Eyes by Hand: Dan Roche’s deep dive into the world of oculastry

 Ocularists; Glass Eyes; Healing from disfigurement; Eyes by Hand; Dan Roche, Psychology, Psychoanalysis

Dan Roche and I have been friends since graduate school when a mutual friend in the English Department, a poet named Phil Terman, suggested we all rent a house together.  Dan, a good looking, athletically built essayist, shared not just the house with us, but Saturday morning Basketball games with the English Department, some of the best (and worst) parties thrown at Ohio State, and, with me, a history of having been an army brat, that pretty closely mirrored my history of having been a corporate brat, both of us moving from place to place as children.

Dan differed from Phil and me in that he was married.  Or at least purported to be married.  I am told that I met his first wife, Julie, at some point.  She would later be the teacher of my younger reluctant daughter, but I kidded Dan that she was imaginary, especially after having made a trip with him to her home in West Virginia, only to find her not there.  His relationship with her resulted in his first book, Love’s Labor: A Story of Marriage and Divorce.  I still think it would have been better titled A Marriage Apart.  In any case, it was written during the first year of his marriage to his second wife, Maura, who is a saint…

His newest book is, according to the blurb on the back cover, autoethnographic academic writing.  That’s a mouthful.  And this book chews off a lot in its slim 176 pages.  It is about the process of preparing for, creating, and wearing a prosthetic eye – what I grew up calling a glass eye.  These prosthetic eyes, I learned, are still made from glass in Germany, but here, in the United States, they are more likely to be made from resin – which is a fancy name for plastic (Fountain pens, for which Dan and I share a passion with his saintly wife; especially when they are expensive, are also described as being made from resin – never plastic).

Dan begins the book talking about repulsion: the pushing away that someone experiences when they look at someone with a deformity.  He uses as his source writers from the 1800s, ocularists advertising their services who promised a diminishment in the repulsion people would feel looking at the person with a missing or deformed eye.  My reluctant son enthusiastically stole away this book before I could read my copy having read Dan’s other books and he commented that this is an interesting advertising strategy – to tell your prospective customers that they are repulsive.  Of course, it is often how we sell products – mouthwash, weight loss programs, but even cars and clothes – the fear of missing out (FOMO) is just a version of this: being the one who doesn’t know, who is out of the loop, and who is therefore less than, and we are highly motivated to diminish our feeling of being an outcast, in whatever form.

Even though I love Dan, I almost didn’t make it through chapter two.  Here, in the chapter titled removal, Dan was writing in his academic voice, and describing the processes of extirpation through enucleation (complete removal of the injured or diseased eye) or evisceration (emptying out the contents of the eyeball).  Even writing out that sentence made me squeamish, much less reading the details, but Dan is now a journalism teacher and he has long been observing the treatment of his own diseased and ultimately extirpated eye from among other perspectives, at a journalistic, “objective”, remove.  He also needed to get some technical aspects of the physiology on the table so that we could understand something about the craft, as well as the art of creating objects that, he would clarify, are integral components in what can be life changing experiences.

(I feel comfortable telling you that, if you haven’t read the book, and become interested in the latter chapters and, like me, you fear this chapter would be too gross to read closely, you can skip it.  I feel comfortable telling you that because Dan has told me that when he reads my blog posts, he routinely skips the paragraphs in which I describe the psychoanalytic insights I have derived from whatever object I have been interrogating.  Also, because the information in this challenging chapter, while useful to the technical components (Dan was trained as an engineer before being trained as a writer) of the rest of the book, are not necessary to what I see as the most psychoanalytically meaningful parts of the book…)

All but one of the eight chapters are followed by transcripts of interviews with ocularists or their patients about the transformative process of creating an object and doing that in the context of relating to the person who would receive that object.  The object, the glass/resin eye, is fascinating in itself – and the process of creating it, and seating it, and the technical challenges in creating a working illusion of the presence of something that is not there are detailed.  We learn about the challenges of creating something that moves – the decisions about how large to make the pupil – the technical details of painting a realistic three-dimensional object, but we also learn about what it means to be seen by a person who is looking at you – when, for much of your life, you have avoided wanting to be seen.  And we learn about the care that the oculist provides – the care for their craft, but also the care for their patient – and the intense, powerful, and healing relationships that can be not just auxiliary to, but feel to Dan to be, at least in some cases, essential to the reparative process of being fitted for a prosthesis.

