each other about sexual misbehavior as women judge other women who act out.”

I sort of rolled my neck, like I was straining to take this in.

“You don’t agree? You don’t think men encourage other men, even boys, implicitly or not, to be sexually active, to have as many partners as possible?”

“I’m not sure that matters with respect to the issue at hand. If women, traditionally or presently, stigmatize men for their sexual misbehavior, and you aren’t disputing that—merely justifying it, sort of—then men will have problems in relationships. Period. It doesn’t matter what the ‘patriarchy’ thinks today. If I cheat on my wife, for example, it’s not like I can say, ‘but my buddy Jay says it’s cool’ and expect everything to be all good with her. And that’s what matters to the men who seek treatment, who are mandated into treatment: they want to fix things with their partners.”

She shrugged coolly, apparently more at home debating this issue amid tangents.

“Seems to me it’s the same for women, only I think history and tradition lingers more than you believe it does. But if, as you suggest, it doesn’t matter so much—this matter of stigma, whether it’s directed by the same sex or not—then what’s this discussion about?” She shrugged again, this time presaging finality. Suddenly, she sounded weary, not so much curious, only I wasn’t done.

“Because it seems important, this question of why people go into treatment and why they don’t—why women don’t seek treatment, which is what you said today, only your bias suggests that women are being under-served, which implies women would choose sex addiction treatment if they were offered it. Like I said, it’s 2016. I think many, perhaps most women are shedding terms like ‘slut’ and ‘whore’, or trying to, anyway—and that places the problem in society, not in individuals. Meanwhile, I think men are internalizing what’s happening to some of their fellow alpha males. That lesser judgement, or entitlement, that you perceive? It has a flip side, one that’s center-stage now. Justly or not, the men I talk to take on board labels like ‘horndog’, accepting their comparison to animals, their compliant exile to the ‘doghouses’ when they’ve ‘strayed’. Then they sit with me, feeling incompetent and saying, ‘I was never raised to share my feelings’, having internalized that feminine critique also.

Joanne averted her eyes, like she wanted out of this conversation; it’s ambiguous agenda and questioning of trends. What would she do with this, I could hear her thinking. She finished her coffee, asked a passing waitress where the bathroom was. The epicene worker whom she stopped had an untroubled, these-matters-are-not-on-my-radar look about her. She (I think) wordlessly pointed to a door just beyond our table, concealed by a disorganized gathering. It was a tiny room, this bathroom—not big enough for the café’s throngs, and amongst customers, unbeknownst to café owners, it was controversially unisex.

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Sex addiction stigma debate (part one)

 

During a local talk on sex addiction to an earnest group of Saturday morning listeners, my two female colleagues, Joanne and Gina, and I gave a modest introduction to the demographics of our business. As we sat listening to one another, we gave supportive nods, affirming all of our thoughts, though in truth, a couple of my one colleague’s ideas had me bristling. One of her chestnuts concerns the under-researched area of female sex addiction: “as shameful as this condition is for the men, it is especially stigmatizing for the women.” She also said something about men being raised with a ‘John Wayne’ model of emotional expression, and were thus constricted, suffering from intimacy disorders, which in turn impacts their partners. Everyone nodded, including me, only more faintly. I didn’t say anything contrary, partly because of time constraints, partly because of the agreeable ambience in the room, and also, frankly…I’m not sure how important this issue is.

It seems worth writing about, anyway. And arguing about, I guess. As Joanne made one or two other similarly-themed remarks, I recalled the comments of her junior colleague, Gina, from a day earlier, during a staff meeting at our shared agency. At that time the context was our much maligned room schedule board, admittedly outdated, but still in use because no one wants to take time to devise a new system, or tear down our old but beloved white board, streaked as it is with cheesy black demarcation strips and years’ worth of dry erase pen smudges. An online calendar would be best, chirped our newest colleague, proclaiming it is 2016, after all, not 1972.

Not 1972. My mind turned back to the present context and Joanne’s assertions. Frozen in time, I think. Afterwards, over coffee, I told her that I thought some of her pronouncements tired and superannuated, though I didn’t quite put it like that. How so? She queried, comfortably unoffended.

“Well, let’s take the one about women and sexual stigma. You say that women feel an extra layer of stigma in society about sex addiction, and therefore shy away from treatment or recovery, which is why we have less research about them.”

“That’s right.”

“Okay, but the point seems moot, because men aren’t seeking treatment either.” Her head sort of went crooked at this point, indicating surprise and perhaps something else; a playful rebuke, maybe. I was nit-picking, or something. Anyway, I continued. “You said later in the talk that many if not most of the men in our program are mandated: there because of a court order, or a demand from a disgruntled partner. So in my opinion the more pertinent question is this: if there are scores of untreated female sex addicts out there, why aren’t their disgruntled partners mandating treatment?”

