Sleep Apnea - The Reluctant Psychoanalyst Gets Treatment:

To sleep, perchance to dream; ay, there’s the rub.  What if sleeping doesn’t go so well?  What if our dreams haunt us and we waken from them not curious but filled with worries – about what things we have to do the next day, and what we’ve forgotten…  This was my plight last winter.  It seemed to get better this summer.  Then one morning, I woke with a crick in my neck.  Must have slept on it funny.  But the crick didn’t go away and then, when I went for a jog, my whole upper back went out of whack.  Well, I went to my physiotherapist who specializes in soft tissue and cranial sacral therapies, but who is really a healer, and though she worked on my neck and back and they ended up feeling better than they had in months, she said that in the long run she couldn’t help me if I didn’t get the underlying problem attended to – which was: apnea.

Her diagnosis was based in part on my symptoms but also on my dreams.  She said that the neck problem was, she believed, caused by my desperate attempts to arch my back and neck in an effort to clear my breathing passages as I slept.  This was, she thought, a reaction to my throat collapsing on itself when I reached the deepest stages of sleep – about 4:30 in the morning.  I told her that I had been consistently waking then and that I had a terrible time getting back to sleep.  She proposed that the near suffocation of apnea could be mobilizing my autonomic nervous system, including cortisol, which then would lead me to awaken with a blast of energy that would attach itself to whatever anxieties I might have running around and keep me awake. 

As for the dreams, she noted that people with this disorder frequently dream of being in enclosed spaces.  This led me to remember a consistent bothersome theme in my dreams of being in a room or other space and finding that the way out was smaller than I could comfortably navigate.  Sometimes the door had shrunk, at others the only way out would be through a window.  Sometimes this was bothersome enough that it would wake me, at other times it just seemed like a distraction – I was able to crawl out of the room and keep on dreaming – and sleeping.

Interestingly, despite the small spaces being a consistent theme in my dreams, I had not been able to understand how they were related to the dynamic themes that the dream was representing from the rest of my life.  My physiotherapist’s explanation was that this was because they didn’t have a dynamic, psychological meaning, but they were representing a physiological state.  The dream was creating a symbol, but this symbol was intended to clue me into a threatening situation – suffocation - but I experienced this as a distraction – which was what the difficulty breathing was – if that’s indeed what it was – from the dream.  I don’t have a definitive diagnosis yet.  She referred me to a treater who has now referred me to another treater, and I am waiting for an appointment to be screened before I can go to a sleep lab, which I hear is a joyous experience.

So, why am I writing about this before the diagnosis is definitely made?  Well, in addition to being treated, I also went to a workshop given by a nationally acclaimed analyst at our local institute.  He presented in a number of forums, but his formal lecture was about the importance of including the entire experience of the analytic patient in the treatment – including, in the case he was discussing, attention deficit hyperactivity disorder (ADHD).  This would not seem to be something novel.  ADHD was a very popular diagnosis in the 90s, and is still widely seen.  There are widely accepted, though generally not curative treatments for it.  But analysts have blind spots.

Dr. Karl Menninger, a widely known analyst and thinker, used to maintain (as many others probably have) that when the only tool you have is a hammer, the whole world looks like a nail.  Psychoanalysis is a very powerful tool.  As the speaker said this weekend, it is used to treat people who come to our offices in pain.  It is such a powerful tool that it can help, over a period of time, people better understand their pain, where it comes from, and, eventually, learn what to do about it.   We can, however, come to see this tool as being so powerful that we overlook other means of ameliorating the condition of those who seek our help.  The presenter was urging us to avoid this trap.

My physiotherapist was practicing what the presenter preached.  She was seeing a patient in pain.  She was able, with her powerful and useful skill, to ameliorate that pain.  But she was also able to recognize that there was an ongoing stressor that was likely to continue to create the pain and that her treatment could not address that underlying problem.  The jury is still out on whether her hypothesis will be upheld.  But the approach she is taking is a laudable one.

My own psychoanalysis greatly helped me with sleep difficulties.  I would, at the time I began the treatment, awaken in the middle of the night – at one, two or three am and have difficulty going back to sleep.  As I learned about dreams, I became able to “catch” the dream I had been having, to reconstruct it, and to analyze the elements that had led me to awaken.  As I consciously worked on the problem that had been presented in coded form in the dream, I was frequently able to come up with a solution that led me to be able to return to sleep.  Sometimes I couldn’t accomplish that, but would pick up the dream in the middle somewhere and work, in a dream state, at coming up with a new, dream solution.  This new dream would mean that I was back asleep – problem temporarily solved.

