The Value of Pain

February 2nd, 2010

He comes into treatment with a curious gift.

He can endure more than most.

He regales me with stories of enduring great physical pain and deprivation.

He could take more than most and therefore he would usually win.

He had an incredibly high pain threshold.

And yet………..

He reminded me of another obese patient I saw.  One day she told me that she never felt hungry.

I imagine that he never felt pain.

Sounds good, but…….

 

 

No Pain, No Gain.

How I hate the truth of that saying.

If we can’t suffer pain, then we are robbing ourselves of growing and developing.  Of course we all have our limits.

But if we live our lives avoiding suffering pain, never feeling hungry, sad, mad, etc., then how do we learn?

If learning is based on experience, and I am doing my best to avoid experiencing pain, then all I have learned is how to avoid.  Perhaps this is why drugs and medications are so effective.  They mask and avoid the pain.  This is probably why it is so difficult to break any behavior that is designed to avoid pain.

 

While I know and believe the value of pain, at times I feel lonely and sadistic as I sit in the consulting room and tolerate the patient suffering.

Shouldn’t I rush in and do something to help–ease the pain?  And I imagine that is what the patient is waiting for.  After all I am part of the “helping profession”.

But…..

I know, that within limits, robbing the patient of their suffering is not a gift, but a curse.

So I usually wait.  Wait for the patient to suffer.  But this is extremely hard at times.  There is so much pain to suffer that some days I want to go home and cry.

But….

 

I imagine a “good enough” parent allows/ doesn’t rob the baby of it’s pain, within limits of course.

There is a fine line between neglect (too much pain to bear) and spoiling (no pain).

And how parents make this discrimination will probably lead to the next generation of patients in my consulting room.

 

If I can bear/suffer it.

 

 

 

Dr. Brody

Problem Solver

November 27th, 2009

He is having problems in his marriage.

After the first session he tells me that he is waiting for me to tell him how to fix things.

I tell him that I will have to triple my price to do that.

I doubt that he got my message, and I could have said it better anyway. 

The point was missed, and the moment gone.  But it will return.

My profession is frequently referred to as a “helping” profession.

Patients come to be “helped” with their problems.  Those riddles of their lives they have not been able to solve, but continue to repeat–over and over and over.

 

She has returned to ground zero–again.  She tells me that all her relationships end badly.  This recent one has just gone that way.  She cries hysterically and looks at me imploringly wanting to know “what to do”.

I usually respond with “Why do you have to do anything?”  But I stop myself.

I am aware of an immense pressure to “help”–to give her the answer to make the pain go away. 

She looks at me like I’m crazy, missing my point.  All she wants is the pain to stop.  She doesn’t want to learn anything from this repeat performance.  Just make the pain go away.

I am struck that no matter what I say, it won’t satisfy her.  She is greedy for an answer.  Anything to stop the pain.  Perhaps that is why alcohol and drugs are so effective.  They do make the pain appear to go away.

 

There is an incredibly strong pull I feel to be helpful in the consulting room.

Yet I am distrustful of being helpful.

I doubt that most patients want “help”. 

Being human, we just want the pain to stop and go away.  We don’t want to learn and suffer the pain of learning.

I read this last sentence and I think to myself, “How cynical”.  The part of me that wants to help has kicked in and begins to criticize my own thoughts.

It is a struggle for me some days to NOT be helpful and tolerate the suffering of the patient.  It is easier and less painful for ME to rush in and be helpful.  Then I don’t have to tolerate the patient’s pain and suffering.

And I feel good about myself. I have “helped” somebody.

 

But have I really?

Oh I have “helped” create the illusion that the pain is gone.  But I doubt it really is.

What has the patient learned other than to depend on me the next time they have the problem/pain?

Will they be able to solve their own problems next time? Will they be able to suffer their pain a bit more?

 

These of course are my biases.

Perhaps I should just give the patient what they are asking for-“help”.

But I distrust the plea for help as real.  It is usually a manner to avoid the pain and suffering involved in learning to think for oneself and solve one’s own problems.

But doesn’t this make me cruel–refusing to help?

This back and forth conversation is endless.

I imagine it is a way for me to avoid the pain of not being helpful.

 

I had a patient once who ran a human resources organization.

She said that she tried to help all her employees.

I asked “why”?  And she looked at me perplexed.

I told her that one has to be careful about who one helps.  Not everyone wants help.  Most just want you to solve their problems for them.

 

In years gone by, when I started in this “helping” profession, I hung a poster in my office that read “Everyone wants to be somebody, nobody wants to grow”.

 

As I write this piece, I have come to realize that this issue of “helping” has been a struggle for me for a long time.

How do I discriminate persons that actually want help from those that merely want me to solve their problems?

And who am I to make such a discrimination/judgement?

 

One theory that I like goes something like this.  The baby communicates what it needs help with, and the mother understands, takes the problem in, and returns it to the baby in a way that the baby can use and learn from.

The problem seems to be when the mother attempts to return the problem to the baby.