I am embarrassed to realize that, as Dan’s friend, I never realized the impact his disfiguring diseased eye had on self-concept.  Frankly, I was jealous of Dan’s good looks.  I travelled with him to Las Vegas when my first wife and I won an all expense paid trip for two at a fund raiser and, because she was planning to leave the marriage, she didn’t want to go with me.  I called up Dan and figured out how to get the plane tickets (first class, no less, for the first time in my life) to include him and me.  He was excited to go, in part because he wanted to look up old friends from when he had lived there in High School.  A picture of him with washboard abs at 16 was consistent with my experience of his comfort putting on a pair of jeans and t shirt to go out for a night on the strip looking like a million bucks with no effort – while I was feeling that no amount of preparation would lead me to look presentable.

Yes, Dan’s eye was a prominent feature, but I had long before learned to have what my friend Bede, the Wired Hermit, calls “custody of the eyes”.  I looked at Dan’s good eye when I looked at him and didn’t notice his other eye.  Of course, I can see now, this meant that I was also not noticing what Dan was feeling about that eye.  When he would talk about feeling self-conscious about it, which he did, I would minimize that – pointing out my experience of him as I have articulated it in the paragraph above.  When, during a basketball game when I was guarding him, my fingernail lifted the contact off his good eye (a very strange experience of feeling small motor feedback while performing large motor movements), Dan was seemingly unworried about how close I had come to injuring his good eye.  I imagined him to be as impervious to concern about his appearance as he appeared to be about his physical vulnerability.  Or, perhaps, I hoped that my comments, intended to be supportive, about his presentation when he would mention his self-consciousness about his eye, had made him impervious - rather than unheard.

My empathic failure is mirrored by a therapist Dan describes having consulted in the book.  Dan listed a litany of concerns to the therapist and then opined that they might be related to and waved at his head.  Confused, the therapist asked him what he meant, and Dan responded, “My [deformed] eye.”  The therapist stated that he hadn’t noticed.  Dan curtly characterized the therapeutic relationship as short lived.

Would I, as Dan’s therapist, have taken his concerns to heart?  Would I have offered the kind of care that he received from the husband and wife team who created the prosthesis for him when he finally received the ophthalmic care that he wishes he had received earlier in his life?  Does caring for a friend differ from caring for a patient?  Should we join our friends in their infirmities and vulnerabilities?  What keeps us from talking about the things that are most important in our lives?

Here is the paragraph Dan might skip in his reading of this post:  Peter Fonagy, in talking about the sexuality of men, talks about our sexual selves as being ignored by our parents and peers – when infants have erections, he says, care givers frequently look away.  This preserves our sexual selves in a child like state, he opines.  Thus, when we become sexual, there is the potential for a delightful, child-like connection with our sexual partners.  We can explore sexuality with the joy of discovery that children have – we don’t turn from it with the jaded sense of having been there and done that; something that can spoil other new and challenging endeavors.

Perhaps the deep connections that Dan articulates between the ocularists and their patients – and this would mirror the connection between therapists and their patients – and all healers and those they heal – is access to hidden aspects of the patient; the parts they have kept hidden or, perhaps even when they have invited others to see them, as Dan did me, they have been repelled – as if to minimize those parts would protect the person from feeling shame – or perhaps would protect the “friend” who might care from having to explore his or her own feelings of being vulnerable, disfigured, or whatever the friend is hiding.  What we might miss, at these moments, is the opportunity to connect with the childlike, undeveloped, and therefore perfectly lovely and accessible parts of the person that we care about.

Dan describes the moment when a person who has long had a visible deformity see themselves in a mirror for the first time with the prosthesis in place as an experience of seeing themselves as they have always hoped they would be seen as profoundly validating.  I have a friend, Virginia, who does research on plastic surgery, and she reports that often the opposite occurs – especially on reality TV shows where patients are given a big reveal.  They often see themselves, and still see flaws, and this leads them to… more plastic surgery.

