Talking Cure

Conversation

Sherry Turkle, a sociologist and psychologist who studies the impact of technology on relationships, wrote recently about the need for face-to-face conversation in a world increasingly dominated by texting and smartphones. It is through this “talking cure” that we build empathy, intimacy, and self-reflection, coming to know ourselves and others deeply.

Turkle wasn’t talking about Freud, but she was describing the mainstay of psychotherapy.

Soon after Turkle’s essay appeared, new research questioning the efficacy of talk therapy in treating depression made headlines. That same day, I listened to a podcast about Dr. James O’Connell, who has been providing healthcare to Boston’s homeless population since 1985.

O’Connell’s approach is more art than science.  He described having to unlearn the techniques and arrogance he’d perfected as an ER doctor when he took a job at a homeless shelter. The nurses, unimpressed with his skills, advised him to keep quiet about his medical expertise. They instructed O’Connell to spend his first two months doing nothing but soaking the feet of those living on the street.

“Don’t judge, these people have been through hell,” the nurses told him. “You will not gain anyone’s trust without being present.”

O’Connell spoke of the profound isolation and loneliness as well as the tremendous courage and resourcefulness of the men and women he came to know in his decades on the street. He believes the adversity they experienced would have broken him. This knowledge is fundamental to engaging in such hard work:

“We’re all broken in our own way,” O’Connell says. “It’s a connection with that brokenness that actually keeps us going.”

O’Connell’s words took me back to what inspired me to become a therapist: volunteering at a crisis hotline.

I had never before encountered the level of adversity our callers faced—poverty, abuse, addiction, chronic mental illness. Like O’Connell, I was awed by the courage and dignity of those whose lives were unimaginably precarious. The work was hard, but I loved it—the listening, the immediacy of the connection, feeling that my presence made a difference. Nothing much changed in anyone’s life, mine or theirs. Yet everything changed because we mattered to one another.

This is the essence of therapy. Our work is a modest endeavor–a conversation, a space of undivided, unhurried attention and exploration. The talking cure depends on humility and presence. These are the ineffable, unmeasurable things that matter—on the streets, in conversation, and in psychotherapy.

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 How do you preserve conversation in a technology-obsessed world? What is the essence of presence for you?

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(Originally published in Impulse, the electronic newsletter of the Northern California Society for Psychoanalytic Psychology)

The Pull to Be Positive

happy and sad face“Fake it till you make it.”

I thought of this adage when I took a friend who had never been backpacking into the wilderness years ago. We encountered a stream crossing that involved balancing on a log high above the roiling waters below.  I was terrified, but I never let on. My confidence was key in helping my friend safely across. It also helped me become as light-hearted as I had pretended to be.

Three years ago a cancer diagnosis thrust me again into the territory of needing to go on despite my fear. I wanted to lead everyone who cared about and depended on me, especially my children, through the treacherous waters without raising undue alarm that I’d go under, taking them with me. My darkest feelings were confined to my journal, my therapist, my husband, and a couple of trusted friends. For public consumption, I presented a sunnier side, writing breezy blog posts about wigs and Chinese medicine, stressing my gratitude and good fortune. It wasn’t a stretch: I was tolerating chemotherapy well, and felt truly lucky about early detection, great health insurance, an excellent prognosis, and lots of support.

The plaudits poured in.

“You’re so strong!” I was told all the time. “You’ll be fine because of your positive attitude.”

The implication that it would be my fault if things didn’t turn out fine always brought me up short. But being strong for others helped me be strong. Inspiring others kept their and my own spirits from flagging. I loved and needed the admiration.

I also hated it. For what if my spirits sagged? If I expressed too much doubt and fear, would I be letting down my fan base?

More important, would people desert me?

No one means to withdraw, but it happens: the involuntary recoil, the averted gaze, not knowing what to say, so saying nothing. I couldn’t bear the burden of people’s fear and helplessness. I couldn’t bear my own. So I tried not to add to it. Besides, who doesn’t want to flee the quicksand of negativity? Emphasizing the positive truth, even if it wasn’t the whole truth, was an act of self-preservation.

Only much later, long after treatment had ended and I knew I was fine, could I fully let in the darker side. It reminded me of the time years ago when I tripped and fell carrying my newborn daughter, asleep in her car seat. The seat, with Ally in it, landed hard on the concrete walkway. Fortunately, it remained upright, my baby safe and unperturbed.

