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A patient tells me “I know it’s my sh-t, but at least when I lay down to go to sleep it keeps me warm”.

Another patient, in what appears to me to be a flash of insightfulness, says “I must sound like a broken record. I always come and talk to you about the same issue–my relationship with my parent”. And then they immediately return to their broken record.  It is as if for a moment they were able to open a door, and then full of fright quickly slammed it shut.

With these patients, my experience is that whenever I say anything it is taken as an interruption.  Whatever I say or do threatens to stop the broken record from playing.  And when I am done, the broken record continues to play.  It is as if I am only allowed to be there and hear the broken record.  I can’t do anything which might jar the broken record and stop it from playing.

I used to think that this was some kind of resistance on the patient’s part.  Perhaps a distraction to make me focus on the broken record so I would not notice anything else.

Lately, I have begun to wonder if the broken record is really a life raft which keeps the patient from drowning.  If so, then the broken record must be clutched and held on to for dear sake.  It may be the only thing the patient has to hold onto.  And letting go may represent an even greater awaiting calamity.

Another patient describes to me that they imagine they are like in those scary movies where the actors are hiding in a safe room to avoid the monster.  They have to keep the door shut, because they fear that if they open the door the monster will kill them. So they never open the door.  And of course they never discover if the monster is still there or gone.

So maybe the broken record is a life saver and a safe space to hide in from the monsters on the other side of the door.

Perhaps this is a way of viewing some patients that repeatedly and continually complain of their situation, very often what they know is a toxic relationship, and yet they are never able to let go of and leave.  They continue to hang on.

W.R. Bion utilized the term “no-thing” to refer to a dimension of ineffability. Experiences, words, thoughts, dreams and feelings. That which is non-sensible. The world of “things” refers to that which can be perceived via the 5 senses. That which can be observed and measured.  The world of logic, rationality and science.  Where there is not space for unexplained phenomenon, always answers and solutions and fixes.  Always something to do.  As the surgeon said following the operation, “The operation was a success.  It was by the book. I don’t understand why the patient died”.

And yet, in the consulting room, it seems to me that there is a lot of “no-things” which can’t be contained and are perhaps searching and waiting for a container.

A new patient complains of “new” disturbing thoughts and feelings.  They feel hopeless and helpless which is not who they used to be.  They feel like they are not themselves.

Another patient tells me of witnessing someone kill themselves.  The patient states that this has turned their world upside-down.  They can’t sleep or eat.  Their moods are unstable.  They dream about the suicide, and get flashbacks of it.  They can’t get the pictures out of their mind.

Of course I cannot see a patient’s feelings, thoughts or dreams.  I cannot measure or observe their experiences, and yet patients do complain of these “no-things”.  That is if “no-things” actually do exist.

I have begun to imagine a trans-generational model of “no-things”.

I imagine that all humans, especially when we are babies and infants, come into contact with these “no-things” which are too much for the baby/infant to contain and digest.  And a significant task for the parent/caretaker is to provide a “container” for these uncontainable experiences of “no-things”. How the parent is able to do this may determine how the baby/infant learns to deal with their “no-things”.  Of course parents were babies and infants once upon a time and their parents “taught” them what to do with “no-things”, and this gets passed along generation after generation.  Can the parent be “receptive” enough to the babie’s/infant’s uncontainable “no-things”? Do babies/infants need receptive parents?

Of course I can’t “prove” any of this, because by the time a patient enters my consulting room this imagined process has already occurred and all I can intuit is how the patient now handles “no-things”.

If one can conceive of “no-things”, another question would be what is the fate of the “no-things” that could not be contained by either the parent or the baby/infant?  Do they go away?  Do they erupt at a later time searching for a container? Do they drive the person “crazy” or to my consulting room?

Several patients have recently told me that their very religious families think they are “crazy” because the patients can’t “pray-away” their feelings and thoughts.  Religion has not proven to be a receptive container for these patients, so in their families see them as “crazy”.

Another patient frequently and repeatedly describes their interactions with their mother.  These interactions appear to describe a mother who is attempting to “help” their adult child by offering advice and admonitions to be positive.  But the patient experiences this as talking to a wall.  The mother is unable to receive/accept what the patient is trying to communicate, and the patient feels alone, isolated and overwhelmed with her feelings and thoughts.

What happens when the uncontained “no-things” meet an unreceptive container/human?  Do they remain uncontained?  Do they disappear?