I imagine that, for some of the patients that Dan describes, especially those for whom a prosthetic eye is just part of recovering from a traumatic disfiguring accident, there may be disappointment that, for instance, the prosthetic eye doesn’t solve the entire problem.  But I think that Virginia would wonder if the patient who is simply having plastic facial surgery to repair being unsightly – is disappointed because they were looking forward less to a physical change than to a psychological change.  They want to feel desired or connected, or to feel that they won’t continue to be overlooked.  The physical change does not assure them of the result they want.

For the individual with a prosthetic eye, the defect is more focal, and thus the remedy is more clear – and it may inspire hope that the desired social effects can now be pursued.  Especially, and this is the central point that Dan makes, in the context of a relationship with an ocularist who has heard and understood the impact that their disfigurement has had on them, seeing the eye in place gives them hope that they can achieve both the personal integration they desire, but also the social acceptance of them as a whole person.

If you are curious about Dan and his eyes, you can see a quick video of him talking about the book here.

Addendum:  After writing this post, I realized that I was being less than candid in my "objective" experience of Dan.  When his eye was withered, I purposely avoided looking at it.  I practiced what my friend the monk called custody of the eyes.  When I did look, I felt, Okay, I hate to say it, revulsion.  I imagine that Dan read that on my face - I don't have a good poker face.  Or if not on my face, on other's faces when they experienced something similar.  This might be a momentary reaction, but that moment surely packs a huge punch.  I put that squeamish feeling (perhaps that is a better term than revulsion) aside, in part by retaining custody of my own eyes and making eye contact only with the good eye, and my overall impression of Dan is what I report above.  I overlooked, as it were, the blemish - something that we do in relationships with others - but when others have seen that we have seen that blemish (whether it is visceral or psychical) I think they don't forget that we have seen it, and neither do we, even if we have successfully directed ourselves away from it and believe we have constructed them without it...  So I applaud Dan for acknowledging what he and I would rather not acknowledge.

 

  

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Joan Didion’s Letters to John: A different perspective on therapy from the patient’s perspective.

 Joan Didion; Letters to John; Psychoanalysis; psychotherapy; psychology; memoir; journal

A friend lent me his copy of Joan Didion’s letters to John as I was finishing, unbeknownst to him, Untangling, by Joan Peters.  These are two very different books about very different treatments, but both are told from the perspective of the patient about their treatment by a mental health professional, and so it made sense to read them.  It is also the case that a significant corner of my practice involves meeting with parents about managing their parenting of adult children with mental health issues and, though the focus on the daughter faded quickly in Peters’ case, that was front and center with Didion’s book.

Both authors entered treatment (for Peters, her second treatment) to address issues related to raising an adoptive daughter.  From that common starting point, the two diverge significantly.  Peters’ book is about her analyses, each last for about eight years meeting three or four times a week; Didion’s is about the first year of a ten year once a week therapy.  Peters’ book is a memoir, Didion’s book is a series of letters to her husband to keep him up to date on the treatment – and therefore is more like a journal than a memoir.  Peters’ book was intended from the get-go to be published; Didion’s letters were discovered posthumously and published without her consent, nor John’s, nor her daughter’s, because all three of the principles are deceased, as is her therapist.

The issue of (lack of) consent to publish weirdly raised similar issues with me as with Peters’ book.  I was uncomfortable with the amount of information presented in both.  With Peters’, where she is the author, I had a someone paternal concern that she may not have realized how open she was being in her presentation.  Of course, that is not my call at all – but I acknowledge my paternalistic concern in my review as a feeling state.  For Didion, I have only read The Year of Magical Thinking, a memoir of the year following her husband John Dunne’s death (the John in the title of this book).  The Year of Magical Thinking is closer to a journal though it is also a memoir, and her writing was very open – but it was also something she intended to publish.  It is not clear that these letters, again even more like a journal than a memoir, were ever intended to be published.  Do the dead have a right to privacy?