I imagine the baby thinking/saying “No thanks.  It’s your problem now”.

And if the mother agrees, then…..

Then at least she can feel “helpful”.  But what has the baby learned?

And does it matter?

 

Dr. Brody

I’ve Been Spending Too Much Time At The Courthouse

October 31st, 2009

I’ve been spending too much time at the Courthouse.

I’ve been spending too much time at the Courthouse.

I look at these words and realize that I haven’t been able to think or write for some time now.  I link it to the unusually large amount of time I have spent in the halls of justice.  Sitting around. Waiting.  Exposed to tension, stress and anxiety from every direction.

Why did my father tell me repeatedly, “If you are looking for truth or justice don’t go into a Court of law”?  He should have told me “If you are looking for chaos, you will find it in the legal system”.

As I sit and am finally able to think about the inordinately large and excessive amount of Time I have spent recently in the Courthouse and the legal system, my mind begins to turn to the matter of CHAOS and I begin to feel anxious.  My hands get cold and my breathing becomes shallow.  This is what I usually experience everytime I step into a Courthouse.  I used to associate it with performance anxiety–how well would I do on the stand?  It’s funny because I have been testifying in Courtrooms for over 20 years, yet I still to this day get anxious everytime I have to go into what I have come to term “the pit”(–the pit of my stomach?).  I do usually get a severe case of diahrrea whenever I go to Court.  I have come to expect it and now refer to it as my Courthouse shits.

But now I think it has more to do with the notion of chaos–the unpredictable, unthinkable, uncontrollable.

From my recent experiences with the legal system, I have taken away another view of my anxiety response.  It has something to do with chaos.

I now think that the legal system–the laws and Courts–are all designed to give the illusion that chaos can be controlled.  The chaos of what humans do and feel.  How crazy we humans can be and act.

There is pretty much a law to control/contain most outrageous things we humans do.

But can chaos be contained/controlled?  I doubt it, and now I think that in attempting to control/contain chaos, chaos wins and the container/controller becomes chaotic.  The legal system is a mess.  It is in total chaos.  It may have been designed to control chaos, but in the process it has become chaotic.  And as the chaos of the legal system spirals, more and more laws and rules are enacted to control/contain the chaos until the legal system is totally chaotic and out of control.  No wonder I refer to it as “going into the pit”.  Who would want to go to such a chaotic place?

 

 

And yet…

She comes, as perhaps most of us do, to therapy looking for some way to control/contain the chaos she has experienced in her short life.  She recounts a tale of horrors.  Early in her life she starts to have panic attacks.  She is frequently sick as a child going to the hospital often.  Mom and Dad are engaged in an endless cycle of domestic violence.  She does her best to control their chaos.  While she is somewhat successful, her success at controlling/containing her parents chaos exacts a price.  The chaos goes into her.  She becomes hypochondriacal, always worrying about her body.  She develops multiple phobias.  She fears that at any moment the chaos will return and swallow her up.

In therapy, I can collude with her and avoid the chaos she carries inside her.  I can steer the conversation away from it so I do not have to deal/experience it, or I can allow the chaos to be present and try and tolerate it as best I can.  Perhaps if I can tolerate/contain the chaos then some alternative will emerge for her.  It is difficult at times for me, but I do the best I can.  Chaos can be overwhelming, frightening, potentially annihilating.

Perhaps we all spend our lives avoiding the experience of chaos–creating illusions, like the legal system, that chaos does not exist or that it can be contained/controlled.

But chaos exists.  And I do believe that it can be momentarily/temporarily contained, but this will exact a price on the container. The container will become chaotic/destroyed/damaged.  Which, of course, it one of the dangers of being a therapist.  Perhaps this is why the suicide rate is so high among therapists–too much collateral damage from trying to contain too much chaos?

The other alternative is to tolerate and experience the chaos–as opposed to trying to control/contain it.  I imagine this is a scarier alternative because it will require faith that one will survive the experience.

 

My mind now drifts to thoughts of faith, chaos and babies. 

Where does faith come from?

Where does chaos come from?

Where do babies come from?

I imagine the experience of coming into this world is chaotic.  And perhaps it is in this experience and how it is traversed that the answer lies. 

Or perhaps there is no answer, only a solution–faith.  Faith that one can survive the chaos.

But wouldn’t this require a faith-ful Other person to help us cross the divide?

 

 

Dr. Brody

Coma

September 20th, 2009

She had described an image/picture in a previous session.

It appeared out of nowhere–that gap in continuity that may peek through the veils of our conscious mind unexpectedly.  She is standing at the side of a hospital bed looking down at a person in a coma.  She can’t leave because the person might wake up.  The person in the coma is herself.

This session I sense that she is getting ready to reveal something she has never told me.  Something of great significance.  I tell her something like “You appear to be getting ready to tell me about something that you have kept locked away for a long time”.

She agrees, and tells me that after all our sessions together she was about to unlock this door last session, but I rescued her by talking about myself.  Obviously I missed this last session.

