Moving On

October 24th, 2010

He comes into therapy sad and depressed.

He can’t get over (move on) a cataclysmic event from his past.  It haunts him and haunts him and haunts him.  Forever it seems.


I watch a Dr. Phil show on alienated parents.  The parents have been battling for years in the Court over their two children.

Dr. Phil advises that they must stop fighting for the sake of the children and that he will get them help to move on. 

This is obvious.

 I doubt they will.

I am more interested in why they cannot move on.


One way to conceptualize therapy is that people come into therapy because they are stuck.  They can’t move on.

They may be stuck on a marriage, a death, an obsessive thought, a repetitive behavior, a feeling that they can’t seem to get rid of.


She is stuck and unhappy.  She talks about how depressed and unappreciated she feels in her relationship. 

She knows all this.

What she doesn’t know is why she holds on and won’t move on.

She says to me “I don’t know what to do”.

I am tempted to tell her, but I won’t.

I am more interested in the question then the answer.

Sometimes, questioning and searching for an answer, is just a way to avoid moving on.

The eternal search for the “why”, which can become a way to retreat from the bridge to the other side.


A mentor of mine committed suicide.

His autopsy report was posted on the Internet by some persons and mental health professionals who disliked what he wrote, thought and said.

I doubt if any of them had ever met him.

I remember writing something like that even though my mentor had died, some of the living couldn’t move on from attacking him.


To be continued….




Dr. Brody

Family of Secrets

May 24th, 2010

They view the child as a heavenly gift. 

Given to them from on high.

She is theirs.  To be part of their family forever.


The mother is an outsider–not one of them.

She will be allowed into their family, but only if she releases her child to them.  It is their child.

She refuses.


The family secretly plots to obtain/steal what is theirs–the divine child.

They are successful.  They abduct the child and take her to their country.  She is now one of them.

They do not hide her–this stolen baby, instead they parade her for all to see.

The family knows that the best place to hide a secret is in plain sight.


While this may appear to be a fairytale, it is not.  Child abduction is so commonplace that this month Governor Christ signed into law the Florida Child Abduction Prevention Act (CAPA).  The law is designed to prevent parents from abducting their own children.

Whether it will be effective remains to be seen.

Can you legislate parental/family behavior?

Can you legislate human passions and emotions?

Can you legislate family secrets?


As for the heavenly child….

Perhaps she has too early on had to deal with the ghosts lurking in all family secrets.




Dr. Brody

New York

May 3rd, 2010

I grew up in New York.

The front door to our apartment had two dead bolt locks, but I paid them no mind.  Perhaps I paid the locks no mind because I could not bear knowing the truth.

Many, many years later I realized/explained that the locks were there to protect me and my family from my natural father coming back and doing something unspeakable.  Whether this was the “truth” I will never know.  All the people who could explain the locks are long gone.

This morning, as I was leaving home a SUV drove up out of nowhere and stopped a few feet from my driveway.  A woman gets out and comes towards me carrying some papers.  She appears to be familiar, and I become anxious.  She reaches into her papers and hands me a leaflet.  It is from a religious group detailing the coming end of the world.  I am relieved and shaken.  Her group believes that they know the truth.

Several years ago, a mentor of mine killed himself.  His detractors posted his autopsy report on the web.  When alive, the mentor would call me late and night and ask “Why do these people hate me so much?”  I never had a satisfying answer.

Because I am not sure anymore if these sorts of experiences can be explained.  Explained to be explained away.  Words used to substitute for a perhaps intolerable experience.  Words used to make the experience more tolerable and perhaps go away?  Words used to filter/buffer that which can’t be filtered/buffered, perhaps only distorted and transformed into some untruthful facsimile of the “truth”.

Years later, when my mother dies, we travel to New York one last time.  We drive past the apartment with two dead bolt locks.  I think to stop and see the apartment again.  Perhaps I can find the truth.  But of course someone else lives there now.


As for the truth…


A young man discovers a truth he should have never known.  His boss, a psychologist is sleeping with female patients.  The young man tells the authorities.  They don’t believe him.  They think he is lying and don’t investigate.

Years later, a female patient comes forward.  The authorities investigate.  The psychologist admits, but only to having sex with this one patient.  The authorities let him continue to practice.

Then several other women come forward.  The authorities realize they have been lied to and want to revoke the psychologist’s license.

It is too late.

He voluntarily surrenders his license.


I sit in the first pew, again, waiting my turn to testify.

The couple in front of me sit waiting for the judge to enter the courtroom.

They will argue/compete/contest for a child or the “truth”.

I have been witness to too many of these competitions for the truth.

I seem to see a pattern.  The couple and the third.  Someone will have to be sacrificed.  Perhaps the child. Perhaps me. Certainly the truth.


A patient recently tells me that they believe that all truth is a conspiracy.  The “truth” is merely a spin that they want us to believe.

The real “truth” is what underlies the “spin”.


I look up belie and belief in the dictionary.

One letter separates them.  The truth and the lie.

I wonder if they are somehow connected.

Then I wonder about a bright lite-at birth and at death.

What if the light is the truth that can’t be known, but only experienced.

What if before we are born, perhaps before we are “conceived”, we experience the “truth”, the white light, and as we travel down the birth canal we forget it because it is such a shock coming into this other world?

And what if we spend our lives somehow looking for that unknowable truth, that white lite, only to be re-connected with it at death or at a moment of sacrifice?

Is that why sacrifice is considered a sacred act?


The last words my dying wife spoke to me were “Can I go?”

I lied and said “Of course”.


Some days I wonder if there is a white light out there waiting for me.

Or is the truth really that this is just another lie?





Dr. Brody

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”.


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.



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


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


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


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