COVID Chronicles XXIX: A New Year's Review (2023)

 COVID, reminiscences, personal experience, psychoanalysis, psychology, psychology of isolation

The following is a bit of an experiment.  I have been posting throughout the pandemic on lived aspects of the experience.  I have done this for a couple of reasons – one is that an early story on NPR suggested that we don’t have many records of what happened during the 1919 Flu epidemic – the author of the piece thought that people were too ashamed of their experience to look back on it and write about.  A later piece opined that the government did not want people to become too upset by the extent of the epidemic and so suppressed journalistic writing about it.  For whatever reason, I thought it might be useful to track the experience from my little window on the world. 

So: the experiment.  Without going back and reading my posts, I would like to write a review of my experience of the pandemic.  I am curious about how the two accounts will jibe.  Of course, as I start on this project, moments from posts are occurring to me, and the posts are about memorable aspects of the experience, so my “free” writing will necessarily be guided by my earlier posts.  None the less, I think that a holistic, after the fact (if that is where we actually are) account may differ in significant ways from the moment to moment lived experience of an author.

 

I think I had COVID.  In the winter of 2019 into 2020 I became very sick.  The sickness was so powerful that it knocked me flat on my back for at least a week.  This is unusual for me.  When I get sick, I tend to just carry on.  I don’t remember much about that time.  Did I take a day or two off from teaching?  I might have, again something that would be unusual.  I do remember feeling in the wake of it that I was having a much more difficult time recovering from what had seemed like a bad cold.  It seemed like I had aged a decade and I had no interest in returning, for instance, to playing basketball and indeed took a hiatus from working out for longer than I could remember.

I think it might have been COVID because I caught the cold from someone who had caught a cold from someone who had just returned from a trip to China.  They were concerned that they had infected me with the cold that had been a doozy for them.  This was in late December or early January.  Perhaps I didn’t miss any classes because it was over break.  The weird thing is that I don’t think anyone caught the cold from me.  None of my patients complained of being sick, and The Reluctant Wife did not become ill.  So maybe it wasn’t COVID, but I am deeply suspicious.

Sometime later, (a month?), COVID became a thing.  I heard about the cases in Washington and in California.  I was not too worried about it.  SARS had been caught a few years before by the Canadians and had never become a thing, but of course, this did.  The next thing I remember is the Reluctant Son’s College shutting down and my driving to pick him up.  He was in school in Chicago and I think there were more cases there than here – I don’t think my school had shut down yet, but I’m not sure of that.  In any case, it was very awkward picking him up.  I didn’t hug him as I customarily would have – I had just driven there and only gotten out of the car to pump gas and, at that point, I was using disposable plastic gloves to keep from getting contaminated by the gas pump – and by using the washroom - avoiding people as much as I could going in and out.

It is somewhat startling to think that I may have had the virus already and was thus one of the few people in the country who, at that moment, may have been immune to it.  I have not become sick since then and have never tested positive.  I took the vaccines as soon as they were available and the antibodies they developed are indistinguishable from the ones I would have developed if I did have the disease.  I have been shocked that I never got the illness (unless I had it at the beginning) especially during the current wave when so many of my friends are reporting testing positive while the media is reporting a very low incidence locally and nationally.

Of course, after the awkward greeting, the reluctant son and I got in the car together and drove for five hours back home, where we would live in close quarters for the next two years.  On the way home, we listened to an NPR story about the inoculation industry and how the COVID type inoculation would sometimes get funded and sometimes not.  Momentarily, a lot of funding was going to go in that direction.  

In any case, it is a good thing for my health that my son came home with me.  He is a bit of a fitness nut and he ran daily and I began running with him.  I’m not sure I would have run at all if he had not come home, I was not feeling like exercising after the illness.  I also think it might have been hard to sustain exercising across the two years without a running partner to get me in the habit of doing more solo working out even it I had figured out how to get over the sense that I was no longer up for exercise after the mystery illness.

The transition at school and in my practice seems, from this vantage point, to have been weird but relatively seamless.  A patient opted not to continue remotely, and returned to treatment when it was possible to meet again in person.  The rest of my patients shifted to meeting by phone or zoom and I started teaching classes by zoom.  Teaching graduate classes and at the Psychoanalytic Institute went smoothly – the classes were small and the students were engaged.  In fact, the quality of the classes at the institute improved – they had been split before with some people in person and others on zoom and I had always struggled to engage those not in the room.  Teaching large undergraduate classes on zoom did not go so well.  Students were outside or turned their cameras off and seemed unengaged.  I was forced to give exams remotely and thus they became open book exams.  Undergraduate students seemed disengaged.

Personally, things did not change all that much except that my commute was just to my home office instead of to school (which is only 10 minutes away).  I had been seeing patients at home and continued to work in the same office.  Going out really meant going to the grocery store once a week.  At first we were disinfecting all the groceries as they came in the house.  We watched a video about how to do this with a clean side of the kitchen table and a side with “contaminated” groceries.  The grocery store limited the number of people inside and we waited outside in social distanced spots until we could go in and then got out as soon as we could.

So life was pretty cloistered.  Mostly work with a lot of streaming of entertainment in the evenings.  The reluctant son and I would watch Jeopardy every night and compete – he took an early lead and never relinquished it, though I would sometimes get closer.  I had a greater fund of information, but he has much readier access to the information that he knows.  He and I would run and/or work out daily and this was an opportunity to catch up on what he was studying and to tell him about things that I was interested in.  At some point, he read about how pandemics work and informed me about that.

The Reluctant Wife and I had just been settling into being empty nesters, so things were upended for a bit.  For a brief period of time all three kids were home again, but it was the reluctant son who stayed with us the longest.  Perhaps I have halcyon spectacles on as I look in the rear-view mirror, but I think things went pretty well.  There were hiccups, and one protracted period where one the kids was having some pretty significant difficulties, but, I suppose, all’s well that ends reasonably well.

I used to think that I was an extravert, but as I have developed across the course of my life, it has become clear to me that I am just fine with a limited amount of contact with other people.  I missed the people with whom I played basketball, and missed the casual interactions with colleagues at school and the institute, and I found the zoom meetings frustrating in that they were all business – we never found an effective way to simply chat in those meetings.  Across time, I grew increasingly isolated from my colleagues whom I had thought of as friends, but that feeling began, I think, to erode as I lost track, except through things like Facebook, of things like kids maturing and relationships evolving.  Interestingly, this is a new thought as I write – I have noticed a lingering sense of alienation, especially with my colleagues and this seems like a more sensible articulation of the development of that feeling than I have had to this point. 

At some point we learned that COVID transmission was through the air and we stopped wearing disposable gloves and switched to using facemasks; cloth ones at first, then, as they became available, KN95s. I went back to teaching in the classroom and the girls went back to their schools, but the reluctant son’s school was still teaching remotely, so he stayed with us through his graduation and then his gap year. 

Teaching undergraduates got, if anything, worse.  Instead of teaching online, I was now in a classroom, masked, with half of the students, who were masked, and the other half were on zoom.  This was a little like teaching while juggling chainsaws.  At some point, all of the students were back in the classroom, but we were still masked.  This was difficult, but not quite as impossible.  What was tough was the transition back to closed book tests.  The scores of my students, which had risen considerably with open book tests, now plummeted below where they had been pre-pandemic.  My tests had always been hard, but they now seemed impossible and the students revolted, claiming that I was a particular poor teacher while I complained that they had not learned how to take exams.  This led to a very difficult semester with one class in particular.  I have since had a better experience with the subsequent class.