I see a new couple.  The husband is very logical.  He states he believes in using common sense to solve problems.  He also says that he doesn’t like things he can’t control.  The wife is very emotional.  They frequently frustrate each other and end up bickering and arguing.  They each make no “sense” to the other.  His logic cannot receive or contain her emotions, and her emotions can’t receive or contain his common sense.  I imagine that they are each trying to get the other to contain what they alone can’t contain by themselves.  But they keep hitting a closed door.  An unreceptive other.  But they keep trying to get the other to receive what they are sending.

Perhaps this is less painful than the experience of meeting a non-receptive other that leaves one alone with one’s uncontainable “no-things”.

As the commercial says, “Can you hear me now?”

Dr. Brody

The call came in this week.

I didn’t answer.

It was a former South Florida patient.

Of late, I don’t answer calls from former South Florida patients. They have become death notifications–to tell me someone I know has died.

I had believed the illusion that when I relocated to North Florida I would leave death and hurricanes behind.

My attempt at geographic distancing from the facts of life proved to be illusory.

The former patient leaves a voicemail.

They want to talk to me about, Steve, another former patient.

Later that day, I would return the call and learn Steve has died.

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The facts of life.

They, whoever they may be, tell us that death is just a fact of life.

Most of us come to “know” this.

And the culture and society provides us with ways to prepare: grief counselors, hospice, funerals, Kubler-Ross’s eight stages of grief.

But I have to become to doubt that one can “prepare” for an experience that has not yet arrived.

All that one gets is an experience of preparing, not the experience itself.  It is waiting for us to arrive and have the experience. (Are we there yet?)

 

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A young couple comes to see me.

They are considering having a child.

They want me to tell them what this experience would be like.

How could I tell them?

I don’t know, and it would not be my experience.

And it has not yet arrived.

 

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A prospective patient e-mails me.

She asks” What would therapy with you be like?”

I respond, “You would have to have a session in my consulting room”

I guess she didn’t want to have the “experience”.

She never came and found out.

 

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I am living in Homestead, Florida.

I am preparing for Hurricane Andrew, or at least doing what I have been told I need to prepare for a storm.

Hurricane Andrew arrives.

I have and survive the experience, but I was not prepared.

But I thought I was.

There is a stark difference between preparing for an experience and actually having the experience.

 

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I want to become a psychotherapist.

To “prepare”, I go to college, major in psychology, graduate but….

I don’t feel prepared.

I learn about lots of things: theories, experiments, statistics.

But I still don’t feel prepared.

After college, I go to work as a “clinical specialist” at a mental health clinic.

One day, my boss tells me I have to go back to school if I “want to get anywhere in the field”.

I don’t want to. I am content.

I eventually give in and go to graduate school and get a Master’s degree in psychology.

But I still don’t feel prepared.

After graduate school, I go to work at a mental health clinic as a therapist.

Once again, my boss tells me I have to go back to school and get a doctorate degree.

I give in again, but this time I choose a unique graduate school.  It is the first free-standing psychology school in the country.  It is a “professional school” with the goal of graduating trained therapists.

I attend the professional school and earn a doctorate degree in psychology.

But…

I still don’t feel prepared.

What I didn’t realize was that since this school was so unique in the field of psychology, it tried to gain acceptance from the more traditional psychology graduate programs by becoming more like them.  So once again I learned about a lot of theories and schools of therapy.  But I still did not feel prepared.

One day, I recall sitting in a lecture and the professor says “Every session has to be minted new, fresh.  If you are thinking about what Freud or Adler or Jung would have done, the session is over.  You are done.  The session is over.”  This is what I had been searching for.

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In the consulting room….

When the door closes….

It is just me and the patient.

And the experience.

There is no way to prepare.  You either have and tolerate the experience or find someway to avoid it.

A good way to avoid the experience is to rely on what I know–theories, techniques, what has been effective with other patients.  This way I won’t have to discover anything new.

Of course, the patient also brings their well-developed experience-avoiding skills.

If we are lucky, then perhaps one day, one session either myself or the patient or both of us will be able to stop avoiding and tolerate the experience.

 

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I really don’t know or understand why patients come to see me. I doubt I ever will.

And I am bewildered as to why some patients come back more than once.

I recall Steve strutting proudly into the consulting room.

He wanted to share his discovery with me.

He went to the chalkboard and drew three concentric circles which he said represented the workings of a watch.

He said that most people come to therapy for the outer circle–the symptoms they are experiencing, and once the symptoms abate they leave.

Then Steve pointed to the inner circle and said this is what makes the other two circles work, and that some people come to therapy to figure this out.

Perhaps Steve was correct.

 

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If you the reader has come this far, I imagine you are looking for some answer that you think I will provide, as you are probably unsatisfied with the “experience” I have attempted to provide.

