Tag Archives: psychoanalysis

September 17, 2014 · 6:36 am

No Place To Go

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There is no place to go, nothing to do, participate in, or witness, that will achieve the elusive state that exists in Bryan “Weed” Tecco’s head. Not that he doesn’t imagine: its glory and the path backwards through memory to the thing he really wants, the euphoric recall. But it’s in the subtext now, this longing. Even at the premature age of twenty seven he’s been coasting along, living with subdued disappointment and thwarted experience; a specimen of ennui and muted self-loathing. In the post-script of this missive, I’ll give him a break and call him by his real name.

Bryan’s day job is that of a game-tester for a telecommunications giant called Sahi communications. Ten years ago the average reader of a book like The Situation might have asked if being a tester of video games was a real job, but these days, with e-sports an actuality, role-play video games more popular than film or music, the job in question might now be the ultimate career choice for the average teenage or tweenie male. Girls wouldn’t want this gift, except maybe those desperate to squeeze into the male world; one-time little sisters playing out the drama of not being left out. However, Bryan works his day job by taking it for granted, paying it little heed while using the languidly passing hours as a springboard for the evening’s moonlighting, his wax dealing side-gig. Though seemingly bright, creative, and possibly ingenious, he nurses an old wound that obstructs ambitions, his prospectively society-contributing lifestyle. In his world, whether that is Richmond, California, or the affluent, hippy back roads of West Marin, Bryan is a misfit: born without guidance or guidelines, though he is subject to hasty yet capable nurturing later on. He is destined to plunder his own path, revisit his original script of rejection more effortlessly than Chris “Crystal” Leavitt ever will. He will keep others at arm’s length, generating intrigue in some, contempt in most, but still assessing his limitations all along.

As a serendipitous adventurer, Bryan fits the bill for me, but not for Sahi, a corporate beast that doesn’t notice the special talents of its worker bees. A wildcard in their system, Bryan recognizes special elements in a game he’s been given to test; elements uncannily similar to the hallucinogenic visions (called ‘Shadows’) that he shares with his also wayward friend, Chris. Galvanized by an impulse not fully expressed to the reader, Bryan steals the files for the game, called ‘The Situation’, half-believing that he’s found a cause that will stoke a dormant heroism. In the novel’s predecessor, Crystal From The Hills, the notion of a situation is given some comic mileage as an inside joke between friends: a situation is a personified event with an attitude, and given a cosmic edge. A situation, as introduced in the first novel, is an umbrella term for an event with some manner of sentience at its core. A situation: it has opinions and feelings; it wants things, and like God, will fuck with people if it has to. It’s a signal that all things, happenings and beings that wander aimlessly, congeal in order to find meaning, reflecting the existence of an overseeing power.

The presumptions of a psychotherapist, which are perhaps similar to those of a dramatist, are that people care: they care about themselves, about their friends, their parents or siblings, their lovers. They care about their communities even, and given half the chance, lifelong frustrations or limitations notwithstanding, they’d seize the opportunity to make a difference, disrupt the presumed versus natural order of things and bring forth something like goodness. Bryan’s adversaries generally see him as an opportunist and a sociopath, and so they miss him. His doppelganger, Eric “fierce” Pierce, chases Weed across the landscape of California, pursuing him with all the righteous fervor of Javert, but also the collapsing delusion of a failing system. Pierce haplessly represents his employer, which thinks it can easily squash the individual, the fly in the ointment, “between the pincers of a superior being”, I write. But of course it isn’t superior, this corporate behemoth that is Sahi Telecommunications. It’s made up of individuals, after all: all lost in the mix. Like Bryan, it only acts as if it knows what it’s doing. Underneath the pretense, my protagonist acts as if he doesn’t stand a chance. That’s why he separates, as in separates from everything and everyone as often as he can. The backstory? Sorry (or not), this story’s not like CFTH; it’s locked into the present and future, not the past. It’s in the subtext also, Bryan’s quiet lack of self-worth.

Who he is lies somewhere in between the texts of the two novels, or else before either, out of sight of his author even, and hiding defiantly. It’s late now, a good several months since I finished The Situation, plus a year or two since I birthed Bryan “Weed” Tecco. I know he’s better than he thinks he is. I knew from the start that he’d be much more than the cardboard nasty I expose in CFTH. I thought he might be a good anti-hero, a curmudgeon with a tender heart, a bit like the John Milner character from American Graffiti: greased, beefy and sour, yet sweet enough to give a kid a break; kissing the thirteen year old girl on the cheek at the end of the night. If you read the dense yet worthwhile gem that is CFTH then you might have thought you’d seen the last of Weed, and thought good riddance (to Weed, and maybe the book, I guess). You didn’t know I had plans, ideas that were only half-thought through as I got started. I was playing it by ear, looking for redemption in a sequel, hope in ordinary guys—not even men—and believing in few things less than I do heroism, which is a problem for me, I admit. Really: the way heroism is sold in this life is a deadly lie. I prefer redemption as a concept. There’s more personal history, less of a script for others to steal, transform into something banal, there just for common consumption, or exploitation. Instead, there’s something musical, un-captured and pure. There’s even more syncopation in the sound of the word.