I ask her what it is.  She says she doesn’t know, but I don’t buy this.

She tells me that she has told me “everything”.  I respond with something like, “I know you read my blog, and you know what happens when you run out of stories and have nothing to say.  Now you can tell me what you don’t know.”

She regales me with more stories to hide behind.  I allow this, but comment on it.

I can feel whatever it is inside her building.  I allow it and resist the temptation to rescue her again.

Finally, she explodes her secret into the air of the session.  It is now public.  Out in the open.  Perhaps now she can come out of her coma for a while.

 

 

The patient assaults my mind with their words–endless, incessant chatter.  I am alternately bored and irritated.

I can’t find a way to connect with them.  This is obviously the idea.

I can’t think, as if my mind has become entombed/enveloped in a wall of words.

I keep searching to sense the patient, but they are not there.

I relax, and finally am able to wrest my mind free for a moment from their words.  I stumble out some comment on what they are doing with me.  The words stop, and emotions start to emerge.

Finally, the wall is down for a moment, and we see each other.

 

 

It is not difficult to hide in the consulting room.  Some patients are more skilled at it than others.

It is only 50 minutes of agony.  Patients can avoid/hide for that amount of time, which I imagine for some seems like an eternity.

But eventually, the stories, catastrophes, words, crises run out.  There are just the two of us, and perhaps at that moment we can briefly meet to retreat until the next 50 minutes of agony.

 

Dr. Brody

Terror

September 9th, 2009

She tells me a story I have heard before.  She is in an abusive relationship.  She can always sense it/feel it coming.  When she does, she provokes him to explode and get it over with.  It is not the attack and beating that she can’t stand, that she wants to get over with.  It is the feeling/sensations mounting inside of her that she wants to short-circuit and flee from.  If he beats her, the feeling inside her goes away.  She experiences relief.  Relief until the next time.  There is always a next time.

As I listen to her, I can feel the terror inside her building– she can’t tolerate it, sit with it or contain it.  It flows over and into me and it is almost too much for me.  It is visceral.  Pure bodily sensation.  Beyond words.  Perhaps before words.

I can’t tell you how many times I have heard this story.  It seems too many to count.  The experience is always the same for me.  A nauseating, sickening, shocking sensation in the pit of my stomach.  I have heard it spoken from victims of domestic violence, from children that have been abused, sexually and physically.  It seems their only defense is to control the feeling inside by provoking their abuser to get it over with.  Then the feeling inside goes away, recedes for a time.  Until the next time.  There is always a next time.

But what is this terror, this unworldly experience?  I used to think of it in terms of the concept of predator-prey.  The primal experience of being hunted, chased, stalked.  Or Melanie Klein’s concept of the fear of annihilation.  But these concepts are not able to capture or contain the experience.  In fact, I don’t think words can describe the experience, it can only be experienced.  And once you have experienced it, you will never be the same.  It  will change you forever.  Shake you to your roots.  It will haunt you as it waits in the recesses of your mind waiting to return.

One root of the word terror is a Greek word for tremble.  It may be that this is closer to what I am attempting to write about that can’t be written about.  It can’t be written about because it is experienced in the body, not the mind.  The mind cannot even conceive of this experience.  It is inconceivable, beyond thoughts and words.  In fact, when experienced, one loses their mind, their thoughts and all that remains is overwhelming physical sensations, shock and panic that you want to flee from.

Perhaps terror is so intolerable because it is not verbal.  It can’t be thought about, it can only be felt.  It is pure bodily sensation.

And yet, perhaps the fact that it is wordless, beyond words, beyond mind, just pure sensation is the reason why it is so devastating.

How do you digest/tolerate/process the unthinkable–what can’t be thought about.  The horribleness of the experience.  Is this why some deny the existence of the Holocaust?  It was just too horrible to think about?  Is this experience at the root of what happens to people who go to war and have to return home carrying the horribleness of their experiences?  Is this what happens to police officers, paramedics and surgeons and staff who work in emergency rooms and ICU’s?  Too much terror and horror to stand/process?

We pride ourselves on out ability to think and digest experiences.  But what if there are some experiences that are just too much for our minds?  What if there are some experiences that we can’t process or digest, only experience.  Some experiences that can’t even be put into words or communicated? Then what?  It is these type of experiences that I believe haunt all of us, and that we are attempting to do something with, hide from or avoid.

When I often think of babies and mothers, I can imagine that a baby might have just these types of experiences. Before words, there probably exists an infinite number of experiences that babies and mothers have.  What if some of these are terrifying?  And if they are pure terror, how does the mother respond?  Will she even notice?  How can a baby communicate an experience of terror to mother?  And what happens if the baby can’t?

I do not have any answers to any of these questions, only more questions.

But I have felt this experience of terror in and out of the consulting room.

Here are some images from inside the consulting room.

She is talking about a game she played as a child.  A game called catch the head.  She would play it with her parents.  As she continues to talk about this game, I start to feel a shaking, sickening sensation in my stomach.  I can’t shake it or understand it.  It’s just a game.  It’s just a game.  Until I get it.  The head was a human head from a man the parents had killed.