By the way, I suspected that many others had done what I had done – gone to open book exams, so I asked the University data people to figure the average GPA for our graduating seniors in 2012, 2017 and 2022.  The numbers were same for 2012 and 2017, but had risen by 3 tenths of a point in 2022.  Fully half of our students graduated with honors.  This is concerning because I don’t think the learning experiences of those students were of the quality as the cohorts before then.  Reading transcripts of the students who are currently applying to our graduate program, some have notations on semesters during the pandemic suggesting that the grades may have been affected by the learning conditions.  The implication is that they may have been lower because of the challenges the students faced.  It may turn out to be that there was massive grade inflation, not deflation, during this period.  We will need data from more than just our institution to know this.

In fact, my experience is far from normative.  Each age cohort had their lives affected differently and each individual reacted differently to the challenges of this time.  If this had happened when I was in college, and suffering from the delusion that I was an extravert, I would have felt cheated out of the best social years of my life, and that would have been true!  For my colleagues, those who had young children in school who suddenly needed to be home schooled were much more challenged than I was.  Some of them found the challenge to be beyond what they were capable of managing and resigned from positions at the university to move to places where they had more familial support. 

Each of the cohorts of children will have had an altered experience that will vary from age to age and that will likely have their impact, for instance, on their experience when they wash up on the shores of the university in different ways.  Those who missed first and second grade will have more time to recover than those who missed sixth and seventh grade, and they will have different social and learning impacts to recover from.

My patients have largely returned to meeting in person, though we are mostly masked when we meet (though some patients do not wear masks and I don’t insist that they do).  Some continue to meet remotely, though not out of fear of infection, but rather because of convenience.  My practice became quite full during the pandemic.  Many patients I had not seen in a long time returned to treatment.  Other people’s practices became full, and people begged me to take on patients they could not see because of that, and so I stretched to accommodate as many as I could.  This meant that I worked many more hours per week, doing research and preparing to teach in the evenings and on the weekends because most of my daytime hours were filled with teaching and seeing patients.

Perhaps I would have been becoming more and more ready to retire from my academic position, but I feel readier to do this than I expected to at this point.  I have found it challenging to remain connected to the University and to care about it – I have not felt particularly cared for by the University, I suppose.  We returned to the classroom before there were effective vaccines, and I felt like they were more concerned with the bottom line than with the health of their staff and faculty (the students did not seem to be at grave risk given their age).  I think the disengagement of the students under COVID conditions was also a bit disheartening, though the graduate students continued engagement and that of the students at the institute heartened me about that portion of my work.  Perhaps I will be able to continue doing some graduate teaching – and will certainly teach at the institute and continue to practice, after I retire from the academy.  I don’t plan to retire from the university immediately, but, as I said, I anticipate being ready to do that much sooner than I thought would be the case, though I might have been readier at this point even without the pandemic.

I think I feel not just isolated from the academy, but from the world.  I am very concerned about climate change, about the political polarization and denial of imminent threat that is a part of that.  We are planning to travel this spring – and I am hoping that will reignite my interests in the world.  That said, it is hard to look forward to increasing my carbon footprint to see a part of the world whose riches are largely built on the process of colonization.  I feel bitter about the state of the world and powerless to change it.  Again, this curmudgeonly attitude may have arisen “organically” without the help of the pandemic, but it is not hard to see how, at my worst moments, I have been convinced that the pandemic is the earth’s latest attempt to rid itself of the greatest threat to life.

Perhaps getting out in the world, though, will be a cure for these isolation blues...  Assuming the second wave of infection coming from China doesn't shut things down again...

The NPR story that I referenced at the beginning of this post opined that people were uncomfortable looking back at their own behaviors during the influenza pandemic because they had been selfish and allowed sufferers in nearby houses to die rather than risk being infected by them.  The flu had, in effect, exposed just how selfish and uncaring they were and not writing about this allowed those folks to distance themselves from that existential realization.  The malaise that I am reporting is of a different sort.  The existential concern is similar – I think we are driven by self interest and continue to be even in the face of compelling evidence that self interest will be our downfall – but it is more at the state of the human condition than about something particularly lacking in me.  In fact, when I started on this reminiscence, I was not feeling so bad about the state of things.  Perhaps that is what binds me to the sufferers of 1919 – as long as I keep looking forward – not to the big picture, but to what is in store tomorrow and next week and this semester, things are not so bad. 

In terms, btw, of my little experiment, I have not gone back and looked at the posts.  I will do that in a bit, but I only felt them crowding in as I worked towards a conclusion.  I am curious to see how well this narrative stacks up with the elements I have been posting to this point. 

Hmm...  Now I have gone back and this post sounds a lot like my very first post on COVID.  Perhaps the more things change, the more they are the same...  

What was intriguing about rereading all of these posts is the amount of angst that is in them that I seem to have forgotten.  Reading it, the angst comes back.  Some of it, especially in hindsight (and we aren't out of the woods yet), seems overwrought, but there is, in fact, a thing called long COVID.  Many of my friends and students have been diagnosed during the past three months.  I wore a mask this past semester in class.  I wonder about that - especially given how vocal I have been about how pedagogically bad that is.  Am I reminding myself and my students that we aren't out of the woods yet?

Yesterday I went to my first basketball game since before the pandemic.  I was uncomfortable.  Usually I see lots of people that I know at the games.  One of the people I saw I hadn't seen in three years or more.  She had aged considerably during that time.  But most of the people were strangers.  And they felt like strangers - it felt odd to be in this large group of people rooting for a team that is somehow affiliated with the school where I have worked for thirty years.     

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The other posts on COVID are listed below:

I:       Apocalypse Now  my first posting on COVID-19.

II:      Midnight in Paris  is a jumping off point for more thinking about COVID.  (Also in Movies).

III:    Hans Selye and the Stress Response Syndrome.  COVID becomes more normal... for now.

IV:    Letter on the occasion of a Town Hall Meeting

V:      COVID craziness at the University continues with no end in sight.

VI:    Get back in that classroom  Paranoid ruminations.

VII:   Why Shutting Classes Makes Fiscal Sense A weak argument

VIII: Catholic Social Teaching Marshaled to support Rationalization...

IX:    What will school look like?

X:     Denial is not just a river in Egypt...

XI:    Back in the Classroom

XII:  Labor Day is for WORK!

XIII: Ennui

XIV. Where, Oh Where have my in-person students gone?  Split zoom classes in the age of COVID.

XV.  The First Complete COVID Semester is Done.

XVI.      More of the Same: The Second COVID Semester begins.

XVII.     Surviving the First Year of COVID: Will education be the same?

XVIII.    I miss my mask?

IXX.      Bo Burnham's Inside Commentary on the commenter.

XX.       The Olympics Mark the Oddness of the Time In Between.

XXI.      It's baaaack...  Joy and Horror and Maybe a Little Bit of Hope

XXII.     The Great Resignation Hits Home

XXIII.    The Great Resignation (cont.): A Family Reunion

XXIV.    COVID in the Classroom: The Great Dis-integrator

XXV.     First COVID, Now No Snow Days?

XXVI.   Not with a Bang but a Whimper: COVID is over... or is it?

XXVII.  Post COVID (we can hope) reflections on morale and morals...

XXVIII. How will we move on from our Empire of Pain? (Also in books)

XXIX.    A New Year's Review...

Stutz: What's Love Got to do With It?