For e-book link for The Situation, click on the following:

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June 30, 2014 · 6:54 am

Crystal Surreal

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As my next novel, The Situation, becomes available today, I step back two years to reflect upon its predecessor, my much maligned Crystal From The Hills. You don’t have to read CFTH to get The Situation. It’s easy enough to follow the action, infer the major events of the previous novel, if not its subtext, and get involved in its story. What you might miss is the contrast between friends pictured above–the paths defined by different needs for both characters and readers: for mere consciousness on the one hand, for heroism on the other–for empathy above all. Who are you? Where are you in your life, and what do you want from drama? Here’s a few thoughts from November 12′:

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

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

            CFTH is a story that concerns itself with many ideas. It relies on continuity and the experience of ideas, fragments that have been indicated previously in the text. If you read a few pages then put it down for three weeks, then I’m sorry if I bored you. If that’s not the case and you’re just dilatory in your reading habits, then I’m afraid you may miss out. A good read is like good therapy. You don’t go once a month, like it’s a check up. You’re supposed to remember bits and pieces, like it’s embedded in your experience, and just know where you left off—no bookmarks are necessary if it works. There are associations to be made along the way. Don’t look for patterns, just experience the sense of revisiting as you note terms, phrases that appear to get repeated in the novel; themes that seem to link to one another. This is a story about accidents; personal, physical, even sexual, and habitual. It’s a story about rejection: also personal, and also institutional. There is trauma involved, and the problems related to poor memory and dissociation. You might feel what my characters don’t: that’s the point. Chris doesn’t remember much in the beginning, but builds his story along the way, and tells others, and you, what’s happening in his own time, on his own terms. His friend Sweet has an even worse memory than he does, but low and behold, it is he that becomes the chronicler of events in the end; the witness. Trauma victims need witnesses. That’s written somewhere. Above all there is a problem with reality, regressions in time, age. Characters aren’t sure what’s happening. They lack real perspectives, real goals. They don’t even use their real names. Despite all this, CFTH is actually not a confusing novel, in my opinion—not if you’re present, that is. It’s not all in Chris’ mind: things actually happen.

            Bad things happen. Evil lurks, as in any good action movie or pulp mystery novel. Darth Vader types hover, and towering infernos exist. Read the novel some of these cheeky references will make sense. Meanwhile, like the “Shadows” of Chris’ imagination or psychosis, the author and reader are witnesses to all that goes down. CFTH is a novel that may move you, or it may leave you cold, or I suppose—just to cover all bases—it may leave you feeling something (?) in between.

 