He is an undercover cop.  The first day in my consulting room he tells me that I’m a sitting duck for anyone that would want to kill me.  He explains that my office is a corner office with the stairs just outside my front door.  There is only one way in and out, and I allow the patient to sit between myself and the door.  This was a cardinal rule I learned when working in state mental hospitals–always sit between the patient and the door.  The cop explains that someone would just come up the stairs, enter my office, kill me and leave.  I immediately think of four specific clients I have been involved with relating to child custody matters.  All are fathers.  All are abusers.  All evoke the feeling of terror in me when I have to deal with them.  I can sense that terror just by being in their presence.  I have joked that anyone of them would kill me if they could.  I decide to have an alarm system put in my office.  I still sit with the patient between myself and the door, even though I know how many therapists get killed or injured each year by their patients/clients.  It happens either because the therapist underestimates the patient, overestimates their own ability to handle situations in the consulting room, or they have numbed themselves to the feeling of terror.  The alarm system is installed, but it does nothing to lessen the feeling of terror I experience.

Today, I have come to believe that this feeling of terror cannot be destroyed.  It can be avoided for a while, but it will persist.  I do have faith that we can all develop a greater capacity for tolerating the experience which will lead to either catastrophe or growth.  Or perhaps catastrophe is a form of growth.

I doubt that there will ever be a way to understand and think about this terror.  It is just too much.  It can only be experienced and perhaps tolerated and sat with for a while.

I had a supervisor once who told me “Never ask a patient to do something you’re not willing to do”.

Some days I play in my mind with changing the seating arrangement in my consulting room.  You know, have me sit between the patient and the door.  I usually consider this after another experience with this thing I have called terror.  I always dismiss the idea.  I know it wouldn’t take the feeling away, and anyway I still want to experience it.  Where will it lead?  Catastrophe, growth, some unknown place waiting for me to discover?  Besides it would be hypocritical.  I hear my supervisor’s words in my head.  I cannot continue to assist/ask patients to go to a place I am not willing to go.

 

 

Dr. Brody

Thresholds

September 2nd, 2009

The first threshold.  Maybe it’s birth.  Crossing into this world and leaving that Other world.

But there is an earlier threshold that has to be crossed first.  The two people have to cross the threshold from being sexual partners to being parents.  At some level the empty space of no baby has to be filled with the conception/decision of the birth so that the baby can be actually conceived and cross the threshold into this world from whatver place babies/we come from.

I imagine a circle of thresholds/doors/cliffs/ bridges–one leading to another like spokes of a wheel.  Some we are able to cross easily, others are more difficult.  Some we retreat from waiting for the right time, some we approach and recoil from, and then there are some we never cross.

Society clearly knows about these thresholds and has attempted to assist us/ shield us from them by ritualizing these rites of passages, these bridges, into ceremonies–funerals, inaugurations, graduations, baby showers…. They all appear to be designed to assist us in the process.

It is so obvious that is ignored/taken for granted that for all of us our lives are framed by two thresholds–our birth and our death.  Each one leading to some unknown, uncharted place- perhaps growth, perhaps life, perhaps death, perhaps a catastrophe or some wonderfully ecstatic state. 

 

 

 

I am 23 years old working at a state mental hospital, fresh out of college.  I have to make a home visit to a patient.  She has missed several of her therapy appointments.  When I get to her apartment, her two young sons let me in.  Their mother is standing in a catatonic state at the edge of the kitchen sink.  She is non-responsive with her hands locked/fused to the edge of the sink, staring blankly out the window, as if she had been frozen in time by some catastrophic experience.  Her sons tell me that she has been there for days.  We take her into the hospital.  When I get to work the following day, I inquire about how she is doing.  She has had a massive stroke overnight and died.  I am asked to tell her sons. I don’t want to, but  I return to the apartment and sit the two boys down and break the news to them.  I remember thinking that I was too young to be doing this.  I felt helpless, useless and impotent. I wasn’t ready/prepared to be inflicting such painful news on these two boys–forcing them to cross a threshold too early in life.  It was a threshold I didn’t want to cross either. 

Many years later it is my turn.  I am at a hospital.  This time it is my mother.  She has been hospitalized for surgery to deal with the long-term complications of diabetes.  The gangrene had started in her right toe.  The doctors amputate one toe, then all the toes, then her right foot.  But the gangrene continues to spread.  Now they want to amputate her right leg just below the knee.  I am in her room.  Just her and I.  I want to talk to her about the surgery.  I tell her that she doesn’t have to do it, at least not for me.  It is her choice, her life.  Whatever she decides is fine with me.  I know that she is a very vain woman, and that living in a wheelchair will be difficult for her, but she will never have to experience that.  She will never leave the hospital alive.  She tells me that she has to do it for my Dad.  I say okay, but … The surgery is not successful.  The surgeon meets with myself, my sister and my Dad.  He tells us that there is nothing further he can do.  She is being kept alive now by machines and mechanical appliances.  The surgeon asks us to decide what we want to do, and walks away.  My sister and father look at me, to me, to make a decision they clearly can’t/won’t make.  Once again I am asked to step up to the edge of the cliff and cross over.  I make the decision.  I tell them that mom has a living will and I will see to it that her wishes are respected.  I tell the surgeon.  She enters hospice and  is withdrawn from the machines.  We watch her for seven days as she wrestles with her final threshold.  She finally crosses over.  My sister and father have never forgiven me.  Sometimes I can’t forgive myself .