Now, in the wake of a stressful year, I am having trouble sleeping again.  I tried to apply psychoanalytic principles to my symptoms.  As deep and wide as my analytic training may be, it did not include looking over the wall into the world of world of physical symptoms.  It did not occur to me that the symbols in my dreams might be based on them rather than psychic concerns.  I have to be careful that I don’t use my tool beyond its reach.  When someone with ADHD or apnea seeks a psychoanalytic treatment, the psychoanalysis can help improve his or her condition.  The lowered anxiety resulting from treatment leads to a decrease in the disruption that ADHD can cause.  The psychoanalysis may well help the apnea patient recover more quickly from an apnea moment to return to sleep.  That said, it does not eliminate, nor even explain, the underlying dysfunction, one that needs a different diagnosis and treatment to help the client achieve optimal functioning.

Post Script.  This was posted in 2011.  It is now 2015.  I did, indeed, have apnea - a painful night in the sleep lab proved this.  I have been successfully treated with a mouth appliance that forces my tongue forward and thus opens the breathing passage (see the description of that here).  It also stops my snoring, which the reluctant wife believes is worth the price of admission, which was pretty steep.  The other common treatment is a CPAP machine.  I tried this and, for me, it was like sleeping in a wind tunnel.  Maybe I would have gotten used to it in time, but thankfully the appliance has worked.

A couple of other things I have learned.  About a year after I began treatment, I looked back at my ratings of my sleep and my health when I sought treatment.  I was in bad shape, but once I got better I forgot how bad it was.  I was having heart palpitations and significant problems with attention and concentration.  A year later, I recalled that when prompted, but really had lost track of it.  I think that happens with our patients who are doing better and sometimes don't remember how bad it was when they weren't.

My sleep is not perfect now.  Especially when I am distressed about things at work, it can get pretty bad.  But I can also analyze my dreams, work on what is distressing me - which usually means facing something I would rather not - and the sleep will get better.  And I don't have dreams about being trapped in small spaces.  Just remembering them as I write this is enough to give me the Willies and to fear they will return, but they haven't.  I couldn't process my dream life in the ways that I am now  when the apnea was interfering with the sleep.  Then the stress related disruptions were much larger and addressing the problems did not lead to a return to sleeping well.  I think this, too, is part of the human condition.  Our various difficulties tend to be additive.  When we are not doing well in one area it contributes to difficulties elsewhere.  Yet another reason to do a very wide ranging diagnostic work up to identify multiple possible contributors to the presenting symptoms.

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Get Low - The Reluctant Psychoanalyst Goes to the Movies

Get Low is a quirky independent film with a great cast including Robert Duvall, Bill Murray and Sissy Spacek.  Loosely based on a 1938 event when a hermit threw a funeral for himself, the movie is a study of a character who is deeply human, terribly manipulative, a recluse who thrives on having others think about him, and a person about whom we care deeply, which is surprising because of what I see as his considerable lack of care for others. 

The film unfolds as a mystery and, since I need to reveal its secrets in order to discuss it, if you plan to watch it, stop reading now or bear the consequences.   The hermit, played by Robert Duvall, has been living alone on his land and shooing off strangers (and scaring the bejeezus out of kids who dare trespass) for forty years.  Everyone in town has a story about him, everyone is curious about whether the stories are true, and he decides to invite the whole town out to his place for his funeral where they can tell those stories.  As a kicker, he raffles his land for five bucks a throw with the winner to take all after his actual death. 

The character, Felix Bush, is very good with his hands.  Forty years ago, after doing something heinous, he heads north and, perhaps as penance, builds a spare but magnificent wooden church.   As my beautiful, but reluctant, wife said to me, his being a carpenter who is about to die creates a Christ like aura.  Certainly Felix sees himself to be a martyr.  He did something about which, as he says, he is deeply ashamed.  He built the church and then jailed himself – withdrawing from others as a form of self-punishment - for what he did wrong.  Now he is reconnecting with society.