“Oh, thank God,” I’d silently gasped, brushing myself off, scooping up Ally in her car seat, and continuing on, barely registering the close call.

It was only later that I could allow in the terror, all the What ifs? Ally is 24 now, and I am still overcome with dread whenever I think back to that moment.

Cancer is never over in a moment. Even when it’s gone, the possibility of its return menaces. Of course I celebrated leaving treatment behind. Yet the more chemotherapy’s protective shield of poison withdrew from my body and faded into the past, the more vulnerable I felt.

As previously disavowed feelings of fear and sadness bubbled up to the surface recently, I happened to tune into a TED Radio Hour about fighting cancer. A hospital chaplain who herself had gone through the ordeal stressed that only well after treatment has ended can survivors even begin to process their cancer experience.

Finally! Someone willing to challenge the platitudes about looking forward, not backward, the claptrap about cancer’s gifts. I listened eagerly as the chaplain described meeting with a woman a year after the latter had been declared cancer-free.

Revealing the suffering and fear she’d repressed during treatment, the woman remarks, “I felt like I was crucified on the cross.”

I waited expectantly for the chaplain to enlighten the TED audience about the isolation of cancer; the need to express what it’s really like; how crucial it is to listen to what’s hard to hear.  Instead, the chaplain recounts what she said to the woman:

Get down off your cross.”

My worst fears were confirmed: Fake it till you make it, or you may find yourself having to make your way alone.

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What’s your experience with the pull to be positive? Upsides and downsides? What’s your best (or worst) “Fake it till you make it” story?

Joy’s Shadow

Joy and SadnessIs broccoli an adverse childhood experience? That’s about the biggest upset Riley, the protagonist of Pixar’s new film, Inside Out, encounters until age 11, when her family moves. Even for this securely attached child with loving parents and a sunny disposition, calamity ensues.

Riley’s destabilization is triggered by loss of everything familiar, preoccupied and misattuned parents, and looming adolescence. The biggest threat, however, is that Joy is planted too firmly at the helm, with Sadness practically banished.

Inside Out has been acclaimed for its attention to neuroscience, but there are also strong influences from contemporary psychoanalysis. The movie echoes pediatrician and psychoanalyst D.W. Winnicott’s notion that “there is no baby without a mother and no mother without a baby.” It opens with newborn Riley’s first blurry glimpse of her parents, who exult in their baby. She is truly the gleam in her parents’ eye. Joy is not only a core emotion and an aspect of temperament, but a product of mirroring crucial to personality development.

Those of us who are therapists do not often encounter in our work clients whose earliest relationships result in Joy’s authentic governance. Yet we frequently see people who have long labored under the command of relentless good cheer. This, too, is the life of Riley. No wonder the other emotions are content to go along with the premise that Joy ought to be in charge: She sacrifices aspects of self to protect and please those she depends on.

Luckily, Riley is blessed with good-enough parents and optimal frustration: growth follows de-integration as split-off parts are integrated in an ongoing process of empathic failure and repair. Most important, Riley is allowed to mourn.

Inside Out has been lauded for its depiction of emotion, yet it is also a depiction of mania. And no wonder. Manic defenses ward off feelings of despair through constant activity, the fantasy of omnipotent control, and disavowal of sadness. Mania masquerades as happiness, but underneath lies the inability to feel sadness. This is Joy to a T.

It’s also a big aspect of American culture. Perhaps this explains why Inside Out has garnered such massive acclaim. The importance and integration of all emotions may be a given among therapists, yet the movie has been hailed as Revelation.

This may say more about us than Inside Out purports to say about the brain, emotions, memory, or personality development. But to the extent that the movie reaches a large audience about the role of affect and empathy, and the perils of happiness on command, it’s good to have Pixar at the controls.

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If you saw Inside Out, how did you like it? What aspects did you identify with? Have you experienced the pull to be positive no matter what?

 

Insane

No gunsMy husband and I were hiking in the Alps with a group of Australians shortly after Dylann Roof murdered nine members of a Bible study group in Charleston, South Carolina. We felt like we were on a different planet trekking all day among towering peaks and wildflowers as at night we kept abreast of the horrific news on our smartphones.

The stark racism behind the Charleston shooting makes it almost beside the point to zero in on guns; a massacre so intertwined with America’s long and sorry history of racial oppression, particularly in the South, has understandably made this the prevailing focus. Nonetheless, although the why of Roof’s violent bigotry is deep-rooted and complex, the how is simple: easily obtained guns and ammunition.