Lately, more now than ever, I wonder about how/if we can possibly develop the capacity/incapacity to deal with life’s thresholds.  At times life is just too much for any of us.  I know that we each have different thresholds to pain.  Not just physical pain, but perhaps more importantly to mental pain and anguish in ourselves and others.

But how do we learn what to do with these doors/cliffs/bridges/passages/journeys–cross-over, avoid them, ignore them, retreat from them…?

I imagine, with no way of knowing, that how we learn to navigate thresholds starts early on, probably while we are still in the womb.  What a shock and a joy to be born.  To come into this other world leaving behind the safety and security of the womb.  Perhaps the way this is experienced by the baby and dealt with by the parents makes a lasting impression/impact on the baby about thresholds and what awaits on the other side–a cruel joke, a loving presence, an absent mind, a nirvana or a catastrophe of unspeakable dimensions. 

Patients coming to my office are about to cross a threshold, but I doubt that consciously they know this. Once the patient crosses the threshold into my office, they have entered into another place–perhaps it can be imagined by me to be a place where the capacity to deal with thresholds can be developed.  But for the patient they just want to get rid of the pain or the problem.  I imagine if I were to start by talking to them about thresholds, bridges, journeys they would look at me like I am crazy, so I keep my mouth shut until….  Until we reach the first threshold.  And we inevitably do.  But once the patient makes the decision to call me and have a consultation, they have decided at some level to begin the journey, the passage–to develop the capacity as much as they can to deal with their thresholds.

And I know/sense that if I can resist trying  to save them/rescue them/ protect them/ shield them from experiencing their thresholds, perhaps they will be able to decide to cross over and discover what has been waiting on the other side for them all their life.

 

 

Dr. Brody

How Do You Say GoodBye?

August 31st, 2009

How do You say goodbye?

Some people never do, never let go, never move on.  Others avoid saying goodbye by never getting connected to anyone or anything.  They are hit and run artists.  They have developed the art of saying goodbye to saying goodbye.

It seems we all have a goodbye problem.

And yet, we are forever and constantly saying goodbye, whether we to know it or not.  Oh we try and hold on and not let go, but…

He has had an affair.  Is this an attempt to say goodbye?  To what–his marriage, some part of himself that he wants to regain after sacrificing it for the marital relationship?  He says it will never happen again, but he doesn’t know why it happened and doesn’t want to understand why it happened.  He just wants to say goodbye to it and move on.  Maybe he will be able to, but I have my doubts.  He says he is good at moving on and closing chapters.  His wife is tormented by the affair.  She can’t say goodbye to it, and all he wants is for her to let it go so that he can move on.  What are they struggling over?  Perhaps for her it is saying goodbye to the marriage and who she thought her husband was.  What will happen if she says goodbye to this.  What will the next chapter be, the future hold?  Will she have to sacrifice her marriage, say goodbye to it to find a new relationship withher husband?  They are both stuck in a timeless place.  Neither can move or say goodbye.  Perhaps they are uncertain of what they would be saying goodbye to. All they can do is hold onto what they are unwilling to say goodbye to.

Curiously, the affair occurred just at the moment when their last child was about to say goodbye and leave home.  Was this final goodbye a sign, a reminder of their goodbye problem?  A sign of what they had covertly, silently said goodbye to in order to stay married?  What quiet, unheard, unthought, unspoken sacrifices we will make to have a relationship.

The patient came into therapy following a case of being in the wrong place at the wrong time.  The accident was witnessed and should have never been seen.  They had other therapy and the recommendation had been made to leave the area where the accident occurred–leave the scene of the crime so to speak.  But this didn’t seem to help much.  In listening to the patient describe the accident, I could see and feel the impact.  They are sitting, waiting at the railroad crossing on their way to work.  The gate is down signalling a train is coming.  They hear the train approach and look down to check the time.  Then they look up to see the collision/impact/explosion.  The train runs headlong into a vehicle.  Bodies go everywhere.  The patient has to get out and helplessly survey the carnage.  The images, sounds, smell of the accident are too much to say goodbye to.  We work for a good while, but they can never say goodbye.  Instead they say goodbye to me and therapy.

I think that this goodbye problem is one reason patients are driven/dragged into therapy.  There is something they need to say goodbye to–a thought, symptom, problem, relationship.  But in my experience this is not really the issue, only the marker of what is hidden and out of sight.  Something grips them, possesses them.  Something overpowering.  Something they can’t let go of and say goodbye to.  There seems to be some in-born reluctance to let go, and instead they continue to suffer.