Our first layer of curiosity is about the nature of his crime.  We learn that he “had a go” with Mattie, a local widow, many years ago and she characterizes him as having been both handsome and deep, with layers that she has not seen in anyone since.  We discover that he has a picture of a woman and that he kisses and talks to this picture, and that Mattie has the same picture.  We now wonder how they are connected.  But, as he interacts with this picture, we also wonder what he knows, what he contains, that we ordinary mortals do not.

In the past year or so, I have lost two very important men in my life; my father and a very good friend.  Both of their fathers killed themselves.  Both of them were deeply affected by that.  Both were people that I worked really hard to get to know, to connect with, and both were people about whom, ultimately, I had a great deal more curiosity than they had about me.

Felix reminded me of them.  He said to Mattie that he was surprised when she showed interest in him.  He did not think that he had that much to offer women.  My father, an incurable flirt, commented to me that he did not pursue a whole series of relationships with women because he was certain that, if they got to know him, they would find nothing of interest.  My friend, Armando, bragged that he could “have” any woman that he wanted, but he had a terribly difficult time sustaining relationships with them.

But it was not the parallels with Felix that called them to mind – there was something in his essence that was reminiscent of them.  Felix acknowledged, privately, to Mattie that he had fallen in love with, indeed still was in love with her sister, Mary Lee, the woman in the photograph.  He had done this while he was dating Mattie, and while Mary Lee was married to another man.  But Felix did not express remorse to Mattie about having cheated on her.  He observed that he had loved Mary Lee, and she was the only person that he had loved – and that he still loved her.  This was, to him, an immutable fact.  And he shared it with Mattie as such.

To us, as observers, there is something, I think, callous about this.  Mattie cared about Felix.  She might still have feelings for him.  Discovering that Felix betrayed her with her sister and best friend, she becomes angry with him.  We also discover that Mary Lee is dead and that Mattie wants to know what Felix had to do with that.  He refuses to tell her.  He also fails to apologize to her or to ask her forgiveness.  The preacher of the church Felix built, and apparently the only person who knows his crime, has encouraged Felix to ask for Mattie and Jesus’ forgiveness.  Felix says that he didn’t do anything to Jesus, so shouldn’t have to ask for his forgiveness.  There is also a sense that Felix doesn’t realize that he has done anything to Mattie by betraying her trust and affection.  His love for Mary Lee is a fact, and it is the only fact that matters – at least in this part of the story.

Which brings us to the funeral.  Ten thousand people gathered for the original Felix’ funeral.  They couldn’t get nearly that many extras to show up during a cold snap in Georgia, but there was a good crowd.  There was some question over whether, when push came to shove, Felix would be able to tell his story – and it became clear that he really had no interest in the stories people had about him, he wanted to be able to tell his own story.  I think he feared telling his story because of his shame, but I think he also wanted to because of his pride.

Felix was proud of his love for Mary Lee and her love for him.  They had agreed to run away together.  When she was late for their rendezvous, he went to her house to find out what was going on.  Her husband had apparently discovered her intent, beaten her with a hammer and set their house on fire.  All three of them ended up on the second floor, the house in flames, and Felix, to his dismay, was thrown from the house without being able to rescue Mary Lee.  For this failure, he asked forgiveness from Mattie.

I wonder whether my father and Armando shared a similar secret.  That they felt guilty for failing to rescue their own fathers.  And I think that this secret may have led them to feel deeply ashamed of themselves as people – that they were not worthy of other’s affection, concern, caring.  I think that this also, then, while making them objects of interest and curiosity to those around them, and paradoxically fueling other’s concern for them, may have closed them to the kinds of interchange that are life-giving.  The intensity of their connection with a lost other, as was the case for Felix, closed them to possible relationships with those now present around them.  At the same time, the intensity of their devotion, their self- conscious, almost pious, concern for the other who is not present, promised, perhaps falsely, that they would be as committed to the people currently in their lives as they were to their ghosts.

Felix’s journey in the film from hermit to town character to apologist was a journey of increasing openness and connection – but Felix never quite made it back to society.  He died married to Mary Lee – or to his memory of her, and the rest of us remained locked out despite his having a very public confession of his sin.  He claimed to feel ashamed of having failed to rescue her, but I think he also felt intensely proud of the love that he had for her, and his hermitage and the subsequent funeral were both means of portraying that connection and his own special position as her lover.  Though he promised to "get low", to put his things in order, I think he remained on a very high and mighty plain, separated from the rest of us who do not have what is, in his mind, this unique connection.