 Stutz, Film, Jonah Hill, Psychotherapy, Psychoanalysis, Tools, Psychotherapeutic Action

There was a bit of buzz around Stutz on the analytic list serve.  Since I hadn’t seen it, I didn’t quite know what to make of the comments, but people seemed a little up in arms around it.  Then one of my students recommended that I see it, so I talked the Reluctant Wife into watching it on a stay in Friday night date night. 

I have to admit that I can’t give a complete report on it, though, because I fell asleep for a bit in the middle of it.  The next day, the Reluctant Wife mentioned to her mother that we had seen it, and the Reluctant Mother-in-law also watched it and she too promptly fell asleep. 

I note our parallel soporific experiences of the film not as a condemnation of it, but actually as a sort of recommendation.  The vibe of this movie is very serene and the pace is slow.  It is a documentary of sorts, and what it intends to document, the treatment of Jonah Hill, is not what actually gets documented.  We watch a blossoming of not one but two people and this occurs at a lovely pace with just a few plot twists and turns.

Jonah Hill, the patient, director and star of this film, is an actor that I have enjoyed seeing in a variety of films; The Social Contract and Moneyball come immediately to mind (and, interestingly, neither is a film that I posted about).  In both films he played a character who was socially isolated and viewed the world through a judgmental lens – inhabiting an aloof space that included a certain level of touchiness.

While Hill was playing a role in these films, his playing of that role seemed deeply rooted in who he was as a person – the round kid who was used to being excluded from cool social things while being smart and acerbic enough to stay in touch from a distance and to make things happen – in the Social Contract, to found Facebook and, in Moneyball, to supply the statistical knowledge to be able to disrupt the old school scouting machine of Major League Baseball and support a new way of valuing players.

Some time after making these films, Hill went into psychotherapy with Stutz, a therapist to the stars in LA.  Hill found the treatment so helpful that he decided to make a documentary about it while continuing to be in treatment. 

The first thing that is remarkable about this film is both Hill’s acknowledgement that he was playing to type in those films, but also the ways in which that type has been altered as a result, at least in part, through his relationship with Stutz.  Hill is physically trimmer and is upbeat.  At times his mood feels a little forced – as if he is agog – in love with life, but also with Stutz, and working hard to maintain the belief that he feels better, but he seems to actually have a range of feeling states that seem quite genuine across the arc of the film, and they seem to be at marked variance to the person I have come to know through the parts he has played.  Jonah Hill seems younger and more buoyant than I have seen him in films.

The second thing that is remarkable is the way in which the making of this film openly articulates what is known as a dual relationship.  Stutz shifts from having one relationship with Hill – psychotherapist – to having at least two – psychotherapist and costar in a documentary film, but in fact there are many other relationships that emerge.  At times, Hill is serving as Stutz’ psychotherapist.

Phil Stutz is an interesting character – not one that I have heard of previously.  He co-wrote a book on his technique, called The Tools, ten years ago.  The book has recommendations from Gwyneth Paltrow and Drew Barrymore.  Stutz himself is a nicely centered person – self assured without being cocky, he is comfortable saying what he thinks – and somewhat formulaic in his interactions. 

In fact, the film starts out as if it will be bracingly formulaic.  We are in a therapy session.  Hill and Stutz are facing each other in Stutz’ office.  They are engaged in a conversation that is filmed in black and white.  But there is something weird about it.  Though they are facing each other, some of what they say is filmed from directly in front of the speaker – but there are no cameras evident.  Though this seems like an organic interaction, it can’t be.  It feels simultaneously too real and oddly staged at the same time.

Thankfully, Hill breaks the fourth wall, reveals that we are not really meeting in Stutz office, but in a green room that allows them to paste the office on later, that shooting has been going for some time and that Hill is feeling lost in the middle of a project that may have seemed simple enough to begin with but it has become huge and he is disheartened by the enormity of it.  The somewhat forced happiness he was professing at the beginning of the film disappears, and we are treated to a new, more integrated version of Hill, but also of Stutz.

Often in films about therapy (Don Juan DeMarco comes to mind as an example of this), the patient changes when there is a change in the therapist, a change that is instigated by the work of the therapist with the patient.  I have speculated that this has to do with a fantasy on the part of the patient that they are repaying the experience of being cared for by the therapist with caring for the therapist.  That, and so much else, gets enacted in this film.

Hill asks Stutz about what brought him to therapy, what his childhood was like, and how he came up with his approach to treatment.  He also asks him about his Parkinson’s diagnosis – the tremors of which are apparent from the beginning of the filming.  Hill doesn’t just collect this information, but puts it into effect, noting that Stutz is stuck in his current relationship and is afraid to be more fully present in that relationship.  They turn the tools onto the teacher so that he can wrestle with his demons and Hill clearly gains satisfaction when the therapist has taken his advice.

Stutz, who is working from a psychodynamic framework, is altering two parameters of treatment here.  The first is anonymity; and the way to protect anonymity is to avoid self-disclosure.  In classical psychoanalysis, the analyst is a hidden figure that is all but unknown to the patient.  The intent is that the patient will be able to project onto the analyst the unconscious transference – the remembered aspects of past relationships that always interfere with our being open to new relationships.  Of course, the idea that they always interfere clarifies that even if we are not unknown to our patients, transferences will emerge.  It is presumably easier for the patient to see that he or she is generating them if the analyst is not playing a part in the interaction.

Contemporary psychoanalytic theory does not prevent us from self-disclosing.  In fact, not disclosing creates a certain persona (one that is lampooned in New Yorker cartoons); it does not create a true blank screen for the patient to project their inner worlds upon.  It turns out that Stutz and Hill share important early losses – both lost a younger sibling in childhood and dealt with the emotional family fallout from that – and part of Stutz’ ability to empathize with Hill likely comes from shared aspects of their lives.. 

In his book on Group Psychotherapy, Irv Yalom noted that group therapy has two advantages over individual therapy.  One is the sense of universality – the patient is in contact with other people like him or her.  Instead of feeling like a unique object of interest, they realize they are part of a community of individuals with shared dilemmas and historical antecedents.  Turning the tables on the therapist and having the therapist disclose more about who he is allows Hill to engage in a very small group psychotherapy – he joins a group of two.  

The second advantage that Yalom points out is that the patients in group therapy get to act the part of the therapist.  This is, Yalom believes, curative.  Feeling that I can help someone else improves my sense of efficacy in general and gives me a sense of value – I feel better for having helped others.  Again, by allowing the documentary to be made and answering Hill’s questions, Stutz offers Hill the opportunity to participate in a group experience where Hill can be the treater.

The second major parameter from classical psychoanalysis that Stutz alters is that he offers direct advice to his patients.  This is not new.  In the middle of the 20^th Century, Robert Wallerstein followed 42 patients in treatment and reported that the supportive aspects of treatment (including giving advice) were more reliably related to outcome than the more expressive aspects of treatment (giving the patient interpretations). 

Stutz starts his treatments by telling his patients that the first step to mental health is physical health – and he tells them to improve their diet and to exercise.  This is sound advice.  Since the 1980s we have known that aerobic exercise is as effective at combating moderate levels of depression as antidepressant medications.  I think both give patients a more stable psychic floor from which to do the difficult work of psychotherapy.

The “tools” that Stutz offers are packaged with his particular language, but are connected conceptually with well known psychotherapeutic interventions.  What appears to me to be unique about his approach is twofold.  First and foremost is his comfort – with himself and with his patients.  He feels as unflappable in his virtual office as in his real one, even though the virtual setting, once the false backdrop is peeled away, feels harsh, cold and uninviting, Stutz is still present.

