Sometimes I get tired and frustrated writing these blogs about the wonderful world of psychiatry out here in the world. I do it because it has become urgent to do so. I much prefer to sit in my office with my patients doing the real work. It is such an honor to delve into the mystery with each individual, and find our way to face and deal with the pains of life together. The mystery of therapy proceeds through the special profound relationship between us. Without heart there is no therapy. Only through caring and trust can the explorations be real and transformative. No matter what, whether it’s sadness, anger, emptiness, feelings, no feeling, sexual fantasies, cruel thoughts, pain, obsession, closeness, distance, softness, emptiness, fears, hardness, or tenderness — there is an air of acceptance and safety. Trust does not come easily. It has to be earned and tested.
Every story is unique. But the path always leads back to one’s Authentic Being. Love is the sustenance, and authenticity is the fountain of our aliveness. Yes we are talking about psychiatry here. All of psychiatry flows from damage to our plays of consciousness. This damage comes from trauma, abuse and deprivation, in our formative years. Additional trauma can rewrite and darken our plays at any time for the rest of our lives. The interplay between our temperaments and problematic experience generates psychiatric struggle. This encompasses all of psychiatry, period. (see – “Psychotherapy is the Real Deal.”)
To have the experience of taking the journey of therapy with so many patients makes some things very clear. When we approach the heart of the mystery, it always revolves around the deprivation of love and presence of abuse. Once one has the experience of sitting with the profound struggle involved in opening up the heart and taking the leap of feeling, it fills one with awe and respect for the pain and resilience of the human spirit. From witnessing this, and being a part of it, both therapist and patient, one is changed forever. It seems so trivial and absurd to have to have these stupid arguments about ‘evidence-based psychiatry’ and psychiatric drugs, etc.
All these ‘experts’ have never even treated a patient. They don’t know the beauty and pain of the journey. I understand there has been a lot of bad therapy. But this shouldn’t diminish the real item. It takes a lot of hard work and dedication to become a therapist. It is a human quest, no more, no less. It seems like a mysterious art to some. But it really is a form of uncommon, common sense in the context of caring. It proceeds through boundaries and love. It can be taught and learned. It doesn’t have to be for the wealthy. Therapists, of all walks of life, can and should be available for those who are struggling. It can happen and should happen. Yes it needs to be outside the medical model. It needs to be appreciated for what it really is on its own terms.
I don’t write about my patients because therapy is about their well-being and for no other reason. But to get a real feel for what truly goes on, only a real narrative will do. Otherwise the spirit of the enterprise cannot be captured. It cannot be convincing. I know you can’t just take my word for it. So I will use the character in my book, Eddie, to try to bring therapy to life.
Turning toward Eddie, seeing an end table with a weeping orchid in my peripheral vision, and a Chinese nightingale in song, on the wall behind his head… He said, ‘“Months after Cathy broke up with me, she called me out of the blue and said she had tickets to a Buckminster Fuller lecture. Did I want to go? She was up front and said that this was not a date. We would go as friends. I was thrilled. While we were there, it felt like the old days, and I was very happy. But then when the lecture was over, she just left. And that was it. She was gone again. I felt just like I had when we first broke up.”
“I think it was problematic for you to go.”
“Why? I like Buckminster Fuller and wanted to hear him speak.”
“Because it wasn’t really about the lecture; it was about Cathy. ‘Friends,’ in this context, is always bogus. You knew that, and so did she.”
“No, it’s not her fault. She was up front with me. I agreed to go on her terms, as ‘friends.’”
“I don’t even think she should have asked you. The pain that followed was 100 percent predictable.”
“No, it was me. I messed it up. You’re just taking my side because you’re my therapist.”
“That’s not true. Obviously, you played a major role, even though I don’t know how exactly, I think it was manipulative on her part.”
“You’re just blaming her because you don’t like her… Now you’re real angry at me!” As he spoke, the little finger of his left hand visibly twitched.
At this point I felt a tension in my chest and my arms, my resonance with denied and suppressed anger. I said, as I usually did when he was mistakenly certain that I was angry, “No, I’m not angry.”
Then he looked at me funny and said, “Maybe you’re not… I’m the one who’s angry! I’m really angry! I feel a rage!” The twitching stopped.
“You know she spanked me every day.”
“Actually, spanking was the family term. But it was more than that.”
“What do you mean?”
“It was a beating.”
“Tell me more.”
“Okay, I must have been four. Margie and Clara had gone off to school, and my brother and I were looking out the window, watching them walk to the bus. He grabbed me, and I pushed him back. And he said, ‘I’m gonna tell on you.’
“So I said, ‘Go ahead,’ and knocked him over. He cried and screamed, ‘Eddie hit me!’ My mother stormed in with that look in her eye. She was yelling and hitting me wherever she could. ‘I told you to leave him alone!’ Her hits felt distant and didn’t bother me. They kept coming. When she was done, she grabbed me by the arm and dragged me to the corner. ‘You stand here ’til I say so!’
“‘No, I won’t!’ I said, and pulled away.
“She grabbed me and threw me back up against the wall, ‘What did I tell you?’
“I said in an even tone, ‘You said, “You stand here ’til I say so.”’ I was thinking, What an idiot. You don’t even know the stupid question you just asked?