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June 1, 2014 · 8:49 pm

An Argument for Depth Therapy in Drug Rehab

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You might think that drug treatment with adolescents and psychoanalysis are terms that don’t go together, and you’d be right…sort of. Actually, a psychoanalytically-derived therapy is precisely what James Masterson, considered by many the father of adolescent psychiatry in the United States, intended for a residential treatment of troubled youth. His 1967 book, The Psychiatric Dilemma of Adolescence, offered the view that troubled kids do not “grow out of” problems of anxiety, depression, and acting out behaviors, as many of Masterson’s contemporaries appeared to assert. In this review, Masterson found that upon five years upon initial evaluation, over 50% of the adolescents previously treated in hospital settings for psychiatric conditions remained severely impaired. Although symptoms of anxiety, depression, and delinquent behaviors achieved modest reduction, some psychiatric disorders, such as pathological character traits, had not been touched upon in treatment at all.
Subsequently, Masterson was invited to take charge of adolescent inpatients at the Paine Whitney Clinic connected with Cornell University, which later resulted in his seminal text, Treatment of the Borderline Adolescent, in 1972. This book introduced the stage progression system of movement through a long-term residential program, intended to mirror the child development stages of separation-individuation as observed by Object Relations theorist Margaret Mahler. In this book, Masterson describes an initial “testing” phase of treatment in which patients relentlessly break rules or challenge staff, testing the limit-setting capabilities of staff, substituting them as parents (alloparenting, some call this), unconsciously determining who cares enough about them to maintain said limits and thus provide safety. The job of the therapists in such a setting is to convert patients from “actors and non-feelers” to “feelers and talkers”. Twenty years after this text was published, I began my career working in the field of adolescent drug treatment, though it was a further ten years before Masterson’s ideas really sunk in.
During my early years at Thunder Road in Oakland, a Therapeutic Community whose structure once bore a distinct resemblance to that described at Payne Whitney, I adapted to a cohesive treatment structure that more or less supported the Masterson approach (though few referenced him specifically), while adhering to the psychodynamic underpinning. Staff commonly used terms that were of psychoanalytic pedigree, such as “containment”, “splitting”, and “failure to thrive”; interns such as myself were repeatedly encouraged to observe transference (feelings in present relationships that are unknowing reflective of past relationships) meanings in the behaviors of patients, and more importantly, to attend to countertransference feelings in ourselves that may impinge upon therapeutic goals. Even staff not trained or educated in psychoanalytic concepts appeared to observe unconscious process in patients; in confrontation groups, counselors would routinely call out the negative behaviors, tease out the secrets of “acting out”. Then, upon the dropping of defenses, staff would zero in, often compassionately, sometimes not, upon the deeper meanings, the unacknowledged feelings.
For many in treatment this seemed not only fruitful, but also necessary, even exciting. They appreciated feeling understood. Furthermore, it seemed like common sense, this in-depth approach. Firstly, the adolescents lived in the facility and were kept clear of substances (at least, much more so than they otherwise would have been). There was clearly an opportunity for multiple therapy sessions per week, in various formats: individual, family therapy, and group. Even daily meetings were possible, and so the table was set for an in-depth therapy to occur. But the truth is that psychoanalytically-derived therapies, which call for an exploration of attachment patterns, links between family of origin memories and latter day behaviors, is frowned upon in many community mental health settings, even rehab settings wherein the intensive structure would seem tailor made for an in depth approach. There are several reasons for this, in my opinion: most concern either expediency or cost, but other reasons constitute a pronounced, if subtle devaluation of not only adolescent capacities, but also the dedicated staff that typically comprise drug treatment teams.
One assumption is that shorter term therapeutic orientations, solution-focused or cognitive behavioral therapies, for example, are easier to train to newer professionals. Their elements are easier to bullet point, sound-bite, and thus install into memory, left-brain functioning, versus the more unwieldy task of integrating a fuller experience. This is why many patients leave rehab centers armed with jargon, making glib pronouncements as to how they’ve changed; promises that all too often they cannot sustain. Often, these patients haven’t changed—not really. They’ve learned some “tools”, can parrot some phrases, maybe a few 12-step slogans. But their complex feelings haven’t about themselves and others haven’t changed, much less their understandings about those feelings. A second reason for the proscription of in depth therapy is that it is presumed to be cost-ineffective. But short term methods mean short-term outcomes, in my opinion, while short-sighted research conceals long-term effects, the attrition of growth that leads people back to rehab without understanding why earlier lessons didn’t stick. Reading this, a proponent of brief models would likely break out the sales pitch language and declare short term models “evidence-based”, and imply that psychodynamic models are not. This is untrue. Don’t believe me? Check out University of Colorado professor Jonathan Shedler’s comprehensive, 10-year meta-analysis research of over 70 studies upon the efficacy of psychodynamic models. It was published in the March 2010 issue of American Psychologist. It’ll open your eyes.
Regardless, especially in my latter years at Thunder Road, I experienced the unfortunate devaluation of psychodynamic models of care, and heard that similar things were happening at other programs. Managers began making philistine comments in staff meetings, deriding psychodynamic models as “that Freud stuff” while unknowingly using psychodynamic terms to reference current and longstanding practices. Few around me seemed to know or remember who James Masterson was, much less perceive his legacy within adolescent psychiatry. Borrowing models concurrently used in schools, clinical managers began using language connected with the Strength-based movement, which presumes a normative population of youth as the focus of care, emphasizes encouragement of adolescents’ strengths versus what is disparagingly termed a deficit-based approach. Thankfully at least, short-term models with worthy methods are coming to the forefront, muscling into the competitive arena of ideas. Most notable are the mindfulness-based therapeutic approaches, which are teaching affect (affect roughly corresponds to feeling) regulation skills (Important note: addiction is increasingly understood as a problem of affect dysregulation, not faulty cognition!), which draw their principles from advances in the area of neurobiology.