The second unique and fun aspect of his interventions are the drawings that he makes.  His pictorial representations of the tools – very spare and conceptual – afford the opportunity for the patient to internalize the message that he is teaching in a novel manner – to give a visual representation to something that he is delivering verbally.  Our brains are built to integrate material cross modally, and his drawings nicely exploit this ability.

Change is difficult to make.  We resist change.  Offering a schematic – quite literally a different way of looking at a novel solution to a problem – allows us to inhabit a non- linguistic space from which to think about how best to solve that problem.  I think it may arouse in us a different, more pragmatic self – one that is used to solving problems – like geometric and architectural and electrical problems, not getting mired in them the way that we sometimes do with more verbally mediated problems.

The drawings also serve as transitional objects – something that we can quite literally hold onto from the session to remember our connection with the therapist and with the solution to the problem.

This films breaks all kinds of norms – stretches all kinds of therapeutic parameters.  On one level, it is a film where a grateful patient shares with the world the process that has been life changing for him.  He is able to do this because of the manifold privileges that his abilities, craft, and resources afford. 

He is also able to have a different kind of relationship with his therapist than most people are, in part because he has something to offer in return – fame, a platform to immortalize a person and his version of a method.  Or does he?  Wouldn’t Stutz have answered the questions if Hill had posed them in the course of his therapy?  Isn’t therapy always a more mutually determined and mutually rewarding undertaking than it might seem?  (And here I don’t mean to minimize the challenges, including maintaining radio silence about one’s own issues so that the patient can better articulate theirs).

But would Hill have known that he was as special to Stutz as Stutz was to him without having made this film?  Isn’t that part of the very issue that brings Hill to see Stutz?  Doesn’t Hill doubt that he is beloved for who he actually is rather than for the person he has become and that he enacts on the screen?  Can we ever be known and loved for who it is that we actually are?

What, then, distinguishes psychotherapy from all other conversations?  In my small college, we were assigned grades but it was considered bad form to look at them.  Instead of grades, our professors would talk about us in the third person in our presence, describing our strengths and weaknesses in the classroom during the term.  One fall, I did particularly badly in class, so they decided I would need to be reviewed midterm during the spring.  Well, at the second, emergency review, my performance had improved tremendously.  One of my professors attributed that to my having fallen in love.  The Dean, who sat in on the conversation, stated that he had never heard love talked about in a formal setting like this.

Hill’s transformation is clearly driven by many things, but one of the chief components is his love for Stutz.  The film allows Hill to realize that Stutz loves him, too.  He becomes Stutz’ favorite son, as it were.  Part of the challenge of therapy is knowing that this is the case – not just that we love our therapist, but that our therapist loves us, warts and all.  But that can be a really hard thing to know – short of, and maybe especially if, we come to know them.

 

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Mark Solms' The Hidden Spring

 

Mark Solms, consciousness, psychoanalysis, psychoanalytic theory, unconscious functioning, feelings, cognition, determinism

I started this book two summers ago on vacation.  Not your typical light summer read, this book is difficult.  Though Solms intended a “lay” audience to be able to read it with ease by placing the technical material in footnotes, he is also writing for a professional audience and defending his take on the “hard problem”, so, even before the footnotes, he is dotting his i’s and crossing his t’s. 

I am no physician, much less a neurologist, but I am an informed psychoanalytic and neuroanatomical reader, and this is hardly as easy a read as I think Solms imagines it to be.  That said, I am a big Mark Solms fan and have written about his prior writing and his speaking, and I have taught his ideas in psychoanalytic courses, in graduate courses and in undergraduate courses.  I think he may be among the most important thinkers about the human condition alive today, but as I neared the conclusion of this book, I became disturbed by it – by its impending conclusion and the implications of that conclusion.  So, I set it aside.

I dutifully picked it again this past summer, thinking that it might have rested long enough (or I might have) that I could see it through to its conclusion.  A year’s rest did me (or it) good.  I am less disgruntled with it than I was before and am able to keep it at more of a healthy distance.

Solms imagines himself to be picking up the mantle of Freud the neurologist – the Freud who believed that we would one day be able to describe human consciousness (and unconsciousness) as a biological function.  Freud set that “Project” aside (he wrote a book early in his career, “Project for a Scientific Psychology”, never finished it, and never published it during his lifetime, but it was described by one of my teachers as containing the blueprints for what he would work on throughout his career).  Freud harbored the belief that when neurology matured it would be able to support the hypotheses that he was putting forward, and Solms has been working to prove Freud right – while also revising big chunks of Freudian theory: see his The Conscious Id.

The conclusion that Solms was hurtling towards that I could not stomach had to do with consciousness.  Arguably the most interesting unfathomable aspect of the human experience.  Not directly observable by anyone else – and therefore discarded by the behaviorists as a legitimate area of scientific inquiry, consciousness is, of course, the most human of our faculties and immediately apparent to each of us when we awaken every day.  It is the seat of all that is beautiful, poetic, and wonderful in human experience, as well as much that is evil and cruel.  Solms (and others – Damasio among them) have been working diligently to crack this impenetrable egg of our existence for quite some time.

This book is his attempt to explain to us others who are not quite as bright and not conversant in all the math and science that he is what he has discovered (and to preach to those who have those chops in the footnotes).  Much of that is really cool and, like my best posts, leads the reader to think about the world in manifold new and different ways.  But the thing that he seemed most proud of was, in my estimation, not something to crow about.  He concluded that he was able to described consciousness mathematically.  Consciousness was reduced, in his ninth chapter, to an equation.  Please.

I am not a poet.  The amount of Shakespeare that I understand is much less than the amount that I don’t.  But I believe that there is something sublime – even sacred – about human consciousness – this faculty that allows us to appreciate beauty and to be cruel.  And reducing that to a mathematical equation seemed to strip all of the poetry away.  We do what we do because it is the mathematically best means of accomplishing the goals that have been set for us.  Please.

Fortunately, this past summer found me in a more charitable mood.  I was willing to cede, for the sake of argument, something that I find personally repugnant; to revisit this work and see what emerges from it if I am less resistant to its message.  And my attitudinal shift has been rewarded.  Weirdly one of my guides in doing this is an artist of pop fiction (though she is also a scientist) the author of “Where the Crawdads Sing,” Delia Owens.  Owens has her protagonist note that Einstein helped us realize that gravity is not the poetic attraction that any two bodies have towards each other, but the alteration in the space/time continuum that occurs as the result of their proximity.  Despite this shift, Romeo and Juliet, when not being lampooned, still holds us in its gravitational spell.  We feel pulled by these two bodies as we watch them being pulled by each other towards their inexorable end.

Similarly, despite Solms’ anti- poetic stance, poetry is still enthralling, so let’s take a look under the hood and see what it is that he has to say.  Secure in our knowledge that poetry won’t be killed by science, let’s see if science can illuminate something about the experience of the poetic, and something important about the human condition itself.

This fall, I assigned pages 133-147 to my psychoanalytic psychotherapy class.  This is a class taken by third year graduate students.  At the beginning of the class, I ask them to articulate their preconceptions of psychodynamic psychotherapy.  These preconceptions are overwhelmingly negative.  They have heard psychoanalytic ideas pilloried by faculty members in psychology departments all across the country throughout their undergraduate careers.  I am the lone practicing psychodynamic therapist left in my department, which was once evenly split between those espousing psychoanalytic approaches and behaviorally based approaches.  They have heard little from our faculty to dissuade them of their prejudices.