What gets someone in the door to therapy?  How do we look for help, especially when part of the reason we may be looking for help is that those who were to have helped us have, in sometimes very important ways, failed us?  Sometimes we come in because of a diagnosis.  In the 90s, Attention Deficit Disorder (ADD) was an important entry point.  Now third-party payers will say that if someone comes in for ADD, they should be treated for that and released once that treatment has proven effective.  But what if the diagnosis is an excuse to ask for help in becoming mentally healthy?  I think that, for both of these women, their presentation of difficulty with their daughters was a legitimate need for help with parenting, but also an entry point for addressing bigger concerns about their own functioning.

When I meet with parents of adult children with mental health issues, I generally meet less frequently than weekly after an initial getting to know you segment.  The mental health system can be hard to navigate even for a mental health professional, and part of what I provide is some coaching in this regard, but managing our feelings as parents of adults is also challenging, and this is the therapeutic aspect of the relationship.  In those cases where we do meet more frequently, generally at the insistence of the parent(s), the treatment becomes more individual or couples therapy - and that's what I think took place in both cases, though in Didion’s case, for most of the year, the part of the treatment reported on remained focused primarily on the relationship with her daughter.

Didion, in her letters, fell into a pattern of paraphrasing what she said to the therapist and putting what the therapist said in quotes.  Didion has worked as a reporter and she seems to be doing that here.  The quotations seem accurate, but also grammatically too well constructed to be verbatim transcripts of the conversation.  Didion is also a novelist and the psychiatrist is, partly, a construction on her part, though I think she intends to represent him both fairly and positively.

Since these are letters to her husband, she does not go into the background of each incident that he already knows about because he knows about it.  At one point she casually refers to a broken hip as a sign of aging and it takes a while to figure out that she is not referring to this as a metaphor or as an illustration of her point, but as the current state of affairs – that she fell at a party and broke her hip – but of course her husband knew this and so her reference would have made sense to him.  The editing is very light – we have footnotes that explain who people are when, for instance, only their first names are mentioned, but there is a lot of context that we have to work to create on our own.  So we don’t know the details of some of the couple’s statements, for instance, to their daughter because Didion will say something like, “I told him about the conversation we had with Quintana we had on Friday.”  Particular pieces may then emerge as she and the psychiatrist then interrogate what took place.

I found myself reacting to the psychiatrist’s position of a). being all knowing and b). seeing he and Didion as living parallel lives.    I don’t believe that this account is entirely veridical – in part for the grammatical reasons stated above, but also because of a mismatch between what the psychiatrist is saying and what he is directing Didion to do.  The psychiatrist, in Didion’s report, is exhorting her – indeed, telling her directly how she should give Quintana more space to make her own decisions, to think her own thoughts, but he is not giving Didion that same space – he is not practicing what he is preaching.

Partly the ways in which the treatment says “Do as I say, not as I do” is, I think, a residue of the culture at large that Didion and her psychiatrist grew up in, partly a residue of the medical and mental health culture the psychiatrist was trained in, but it may also be an expression of, for lack of a better word, a wish on the part of Didion, which goes back to her cultural and familial desire.  The language that the psychiatrist and Didion use is that Quintana was never able to grow up because Didion depended on Quintana to be there for her.  There are clear parallels with Didion’s mother who didn’t know how to express herself – and Didion became a prolific writer – expressing herself – becoming, in her writing, the outgoing party person her father wanted her to be.  And she did this in the context of the relationship with John, and also of Quintana.

The psychiatrist is using language – Didion’s preferred form of communication – to try to overwrite her lived experience.  He is coming out of a tradition of insight being the means of changing behavior.  What he doesn’t seem to see, at least in this beginning of a very long treatment, are the ways in which his use of language – as a directive – ends up re-enacting her experience of being coached by her parents on how she should act while they modelled the exact opposite of what they were proposing she do.  Her father wanted her to be outgoing at parties with his family the way he was not, and her mother wanted her to engage with people openly and warmly while she shied away from close contact with others – including, especially, sexual contact with her husband, Didion’s father.

What Didion reports is an opening up as a result of the contact with the psychiatrist.  Or, more precisely, she reports that the psychiatrist sees her opening up as a result of the treatment.  She gets and understands and fights against her wish to direct Quintana, which she knows will keep her dependent, and is able to see the wisdom of facilitating her autonomy.   At this point, it is important, I think, to say something about the economics of this situation.