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9/11 - The Reluctant Psychoanalyst Remembers 10 years later

Today is the 10^th anniversary of the September 11^th attacks on the World Trade Center and the Pentagon.  The liturgical calendar of the Episcopal Church had a series of readings about forgiveness.  The first reading was about Jacob, who had been sold into slavery by his brothers.  The brothers approached him after their father’s death and told him – though it wasn’t true – that their father’s dying wish had been that Jacob would forgive them.  Moved by the brothers’ request for forgiveness, Jacob wept and gladly forgave them, especially as his having been sold into slavery had part of God’s plan – Jacob had been able to influence the Pharaoh on behalf of the Jewish People.

The second reading was Paul’s admonition for Christians not to criticize each other’s religious practices as each is trying to accomplish the same goal.  The third was from Mathew and was a parable about forgiveness.  In the story, a slave, who has accumulated great debt, is to be sold to repay the debt to his master.  The slave begs for the debt to be forgiven.  It is, but then the slave demands payment of a debt to him from another slave.  The master is angry about this, as Jesus says God will be if we ask for forgiveness but have not forgiven others.

The minister, an eloquent and thoughtful man who is able to articulate complex ideas in very ordinary and approachable ways, said that his thoughts were too scattered to be able to offer a sermon, so he read a letter from the Bishop.  The letter called attention to the readings and noted the complexities of the situation, but also asked us to offer forgiveness to those who had done this.

I found this message to fall short.  September 11, even for those of us in the Midwest, left us foggy.  We were scared, felt under attack without quite knowing for what or by whom.  On September 11^th itself, as a number of campus administrators gathered to figure out how to respond to the situation, I realized that we were a bit off our rockers when the campus police chief suggested that we cordon off the new basketball arena to protect it from terrorists.  As proud of it as we were, I was certain that it was not on any enemy’s list of top 1000 targets and I began to return, ever so slightly, to feeling less vulnerable – less personally under attack.

It took considerable time, though, for the feelings of being very personally attacked to clear completely.  It took considerable time to create enough room in my head to realize how elegant the attacks had been.  Symbols - of what?  of our might?  of our technological superiority?  had been successfully attacked.  Those gleaming towers, that huge building of military control, had been attacked using stone age technology; our naïve wish to save the life of a stewardess, and our own technological wonders – our planes, had ultimately become the weapons of destruction.  Our technology had been turned against us.  And this had been done, not by a nation with a population of its own to protect, but by a band of men united by an idea – an idea of us, of the United States, as a, again, what?  I think if we follow our feelings, we get a sense, perhaps, of what they believed us to be and therefore what they were trying to communicate, perhaps unbeknownst to themselves, to us.

I think they were trying to communicate what they themselves were feeling.  I think the powerlessness we felt on that day may have been a sort of replication of the powerlessness that they were feeling.  I think the vulnerability that we felt paralleled the vulnerability that they felt.  And I think the rage we felt paralleled the rage that they had been feeling.  I believe this in part because of the concept of projective identification, a concept that I have lived through with many patients in their most primitive moments.  At these moments they do not feel that communicating with words is adequate.  They use actions to convey their feelings by doing to us; their treaters, their families, or their friends, as they believe they have been done to.   And when this happens we feel what they have not put into words.  We feel rage, we feel helplessness, we feel fear.  And often, sometimes years later, we are able to communicate with each other about these moments and to realize that what was communicated was what they were feeling.  We felt their feelings.

Clinically, I believe that our patients resort to this means of communication when they feel out of touch with us.  When they feel that we are not connected to them in a real, vital and humane way.  At these moments, I don’t believe they perceive us as another person, like themselves, but as an other, someone who does not get them and about whom they, at least on the level that they are operating from, do not care about.  Of course, if they truly didn’t care, they would not communicate with us at all.  If we didn’t matter to them, they would ignore us.  But we do matter to them, which exacerbates rather than ameliorates the situation.

When this occurs, we are confronted with the most difficult of treatment situations.  I think the terrorists have confronted us with this type of situation.  They have used our openness, our trust, against us.  They have used the connections that we have with each other as a means to induce chaos.  And we have responded, as we do with our patients, by withdrawing.  By becoming inhibited and fearful, closing down the connections that allow us to communicate efficiently and effectively.  When this happens, the terrorists have won.  When this happens with our patients, the treatment is at an impasse.