 

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May 1, 2014 · 7:16 pm

Servant of the Process: Team v. individual approaches in drug treatment

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What process? You mean the process of addiction? Do you mean the process of working with teens in a rehab setting? There are several elements of Working Through Rehab: An Inside Look at Adolescent Drug Treatment, that bear explanation. One of the more important features is this whole question of whether to treat the substance dependent individual (teen or otherwise) through a team approach or through the model of individual therapy. In a hospital-based drug treatment program, professionals assert that they work as part of a team which may include a variety of collateral contacts, each of whom may come from differing disciplines: therapists, teachers, doctors, psychiatrists—you get the point. If not characterizing a team approach, practitioners may use synonymous language, and describe their work as “systemic”. Among other things, it means that information drawn from patients, in individual, family, or group therapy formats, is shared with all members of a treatment team, in or outside of a program. The idea is to contain destructive behaviors, including but not exclusive to the addictive use of substances, and to uncover discrepancies in reporting by the patients. The premise is that addicts lie so the information they share with individual therapists is not reliable. As a result, traditional rules of confidentiality are loosened, especially with patients mandated through legal authority, such that the priority task—interrupting problem behavior—is more likely achieved. The argument goes something like this: since patient disclosures are unreliable, the traditional ethos of treating disclosures as sacrosanct is misplaced. Therefore, in a hospital or group home setting wherein therapists are operating from a “team approach”, individual counseling sessions aren’t really what they appear to be. There are invisible parties in the room.
For the most part, I have supported this therapeutic stance, especially on occasions (more numerous than not, actually) when it seemed obvious that patients were not truthfully reporting either cravings or continued using behavior. It has often seemed that if programs are to really intervene with a pattern of drug use, then it is necessary to maintain a skeptical position with a patient; to not get caught up in a patient’s denial system, and to consult with others—in short, to not get fooled. To work in a rehab setting and learn the ropes is to have the experience of being played by slippery drug addicts, over and over again, until this lesson is learned. Problem? To share information with colleagues and collateral contacts risks stalling or undoing the fragile trust-building that all therapists must achieve with their patients. So what, I hear the average drug counselor saying, especially those of the so-called old school variety. That trust-building isn’t happening anyway, they’d argue. After all, it is the addict, not those who live or work with them, who fail the exercise of trust. It is they who fail to trust others, family, friends, and helpers, by repeatedly not sharing the truth.
These are sound arguments that routinely bully therapists who otherwise hope to not waste their time with reticent, untrusting patients who will likely resist the spirit of help being offered. Despite my overall support of the “addiction model” ethos, I nonetheless think the arguments of individual therapists, particularly those working outside the addiction model, make compelling counterarguments regarding the loss of confidentiality. From this tradition, derived from a plethora of psychoanalytically oriented therapies, the patient in therapy must be assured that their disclosures will be treated confidentially. To do anything less would compromise trust and inhibit disclosures, rendering therapy an exercise in compliance—not meaningfully different from a relationship with a teacher, probation officer, or some other obvious figure of authority. Trust-building is a long-term task that can and should transfer to personal relationships, enabling meaningful dialogue about difficult subject matter over a lifetime. Trust-building isn’t simply a therapeutic nicety that will allow a therapist to have cordial exchanges with a reluctant patient. Secondly, and perhaps most interestingly, some argue that the containment bias of addiction model proponents sets up an artificial situation, one that is ultimately unhelpful to addicts and their loved ones.
To explain: one of the most difficult things for a loved one to say to the addict is something like “I don’t believe you. I think/feel you’re lying.” Fundamentally, it feels unempathetic and disrespectful to confront someone in this manner, and therapists usually feel a parallel dilemma: how to confront with tact while not rupturing the therapeutic bond. Paradoxically, many therapists have found that when they do confront lying behavior in patients, tactfully or not, it often improves the bond as opposed to disrupting it. Some of the best moments at Thunder Road occurred when committed staff, on the back of a solid bond with a difficult kid, pronounced its belief that the patient/addict was lying. This action, fraught as it is with anxiety and risk, enables the therapist to more fully empathize with the oft-gaslighted loved ones of addicts, those whose entire lives seem to revolve around similarly painful dilemmas: what can I say when my gut tells me something’s not right? What’s the easiest way to say I don’t trust you, don’t believe you?
No model of care is perfect or even close to being perfect. Addiction models and traditional psychotherapeutic models are not mutually exclusive, and don’t believe anyone who tells you they have evidence of what works and what doesn’t. They’re lying.

 

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April 27, 2014 · 4:11 pm

Fill My Holes, Please

You’ll have to get past, way past, the innuendo in order to read this one. But it is about sex, not drug rehab.