At the beginning of the course, I have them read Jonathan Shedler’s 2010 American Psychologist paper demonstrating empirical support for psychodynamic therapies across a wide range of disorders.  We then begin to look at how these psychodynamic psychotherapies work.  Having discovered that psychodynamic psychotherapy makes some sense to them, I offered the Solms reading in the middle of their learning about the middle phase of psychodynamic psychotherapy.

They were mystified by the reading, and by the positioning of it in the midst of learning about how to do psychodynamic psychotherapy.  When I was reading, because I knew both Solms and psychotherapy, I was able to translate his experience distant terms into a sort of guide for doing psychoanalytic therapy.  I offered the following notes on the reading that I made as I read it:

1. The patient needs to learn to behave in new ways – that is the goal of psychotherapy.
2. In order to achieve that goal, we need to understand (assess) how the patient is currently behaving.
3. The patient will, because of how they are wired, re-enact what they have experienced previously (Solms maintains that memory is a faculty that we have primarily to predict the future.  So, we remember to re-enact; to automate – so that we don’t overburden consciousness).
4. In order to change behaviors, we have to interrupt the normal (unconscious, memory driven) way of functioning.  That is, we need to get the patient to be conscious of what they would otherwise be automatically doing.
5. One way to do that is for the therapeutic moment between the patient and therapist to become actively alive and therefore to have the patient consciously experience it and make novel conscious choices about how to handle this kind of situation.
6. Because memory is predictive, we have to lay down new memory tracks (We can’t erase the old ones, but we can add new options to the library of available responses to a situation). 
7. Psychotherapy is a developmental process that parallels all other developmental processes.
8. We want to help the patient fulfill wishes in the real world rather than exclusively in fantasies or in dreams.
9. We want them to have the confidence to act effectively – this means that they have to practice the newly acquired behaviors and lay down the tracks that are so hard to learn in muscle memory.

We then reread together the 15 or so pages and discussed them as we went through them.  A student in the first section spontaneously said that this is what she came to graduate study to study.  In the second section, a student similarly appreciated that this writing, once she understood it, was consistent with what she is trying to do in psychotherapy with the children that she is working with.

A little context.  Solms spends the first 100 or so pages articulating that consciousness is something that takes place not in the cortex, as neurologists from the time of Freud onward have thought, but in the older sections of the brain.  And, he goes on to assert, consciousness is a very limited resource.  We decide what to attend to (what to be conscious of) based on a hierarchy of emotional urgency.  Those things that need our attention get it.  So, for instance, when we can’t breathe, we work on that problem first.  The task of the mind, then, is to automate as much of our actions as possible so that consciousness is not necessary for most of what we do – but is only called up when it is essential.

Most of our interactional patterns – the ways that we manage situations with other human beings – have been over learned and over practiced.  And these overlearned behavioral patterns are stored in a type of memory that is like muscle memory – hard to learn, but also hard to forget – like remembering how to ride a bicycle.

The pages that I had the students read spell out how the system of consciousness works – a system that is used only when necessary.  Mostly our patients (and we) don’t recognize most of what is going on when we are meeting together (Glen Gabbard makes this point when talking about therapeutic action).  We have to make the psychotherapeutic process urgent and real enough that the patient feels that it deserves being attended to in a way that will allow for learning something new about how to interact with others.

When we are conscious of our experience, we make new decisions about how to handle situations that have been handled automatically.  Solms makes the point that not only is consciousness called up by emotions, the ultimate decision about what course of action, though informed by cognition, is not a cognitive decision, but an emotional one.  We feel that this is the best course of action in this particular situation based on all of the imperfect, conditional information that we know about it.

The human condition, then, is an interesting one.  When we don't know what we are doing (when we act unconsciously) we are reasonably certain that we are doing the right thing - we are not alarmed enough to call in consciousness to help us work through what needs to be done.  When we are alarmed - when we are conscious, we do not act rationally and with certainty, but with what we feel is the best solution.

I think this book may be the most important organization of neuropsychological empirical results through the lens of psychoanalytic thinking, and therefore perhaps the greatest contribution to psychoanalytic and neurologic thinking in the twenty first century.  I think that Daniel Stern’s Interpersonal World of the Infant was perhaps the most important psychoanalytic work of the latter half of the twentieth century because it organized the empirical developmental literature in much the same way.  Fortunately, these two pieces of work nicely interdigitate with each other.  Stern was articulating how we learn, as infants and then as children, how to interact with others.  Solms is specifying the brain mechanisms that allow this learning to take place. 

Stern proposes that it is emotion that drives the learning system because it is emotion that allows for the transfer of information from one sensory system to another (this piece of cloth feels like what it looks like – it looks like it feels soft and smooth), and Solms clarifies that the emotional system is at the root of how we make decisions about the world and how to act in it. 

It is ironic, then, that at the moment that Freud’s ideas are getting the strongest empirical support they have ever had – in developmental science and in neurological science – while simultaneously there is increasing data that suggest that psychodynamic psychotherapy and psychoanalysis are at least equivalent and perhaps superior to other means of addressing the woes of the human condition (medication and cognitive-behaviorally based interventions), that psychology and psychiatry are turning away from the psychodynamic and towards more mechanistic means of describing and altering behavior.

Solms himself is trying to heal this rift by demonstrating that, yes, at root, psychoanalysis is the true mechanistic explanation of human behavior.  Look, he says, we can reduce human behavior (and experience) to a mathematical equation.  We are the true science!  Ironically his book is centrally about how mistaken scientists have been in looking to the cerebral cortex as the seat of human experience – we are not essentially thinking creatures but essentially feeling ones, he would prove.  But he substantiates that with the most cerebral argument of all – we can ultimately predict behavior with an equation.

Never mind that the equation would be immensely complicated and never worked out for any practical purpose.  I think he is trying to reassure us – just as the behaviorists would – that we can control and articulate and predict, with certainty, how things will occur.  And he does this by clarifying that this is how our mind is built – to predict, and therefore to be able to ignore – to make the mundane process of living unconscious and automatic.  He would have us not act with uncertainty, but know - as if that were possible in the system that he is describing!

In graduate school, a friend proposed that by the time we are thirty years old we have lived 80% of our perceived lives.  Time speeds up as we get older because more and more of what we do becomes routine.  And what do we do when we get together with family and friends?  We reminisce.  We remember when the world was a more complicated place and we were trying to figure it out, because that is when we were most alive.

Yes, Dr. Solms, memory is predictive and we may lay down those tracks primarily to be able to be less observant of the world around us.  But perhaps we turn to the artists when we have finished with our daily, mundane tasks mostly done unconsciously because they are inviting us not to foreclose on our experience, not to predict it, but to be open to it – to feel what this world is made of.  To be free, if only for a moment, to take in something new and to feel it, to experience it, to luxuriate in it.

When working at the Menninger clinic – where, at the time, we were practicing psychodynamic psychotherapy and psychoanalysis (it has become a more behaviorally driven place) – we were surprised to discover that we were included in a list of great spas of the world.  But perhaps that was appropriate.  If psychotherapy allows us to be conscious in a relationship, what could be more restorative?  What could help us be more alive?

But we also flee from these moments.  They are scary.  We don’t know what will occur in them.  We don’t know what feelings will emerge.  My novice therapists prefer the safety of cognitive behavioral interventions, with their worksheets and prescribed outcomes.  We will talk in therapy about what we know about – not what we don’t.  But when we have been exposed to that for a few years, at least some of them think – this is not what I came to graduate school to learn about.  I did not come to learn a script, but to learn something essential about the endlessly fascinating thing we call the human condition.  How much fun, and scary, might that be? 