Didion and Dunne are professional writers.  One of the things that I remember from the Year of Living Magically is that John Dunne said that a writer never goes anywhere without his pen.  I frequently think about this when I delay writing a blog post and my command of the material fades across time (as is the case a bit here – I finished this book three days ago and I have been writing this post in my head over that time).  They are disciplined writers.  Didion doesn’t (I don’t think) miss a letter to John once she starts writing them until she is done with them – and I think she finishes writing to him when the treatment turns away from Quintana and becomes more overtly about herself (more on that later).

Didion and Dunne earned most of their money from writing screenplays (they wrote the first draft of the Streisand/Kristofferson A Star is Born and retained the authorship credit even after they were fired from the project).   They claimed that their true love was reporting and writing novels.  They wrote the screen plays for the money.  But the money was not peanuts.  Quintana is meeting with her psychiatrist once a week for part of this treatment, Didion’s psychiatrist is meeting with Quintana’s psychiatrist, Quintana is in day treatment for part of the time.  Quintana lives in a New York apartment that her parents have bought for her.  She quits a job and she is gifted 100,000 to tide her over – or maybe there is a hope that she will invest it – but if she doesn’t, there’s more where that comes from.

But it is not just the money that is a lot – it is the comfort with moving in rarified circles.  Quintana is a photographer and photo editor.  She is working for the top magazines.  And she is drinking a lot of alcohol.  She is shy about presenting her work – she has won awards for individual photos, but she has never had a gallery show of her own, which would be her next step. 

Didion grew up with her one of her high school friends becoming a Supreme Court justice.  She and Dunne penned blockbuster movies, hang out with movie stars, and Quintana has been part of that – but as their appendage.  Being independent and autonomous may be a different hill for her to climb than for others.  When you are born (or adopted right after birth) on a very high peak, it can look like a long way down from there.  And it can feel shameful not to be able to maintain yourself at that level.

Just as there seemed to be a lot of directing of Didion by her therapist – which I think she craved and profited from – there was not as much emotional connection with Didion or with Quintana as Peters experienced in her second analysis that she described in Untangling.  The empathic connection that Peters experienced was definitely a mixed bag.  It stirred up for her feelings about not having empathy early in her life – and triggered her to re-experience, or perhaps experience for the first time the intense feelings that she figured out how to manage on her own as a very young child. 

Didion’s psychiatrist seemed to be relating to Didion as a peer.  He made frequent self-revelations about, for instance, his own aging process.  I think that, empirically, people like and respond well to both direction in psychotherapy and self-revelation.  The former helps them feel less uncertain, and the latter helps them feel less alone.  Didion certainly appreciated – even almost revered – her psychiatrist. I don’t know where the treatment ended up, but I would be curious if they became curious about the quality of their relationship.  I don’t think that was likely to happen though.  They seem to have fallen into a kind of avuncular friendship with the psychiatrist as the older and wiser guide.  Perhaps he shows up in The Year of Living Magically and I have just forgotten that.

In any case, the book ends as the treatment of Quintana reaches an impasse.  My own guess is that at this point, the treatment took a turn and was more related directly to Didion's life.  The reason for the letters was so that John could have insight into the material that came from the sessions with the psychiatrist.  Maybe the psychiatrist was presented as more authoritative because Didion wanted to have someone on her side in dealing with John, but that does not make sense.  Both she and John, like the parents that I have worked with, seem genuinely invested in supporting their child.  They also seem genuinely perplexed about how best to be helpful.  My own style is to join them in the perplexity - and to offer some ideas, but to elicit ideas from them.  The psychiatrist here is reported to be working from a different, more authoritative position, and that seems to suit Didion just fine - and to be genuinely helpful to she and John, even though Quintana's situation, at least as far as it progresses in the book, does not get through a very difficult period in her life.  

The description of Quintana's death offered at the end of the book speculates about the ways in which her drinking may have contributed to the natural causes that led her to predecease Didion, but it does not clarify whether she was able to reduce or end her drinking before her death.

 

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