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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

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

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