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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

Working Through Rehab: Growing out of it

 

In Masterson’s The Psychiatric Dilemma of Adolescence, published in 1967, the problem of treating kids in the psychiatric setting is exhaustively examined. Noting the tendency of clinicians to dismiss diagnoses of clients, saying “he or she will grow out of it”, in reference to a plethora of acting out and mental health problems. Meanwhile, Masterson recounts that social scientists in the 60s were attempting to organize the phenomena they studied, rather like researchers of the physical sciences, and thus methodology changed; so-called objective research, focusing upon variables like validity, reliability, and statistical analyses, were coming to the fore and changing the ways clinicians addressed problems. Masterson, however, grew conflicted about the differences between the social science methodological point of view, and his and others’ clinical observations.

Masterson found after his twelve year study, that 50% of the adolescents he studied did not “grow out of problems” upon five year follow-ups, and that while symptoms like anxiety, depression, and acting out (with sex, drugs, or violence) did diminish, but that which brought the most difficulty, in terms of sustaining meaningful relationships, activating healthy goals, ambitions, accessing creativity and self-care–their pathological character traits–had not been touched upon in treatment…at all.

As much as anything, my reflections in Working Through Rehab: An Inside Look at Adolescent Drug Treatment, are derived from Masterson’s implied warnings about the costs of a superficial treatment approach. I recall working with a young lady in my private practice–a late teen–who was supposedly drawn to relationships with boys “from the wrong side of the tracks”. Much thought, encouragement, argument, and time had been put into making her see reason, re-think her “choices”, and make “rational” decisions. The cognitive dissonance was pervasive: she wanted safety and “respect”, but was drawn to men inclined to hurt her. She wanted independence, but ended up feeling anything but. She was drawn to the bohemian, the pull of rebellion, and found separation in rejection of her family’s fears. Little did she know how conflicted she was with herself, not others, and how long the conflict would last if she did nothing about it. In my first novel, Living Without Blood, I presented the consequences for a family living by the rule, “time heals all wounds”. The Metcalfs  discover that time passage without conscious intrusion does little more than fossilize understandings, generating alienation.

In Working Through Rehab, I depict therapeutic environments that are either forgetting, actively disregarding, or plainly ignorant of Masterson’s now forty year old caveats. Programs working with kids are operating upon the assumption, “they’ll grow out of it”, seeking to emphasize kids’ positive traits in the hope that their deficits will fall away under the power of love. Or, they’ve taken a subtly defeatist tact, thinking the wounds are too great, the fossilization too hard and too widespread, such that the roots of problems are impenetrable.

Do you think this, my would-be reader? Are you a mental health practitioner? A consumer of services. Who are you that you might be interested in this topic? Who do you need to be? Who am I to make pronouncements on trends that flit in and out of fashion, some sticking, some not. Who do I need to be?

 

 

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August 13, 2013 · 8:57 pm

 

Here’s a passage from my novel, Crystal From The Hills, about an accident, a trauma, a disappearance, and a mystery.

Chris’ parents, not long before Eric’s death, actually had one more shot at reconciliation—a brief one in late 2001, under tragic, yet bizarre circumstances. Nancy’s then husband and former lover was a financier in Manhattan, and died, it was later presumed, in the 9/11 attacks. It took several days for this conclusion to hit home. Initially, Nancy held out hope like countless others, thinking or rather assuming at first, and then later praying, that her husband’s failure to respond to calls following the breaking news would be easily explained. The phone service told a cold, disinterested story: “That caller cannot be reached at this time.” It persisted with that message, like an aphorism of cosmic loneliness. Eventually, that message gave way to the more earnestly sepulchral, “That number is no longer in service.” She spoke to Chris on that terrible day, as well as many others. Their call was cut off—twice—as others, friends mostly, desperately tried to get through. Chris was understanding, but struggled nonetheless with the implication of relegated status. Frantically, Nancy would put him on hold, and promise a return call in minutes. An hour passed, followed by another interruption—this time his mother apologized, sensing for the first time that she was indulging herself at the expense of her son. Then two days passed without hearing anything new. Nancy had made arrangements with friends to take a pilgrimage to what was already being dubbed “ground zero”, to walk around with a photo in hand, and to pin copies along with flyers upon temporarily erected bulletin boards.

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April 4, 2013 · 6:24 pm