Mar 13, 2010 | Clinical, Psychiatric Writings |
I am listening to the psychiatric resident describe her session with her patient. She is well along in her training, reasonably poised and reasonably convinced in her approach. She is telling a story and, in this story, she comes off as both kind and competent, The patient comes off as a bit confused, clumsy, dependent, not very good either at thinking or feeling. The patient seems pale and out of focus. I keep wanting to sharpen the focus to make the patent clearer. Of course I can’t do this. I am mildly annoyed that I can’t – mildly annoyed at the patient, at the resident and at myself. I ask myself, “Why do you ask for the impossible? Why can’t you just be patient and let things be what they are and find their own natural pace of development? I am sitting in my rocking chair. I am, as more than one patient has pointed out, “on my rocker.” My rocker is a beautiful hand made cherry rocker with flexible back slats so constructed as to provide considerable unobtrusive lumbar support. The chair is the vanquisher of the back troubles that were incipient when I got it. For this, I am very grateful to it and to my wife at whose instigation I got it. It is the single most expensive piece of furniture I have ever bought. I remember how acutely uncomfortable I was waiting for it to arrive from northern California nine months after I had ordered it, how worried I was that after all the expenditure of money and effort I would hate it. I do...
Mar 13, 2010 | Clinical, Psychiatric Writings |
I sometimes urge that I should be titled the Vicar of Towson, since I specialize in vicarious experience, sitting and listening and living with what people tell me. I do this on the grounds of Sheppard Pratt, one of America’s great old and very beautiful mental hospitals. Just outside my office is a beautiful old ornamental cherry tree. I have lived in Towson immediately north of Baltimore for more than twenty-five years now. I am acquainted in depth and detail with many parts of town where I have never been or through which I have passed only occasionally – Dundalk, Glen Burnie, Pikesville, Pig Town, Randallstown and so forth. There are houses and and dinning rooms and basements and kitchens and bedrooms and yards and woods and school rooms that live vividly in my mind although I have never seen them and they existed in other times and other places. I have lived vicariously, too, in foreign countries – Israel, Iran, Zimbabwe,France, England, Trinidad, Argentina and more Proust wrote that “the only real voyage of discovery consists not in seeing new landscapes, but in having new eyes, in seeing the universe with the eyes of another, of hundreds of others, in seeing the hundreds of universes that each of them sees.” Psychotherapy is an art of such listening that the other can world forth a world, this world being his world – and have it shared, not statically, but so that it can live and breath, declare itself and grow. Psychotherapy is a partnership in presence. A good psychotherapist is a gifted story listener. In his great ballad about...
Mar 11, 2010 | Clinical, Psychiatric Writings |
Don Quixote, the incomparable, comic, tragic, absurd, possessed by his destiny, dispossessed of his life by his destiny, an explorer who leaves home to find himself but loses himself in trying to find himself, someone perpetually homeless and proud of this homelessness as a quest for the impossible but imaginable. Sancho Panza, a man like other men, moored in a web of human relationships, not so very grand, but very real, a nobody who is somebody by reason of how he carries being a nobody, being as close to the earth as any other clod, capable of a loyalty that is itself a kind of realization of the imaginary, someone who lives as himself but not so much for his own sake. A distinguished, tall, thin. extremely learned, very ill elderly man came to see me looking for I didn’t at the time know exactly what and I still don’t know exactly what it was that he was seeking. I find myself thinking he was looking to be made whole. In life as in the law this concept of being made whole is no simple one. This man yearned to be restored to being who he thought he was. Actually it went far beyond yearning to an insistence that bordered not only on religious faith but on an idiosyncratic religious fanaticism – “I can only be if I am who I take myself to be, even if who I take myself to be is not only complicated but also multiplex, fabulous.” Ailing had been an integral part of his life, reaching back into childhood. Part of ailing was an...
Jun 18, 2009 | Clinical, Psychiatric Writings |
I have worked on the telephone with patients from twenty-five to seventy-five, men and women of diverse backgrounds and dispositions. I have always started with them in the office and then good reasons intervened to make it make sense to go on on the telephone. This work has spanned states, countries, hemispheres, the complexities of time zones. It is a testimony to how remarkably robust communications infrastructure has become that this has been possible. There are limits, too. I have never tried working with a patient who was acutely or chronically suicidal in this way. I have never tried working with a floridly psychotic patient. One woman who was on the other side of Mississippi from where I am here in Baltimoreused to end each session by saying quite brightly, “See you next time.” It was some time before it struck me just how remarkable this sign off was because in the usual sense related to the visual apparatus it was precisely seeing each other that we could not do and would not do. But, of course, I think she meant another kind of seeing, one constituted by emotional presence in relationship mediated by inner attachment processes that guide imagination. So I found myself slowly wondering how presence is constituted. We often speak of it as if it had primarily to do with shared location in space and time. But perhaps it is much more imaginary than that. Yes, it requires some back and forth as a condition,but many different kinds of back and forth are possible. I realized that I had patients who came to see me in...
Jan 27, 2008 | Clinical, Psychiatric Writings |
The major work of psychotherapy is in the “being with,” a task that inevitably calls upon our resources in being with ourselves, a process that is always in development, that is, always involved with struggle, impasses, reevaluation, creative surges, disillusionment and reillusionment. To be useful to our patients in large part depends on our capacity because of her capacity to stay with our own difficult and distressing affective experience, in therapy and outside of therapy. It is the “being with” that brings affects from what we might refer to as a vapor state to condense until they achieve representability, even crystallization. Where we speak so much about affect containment, we might do well, as Erna Furman has pointed out, to speak of affect attainment. Of course, attainment and containment are two aspects of a single process. Our involvement with others is a mystery, not in the sense that we should remain quiet about it, following some dictum like Wittgenstein’s “Of that whereof we can not speak, thereof we should remain silent,” but in the sense that, whatever we may say about it, there is always more, something about what we have said that falls short, is wrong, does not fit, raises more questions than it answers, deeply unbalances us just when we thought settling the matter (and ourselves) might actually be in our grasp or at least almost in our grasp. Of this mystery of our involvement with others envy is a large and central part, a province teeming with life and hope and despair. Envy means lack, want, desire, insufficiency, incompleteness. Envy is a means, not just an...
Oct 10, 2007 | Clinical, Psychiatric Writings |
“I don’t know when shame came to live in my house,” observed a woman in her early fifties, “but once it did, it moved from room to room until it had taken over the whole house.” Although she did not say this in so many words, the implication was that once shame “had taken over her whole house,” there was no place for her to live. If we live in our minds, as surely we do, although not only there, then she was psychicly a homeless person, rendered so by her shame. Notice, too, that her shame is dynamic. It moves from room to room. It takes over. It grows and thrives at her expense. It is a very dangerous parasitic life form. Remember, too, that houses often stand for selves. These are often every bit as ramshackle as old homes, every bit as difficult to maintain. Where might shame come from? How does it enter our homes, ourselves? One place to start is with the name, itself, “shame.” The Oxford English Dictionary traces one speculative origin of the word “shame” back through a pre-Teutonic “skem” which in turn connects to “hame”, “A covering, esp. a natural covering, integument; skin, membrane, slough (of a serpent). It also quotes Darwin, in Emotions XII 321, “Under a keen sense of shame, there is a strong desire for concealment.” I am not learned enough to know if there is a word for shame in every language, but I can venture that most have such a word and if some do not, then the underlying cultures would be very interesting for the study...
