She Is Telling A Story

She is telling a story as she has been telling a story for years — this imaginary person, this imaginary patient. This story is not one story but many stories nesting in each other, sometimes bursting into flight to land somewhere else and make a new beginning. She is a reliably unreliable narrator. It is not even clear when she plots beforehand, when she does not, when she is speaking for calculated effect, when she is speaking because she can not help herself, can not any more impede the rush of words from her mouth, She is present at once so carefully and also so self-indulgently. There are so many of her and and this crowd is not even one. I am listening to her story as I have been for years — this imaginary person, this imaginary doctor. I am listening to her and I am making it up as she goes along. I am breaking it into pieces as she goes along. I am elaborating these pieces as they wake me up and develop fingers of dream that reach from her into me and touch me not in one way but in many ways. Listening to her is a kind of ecstasy that almost lets me stand outside myself except that I keep tripping on the threshold. As she is a reliably unreliable narrator, I am a multiply and extravagantly unreliable curator of her story, not from malice, but out of that most peculiar hope of helping. This hope is imbued with pride and shame, the two sides of an exquisite fabric. Look at this side and... read more

End of Life

When we discuss end of life medical care, we have to be careful to recognize that the word “end” has multiple senses. We regularly mean it in the sense of “terminus”, where life reaches its stop, its limit and is no more. but we need to remember that “end” also has the sense of purpose. Is life an end in itself? Is life good in itself, no matter how painful and restricted it is, no matter if a person is utterly demented or comatose? If life is good in itself, an end in itself, then whose good is it? Is it a personal good, a social good, a theological good, a combination of all these? Of course the question of what life is for, what its end is comes up for us everyday in our living, if we let ourselves arrive in the vicinity of the question “How shall I live?” and dwell there. What gives lives its worth is not the same for all persons. In fact the diversity is staggering. What life is for, what its end is is not the same for one person in different phases of his life. Different people identify themselves differently with different faculties. When persons can not communicate with recognizable lucidity or at all, then we are in the realm of inference about their dispositions. Inference calls for what can be excruciating... read more

Freud’s Lasting Achievements

Freud’s two great contributions were taking child mind seriously in a new way and taking the possibilities of intimate communication seriously in a new way. For Freud, the mind of a child was a marvel in development, that is, a moving marvel with its own predilections. He believed we encountered the history of the child mind in the predilections of the adult mind. The vast field of inquiry into child development received enormous impetus from Freud’s theories. For Freud, a special kind of emotional intimacy, a special kind of conversation, one he called “analysis”, made possible changes in how we experience not just the world around us, but ourselves. Psychotherapy, in all its variety and peculiarity, was born out of this new emphasis, which, of course, hearkened back to rabbinical practice and confession, perhaps also to shamanism. Both of these fundamental notions of Freud, taking child mind seriously and taking the possibilities of emotional intimacy seriously, have borne rich and varied... read more

Shame

Shame is a raw psychological surface, a prototypical border, a first draft of skin. When early attachment is difficult, shame acquires the status of an active drive to avoid what is intrinsic to us because acknowledging it might not be compatible with our survival. Shame is arousal we disavow, perjuring ourselves in a realm before conscience, which may later prosecute us on this basis for crimes of which we have only the dimmest, most diffuse and vestigial awareness. Shame is the origin of much of the disposition of conscience to be bad. Shame is all at once agonizing, voluptuous and addictive. The luxury of shame’s certainty, which depends on the inner fictive presence of a cherished intolerant and absolute other, deprives us of a chance to see ourselves with our own eyes. To the extent that our prior states and situations in life shame us, we will find ourselves lying even to ourselves about our current state and situation. The resolution of our shame requires that we be able to look at it through a maximum security prism. No one of us can do this alone. Our best qualities embarrass us as much as our worst ones. We may be shamed by what is deep, tender, powerful and true about us. Shame and embarrassment are the consternation of the current regime. Consternation may be for the good , as well for ill, but it is always uncomfortable. So many people can let themselves be known only when they know they are leaving, as if they need an escape route from their shame. Shame is a most intimate part of... read more

Dangling

Almost twenty-five years ago, a middle aged man came to see me and told me a tale of woe and victimization that, after five sessions, began to seem a bit extravagant, almost as if the man was drunk, not on alcohol, but on something subtler and deeper. I must have tipped my doubts because he did not come to the next session. He did not come and did not call. When I tried to reach him, the telephone was not a working number. I called the employer he had named. I was told that there was no such employee. I tried the number of the person he had named as a contact. That telephone number did not work either. The man came to see me, then disappeared, as if he had been made up in the first place. I still think of him, still wonder about him, illustrating the power of the incomplete. The problem about deceiving your psychiatrist is that it is too easy, since the psychiatrist knows only what you tell him, so may actually know only a figment of your... read more

Before The Beginning, After The End

Psychotherapy begins before it begins and continues after it ends. Before the first appointment’s encounter, psychotherapy starts as a hope, an intuition, a hypothesis, even a prayer. A patient says, “Even before I saw you, I think I invented someone like you to talk with, even though I didn’t know that this person that I invented had to exist.” So we realize that much as the question about a transitional object – did I discover this or create this? – should not be resolved, so, as therapists, we are co-creators, co-discoverers of ourselves. A therapist who has been helpful remains in the mind after appointments cease, changing the inner light by which we see ourselves much as a stained glass window changes the light that passes through it to something quite different than ordinary sunlight. Oddly, a therapist who remains an inner presence can develop along with the person who has taken him in, becoming almost someone else from who he once... read more

Seek?

“Seek and ye shall find.” “Don’t seek and ye shall find.” Basic research and art and psychotherapy all explore the territory between these two poles. Targeted effort can be a good friend and also a devastating opponent, closing off the land of mischief and inspiration, the odd thought that illuminates a new path. Mixed states probably hold the most promise. If we are to temper our seeking with not seeking, then we can not take ourselves too seriously: “I am and am... read more
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