This is a story about the birds and the bees…and insects. I’m referring to Nymphomaniac, avant cinema provocateur Lars Von Trier’s last installment of what’s dubbed the “depression trilogy” (the other films are Antichrist and Melancholia). If you’ve heard anything about this controversial 4-hour, Volume I & II epic (apparently 5 hours in its uncut version), then you’re likely aware of the explicit sex scenes, the use of digital compositing to superimpose the genitals of porn actors over those of the film’s actors. You may be less aware of its dense symbolism, thematic complexity, and stridently taboo outlook.

Charlotte Gainsbourg plays Joe, the self-loathing title character, discovered beaten and bruised in the film’s opening scene by a diffident, scholarly recluse, Seligman, played by Stellen Skarsgard. Refusing either medical attention or help from police, Joe accepts Seligman’s hospitality, returning to his humble home, a sparse, shabby room, wherein she can rest, recuperate and, as it turns out, tell the long confessional story of her self-proclaimed nymphomania. From the outset, Joe makes it clear that she is ashamed of her sexuality, saying she has callously used people throughout her life, and that she therefore deserves the brutality she has endured. Seligman listens intently with a combination of sympathy and detachment—less a confessor than an analyst. No solution-focus in his repertoire. Still, he confronts Joe’s self-loathing, challenging with intellectual arguments that compare Joe’s behavior to that of an immature insect (the definition of a nymph, for viewers who don’t know). He also weaves in references to mathematics and religion, and in so doing, becomes a comic counterpoint to Joe’s compulsive hedonism, and also an unlikely listener. He is a forgotten kind of neutral: not only “non-judgmental”, he is a virgin, perhaps a eunuch.

Anyway, Joe seems to trust him, though she is irritated by his tangential curiosity in academic versus taboo or sensual matters. She attempts an argument that she is evil. His rebuttal is a proclamation of what is merely natural. Thus, Seligman is undisturbed by the story of Joe’s once teenage competition with a rival to see how many anonymous sexual conquests can be made on a train. As she recounts one presumably disturbing sexual episode after another, he maintains his cool, non-judgmental stance, ever keeping the horror at bay, ever blocking an imagined audience’s shock. The character of Seligman seems like a stand-in for Von Trier: fascinated, but rebutting society’s finger-wagging, defending sex. However, Joe is a tough, complicated patient/penitent. Her shame is powerful, but so too are her defenses. In Volume I, we learn of her “pact” with peers that entails the rejection of love. The compulsion to act out sexually is integrated into a philosophy that normalizes exploitation and quietly justifies an ongoing and progressive habit. In her confessional, Joe disdains sentiment, and alternates her self-loathing with fiercely defensive diatribes.

Volume I ends with a crisis of sorts: Joe’s sexual tolerance (in addiction terms) has peaked; she can no longer “feel anything”. In Volume II, after experiments with sado-masochism, among other things, the specter of “treatment” for Joe’s nymphomania is finally raised. But she rebels against the pedestrian and “bourgeois” therapist who prefers the term “sex addict” and who glibly counsels Joe to methodically abstain from her sexuality. After three weeks of abstinence, Joe stands up in a support group, subverts the implicitly rote exercise, proudly declares that she “loves her cunt”, and triumphantly walks out of the session. Shame? It comes and goes in this story framed largely around flashbacks. Only as she ages and the present-day telling begins does she contemplate the emptiness within her double entendres: “Fill my holes, please”.

And it is ambiguous when the shame began for her. As Joe tells the backstory of her nymphomania, a younger Joe is characterized as a somewhat blank, almost doltish (though not innocent) figure, played by novice actress Stacy Martin. As a teen and early twenty-something, Joe seems dissociative, not exactly there, whether seducing a future husband, Jerome, or scheduling-in a series of lovers into her daily routine. Even when confronted by a lover’s humiliated wife and pre-teen sons (a dark but comic scene featuring Uma Thurman), she seems unmoved and distracted. Meanwhile, Joe neither seems seductive or even flirtatious with men, mostly because it simply isn’t necessary for her to be so. It’s as if Von Trier is making an adjunctive statement about male sexuality, one that—from the POV of a man—makes for uncomfortable viewing: namely, that seducing men doesn’t require much effort, much less qualities like charm. To side-bar into something self-serving, she reminds me of my character Chris Leavitt from Crystal From The Hills, who I think is difficult to like or become interested in, largely because of his dissociated, secretive, not there qualities. Yet having readers like him is the task, wrapping backstory and more energetic characters around my wayward protagonist because the traumatized have an important story, whether they tell it well or not.