Perhaps holding on and suffering is preferable to letting go and saying goodbye.  It is as if we all get stuck at some mystical threshold.  We know we need to let go and cross over, but there appears an immense fear and anxiety at the moment of passage.  As if something in us will die .  The image I frequently associate with this is a person at the edge of a cliff.  They know they have to get to the other side, but they are scared.  Once they say goodbye and move on to the other side, they can look back and see their old self across the ravine, alone and desolate.

I remember as a child that my grandparents would take a cruise each winter on the Queen Elizabeth.  I can still see myself at the dock waving goodbye as the Queen Elizabeth leaves port.  I don’t remember that goodbye being upsetting.

But in the following years, there have been an accumulation of goodbyes.  My grandparents, my parents, my wife have all died.  As have portions of myself.  I am not the small boy anymore at dockside waving goodbye, nor am I the dutiful son or devoted husband.  The roles have been easier to shed than the parts of my personality that I have said goodbye to.

On my good days, I accept that saying goodbye is an inevitably painful process which I may be able to endure.  It doesn’t matter if I can endure it or not, the goodbyes will remain waiting for me to have the courage to move on and become someone new.  Perhaps it is a continual chance to re-create myself, if I have the courage to say goodbye.

I finish writing this piece, and step outside.  I haven’t seen Gilda my pet goose in a few days.  She has a broken wing and is recovering from a broken foot.  Recently she has taken to floating in the pool having a good time.  I originally separated her from the other geese for fear that they would attack her because she was injured.  So she had become a favorite pet of mine.  As I step outside, I see Gilda floating in the pool.  She is dead.

Can I say goodbye?

Can You say goodbye?

 

 

Dr. Brody

Writing

August 28th, 2009

Why do I write?

I have been writing for a long time.

Why do I write this blog?

I really don’t know.

Oh, I can give all sorts of rationalizations and reasons, but….

There comes a time when many therapists who have been doing this for as long as I have, have to write.  It is not just an impulse or an urge.  It becomes an imperative, a matter of survival.

I recently read this passage by Michael Eigen, one of the few writers I read that is still living, “I suspect there are many psychoanalytic writers who write from the depths of their beings, hoping to create a therapist who can cure them, or communicate through deaths with another living flame.” 

What does a therapist do with all the truth and lies, all the impacts received from the patients he/she sits with day in, day out, session after session, hour after hour? 

I like to tell some patients, if appropriate, that I have had more therapy than anyone I treat.  While this is absolutely true, there appears for me to be a limit on how far this has taken me.  I have considered returning to therapy from time to time.  I even had a patient who when my wife died had the courage to give me a card of a psychologist to see.  The patient wanted to ensure I was taken care of, and she was concerned that I needed someone to talk to.  I briefly considered the offer, but declined.

In a novel I am trying to write there is a room where the main character goes at night.  It is a consulting room where he is analyzed by all the dead, great therapists–Freud, Bion, Klein, Jung.  Perhaps in my mind there is no one alive that could treat me except for myself.  I don’t think this is arrogance.  I have a particular way of working and a particular personality.  I did once a few years ago go to see a psychiatrist.  I carefully selected him from all of South Florida.  I thought he would be a good fit.  I had a particular thing that was bugging me.  When I brought it up, he dismissed it as unimportant.  I never went back.

I consider what I do for a living, whatever it is I do, as a privilege.  Patients come to see me session after session.  It takes courage to be a patient and continue wrestling with oneself week after week. It especially takes courage to be a patient of mine.  But I have infinite admiration and respect for the patients that allow me to be with them in the consulting room. 

But there is a price to be paid, both by the patient and myself.

I doubt the price I pay can be calculated or described.  It can merely be experienced, and different therapists pay different prices.  But here are some glimpses of what I imagine the price to be.

In graduate school we watched a famous video of three great psychologists-Carl Rogers, Fritz Perls and Albert Ellis, all having a single therapy session with the same female patient.  I recall how boring I found the video.  It was like watching two people randomly talking in a room.  I imagine that this would be how someone would find a session of mine if they could watch a video of it.  But I now realize that this is probably due to the fact that what is missing from the video is the actual experience of being in the consulting room with a live patient.  The experience is alternately jarring, deadening and otherwise.  But it is definitely alive–if I can tolerate being present and open to the experience and impact.

I used to, and still do, think that being a therapist offers the unique opportunity to deal with my cowardice and courage on a daily basis.  In every session there are moments where I have to choose to tolerate what is going on in the session or shrink away and evade the experience.  Most of the time I act with courage, but there are times cowardice wins out.  For all of us some experiences, impacts are more than we can bear.  Hopefully on those days, I learn to grow my capacity for courage by experiencing my cowardice.  Being a therapist is a continually humbling experience.