 To access a narrative description of other posts on this site, link here.  For a subject based index, link here. 

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Nope: Jordan Peele continues to articulate hidden aspects of power politics

 

Nope, Psychoanalysis, Psychology, Jordan Peele, Meaning of Nope

Nope dropped last summer, and, though I was interested in seeing it and have enjoyed Peele’s two previous feature films, Get Out and Us.  The second was disorienting enough, and so clearly in the horror genre, that it was both difficult to write about and scotched the reluctant wife’s interest in seeing Nope.  After seeing a review that suggested the horror element was deemphasized and after she had heard from the reluctant stepdaughter that it was a good film, we decided to watch it last night.

Nope is a violent film and deeply disturbing.  Neither of us was very surprised to discover that the reluctant wife had nightmares last night.  She does not remember the content, only that she awoke to the fear that she would see a bloody chimpanzee staring at her.  And this is a central image in the film, one that is hinted at early but lies, I think, close to the core of understanding one layer of the multilayered film.

In addition to being violent, this film is complicated and, despite being extremely well made, disjointed in ways that made it very hard to piece together.  On one level, it is a basic western film.  OJ (Otis Junior: Daniel Kaluuya) and Em (Keke Palmer) are brother and sister trying desperately to save the family ranch (OJ more than Em) after Otis Senior is mysteriously killed.  It is also a film about the aftereffects of trauma, and the splotchiness of the narrative, and the returns to such things as the bloody chimpanzee where we learn a bit more each time about that scene, mirror traumatic memory systems.

There are two twists.  One, OJ and Em are black. They are the great-great-great-great grandchildren of the first person to be filmed in a moving picture – the jockey on the back of the horse filmed by Edward Muybridge.

The second twist it that it is not the bank that is trying to repossess the land; the land is being haunted by an extraterrestrial form that looks, when it can be glimpsed, like a flying saucer, but turns out to be a voracious flying octopus.

So, this is a black science fiction western movie.  But wait, there’s more that makes it complicated to understand… 

The ranch next door is where the true evil lies, but we don’t discover this until we are so deep into the movie and so scared of the extraterrestrial flying octopus that we don’t recognize how evil it is at first.  It is the latter day theme park/ dude ranch owned by the now grown child actor who was terrorized by the bloody chimpanzee when the chimpanzee was a character in the child actor’s sitcom.

I hope you can understand why we were trying to puzzle through how the film hung together (which it clearly did – but how?) and wondering what Peele intended.  Don’t get me wrong, it was a thriller.  We were on the edges of our seats, just as one should be in a horror film, but why?

In the reviews we read, Peele stated that he intended Nope to be a metaphor for our addiction to spectacle.  He intended a morality play with OJ and Em as the embattled movie industry trying to hang onto the old fashioned story telling that movies have been to good at, and the ranch next door as CGI promising the allure of bigger and better spectacles. 

The metaphor works – you’ll have to trust me on that, I haven’t articulated all of the elements that tie the two together, but I just didn’t resonate with this reading of the movie.  There was something more terrifying and unsettling about the movie than this level of read would suggest (even though I can resonate with it as being, in my profession, like the war between therapists who are trying to help their clients find meaning in their life – a complicated and difficult process that requires relying on therapists to think on their feet and therefore is tough to study scientifically – and the scientists who would tell therapists to do exactly what they say they should in order to help patients get rid of their symptoms – essentially turning therapy into a form of psychiatric medication.  In this reading of the metaphor, thinking therapists own the family ranch...).

My reading of the film came to me this morning.  It is idiosyncratic and may not have been at all what Peele intended, but I think it may be valid (and is not in competition with what he has proposed, but is, perhaps, complimentary to it).

A key to the movie is eye contact.  OJ discovers that the monster is drawn to eyes – or representations of eyes.  It is what pulls the monster out of its lair and how it discovers its prey. 

Twenty years ago or so I participated in two versions of a runaway slave enactment.  In both versions, we were instructed, as runaway slaves, not to make eye contact with any white person.  To make eye contact would be enraging to a white person and would evoke their wrath, so we were to keep our eyes pointed downward.

This was very disorienting.  I immediately lost 20 IQ points.  It was harder to understand the meaning of words when you couldn’t see someone’s face, and it was also hard to read their emotional intent without having access to their body language.  I felt myself to be afloat in the world, even before having to withstand some of the insults and the terror that were part of the enactment.

Of course, in traditional psychoanalysis, the analyst sits out of view of the patient.  This was traumatic for an early patient of mine and I have adjusted my consulting room since then so that the patient can see me if they choose, but also so they can easily look straight ahead and have me be, at best, in the periphery of their vision.

In the film, OJ is the quiet, industrious brother.  Em is the flaky, outgoing sister.  Em’s trauma was having the horse that was to be hers taken away when she was a child to be trained for a movie.  She stood upstairs looking into the training arena, willing her father to look at her, but he wouldn’t.  It was OJ who had his eyes on her – who knew of her pain.

OJ is sensitive to the horses and their needs, but not so good at managing relationships with human beings.  He works more on feeling his way through interpersonal spaces, not asserting himself; he does not look others in the eye.  He is smart about people precisely because he doesn't look directly at them but senses them instead.  It is he who figures out that the monster is attracted by eye contact, and he devises a plan to capture the monster on film based on this understanding (capturing the monster on film will allow the kids to keep the ranch because they can sell the photos to Oprah and become rich and famous).

Jupe (Steven Yeun) is the grown-up child actor next door.  He had eye to eye contact with a monster: that bloody chimpanzee.  The chimp became enraged on set when some balloons from his birthday party started popping.  He proceeded to maul some of the other actors and crew.  Those who were able ran from the room, but Jupe was forced to cower under a table and watch the chimp’s rampage with nowhere to escape to.  There was a sheer table cloth that came over the side of the table and would have hid the upper half of him, more or less, from the chimpanzee.

After the chimp has attacked and hurt others, and when the chimpanzee is alone with Jupe and the now nearly unconscious costar of the sitcom on stage, the chimp finally catches Jupe's eyes through the sheer tablecloth and approaches him.  We are afraid for Jupe.  But somehow, seeing Jupe through the cloth, Jupe’s eyes don’t insight the chimp in the way that, presumably, other’s have.  The chimp is able to make contact with Jupe, not as another victim, but to remember their shared language and offers the fist bump that has been an indication of their previous affectionate relationship.

Eye contact can, apparently, go both ways.  We can see the other as another animal - as prey - and we can find them, attack them, and consume them when we identify them.  Of course, the chimpanzee is insighted by fear - the balloon popping is scary - and when we are afraid, we project our aggression onto others which frees us to attack them (think of war and slavery here).  On the other hand, making eye contact also allows us to empathically connect with others -  we experience our shared humanity.  It is dangerous to make eye contact with those we assume are other - they may turn out to be made of the same cloth we are.

Unfortunately, Jupe, who has been terribly traumatized by the situation on stage (as has the current audience), decides to hide that part of the experience and to, instead, pass it off as something that he had more mastery over than he actually did.  In fact, he turns the experience around to indicate that he is the “chosen one” who is immune to being destroyed by powerful creatures.  This allows him to lure the monster in to feast on the horses that he has bought from OJ in a spectacle for paying customers.  OJ, of course, has no idea that his horses are being consumed.  It is only when his second best horse, Lucky, refuses to leave the cage when the monster arrives at the appointed hour, that Jupe and all of his paying customers are consumed.