So it is with Joe, though because we meet her elder version as an articulate and wounded storyteller, we perhaps feel more hope for her character, and more understanding from her POV. Nonetheless, her sexuality is an enigma: there seems to be little joy or even creativity in Joe’s past or present scheming, such as we might expect of a womanizer. For example, when seemingly traumatized by the delirium tremens of her hospitalized and dying father, she ventures down into the belly of the ward and is soon naked, bucking rhythmically atop an anonymous orderly. For Joe, getting laid is about as difficult as finding a break room with a vending machine. I make this point because amid the controversies that Nymphomania will likely spark, few will draw attention to how men are depicted. That’s because this is a film about a female protagonist as directed by a man, and is dominantly about women’s sexuality, so no matter how unflattering this film may be of men, it’s still far more likely that Von Trier will be accused of misogyny.

Regardless, of all the provocative tidbits in Nymphomaniac (there are soapbox moments about pedophilia and race for example) I think the most important issue concerns the filmmaker’s apparent attitude towards the genesis of Joe’s nymphomania. Using Seligman as a mouthpiece, Von Trier essays that Joe’s affliction, if it is even to be called that, is a natural condition, versus, say, a proclivity borne of childhood sexual abuse, as might be supposed by many viewers. I will admit to supposing this, partly because trauma is the etiology of Chris Leavitt’s affliction in CFTH, but mostly because Joe’s father, played by Christian Slater, is an alcoholic to whom Joe betrays an element of Electra complex—I made a guess during Volume I that Joe’s attraction to the mechanically inadequate and even mathematically precise lover, Jerome (8 thrusts: 3 missionary, 5 from behind) is a reenactment. Alas, there’s nothing in the film to substantiate my interpretation. Von Trier’s position seems to be more or less a Freudian/Kleinien statement: an assertion that human beings are sexual as infants. Without apology, Trier eschews latter day speculations of traumatologists, not to mention polite society, which remains horrified, not only by pedophilia, but also by the notion that children can have anything like sexual feelings. Seligman’s mini-speech towards the end—an unfortunately trite statement declaring that, if anything, Joe has been oppressed by a patriarchal society—suggests a feminist sympathy and a rebuke of mainstream prurience. Maybe Von Trier remembered some things as he was writing this story. Maybe he felt ashamed.

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Aside

Fictions from memory

At the outset of a psychotherapy episode, a man referred to me by a trusted colleague outlines goals drawn from a course of group therapy: “I’d like to get to the root of my anger,” he says. I nod, affirming that this seems a worthy goal, though in truth I’m not sure what he means. I mean, I know what a root is, and I know roughly what is meant by the phrase he uses. But I feel uneasy, because I don’t know how to get to the roots of this man’s problem. I don’t think we’ll decide upon something; at least, not in the tidy, package way that treatment plans and opening discourses on therapeutic goals suggest. I don’t think that anyone would find roots to a problem in the sense of finding a definitive answer.

In the first five chapters of Paul Renn’s Silent Past and Invisible Present, the reader gets a review of neuroscientific thought relating to trauma, the formulation of memory; the history of psychoanalysis and its treatment of trauma; how it conceives of childhood memories as either the product of fantasy or else real life events. I am reminded that Sigmund Freud once attributed fantasy wish-fulfillment to patient who reported seduction by a friend of her father. While acknowledging the real-life event, the focus turns to the intrapsychic as far as treatment is concerned, and the case study appears to predict the later disputes between the likes of Klein, Fairbairn, and researcher John Bowlby.

We have declarative memory, autobiographical information that speaks to who we are, or who we think we are. Emotional memory, including thoughts and feelings operating in a relational context, shapes memory and fosters experience of reality. Trauma, the readings propose, distorts or inhibits play, wounds consciousness, and generates false equations, the psychic equivalence between internal reality and external reality. “I know for a fact that she hates me,” said a teenage client once to me. I could not have convinced him otherwise—not that I tried. This problem likely stemmed from the aggregate of events that could not be remembered in detail, or symbolized by verbal description. They were rooted in affect dysregulations, the creation of a false self as trained through misattunements. The amygdala of the limbic system will have been developed to interpret cues coming from early caregivers, process the fight/flight emotional response and provide emotional meaning, and activate memories such that they are experienced thereafter in the moment, as if time stands still. The Hippocampus, that evaluative organizer of information, is inhibited in times of trauma, suggesting a triage of tasks that strikes us as—what?—short-sighted? I suppose I could reflect on experiences of cold feet and sudden holes in my stomach to relate instances of my enteric nervous system influencing my own reactions—memories in my body.