The terrorists, unlike Jacob’s brothers and unlike the slave, have not asked for forgiveness.  They do not believe that they have attacked humans, they do not believe they have injured people with whom they are connected.  They have killed an enemy about whom they have powerful feelings – feelings of powerlessness, mistrust, and anger.  

The minister ended his sermon today talking about the effects of a thunderstorm when a tree across the street, struck by lightning, fell on the electric lines attached to the church and pulled some of the stones loose from its façade.  He noted that we are all connected.  In fact, I think we should all be connected, but we are not yet.  Until the terrorists feel that they are connected to us and we to them and that a blow to us is one about which they should feel guilt and ask for forgiveness, they will continue to strike.  And I believe that our forgiveness, as well intended as it may be, is only going to further alienate us.  It will not connect us.  It will not bring us into solidarity with them. 

The process of connecting with a terrorist or a potential terrorist, just as the process of connecting with a hurt and angry patient, is a difficult and perhaps even foolish undertaking.  Malpractice attorneys recommend against my trying to treat the most damaged people with whom I work.  The consequences of not connecting with those patients, as difficult as that is, just as the consequences of not connecting with terrorists, are equally problematic, however.  To see them as humans, and to help them see us as humans is likely to be a long, difficult and terribly vexing task.  It is, though, ultimately, our human connectedness – having a meaningful relationship that will allow us to truly apologize to each other for whatever it is that we have done to each other, and to recognize the humanity within each other.  That is, I believe, likely to be the only lasting cure.

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Copenhagen - The Reluctant Psychoanalyst Goes to the Movies

Copenhagen is a marvelous three person play written by Michael Frayn (1998) and adapted to the screen by PBS.  It is available as a DVD through NetFlix and, I’m certain, other outlets.  The protagonists are Werner Heisenberg, the German physicist who proposed the Uncertainty Principle, Nils Bohr, the Danish physicist who first articulated quantum mechanics and who served as Heisenberg’s mentor, and Margrethe Bohr, Nils’ wife and confidante for all things personal and professional.  The play is an attempt to understand what occurred on a particular night in Copenhagen when, in 1941, Heisenberg returned to visit the Bohr’s when Denmark was then a country occupied by the Germans and he was in charge of the Nazi German attempt to construct an atomic bomb. 

The play fairly calls for an analytic interpretation as the characters speak their thoughts throughout.  But it is the way it elucidates analytic principles in its form, in the essential question it is trying to address, and in the triadic/Oedipal relationship between the three characters that makes it irresistible to me.

The form of the play is an attempt, on the part of the three characters who are meeting again after they are all dead, to reconstruct what happened on the night when Heisenberg came to visit – and more importantly, since the meeting was abruptly cut short by Bohr, to determine why Heisenberg intended to come – what his hoped for intent was.  The players make three passes at the events of the evening, replaying them to ferret out what occurred and what might have occurred.

This repetitious returning to an event occurs over and over in analyses.  Most famously it occurs with screen memories: childhood memories that condense many events into one and that sometimes serve as a stand-in for remembering an event that is too emotionally charged to be remembered directly.  But more generally, memories resurface in the process of telling one’s life.  And when they do, we return to them with new information – we now know ourselves better than we did the last time we remembered this and we can appreciate aspects of it that we didn’t appreciate before because we know more about how we feel about the characters in the story, the situation that is being described, and more about the various layers of reactions that we have to situations of the sort being described.

In the play/movie, the characters remember together, discuss the memory, and then remember again, sometimes with a question in mind when they go back into the story and pick it up again with Heisenberg knocking at the door.  That they are dead gives them some room to push the memory further, to play out what would have happened; they no longer have the passions and concerns of the living.  Even this seems somewhat psychoanalytic.  I remember a co-trainee at the Menninger Clinic reflecting after a presentation on body language that the analytic posture, lying on a couch with hands together staring at the ceiling or perhaps closing one’s eyes, was the posture of death.  And perhaps the deeply relaxed position affords some distance – even a deathlike distance – from the emotionally charged material that we recall.