It seems to me, then, that Jupe may also be representing the white man (and it would not be beyond Peele to hide the white man in an Asian actor).  This white man misunderstands his survival of contact with the dangerous other – the chimp in the case of Jupe, but the African slave in the case of the white man – as due to some inherent superiority on Jupe’s/the White man’s part. 

Jupe didn’t learn that the monster is drawn out by seeing into the eyes – which I can’t help saying are the windows to the soul, but also mirrors of the soul – and didn’t learn to be cautious and canny about how to manage monsters. OJ, as a horse trainer, but I think, more centrally, as a black man, knows that eye contact incenses the monster.  He decides that the eye contact will happen on his terms, so that he can draw the monster out to be seen and to be shown to the world.

If you are still following me, then, the monster is really a representation of voracious white people.  The people who are drawn to uppity (eye contact making) people of color and are incensed by them and consume them.  But those white people are tricky.  They hide in plain sight.  You wouldn’t know that they are dangerous (The monster pretends to be a fluffy white cloud – you only know that it is not a cloud because it does not move in the wind, perhaps a metaphor for those whites who are not willing to give up their privilege).

One other feature of the monster is important.  It sucks the electricity out of the air, rendering modern technology useless against it.  OJ must ride a horse – he must be a real cowboy – to defeat the monster.  I am now getting, perhaps, too taken with my metaphor, but it seems to me that this might be a  commentary on the ways in which modern whites are figuring out how to undo modern curbs on their behavior – the voter’s rights act, for instance – and it will be up to people of color and their allies – OJ and Em enlist the aid of a Latino tech operator and a white cinematographer to try to get the picture.  Ultimately, though, it is the old analog system, run by Em, that ends up working to get the needed image.

I don’t know if Peele is telegraphing that we will need to return to nonviolent demonstration to capture the monstrosity of white aggression, but this film seems to be making a case for that, at least in my mind.  The destruction of the monster comes not because the cowboys want to kill it, but because they want to publicize what it is doing.  Its own rampant hunger is what ultimately does it in.  As Ruth Bader Ginsberg quoted Sojourner Truth saying, the goal is not to harm men, but to get them to "take their feet off our necks".  It is their own hunger to destroy that will, in this reading of the allegory, destroy them.

The piece that doesn’t quite fit into this analysis is the chimp.  The chimp must ultimately be, I think, symbolic of the white man and his aggression, aggression that gets projected onto the people of color.  Could it be that the chimp represents the white man pretending to be civilized and that the pretense of civilization is a very thin veneer  over his essentially untamed bestial qualities?  Freud would not argue with that assessment.  And, if you grant me that we are barely on top of our most primitive selves, but we pretend to be holier than others, they become receptacles for what we cannot tolerate seeing in ourselves - our monstrousness - our unbridled rage and entitlement.  And we project that outwards - assuming that it is others, not ourselves, who are the danger.  Could the chimp have been afraid and imagined that everyone was going crazy after the balloon popped?  Could he have seen the fear in their eyes and imagined that it mirrored his state, not realizing that he was the one who was scaring them?

Part of what sets the movie into motion is a moment when Lucky has a mirror put in front of his eyes and he starts to buck, scotching a job that might have helped save the ranch.  When we see what lies within us, when we see our fears mirrored in others, we react instinctively, if you will.  

 To access a narrative description of other posts on this site, link here.  For a subject based index, link here. 

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Glen Gabbard on Psychotherapeutic Action

 

Glen Gabbard; Therapeutic Action; Witnessing; Therapeutic Match; Seeing and not seeing.

Glen Gabbard (virtually) Came to Town the Other Night and Clarified that Psychotherapeutic Action is not what you think it is…

If David Letterman were a psychoanalyst, he would have Glen Gabbard as his first guest on the show “My Next Guest Needs No Introduction.”  Dr. Gabbard has written over 300 psychoanalytic articles – many of the co-authored with other leading analysts - and multiple books, including Psychodynamic Psychiatry in Clinical Practice, which is a standard text in both psychoanalytic institutes and psychiatric residencies.  He also edited the most recent edition of the Textbook of Psychoanalysis.

I have known Glen for about thirty years, since I was a trainee at the Menninger Clinic when he was its director.  I never had him as a teacher when I was there, though he was a consultant on a patient that our treatment team was working with.  I came to understand what he does so well a few years later when he came to present to my state’s psychological association on borderline and narcissistic personality disorders.  As I was walking out of the presentation, I overheard one psychologist say to another, “I could have given that presentation.”  I thought to myself, “I don’t think so.”

Dr. Gabbard’s gift (in my mind) is to take incredibly complex material and make it comprehensible.  In the psychiatric text, he very neatly explained the differences between Kohut’s version of narcissism and Kernberg’s, a difference that was the subject of heated debate in psychoanalysis for decades.  He clarified that these two men were working with very different populations and using the same name to describe the psychological functioning of these two groups.  When understood in this way, it is no longer a question of who is right, but which theory is applicable to which particular patient.  Elegant.  In the state psychological meeting, he presented complicated concepts so clearly that others thought what he was doing was easy.

I was looking forward to Dr. Gabbard’s presentation on Psychotherapeutic Action, which is the question of what it is about psychotherapy that helps our patients.  Recently, due to the COVID pandemic, we have not had the usual national meetings that allow me to connect – even if across the room – with people like Glen whose work I admire and, in his case, with someone that I know.  It was also good to welcome him to our group – even if, because when he agreed to come, it was on the stipulation that it would be virtual because the world was not yet back to our new sense of normal.  I was not prepared; however, for this paragon of analytic doctrine to rock my world.

Oh, he started out just fine.  He noted that when he was a trainee, he presented a case to Charles Brenner who was, at the time, the paragon of psychoanalytic thinking.  He noted in his case presentation, that though there were still a few symptoms, he was prepared to terminate with the patient.  Dr. Brenner chastised him, stating that a treatment is only complete when there are no remaining symptoms.  Dr. Gabbard was publicly chastened and apologetic, but on the ride home from the presentation he thought, “That’s crazy.  When is anyone symptom free?”

Indeed, I remember a colleague at Menninger talking about her own analysis and the fact that she was still smoking (cigarettes) at the end of it.  The newest version of the DSM had just come out that included nicotine dependence as a disorder – and she stated that if nicotine dependence had been a disorder when she was in analysis, surely her analyst would have cured her of that as well. 

I repeat that little story to clarify that psychoanalysis, within psychoanalytic circles, has always been idealized in ways that are not reality based, but those idealizations have had a powerful impact on us – or at least on me.  For instance, the oft repeated ideal that the well analyzed person never unintentionally alienates another person was very attractive to me.  I hate alienating others, but do it quite frequently and, apparently, unintentionally.  The idea was, when I was well analyzed, I would have access to all those unconscious desires to harm others and could therefore avoid acting on them.  Well… apparently, I am not well analyzed enough to have reached that level.

So, I don’t mind (and have often found helpful) a little de-idealization of analysis.  But what Glen did was different.  After tracing the “relational shift” in analysis – the transition in analytic thinking from the 1940s into the 1980s – and indeed even into today – that allows us to realize and consider the ways in which we influence each other, he talked about the influence of thinking about relationships in general and the psychotherapeutic relationship in particular as central to human functioning on therapeutic action.