In reading chapters four and five, which seem to recapitulate post Freudian psychoanalytic theory and the debates of its adherents, I note the familiar divides between the likes of Fairbairn and Bowlby, versus Freud and Klein. I continue to wonder if the disagreements were overstated, and that a difference in accent, as in the weight of focus, was most apparent. For example, could not an emotional attachment to a caregiver (Fairbairn, Bowlby) be thought of as a subset of drive theory, in so far as a libidinal gratification is derived from an attachment to a caregiver? After three years of intermittent exposure to this chapter of psychoanalytic history, my philistine curiosity laments, what was the fuss all about? I appreciate the author’s reminder about Winnicott’s notion of the “capacity to be alone”. It seems to me an eloquent statement of the value of silence, as experienced by two people sitting in a room together, experiencing a feeling. It’s not a shared experience per se, because the autobiographies are different, and because each person’s experience of emotion is different. But there are therapeutic values present: empathy, attunement, a witnessing. I think I have these experiences. Finally, I am introduced to the term hermeneutic: the understanding of subjective inner reality, with a distinction drawn between historical truth and narrative truth, between real events that might not have occurred, but are nonetheless “true”. This notion is a tantalizing one. It lets me off the hook from knowing, and I’ve always liked that aspect of my chosen business. The problem is: it lets me off the hook from knowing.

In my novel, Crystal From The Hills, Chris Leavitt copes with his traumas, recent and past, with distortions, and through play: it is play gone wrong for an adult male with responsibilities and a supposed bright future ahead of him. What he really wants is to go back in time, pretend nothing happened, both on an intellectual and emotional level, and start life over again. The problem, solution, and the hope, lies in the witnesses: the impromptu, reluctant therapists that are the people around him. He believes what has happened to him, whether it has or not, because it fits his narrative truth, and his courage–his happy, yet unsentimental ending–is in facing his distortions.

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February 2, 2014 · 8:39 am
January 7, 2014 · 9:54 pm

Working Through Rehab: opening salvo

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So, you’re thinking of placing your kid in rehab? Or, maybe you’re thinking of getting a job in such a place, as a counselor, social worker, therapist, or whatever they’re being called these days. Do you know what it’s like being in rehab, or working in one? Have you visited a drug treatment facility, or heard stories from your neighbor who sent their kid to an out-of-state boarding school the previous summer, and later discharged just in time to begin senior year in high school. Are boarding schools the same thing as rehab? You wonder. A doctor outlines options: suggests therapy for a troubled teen, or an assessment at a nearby hospital, which boasts detox facilities and an intensive outpatient program, committing kids and their families to eight weeks of group and family therapy, ten hours a week, not counting the 12-step meetings that counselors will ask participants to attend on the weekends. A residential admission is the next level of care. It is the last resort as far as professional intervention is concerned—the last stop on the treatment ladder.

            Do you want this? Need this? Does a kid getting referred to rehab even have a choice: Meaning, is a court presenting rehab as an alternative to incarceration? Or are the parents the mandating authority? Perhaps your kid’s best friend has called you up, or texted you anonymously, warning that he or she is drinking or smoking much more than you realize, or “experimenting” with some other, supposedly more hardcore drug—one that will really scare you. You notice the kid’s grades are going down, and that more time is being spent with sedentary, seemingly anti-social activities: marathon spells of video-gaming; the vague notion of “hanging out”. What happened to that kid that seemed vibrant a year or so before: polite, energetic, and gregarious. Is this normal adolescence? You worry. How long do you wait to see what happens?

Maybe this isn’t your story. Maybe you’re a parent who has struggled with your own substance use. Maybe you’re an addict, and it seems like your kid is following suit. You don’t know what to do, or even if, given your own history, you have the aptitude or even the right to speak your concerns. After all, did you listen to adults when you were a teen? So, your kid is staying out all hours, has joined a gang, become a dealer as well as a user. Involvement in the juvenile justice system seems imminent, if it hasn’t happened already. You’ve already had several phone calls from Child Protective Services; one or two home visits. You and a couple of county social workers are on a first name basis.

Maybe you’re a fledgling member of the mental health profession, and working with troubled kids seems like a good idea: a stepping stone to a career as a social worker, a teacher, or, if you’re really stupid, a psychotherapist.  You’re a tweenie that’s looking for a job while in school. Or you’re a journeyman counselor that’s just completed requirements for certification as a drug and alcohol abuse counselor. An adolescent drug treatment program, attached, say, to a larger hospital, will offer steady employment, some modest benefits, if not a particularly competitive wage. You’re okay with that, maybe…for the time being. You want to reach young minds, work with those who may be more flexible in their ways, feel more hope than the adult addicts you’ve known. It will be less depressing, you think, working with kids.