I am reminded of the last lines that R.D. Laing wrote for his first book, “The Politics of Experience”.

He wrote, “If I could turn you on, if I could drive you out of your wretched mind, if I could tell you I would let you know”.

 

 

Dr. Brody

 

 

 

 

The problem is the glue.

OR

The glue is the problem

 

Many years ago, I treated a fellow for domestic violence on his wife.

The wife had moved to the local battered woman’s shelter.

Following an initial consultation with the fellow, he never returned.  But I did see him again, by chance.

I later learned that he had been arrested by the local police sitting in his car outside the battered woman’ shelter, with a trunk full of dynamite.  Allegedly he was planning to blow up the place.

Several months later, while doing my grocery shopping, I spotted the fellow again with his wife.  They were strolling arm in arm through the aisles appearing to be a couple deeply in love.

What I took away from this is the sense that there is a glue that holds couples together.  And if this glue remains unseen, prediction of future events will miss the mark.

More recently, I believe I have sensed this “glue” or template in my consulting room:

 

They come for marriage counseling. He is convinced that she has a drinking problem, but he cannot get her to see that she has a problem.

He has been trying for 20 years to convince her.  To no avail.

The mother calls me.  She believes that her daughter has an eating disorder–bulimia.  I meet with the daughter.  She does not think she has a problem.

The mother persists in her attempts to get her daughter to see she has a problem.

Another couple comes for marriage counseling. The husband writes that the problem which brought him to seek professional help is that ,”My wife thinks we have issues”.  I laugh when I see this, suspecting that the only problem the husband has is that his wife thinks there are issues.  I am correct.  The husband does not continue with therapy, hoping that his wife will to fix her “problem”.

 

It appears to me that in these couples there exists an unseen template that keeps the partners stuck in repetitive moves with each other.  This template is quite rigid and resistant to change.  Change appears to be a signal for impending catastrophe.

The image I have of this template is that it is a chain tied to both partners, so if one moves, the chain forces the other person to move.

OR

A planet with a satellite orbiting/revolving around it.  There is something that keeps the two in place, repeating the same movements over and over.  What can’t be observed is that they each hold the other in place.  Without one, there would not be the other, and as long as they each keep making the same moves, the orbit is preserved.

 

Of course, this unseen model, templates, also applies to the therapeutic couple. Not only does the patient bring their template of rigid, repetitive moves into the consulting room, but I have my own template of moves.

On my good days, I am able to sense the patient’s template and how I am being positioned by the patient to move in a particular way.

On other days, I may, after the session realize that I had joined the patient’s template.  This is an unavoidable experience.

There is always more for me to learn about my own template.  Which allows me more freedom to see the patient’s template.

 

Dr. Brody

 

There is an anecdote that I sometimes tell patients in an attempt to enlighten:

How do you get an anorexic to eat?  You have to stop WANTING them to eat.

I recently saw a patient who told me that “being in therapy with you is very different from all the other therapists I have seen”.

I believed her because the patient had recounted to me the numerous other therapists they had seen before coming to my office.  The previous therapists had all failed, and the patient’s issues persisted.  I imagined that my predecessors all tried to be helpful to the patient and failed miserably.

I did not try to be helpful, despite my patient’s determined and persistent efforts.

It appeared to me that the patient did not WANT to be helped.  They wanted me to WANT to be helpful, to want something from the patient.  This way, the patient felt they had value because someone wanted them to do something (change).  And on the few occasions where I did try to be helpful, my efforts were rebuffed and I was left feeling handcuffed and that whatever I had to offer was of no value to this patient.  They were the only ones in the consulting room who had anything of value, and they needed me to keep wanting to engage in my futile efforts to be helpful.  As long as I kept WANTING from the patient, they kept coming to my consulting room.  Once they realized that I no longer wanted  anything from them, they left.

I think at times that for some people wanting is anathema.  Wanting or wants have to be gotten rid of.  And an effective way to accomplish this is to not want anything.  Anorexics don’t want to eat, addicts don’t want to stop using, etc. etc, etc.  Their wants are projected into the persons around them.  The family and professionals who obligingly want the anorexic to eat and want the addict to stop using.

The one thing these people I am describing cannot tolerate is someone not WANTING them to do anything.

This leaves them wanting.

A fate worse than death for some people.

So the game goes on.

 

 

 

Dr. Brody

 

This was an advertising slogan from my childhood, “satisfaction guaranteed”. I believe it was for cigarettes.

And along came “Betcha can’t eat just one”.