She was unperturbed by this challenge, but still waffled with unconvincing polemics. Husbands and boyfriends are less forgiving, she opined, and also—many of those women’s partners are also sex addicts; that women are more judgmental of each other’s sexuality than men are. She spoke with authority on these points, as if she had volumes of data at her disposal. We don’t know these things, I contested, though I sort of agreed with the middle assertion, while thinking the first and the third contradicted each other. We danced around items of research for a bit, eventually dissolving the ‘evidence-based’ part of the discussion and finally dropping into what’s left: what people actually think, which is what matters. I countered her first idea: “While there may be something to your first point—the humiliated male being an especially unforgiving figure—I’m not sure that history or tradition shows that the cuckolded man is a fiercer image than the ‘hell hath no fury’ woman. But regardless, as Gina would say, this is not 1272, or 1972, and by the way, millennials don’t even know who John Wayne was.”

“What’s your point?”

“My point is this: over the last generation, possibly two, most of the scarlet-lettering that happens in society—at least that which gets media attention—has been aimed at men. Or maybe you can tell me: who would be the female equivalents of Tiger Woods, Anthony Wiener, Elliot Spitzer…Bill Clinton?”

“That’s different,” she said, a bit sharply. It was on.

 

Graeme Daniels, MFT

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And sharks do not eat gas tanks

 

It’s not as though suspension of disbelief isn’t a thing. In Ian McEwan’s The Cement Garden, the reader has to believe that three children, whose parents have both died of separate illnesses in quick succession, can live undetected by neighbors, schools, police or social services, for several weeks, even as corpses rot in their home’s basement. In Jaws, that trauma-inducing film of my youth, the viewer must accept (or not think too much about) if wanting an optimal thrill, that sharks might leap across boat decks or swallow gas tanks.

In my novel, Venus Looks Down On A Praise Vole, there are numerous events, plot points and situations that stagger credulity to one degree or another, though none are fantastical in nature. Somewhat mundanely, the reader is meant to believe that my protagonist, Dr. Daniel Pierce, a psychologist, can pursue a career while regularly drinking in between sessions; that he could spend several hours in the company of a transgendered individual (admittedly in a pre-op stage) and not notice the person’s transformation; that he could forget names and patient details, not maintain adequate records, stop listening to people, actively dislike some of his patients, and still be a practicing clinician.

Well, that’s why he’s taking a break from his practice. Daniel Pierce goes on hiatus. That’s the opening plot point: his recognition of his falling apart, his need to stop working and deal with issues, some bad habits, and some losses: the estrangement of his son, the recent passing of his wife. But before he’s even fashioned a plan of restful inaction, his working life pushes back, or rather pulls him back into a working stance, only it will be a much different day on the job, what happens next. It will suspend his disbelief, make him think before the adventure’s done that he’s being seduced, patronized, rescued, recruited, chased…scapegoated.

Perhaps the most difficult event to accept is Pierce’s meeting of a former client in a sober living home. Kirkus reviews made this complaint, thinking it unrealistic that a psychologist would drop out of society, drop into a rehab-like environment, and meet one of his former patients, and even have the man as a roommate. Even if I hadn’t given cursory hints that this might happen—indicating that my unnamed setting is a small town; a hackneyed statement that the world is small—I’d grumble about this critique. After all, what’s so hard to accept? That a mental health professional would have a drug or drinking problem, need treatment or a retreat? That he wouldn’t take special care to avoid contact with his client base? Perhaps my reviewer isn’t aware that certain professionals—doctors and airline pilots, for example—do require or demand segregated, occupation-specific services, precisely because of this concern. It’s actually quite strange that the accommodations that are afforded these professional groups aren’t made for psychologists and other professional counselors.

But for me, this rather ordinary discussion misses an important point: namely, that a strict adherence to what is orthodox or realistic isn’t the most important aspect of a fiction; hence the term fiction. I had Daniel Pierce leave the structure he was in, or the rut he was in, because in order to regain his vitality and sense of mission, he has to leave not only his comfort zone, but almost his entire frame of reference. That’s an equally important axiom of drama, surely. Therefore, he has to perform an impromptu therapy in the most unlikely of circumstances; he has to not conform, challenge authority in ways he never has before. He has to observe ugliness that he’d previously been sheltered from; rethink gender, justice, his oldest notions of fitting in. In being responsible, being anything close to a heroic figure, he must consider that he may be right or wrong about the judgments he ultimately makes, but make his decision anyway.

 

 

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