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...
Jun 14, 2008 | Imaginative, Psychiatric Writings |
“I got into philosophy through cooking,” said Sharon Fitzwater. “Iknow it’s not the ordinary path, but then I’m not sure any twopaths have much in common. Resemblance may be fundamentallysuperficial. I certainly never expected I’d have so much to dowith Aristotle. It’s as much talking with him as about him. Or isit that I’m trying to talk with myself through Aristotle? It’salways been something of a mystery to me how I might go aboutgetting my own attention.” She pushed her long blonde hair away from her face. “Cookingalways fascinated me because I was so hungry. My father was amachinist in Akron, Ohio. He was very good at what he did, so he’dget called out of town often on quite short notice, sometimes foras long as a month. I’d come home from school to discover that he was gone. My mother was a different person when he was away. Even before Andy Warhol, she had a love affair withthe Campbell Soup can. She’d take a can of tuna fish, add a can ofpeas, pour a can of Campbell’s Tomato Soup on it, heat it a littlebit and then serve it to us.” “I just couldn’t get it down. My brother seemed to manage, but Icouldn’t do it. So I got interested in cooking and cooking led meto a wider world. I discovered French cooking and I discoveredChinese cooking. I’d get cookbooks out of the library and try toimagine what the recipes would taste like. I’d filch things fromthe supermarket so that I could try a recipe. The first bottle ofred wine I ever had anything to do with I stole...
Jun 12, 2008 | Imaginative, Psychiatric Writings |
Ludmilla Gribovaya We managed to get ourselves invited to have tea with the legendaryballet teacher Ludmilla Gribovaya at her Upper East Side apartmentthe other afternoon. It was a cold dark Manhattan mid-winter day. A desultory snow was falling, the flakes melting and immediatelyturning to gray slush when they hit the pavement. It was about asfar from the enchantment of the ballet as we could imagine getting. Yet, we found ourselves so excited during the elevator ride up toLudmilla Grobovaya’s fourteenth floor apartment that we literallycould not stand still. We got off the elevator, made an effort tostill our feet, sighed and found her door. We rang, then listenedto the chime echo on the other side of the door. Ludmilla Gribovaya answered the door herself. She wore a plaingray smock. She had her hair pulled back away from her face intoa bun. Without any further ado, she invited us in, settled us ina comfortable armchair by the fireplace and got us tea. Although we had trouble catching our breath, we plunged in andasked her a series of questions that seemed foolish to us. Aftera while, we found ourselves relaxing. We were able to diagnose,then, that we had been in terror of her and that the depth of ourrelaxation response was proportionate to the terror we had broughtalong with us “People talk about muscles. Yes, that is right. Muscles, yes,”said Ludmilla Gribovaya. “But that is not enough. Only a part. People talk about music. Yes, that is right. But that is notenough. Only a part. Music makes a space for dancing. Musicmakes a place for dancing. But dancing must find its...
Jun 9, 2008 | Imaginative, Psychiatric Writings |
“The amoeba’s a blob. Man’s a blob with something missing. It’sthis something missing running all the way through that makes allthe difference. The hole makes the doughnut. It’s a topologicalstep up in complexity to go from being a spherical blob to being atorus. Once the hole is there, there’s orientation. “Orientation gives a point to perception, to motion and tomotivation. Then you have emotion growing out of all that. Thenyou have the tremendous problem of sorting and refining perceptionin the service of purpose, that is, turning perception back uponitself. “I think there’s a whole topological theory of biological development that remains to be explored. I sometimes ask myself what liesbeyond the torus. Each new inclusion produces a more complicatedexploration of space and a more complicated space for exploration.” Cecil G. Wheatin grimaced. “The point is so simple and runs so deep. We’ve got a piece of theoutside inside us. The digestive tract is organized around theemptiness that fills us up. It’s the emptiness we strive so hardto fill because it fills us up. Mental function was born out ofthe need for coordination in eating. That’s where the appetite came from. I’m not meaning to debunk thinking and feeling, buttheir complexities were elaborated on a base.” Now Cecil G. Wheatin smiled, a huge ravishing smile that made himlook, even at 6’6″ and 286 lbs., like an oversized infant. “They’ve found most of the neurotransmitters in the gut. When theydid, it shocked them. The neuroscientists like to think ofthemselves as high and mighty, somehow up above it all. They’vegot it all backwards. What happened was that they found the guttransmitters way...
Apr 6, 2008 | Imaginative, Psychiatric Writings |
How I Treated The Dalai Lama Back in those days Cleveland was a steel town. It was before themills shut down. I was just starting out in private practice andI still had an office at University Hospitals. It was down in thebasement in what used to be a broom closet twenty years earlier. Even today, hospitals are busy converting broom closets intooffices. I went there every Thursday for chest clinic. I saw all kinds ofstrange cases. People with the fixed delusion that they had lungcancer. “It’s a way out, doc, ain’t it? Good as any,” said onefellow who’d been working at Jones and Laughlin for forty years. People who wouldn’t stop smoking even when they were already onoxygen. One lady actually did manage to blow herself up. A young woman who had asthma and would put herself to sleep bywrapping the belt of her bathrobe around her neck and then pullinguntil she passed out. She told this story to one of the pulmonaryguys. He took her by the hand and led her to my office. I don’tthink I’ve ever seen a more delighted look on a patient’s face. But all this is really beside the point, just background. It wasone of those cold days in November a week or so before Thanksgivingwhen the year is beginning to wind down and the clouds off the lakelooked like they were freighted with lead. Pete McCorkle said he had an interesting case for me to see. Pete had a reputation as a pretty good diagnostician. He didn’t exactly think like the rest of the guys. He was a big fellow, about six...
Mar 30, 2008 | Imaginative, Psychiatric Writings |
“It was 1973, a pretty strange time. I was young and disgruntled. I left school and was working concrete. We were using flying metalforms, pouring the walls, letting them cure and then going on tothe next wall. We were going fast. We were up on the fifteenthfloor of an apartment building in Brooklyn. There were beautifulviews of the city and the water. I also liked standing andwatching the cranes wheeling through the air and the planesoverhead. “Early one afternoon, a carpenter went over the edge of thebuilding. One step and he was gone. I’ll never forget the look onhis face. It was a mixture of rapture and terror. I was prettyupset by it. The thing I focused on was whether he knew what hewas doing. He was drunk, but I think he thought he was goingsomewhere. I don’t know where, but somewhere he wanted to go,maybe even somewhere he’d been longing to go all his life. “Maybe it was the look on his face that got me out of New York. Idrifted around the country, working when I needed the money. Ilike buildings best when you can still see the sky through them. I never have liked being shut up inside. I was working one cloudyNovember day on a new Ramada Inn on Interstate 70 just east ofColumbus, Ohio when it hit me that we were a nation of nomads. Only our tents are made of concrete. That changed how I felt. I realized I was very mad. I realized nothing in the whole worldmade me happy. Nothing “I couldn’t get the look on that guy’s face out of...