“She got madder and hit me on my back. ‘Don’t you talk to me that way! You think you’re so smart.’ I pulled away again, and she slammed me back into the corner. This time, I stayed there. She continued, ‘You should be more like him. He’s such a good boy,’ and on and on. She went back to the window and continued to mumble under her breath. I stood there. And I stood there for what must have been a half hour. At this point, she was reading to him.
“She turned back to me and said, ‘What do you have to say for yourself?’ I didn’t answer. ‘I said, what do you have to say for yourself?’.
“‘Uhmm… He started it.’
“‘Okay, this is it. You apologize, or you’re going to reform school. What do you have to say?’
“‘I said, He started it.’
“‘Okay, wise guy, I’m calling right now.’
“She went to the phone and dialed what I thought was the reform school. I didn’t know what ‘reform school’ was, but I knew I didn’t want to be there. I assumed it was jail. I was sure I was going, and they were coming for me. So I panicked and started to cry. ‘Don’t send me to reform school. I’ll be good.’
“She waited for a while and then said, ‘Okay, I won’t send you—this time.’ And she picked up the phone again and told them not to come.
“When I was in first grade, my parents took a two-week trip to the Holy Land with our church. We stayed with my grandparents, my mother’s parents. Before they left, my mother said to my grandmother, in my presence, ‘Make a record of what he does while I’m gone.’
“It hadn’t been a bad time. I don’t remember much of my sisters or brother. I actually spent a lot of time alone, outside, up in the apple tree. I also worked with my grandmother in the garden, weeding. I remember sitting at the edge of the garden, snapping the snapdragons over and over—you know, between my forefinger and thumb..
“At some point, I felt super-homesick. I had this sick feeling in my stomach and really missed my parents. Where were they? My grandmother and I were in the den, and she asked me what was wrong. I broke down and cried, and told her, ‘I don’t know what to do.’ I was sobbing. ‘I know that I’m very bad, and my parents don’t love me.’
“She kept telling me, ‘That’s not true. They do love you. And you are a good boy.’
“‘No, I’m not, and you don’t understand. Mommy doesn’t love me.’ She kept trying to reassure me, but I knew what was true. Her protestations didn’t mean anything to me. I was inconsolable. The sobbing went on for a long time This was actually the last time I ever cried. Eventually, I got control back and wandered upstairs to my grandmother’s bedroom. I sat on the floor and traced the patterns in her Oriental rug with my finger.
“Later, the long-awaited day finally came that my parents were coming home. But I went into a panic. Now, I knew my grandmother had made a record of all the bad things I had done. Understand, I was sure this meant a record that you would put on a record player. So I had to find this record and smash it, so my mother wouldn’t be able to play it. I kinda thought the record-making machine was in the upstairs hall closet, so that was probably where I’d find the record. I combed through everything in the closet, but I couldn’t find anything. Feeling really desperate, I began searching the rest of the house for that damned record. But it wasn’t anyplace. So I resigned myself to the fact that I was really going to get it when they came home.”
In addition to the exploration and mourning of Eddie’s past, the most crucial arena in Eddie’s psychotherapy was about our relationship. This was interwoven with all the other explorations. It was only possible for Eddie to mourn his pain anew within the trustworthy emotional arms of our holding relationship. This made the exploration and digestion of his projected play beliefs about me so essential. The hovering personas of his sadomasochistic play had settled onto me as its projection screen. Eddie saw me as the sadistic judge who was judging him as bad, disgusting, and fraudulent and who rejected him on that basis.
While he thought he believed what he saw, unbeknownst to him, Eddie actually saw what he believed, through the projected scenario of his play. He was suspicious (i.e., certain) that I didn’t like him. He believed that he was boring me, that I was critical of him, that I was angry at him, and that I was exploiting him. His exploitation beliefs ranged from the idea I was feeding my ego at his expense and aggrandizing myself as a superior know-it-all, to putting him down as inferior and lacking, all the way to his fear and belief that I had sexual motives and was interested in molesting him.
Each time he addressed any of these out loud, he absolutely believed I was insulted and mad at him. We explored these beliefs over and over, as Eddie bumped into discrepancies between his projection of me and my actuality. These collisions were always bumpy. They were, however, the avenue by which Eddie ultimately tested his play beliefs for himself. The real establishment of trust wasn’t a one-time leap. It took place by increments as he faced and tested his actual beliefs about exploitation on his own terms, in his own way and in his own time. The heart of his therapy would turn on our evolving human relationship.
In conclusion; I’m sick and tired of addressing bad psychiatry on its own terms. It seems sometimes like endless folly. To paraphrase John Lennon in “God” (taking some liberties) “I don’t believe in chemical imbalance; I don’t believe in shock treatments; I don’t believe in pharmaceutical psychiatry; I don’t believe in genetic determinism; I don’t believe in lobotomies; I don’t believe in biological markers; I don’t believe in defenses; I don’t believe in psychiatric diseases; I don’t believe in the neurotransmitter myth; I don’t believe in bad science; I don’t believe in molecular psychiatry; I don’t believe in penis-envy; I don’t believe in nutritional psychiatry; I don’t believe in ADHD; I don’t believe in biological depression; I don’t believe in evidence-based psychiatry; I don’t believe in hallucinogens for depression; I just believe in me, Yoko and me.”
No, wait a minute, change ‘Yoko and me’ to ‘The play of Consciousness, good psychotherapy, and me.’ That’s all she wrote.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.