And of course the Queen offers to Snow White a wishing apple and says, “One bite, and all your dreams will come true”. Echoes of Eve in the garden.

Now today we have “binge watching”.

None of these result in satisfaction.

But they may result in addiction.  Addiction to more and more and more.

None of these appeal to appetite.  Appetite can be satisfied.

They appeal to greed, which can never be satisfied.  Greed always demands more, and more and more.

In the consulting room, I frequently listen to patients and I sense I hear echoes of all this.

He is tormented. He works hard, never cheats on his wife, takes care of the children, cooks and gives his wife anything she wants.  And yet his wife won’t pay him any attention or be intimate with him.  His solution is to assume that there is something wrong with him.  He is never enough.  He cannot conceive that it is his wife who perceives that he is never enough to hide her own feeling of not being enough.  She hides behind her entitlement which he can never satisfy so he must be at fault.

The parents are dismayed.  They can’t understand why their child has no regard or respect for them or anyone else.  He has become a monster that does not appreciate what the parents have done for him.  After all they have done for him, he lacks any sense of value.  Nothing is ever good enough for him.

It appears that greed and addictions are alive and well, which has been known by politicians, advertisers, con men, gurus and cult leaders for eons.

To me, a central issue in all this is the feeling one grows up with of “I’m never enough”.  Curiously, it appears that if you neglect a child or spoil a child you get the same result, a feeling of “I’m not enough”.

This leads to all sorts of remedies which in the end are attempts to rid oneself of this feeling.  All these remedies are greedy.  All these remedies result in addiction.  The remedy is always more and more and more of whatever to get rid of the “I’m not enough” feeling.  But they all fail.  Because greed cannot be satisfied.

When is enough, enough?

When am I enough?

Can one be satisfied?

Can I be satisfied?

Or if I feel satisfied does that mean that I am really not enough and that I have settled for less because I couldn’t have more?

 

 

I reread this writing and find myself feeling pressured to provide some answers, some solutions.

But I resist, because if I do, then I will become just another expert, know it all with all the answers.  Another con man.

The difficult trick is to resist and allow you, if you will, to find your own answers.

It is your journey, not mine.

My journey started a long time ago.

As Fritz Perls one said, “Everybody wants to be somebody, nobody wants to grow”.

 

Dr. Brody

 

We all need some directions, except for John.

John was a handyman I employed some time ago.  He could build and fix and assemble anything.  One day I asked John if he could put together a stereo cabinet I had purchased.  It had what seemed to me like a million pieces.  John said sure and went about assembling the stereo cabinet.  When he was done, I admired the finished product.  The stereo cabinet looked just like the picture on the box it had arrived in.  Then John handed me several unused parts to the stereo cabinet.  I asked John why he didn’t use them and didn’t he read and follow the directions.  He replied, “Directions? I just looked at all the pieces and put it together”.

I guess John didn’t need directions.

In the consulting room, patients often ask me for directions.

One patient recently said to me, “You’re the doctor, just heal me.  Tell me what I am supposed to do to be cured”.

Another patient said to me,”You’re a hard man.  You have all the answers, but you don’t give me any”.

First time patients frequently start their first session by saying something like,”I have never done this before.  What do you want me to do?”

I used to give directions.  But not many these days.

I used to think that I was being helpful by giving directions.  But now I think that the only one being helped was me.

On a good day, I am better able to tolerate waiting and seeing what directions will emerge from the patient. I have less of a need to prove I have all the answers and know everything.  After all we are there to discover what is in the patient’s mind, not mine.  Even though most patients come to treatment to learn what is in my mind, assuming I have all the answers.  As I frequently hear patients say to me, “You’re the doctor. You went to school, I didn’t”.

But in order to learn about the patient’s mind, I have to empty mine.

I have to proceed without directions.

 

 

 

Dr. Brody

 

 

 

 

She is sitting in the room that we have placed her in.

It is called a seclusion room.

We have placed her there because she said she felt like killing herself.

She is sitting in the seclusion room for her own protection.  The room is narrow and empty except for a bed with sheets and a window and radiator.

She is siting in the seclusion room wearing nothing but a hospital gown.  She is on suicide watch so every 15 minutes a staff member looks through the small window in the door to ensure she is safe.

She is sitting in the seclusion room and we have given her medication to keep her safe.

She sits in the seclusion room and hangs herself.

 

The ward psychiatrist stands up and the patient attacks him.

The patient is put in a seclusion room.  This time for our protection.

He is a huge fellow who having won both an academic scholarship and athletic scholarship to Harvard, had a psychotic break.  Perhaps Harvard was too much for him to take.