I had a mentor several years ago.  He was a brilliant psychiatrist who was truthful, courageous and honest. He was always willing to think for himself and speak his mind.  But these qualities created problems for him among his colleagues.  He would call me late at night and ask “Dr. Brody, why do they hate me?”  He was genuinely disturbed by the hatred and vicious attacks from other professionals that his work evoked.  He would eventually commit suicide, the ostensible reason being that he had a chronic, degenerative neurological disease.  But I wonder if the other reason for taking his own life was that the price he paid became too great.  How much hatred from one’s colleagues can any of us stand?  After he died, several of his detractors gleefully posted his autopsy report on various websites in a final attempt to discredit him.

I remember watching a movie, Equus, where a psychiatrist is treating a troubled teen who had committed some atrocity against horses.  As the movie unfolds, it becomes clear that the teen is troubled/possessed/tortured/fascinated by these horses and in one scene he actually blinds some horses.  The psychiatrist desperately tries to “cure” the teen, and is successful.  But the price paid is that while the teen is no longer possessed by the horses, the psychiatrist is now possessed by the horses.

These days I consider the price paid to be just the price of admission for the privilege of working with patients. 

 It cannot be avoided or “cured”. Which is, I guess, one reason I continue to write.

 Every privilege has a price.

 

 

 

Dr. Brody

Empty Spaces

August 19th, 2009

The couple enters the consulting room.  They are my last appointment on Saturday.  I am tired having already seen eight patients, and I am ready to start my weekend.

As they sit down, the woman makes a reference to her late husband, who I had treated years ago.  I hear the comment, but it doesn’t apparently register.

Then she makes another reference to her late husband.  Again I hear the words, but they don’t apparently register.

Except. 

Except.

Except…. My body starts to shake and convulse.  I have no idea what is going on.  I am lost in whatever my body is trying to scream at me.  What is going on?  What has impacted me?  What the hell is going on with me?  Is it my tiredness?  Is it something going on with me personally that has nothing to do with these patients?  I can’t grasp it.  I can’t make sense of this shock/surprise.  There are no words, images or anything to connect the experience with.  I try to listen to what the couple is saying looking for clues as I try and tolerate what is happening to me.

The shaking continues throughout the session.

The session ends and the couple thanks me.  They feel it was a good session.  But I am still shaking.

The male patient and I have to use the restroom.  In the restroom he tells me that he knew the late husband’s family.  Again, I hear the words but they don’t register.  I just want to go home and maybe the shaking will stop.

It doesn’t.

It stays with me for hours.

Finally as I am trying to go to sleep, half in and half out of this world, the name of the late husband comes to my mind and the shaking stops.  I finally got it I think.  Now I remember the opening comments of the woman and the closing comments of her male companion.

I am upset with myself because I couldn’t put this together during the session.  Apparently I was sensing/feeling/experiencing something connected with the late husband.  Something that had not yet been conceived or thought–something unthinkable.

I write my thoughts to the woman.  I wonder if she will think I am crazy.  She sends a polite response thanking me for being of assistance during the session.

This was an odd experience for me-just an unconnected pure bodily sensation.  Odd in the sense that I frequently will sense things in a session-a thought or image of a person.  Whatever this is, it does not appear to be connected to what the patient is discussing.  I usually muster the courage to inquire of the patient about what I am sensing, and usually it turns out to be accurate.  Something that was there in the patient but had not yet been conceived or thought about so it could not be put into words.  I have come to trust this “sense” in me, but at times I do wonder if I have gone over the edge and I am just deluding myself.  Perhpas I am just tired, seen too many patients, lost my mind?  But I don’t think so.

The rational explanation I give myself for this “sensing” is that one of Freud’s great discoveries was the unconscious.  Something unknown which could only be inferred yet exists inside each of us and can control our thoughts and actions.  Freud wrote ” …one must cast a beam of intense darkness so that something which has hitherto been obscured by the glare of the illumination can glitter all the more in the darkness”. And then W.R. Bion conceptualized what he termed “O”.  “O” is unknowable, ineffable and represents the ultimate truth or reality waiting to be experienced, but can never be known.

Recently I was attempting to describe what I do to a friend.  I was explaining that I try to not listen to the words that the patient is saying, but to what is not there.  She commented, “the empty spaces”.  Which is precisely it.

New patients frequently assume that therapy works like going to see a medical doctor.  They tell the doctor what their symptoms are, the doctor diagnoses the problem and treats it.  But therapy ain’t like that.  So after a new patient finishes telling me what their symptoms/problems are and they look at me with that expectant look that I am going to diagnose their malady and fix/cure them, I usually shock/ surprise them and say something like, “That’s what you know/think is the problem. But if you knew what the problem is then you wouldn’t be in my office.  The problem wouldn’t exist. I am more interested in what you don’t know about this”.

After the shock has worn off, or perhaps in the midst of it, I attempt to convey that therapy is not like going to see a medical doctor.  That we are not dealing with physical ailments. We are dealing with the human mind.  And the mind is not sensible.  Thoughts, feelings can’t be seen, touched, heard, etc., only sensed and experienced.

Some patients can tolerate this shock and decide to continue working with me in search of the unknown, the unthinkable, the empty spaces.