The essential question the play is trying to address is the question of intent:  Why did Heisenberg go to Copenhagen?  The answer that is achieved on the second pass is perhaps the most accurate, when he states, “I don’t know.”  We are now in the realm of Uncertainty.  In the play’s afterward, Frayn (2005) states that translating the German term for uncertainty – indeed the various German terms that are used to refer to the principle – is a matter of opinion.  Uncertainty, as a term, carries with it an anthropomorphic quality that exaggerates the rather prosaic – unsettling though it is to a physicist – basis for the principle.  We can’t know everything about a particle.  In order to observe it, we have to disturb it, to touch it, and thus to change it.  Though we can’t know the velocity of the electron if we measure its location, we have a rough idea of what it is.

When we apply the uncertainty principle to human beings, which every analyst and kitchen psychologist alike does, a great deal of uncertainty is introduced.  Frayn, as author, is speculating about a conversation, and even more about the parts of the conversation that never took place.  The scholarly basis for the speculation appears sound and the story rings true, but the scholars that he cites disagree with each other about what Heisenberg knew when, just as the protagonists disagree about what happened within the play itself.  Despite the uncertainty, as they go back and iteratively review the events and what it is that they do know, they construct a plausible hypothesis about what they don’t know – Heisenberg’s motivation, and then, from there, they construct an understanding of what took place when Bohr terminated the conversation.

The movie underscores, by the sumptuousness of the mansion that was ostensibly Bohr’s, the Oedipal quality of the son returning home aspect of the play.  Margrethe is appalled that Heisenberg, the little cheeky scholar whom they supported, is returning as a professor, as the head of an important Nazi office, and as an envoy of the conquering nation to show just how grown up he is.  Heisenberg himself, I think more stridently than in the play (and Frayn nicely discusses the critical responsive evolution of the play as it went from the London version to the one put on in New York, and I imagine another iteration happened on the way to the screen), articulates his experience of coming from a humiliated country – Post WWI Germany – and feeling a real sense of patriotism and achievement in the newfound power of that country, something that contributes to his awkward interactions with the Bohrs.  He is, on one level, returning as the conquering hero, begging that they recognize his accomplishments and revel in them.  On the other, he is consciously appalled at the potential power that the physics he and Bohr did together is about to unleash upon the world.  Bohr, half Jewish and aware of the evil behind the glory, is not the generative and receptive father, but an angry and disappointed one.  So much so that he can’t hear Heisenberg’s fantasy that the two of them, by maintaining control of the situation, can prevent horrible things from happening and instead shuts Heisenberg up before they are able to talk about this hope. 

The repeated references to Hamlet, the great indecisive Dane, help underscore, as my wife pointed out, the ways in which Heisenberg is visiting the ghost of his dead father, hoping to get from his ghost the courage to confront the corrupt murderer of his father, the Nazis.  But he is torn.  He also feels loyalty to this second and, in a twist on the Hamlet dilemma, for him, the primal father.

So, the play wrestles with a compelling historical dilemma, did Werner Heisenberg, the preeminent physicist of his generation, fail to produce the atom bomb for Hitler as he maintains he intended to in the play, because he maintained control over the process, kept Hitler interested enough, but failed to ask for adequate resources so the project could not succeed?  Or, as the play suggests in the final iteration, did the headstrong and impulsive, mathematically gifted Heisenberg need Bohr to steady him and to remind him to do the calculations?  If he had done the calculations, and realized how actually doable the project was, how might things have turned out?  Would Heisenberg have accomplished a mission that was (unknown to him) actually possible?  Was he looking for permission from Bohr the father to do or not to do the fatal deed?  Did Bohr’s fury that he was even working on the project, and his subsequent rage that prevented the conversation, create the ironic situation of Heisenberg, the headstrong, competitive and impulsive physicist, as the preventer of nuclear annihilation, not so completely based on morality, but instead based on a failure to know what power truly lay in his hands, and Bohr, the compassionate, considerate, measured peace lover who escaped to America and contributed to the atomic project there, become the murderer because of his fear of what the Germans might possess?

The possibility that Hitler was only prevented from having the atom bomb by a) Heisenberg’s dread that he would have it or b)  (and more intriguingly) Bohr’s refusal to play the good father – to be the man Heisenberg needed him to be - prevented Heisenberg from being able to engage properly in his work and to become the terrible but independent man that he could have been, which, in turn, could have resulted in the cold war playing out between a London-less Europe united under Nazi Germany and the United States, is a reflection on the uncertainties of our unconscious and interpersonal worlds that is well worth dwelling on and returning to more than once.

Reference:

Frayn, M. (1998).  Copenhagen.  Methuen Press, London

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