He doesn’t sit in the seclusion room.  He rips the unbreakable and secure seclusion room doors down and walks off.

 

I was very young when these two events occurred.

I took from the first one that if someone wants to kill themselves it may not be possible to stop them.

From the second one I took that there are some things we cannot protect ourselves from.

 

Now, years later, I have a different view.  Now I wonder if we didn’t precipitate these events by placing these two people in seclusion rooms.  Seclusion rooms where they were left alone with the very thing that was tormenting them.  And they did what they had to do to escape what was for each of them unbearable.

 

Harold Boris wrote a book ENVY(1994).  The second chapter of this book is entitled, “Tolerating Nothing”.  Boris wrote, “There are some people for whom there is no such thing as nothing.  In their psychic calculus, zero does not exist.  Inside the zero, where there might otherwise be an absence, there is instead a presence of an absence”. (p.21)

 

I take this to mean that tolerating nothing-the absences, the voids, the gaps-is intolerable for most of us.  And to avoid nothing we will do anything to transform the empty space into something-drugs, sex, money, work…. Anything that will allow us to avoid tolerating even a little bit of nothing.

 

Now I think that when we placed them in their respective seclusion rooms, we left them alone to face what they were trying to avoid.  We left them alone with no escape from nothing.  And they did what they had to do to escape.

 

While these may be extreme examples,  I have come to think that to one degree or another we all have difficulties tolerating nothing.  And this may actually be a fundamental human condition which we attempt to evade or solve most of our lives.

 

Like the old saying goes, “Something is better than nothing”.

 

Really?

 

 

Dr. Brody

 

 

 

“The Truth Is Out There”–The X Files

“The best place to hide the truth is between two lies”–The X Files

“Everybody lies”-House

 

The attorney says that “no one can cover all their tracks”.

The attorney is pouring over a desk full of documents–pleadings, statements, and other pages.

The attorney is looking for the lies.  The attorney knows they are there.

 

But how do you discover lies, let alone the truth?  And it is easier to discover lies or the truth?

 

I remember seeing an old British movie.  It was black and white and had a title like “The Three Lies”.  It was the story of a psychiatrist who dies and his three patients.  The three patients are eager to see what is in their files.  As if their psychiatrist’s file contained the truth about them.

 

I recently read a story about a young man that lied his way into Harvard.  What was the ability he had?  What makes a good lie, a good liar?

 

WR Bion proposed that a lie requires a thinker, but the truth does not.

Bion also proposed that Keats’ Negative Capability, “when a man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after facts and reason”, was the road to discovering the truth.

And finally Bion wrote that truth is unknowable, but it could be experienced.  In other words, what one “knows” about the the truth is merely an approximation, if that.

 

But if the truth is unknowable, then facts and reason will not lead us to the truth.  There will always be a gap.  A caesura.  Between an unknowable truth and what we think we “know” about the truth.

And what about lies?

 

Perhaps what the attorney was looking for in searching for lies was the absence of any gaps.

Perhaps lies can be detected because they are constructed to be without gaps–to be logical and reasonable.

Perhaps our conscious minds operate to fill-in the gaps and see things as whole and continuous.  Gestalt psychologists postulated that perceptually our minds see things as wholes.  So when we see a tennis net we see the net, not a collection of holes joined together.

 

Perhaps the only way to discover and experience truth is the find the gaps.  (At which point the patient asks, “But what will I do with the gap?”)

 

 

 

 

Dr. Brody

He says she is crazy.

He says he didn’t do it.

He says he never hit her.

He says he didn’t hurt the child.

 

I have already interviewed the child, the mother and reviewed the Court documents.

Someone is lying.

Maybe everyone is lying.

 

I recall seeing a woman who claimed to have been the victim of ritual abuse.

At the time, I was running a group for persons who claimed to have experienced ritual abuse.

I was “believing” her story until she began talking about being in the basement of the Vatican where she was assisting in building nuclear weapons to use against Israel.

 

Another member of the ritual abuse group claimed to have been a member of a satanic cult.

But when she spoke, I had a different feeling than when the other members talked.  Something was different about her, but I never could say what it was.

She agreed to undergo a series of sodium amytal treatments.

We videotaped the treatments.

It came out that she had been abused by a family member.  She had never been in a satanic cult.

I reviewed the videotapes with her.

She still believes that she was in a satanic cult.

 

 

Truth.

Lies.

Beliefs.

Perception.

Reasonable Doubt.

 

 

How do you prove the “truth” ?

 

 

 

Dr. Brody