Others only want my answers to solve their problems.  They usually don’t continue with me but find another therapist to diagnose their ailment and tell them how to fix their problem.

I remember another patient.  He was an older gentleman.  He called me one day and told me he wanted to see me because he was depressed.  He came to his sessions in an electric wheelchair having been physically ill for some time.  We did some work together and his depression was lessening.  His medical state had stabilized.  One day, I do not know why, I sensed that I had to discuss dying with him.  The issue had never been discussed, and there was no apparent reason for my doing this.  We had the discussion, and he felt relieved.  He died several days later in the hospital.

 

 

 

Dr. Brody

Cutters

August 17th, 2009

He is waiting to be discovered.

By me, or someone or something, but not by himself.  I imagine him to be looking out at me from a fortified bunker where all I can see are his two eyes.  The rest of him is protected/entombed by the bunker–fully encased in cement.

But his “problem”  is that he is a cutter.  He has been for years.  And this is why his parents bring him to me–to stop the cutting that now consumes them.

I don’t really imagine that his “problem” is his cutting, his self-mutilation. To him, his cutting is his salvation.  It is his answer to an experience he has been wrestling with for a long time.  He will clutch his salvation at all costs, but there is a price to being saved–to having found the answer to his riddle.  Part of the price is that people will try and take his salvation away.  Parents, professionals, friends will all become obsessed with wanting him to stop cutting and give up his salvation.

But he doesn’t want me to discover his cutting–this is obvious to both of us, and I know that the matter is not anyway about the cutting.  If I focus on the cutting it will only be a distraction leading to a dead-end.  He wants me to discover him entombed in his cement bunker, as if the cutting is a sign to look here.  I imagine he thinks I have a key to rescue him from his bunker.  Some magic power to see beyond the cutting to where he really is.  He tells me that I am the only therapist he has seen that didn’t try to get him to stop cutting.  He finds this curious and perhaps a bit hopeful.

I meet with his parents.  They are very concerned about the cutting and getting him to stop.  I try to communicate my perspective that the cutting is not the problem, and that in fact the cutting is their son’s salvation.  It is his answer to some other question and he won’t give up his salvation.  I explain to the parents that salvation is rarely relinquished voluntarily, instead it is clutched to with all one’s life and vigor.  So trying to get their son to stop his cutting will be futile.  Of course, I could be wrong about this, but I don’t think I am.  It is similar to anorexic patients I have treated.  The anorexic’s ability to not eat is their salvation.  In spite of the fact that some anorexics will eventually starve themselves to death, they won’t give up their salvation.  But everyone else, professionals, friends and family are so horrified and consumed by the wasting away of the patient that they will do anything to get the patient to eat, usually with no success.  The patient continues to waste away.

I see/sense that the parents are dismayed by my approach.  They want me to stop the cutting–that’s all.  I have failed to connect with them in a way that would allow them to see past the cutting.  The cutting consumes them to the point that they no longer see their son–only his scarred and mutilated arms.

I will not have much time with him.  His parents will hospitalize him in a facility that they think will be able to stop the cutting.  Someplace that will allow them to stop being consumed. 

Cutters, anorexics, alcoholics all seem to have found their salvation–their answer.  The problem for them is that their answer horrifies everyone around them.  Everyone wants them to stop and let go of their salvation.  Everyone around them can only see the destruction wrought by their salvation, not what else is there. 

When I treat patients like these, patients who have found their salvation, I try to be careful to not become like everyone else in their life.  I try not to want them to relinquish their salvation.  At times this is difficult at best.  I experience pressure from parents, friends and other professionals to “save” the patient from themselves.  At times I will wonder if I am mistaken in my perspective and perhaps they are right.  I should be trying to “save” the patient and stop trying to discover what I imagine they want me to.  But in the end I know I cannot “save” anyone from themselves. I am no match for “salvation”.

So what do I think this “salvation” is all about?  What do I imagine that the cutter, the anorexic and the alcoholic are waiting and wanting me to discover?  At times I think is has to do with wanting.  What do I do with my wants?  It appears that these patients have managed to erase all their wants.  Their wants have been replaced by their “salvation”.  They have no wants.  In fact, the only people that want in these dramas are their family, friends and professionals.  They do the wanting so the patient doesn’t have to.  Which I why I try my best to not “want” anything from these patients.  This of course drives the family crazy because they not only want me to “save” the patient, they also want me to “save” them from wanting and being consumed by the patient’s salvation. 

I frequently find that what these patients have been waiting for me to discover is their secret wants.  Those enormous hungers and longing that they have buried and locked away in some cement bunker.  Those unfulfilled, unfulfillable desires that can’t be put into words or thought about.

Perhaps if I discover this, then the patient may have the opportunity to discover that secret wants may be resolved without resorting to salvation.  There is always a price for “salvation”.

I often think of the cutter and wonder if he is still waiting to be discovered.  We didn’t have enough time to achieve this.

 

 

Dr. Brody