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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

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

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

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

When the patient walks through the door…

When the patient walks through the door…

When the patient walks through the door into the consulting room will I be ready to meet/discover them?  Who are they today?

If I am not, then I will meet the patient I saw in the last session and in the session before that ad infinitum.  Same problems, same patient, different day.  Like the patient is one of the chairs in my waiting room–never changing, always there, always the same.

I had a supervisor in graduate school that said that every session had to be “minted” anew.  Each session was fresh and had to be discovered–like starting from zero.  I didn’t understand that back then, but I think I do now.

There is a scene from the movie “The Natural” where Robert Redford realizes that his pitcher is throwing the baseball game.  So Redford tells the pitcher, “Give ’em the real stuff”.

Here is a scene from the consulting room:

He starts twice-weekly treatment complaining of anxiety and depression.  He eventually reduces treatment to once weekly and then will end treatment.  From the outside looking in every session appeared to be all the same.  Same complaints, same problems, same lack of movement or progress.  I could see that he was different from session to session, but I was unable to have him allow himself to discover that he was different–that the same complaints and problems were really all a way to hide the “real stuff”.  He was so desperately afraid of discovering/revealing the “real stuff” that he ferociously clung to his unchanging problems, complaints and feelings.

I imagine that when we are babies we discover a lot–sometimes what we find is terrifying, sometimes joyous, and everything in between.  

But then we grow(?) , the process of discovery frequently is ignored or becomes calcified and hardened.  We prefer to discover the latest technology, what’s on TV, what’s playing at the movies.  But the discoveries of ourself are left in the dust sometimes to be triggered by a shock-wave from life that inadvertently gives us a peek at the “real stuff”.  Perhaps this is what drives people to enter therapy.  They are shocked at the discovery and want to understand it or make it go away.

I understand that discovering the “real stuff” is a painful and potentially dangerous process. We all need to balance our sense of security and identity with the process of uncovering the “real stuff”.  Too much “real stuff” can upset the apple cart.  It can lead to divorce, a breakdown or breakthrough or a sudden change in our lives.  There is a certain security in believing that we are constant.  That we are who we are.  That there is no more to discover about ourselves.  We all desperately cling to our unchanging life circumstances as a sense of security, even if our lives are dull and unsatisfying.  There is a certain sense of security in knowing that this is the way it’s supposed to be.

Another view is that life is not constant, nor are we.  That there is an endless supply of the “real stuff” waiting to be discovered. And that the only constants are objects–chairs, trees, etc.  But hurricanes quickly destroy this notion, for a brief time.

But if we are not constant, if we are not finite, if we are not pieces of furniture, then what?  Where are we to get a sense of security from? 

I am always in awe of couples I see that start every session with the same argument they have been having for years.  I usually get the courage to tell them how I marvel at their ability to keep their relationship in the very same place.  I also will tell them that a relationship is alive and it takes a great deal of energy and persistence to keep it from growing and changing–to avoid the discovery of the “real stuff”.   While this avoids any growth or change in the relationship, it also provides a sense of security.  The security that comes from knowing the unchanging landscape of my life is a never-ending argument with my partner.  But then what would be the cost of changing this?

Most patients, at the beginning of therapy, tell me that they are willing to do anything to get rid of their problems and change their lives.  I believe that consciously this is what they want–anything to remove the pain.

I also believe that the “anything” that may be required is to discover their “real stuff”, and these discoveries will be mightily resisted.

Dr. Brody