Now that you’ve read the brochures and the websites of various programs, or taken tours of their sterile, hospital corridors and dorm-like accommodations, settle in for a first hand look at what happens in adolescent drug rehab programs, from the ground up, because that’s where I started. To do this properly, I have to go back in time to give some history, some context for what is happening today, especially in residential programs, for while some things have changed, others have not. Along the way, there are markers of change, nodal moments in my working life that in my opinion reflect trends in the business as a whole. If by the end of this text, the reader still wants to enter this field, or admit his or her child to a rehab like the ones I worked at, I’ll have no complaints. Just consider this the longest informed consent form in rehab history.

** opening of Working Through Rehab: An Inside Look at Adolescent Drug Treatment

 

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September 13, 2013 · 5:21 am

Everything We Love Vanishes

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

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

 

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August 26, 2013 · 8:00 am

The Mirror Defense

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

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

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

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July 11, 2013 · 9:39 pm

Letter to a therapist friend

 

Hi, sent you a message a few nights ago, haven’t heard back, which isn’t like you. I’m not taking that personally (unless I should be?), but I thought I’d reach out again, imagining you may still be feeling hopeless, as you were last month, mostly because of work. 
I hope this doesn’t sound self-serving, but I think my modest, self-published book about drug rehab and community mental health as a whole does provide hope to those who work in this business. Many like yourself are smothered by the platitudes of directors, administrators, and so on while otherwise feeling technocratic shards of glass pierce into their sides. I felt in your reaching words something(s) unachieved in our world: passion, bravery; risk inflected with humility. I could feel it in your depiction of that unsatisfying exchange with your manager. A “nice” man, you said. It reminded me of something an old SN once said to our group of supervisees in the three-year program: “there’s nothing nice about being nice”–it was in response to a fellow student who was struggling to manage frame issues, and justifying a lack of confrontation by declaring that confrontation was…well, not nice. In my book I am scathing, I think, about rigid adherence to procedure–the tyranny of the HR manual–when not just common sense, but common thoughtfulness, decency, but above all realness, is called for.
 
There are times when I think that the Masterson model can truly be distilled into these qualities. I reflect on my caseload at any one time and I think, with whom  do I feel spontaneous? who do I really know? what connections feel real to me? More often than not, the best work feels like a jazzy, flowing sense of knowing…something that feels right. That may sound a little soft, and a lot unreliable. It certainly doesn’t sound very “evidence-based” or scientific, or “quantifiable”. But the thing is this: it sounds reliable to me. The reason? I trust myself, whether others do or not. Doesn’t that sound wonderful? Doesn’t it sound like a gift, or a real achievement, if I’m to give myself the credit for doing the work. I’m not saying I’m getting it right with all my patients. I’m saying I can tell who I’m getting it right with, and who I’m not getting it right with.
 
I agee that being in the quadrants is tantamount to being unsober. I think this was the basis for our original discussions about blending the Masterson model with a 12-step program. I’m working on myself as I flit in and out of defenses; my therapist is fighting me, I think–thinks me defeatist in my self criticism. Among other things, I defend the hard but fair pronouncements that KS made of me last year. I realize that his cool yet cutting approach stirred something vigorous yet frightened in me. It all lingers, the hurt. I was surprised to read that you “identified” (with being seen? or the “bad” experience you referenced), as I specified being seen in a manner that felt menacing, even sadistic. Did I misunderstand you? Were you writing of being scrutinized, and by KS in particular?
 
You wrote of vulnerability in your last e-mail, “to the toxic foolishness”. I identify with this vulnerability, though I think I have some of the detachment you crave. I’m not entirely free of bad systems. Indeed, there are one or two that are threatening to ensnare me in a fight currently (perhaps more on that in a later e-mail). But TR is nearly two years in my rear view mirror, and completing the book has been, dare I say, cathartic. Anger is draining, despite the sneery, superior tone sometimes evident in the book and especially within this accompanying blog. Whether a handful of people read it (the book), or hundreds more do so, I have cleaned my own internal system of the toxic entity that once dogged me. I have gotten some peace. Like a Schizoid personality, I also have a fantasy, which I’ll share with you: you see, in the future, I imagine achieving a modest, measured (compromised?) fame for my lengthy missive to my peers. I’ll be asked what I think should happen in drug rehabs for adolescents; perhaps what should be happening in all community mental health settings. On the specifics I’ll defer, I think, as I choose to disentangle from Gordion Knots, practice something like a second step, and wait for help from those on the inside. I don’t want to abandon. I don’t want others–least not people like yourself–to give up hope. I just think I need back-up. I need the real selves to present in numbers.
 
Graeme

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