Unlike the old ego psychologists like Dr. Brenner, who saw symptom reduction as the task of analysis, Gabbard says that we have come to realize that focusing on symptoms is not helpful; in fact, it can cause our patients to cling to them ever more tightly.  We need to work on helping our patients live within their own skins; to be comfortable making fuller use of themselves.  When we are thinking about improved functioning rather than symptom reduction, we focus on understanding what leads the patient to get better.  This way of thinking about therapeutic action leads us to be more inclusive than simply looking at what we as analysts/therapists do.  Instead, we are thinking from the perspective of patients do to become healthier.  In support of his position, I would add: when we look at the empirical literature, patient variables account for much more of the outcome in therapy than therapist (or orientation of therapist) variables do.  So, Gabbard’s position is that we need to understand therapeutic action from the position of the patient.

He then proposed three conditions that lead to patient improvement.  The first is the match between the therapist and the patient.  The second is the process of witnessing (or being witnessed, if we focus on the patient).  The third he called “Seeing and not seeing”.

Patient/therapist match is indicative of psychotherapy being a more personal than a technical undertaking.  The patient’s transition to living within his or her own skin – with being able to tolerate and articulate the feelings that have been warded off and therefore relegated to unavailability rather than being available to help guide his or her behavior – happens within the context of a human relationship – a relationship with another human being, not a relationship with a "therapist". 

As therapists, we can adjust ourselves, within limits, to “match” the needs of our patients.  I work particularly well with emotionally remote men.  I think they find my relative ease with emotional expression reassuring.  Emotionally remote women, on the other hand, in my experience, do not respond so well to the same emotional expression.  I think, though don’t really know (because they don’t typically stick around long enough for me to find out), that these women experience me as being unpredictable and therefore threatening.  That said, there have been surprising fits (and misfits) over the years - and I can stretch to work with clients that might not initially feel that I would be a good match for them.

As witnesses, we need to listen.  Gabbard minimized the role of interpretation in change, even though this was seen to be the “mutative” element in early analytic theory about therapeutic action.  He believes patients come to talk, to be heard, and that our interpretations are primarily useful in so far as they help the patient feel understood.   Indeed, Gabbard sided with Winnicott who believed that what our patients need is, essentially, a private experience - a sense of being in contact with themselves.  They want (and need) to be alone – somewhat paradoxically - in the presence of the analyst.  Our job, then, is to create a space in which the patient can feel free to be and express themselves; not for the therapist, but for themselves.

This part of the talk brought to mind for me a description of an evening that Ralph Waldo Emerson spent in the company of Henry David Thoreau.  As I remember it, Emerson arrived and Thoreau invited him into his cabin where they sat in front of the fire for two or three hours.  Neither said a word.  At the end of the evening, they thanked each other for having spent a magnificent time together.  Of course, this happened in the context of a friendship that was based on talking as a means of getting to know one another, but it also indicated an ability to be present to the other without needing to be in the other’s business – and that the presence of the other allowed one to more fully occupy oneself.  The maxim of the witnessing perspective, then, would be: In the context of a relationship, I can more fully get to know myself.

Finally came the unsettling aspect of the evening.  If the idea of witnessing had a bit of a Zen koan feel to it, the idea of Seeing and Not Seeing certainly felt like we were being implored to clap with one hand.  Dr. Gabbard cited research that suggests that much of what we communicate is non-verbal.  Despite the fact that the analytic posture (lying mostly motionless on a couch with the analyst largely out of sight) intentionally minimizes non-verbal communication, Gabbard insisted that most of our communication occurs outside of our awareness.  We don’t understand what we hear and, no matter how well analyzed we are, we don’t really know what we are saying.

This poses a quandary for the analyst – and even more so for the person trying to teach someone how to do psychoanalytic work.  How do we help someone know what they don’t know?  Of course, this is the central dilemma in the psychoanalytic process.  We are trying to help our patients access the parts of themselves that are unknown.

In the discussion after the talk, I let Glen know that, though I had appreciated his talk, I found it disturbing.  As a person who is responsible for shepherding our candidates through the curriculum that teaches them how to do psychoanalysis, a central component of which is to teach them how to follow the “red thread” that binds the analytic hour together, to have him (of all people – I might have added – the avatar of psychoanalytic orthodoxy) tell the psychoanalytic candidates, but also the psychoanalysts and faculty that, when we listen to and follow what our analysands are saying, we are missing the majority of what they are trying to communicate – and likely the most important aspects of what they are trying to communicate, well… that is unsettling to say the least.

Then, that night, I had a dream.  I was wandering about and came across a seam in the landscape – a ripple in a cliff – and I noticed that it went deeply into the side of the hill and, as I started to follow it into the hill, each time I thought I came to the end of it, another alley would open up and I could follow that deeper into the hill.  I was really excited as I was pulled inexorably forward, discovering new depths, until I realized that I did not know how I would find my way out, and I awoke with both a feeling of terror but also a sense of guilt that I did not have more faith in my ability to navigate things in reverse.

The next day, Dr. Gabbard worked with one of our analytic candidates to better understand a case she presented to a group of us.  Glen practiced what he preached.  Generally, our speakers do when they engage in the consultation/workshop the day after a lecture.  But this usually means that they are pointing out the parts of their theory that are being demonstrated in this particular case. 

Glen was doing something different.  He was showing us how to match ourselves to, in this case, not a patient, but someone consulting with him.  He was witnessing what he saw going on, and he was working to be aware both of what he saw and what he didn’t see.  When the person consulting finished presenting a segment of clinical material, he did not opine about what was going on, but asked her what she thought was going on.  He asked her what the material evoked in her – what she felt on hearing the history.  He did wonder if she felt some of the things that he felt, but this was presented in the form of a question, apparently out of curiosity, rather than as a corrective – he was not saying you should feel what I feel, but wondered with her why he would be feeling something she did not, if she did not, in fact, feel it.

I was reminded of his presentation to our state psychological association.  His approach to consulting seemed so simple that I felt I could easily do that.  I know from practice that what he was doing was, in fact, anything but simple.  In fact, I think it is terrifying.  I think it is like following a series of openings deeper and deeper into a cave, not knowing if one has left behind a red thread that will allow one to find one’s way back out.

Towards the end of the consultation, I let the group know that I had had a dream the night before.  Glen reassured me that there was no better place than in a group of analysts to tell one's dream, so I did.  The group immediately grasped the excitement, but also the terror as a response to the talk the night before.  My experience was that Glen was asking us to join the patient in the terrible quest of not knowing – of being present to another without trying to control, mold, or shape them; without knowing where they would go or how they would get there.

I think that, at least in my own analysis, this became a faith-based enterprise.  I eventually became convinced that my thoughts, random though they appeared at first, would coalesce and, when they did, they would make sense.  And more often than not, they did.  And, frequently when they didn’t, my analyst would help me tie them together.

I think Glen would support our gaining as much knowledge as we can so that we are as well equipped as possible to manage the terror that is part and parcel of being immersed in the relatively unstructured mind of another person – especially as we try to be as open as possible to the functioning of our own minds.  But I think he trusts that we will do this.  Our techniques, following red threads, etc., and our concepts, imagining the organizational structure underlying the association we are listening to, are maps that help orient us to the terrain we are inhabiting.  They help us manage the terror.

But I think that he would not have us use those maps to protect us from the terror and the joy the emerges from the immediacy of the human interaction that the analytic space affords.  We should be alive to the moment that we are having with this individual and we should be prepared to be surprised by what will emerge in that moment within them and within ourselves.  When we are able to inhabit that space more fully and, in so far as our past experience and theoretical knowledge helps us, hover in that space and not flee from it, this will support our being well matched with our patients, witnessing their experience, and it will help us see both what is apparent and what is harder to sense – those aspects of the interaction that lie just outside of our awareness.  

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