Our Australian hiking companions were incredulous about America’s failure to do anything about gun violence. These were not our usual crowd of Bay Area liberals for whom guns arouse a knee-jerk suspicion. Our fellow trekkers were arrayed across the political spectrum. Several were ranchers; one talked about getting his first rifle as a kid. Yet Australia chose a different path from the United States after its own traumatic experience with a mass shooting.

In 1996, an Australian gunman killed 35 people in what came to be known as the Port Arthur massacre. Instead of sorrowful hand-wringing and inaction, John Howard, the newly elected conservative prime minister immediately passed with bipartisan support strict gun control laws throughout the country.  Private sales were banned, and only a narrow range of reasons were valid for ownership (self-defense, fear, and gun “rights” were not among them). Gun owners had to pass a safety class, could not carry their weapons around, and had to register and store them properly.

Some legislators paid a political price, but almost 90 percent of the population favored the new regulations. As our Australian friend who had grown up with guns explained, there were initial misgivings, but after a couple of years everyone saw that life continued to be fine, and the resistance disappeared.

The new laws were extremely effective. In the next decade, Australian gun homicides declined by 59 percent, the suicide rate by 65 percent. The rate of home invasions also declined. And there have been no mass shootings since Port Arthur.

As we listened to our hiking companions’ stories, they listened to ours:

  • About how even after 20 first-graders were shot to death in Sandy Hook in 2012, Congress could not summon the courage to mandate universal background checks supported by 90 percent of Americans.
  • About how the NRA’s response to gun violence is to advocate arming more people; “The only thing to stop a bad guy with a gun is a good guy with a gun,” an NRA spokesman said after Sandy Hook.
  • About how men armed to the teeth swagger around advocating open-carry laws.
  • About how restrictions on guns have loosened rather than tightened since Sandy Hook.

“You’re kidding! That’s insane,” one of the Australians exclaimed over and over.

Indeed.

We hear a lot about insanity in conjunction with America’s mass shootings, which now occur at the rate of about every other week. The mental instability of the killers is inarguable, as is the need for more effective mental health screening and treatment. Yet scapegoating the mentally ill (who are far more likely to be victims than perpetrators of violence) misses the point of a widespread cultural insanity. It also misses the point of doing something about the delivery system if not the root causes of our national pathology.  As Australian’s John Howard recalled about the Port Arthur massacre in an op-ed he wrote following Sandy Hook,  “The fundamental problem was the ready availability of high-powered weapons, which enabled people to convert their murderous impulses into mass killing. Certainly, shortcomings in treating mental illness and the harmful influence of violent video games and movies may have played a role. But nothing trumps easy access to a gun.”

We left the Alps much rejuvenated by the scenery and much enlightened by our Australian friends. Because we were on vacation, I didn’t write about it at the time. When we returned, we were gripped and heartened by the sea change that finally brought down the Confederate flag from South Carolina’s capitol in the aftermath of  Dylann Roof’s rampage. Guns, again understandably, took a back seat as we celebrated this important if symbolic milestone in tackling racial oppression.

But I knew it wouldn’t be long before gun violence was in the news again. Sure enough, this week Chattanooga and Lafayette were added to the roster of communities shattered by a gunman. More gun deaths will surely follow—those that make headlines and those that don’t. As glad as I am about the Confederate flag’s downfall, I wish we could take a page from the Australians, and see our gun insanity follow suit.

High Style, Size 0

High Style eta_hentz_ivory_beadsThis week I went to the Legion of Honor to see High Style, an exhibit of 20th century haute couture from the Brooklyn Museum’s Costume Collection.

I could actually care less about fashion. I grow uneasy flipping through women’s glossy magazines, and I hate clothes-shopping. Buying shoes is even worse.

Still, I love fashion exhibits at museums.

First up at High Style were the shoes—sumptuous embroidered leathers that squashed toes into ridiculous points. High style shoeAs someone who seeks out Mary-Janes and who has never teetered on anything higher than a low-heeled pump, I marveled at the tortures women subject themselves to. One atelier boasted of crafting the most expensive shoes in Paris—the equivalent of $10,000 in today’s dollars. This made me feel better about my $150 Arcopedicos, the only shoe besides my Merrell hiking boots I really trust.

Then it was time for the real deal—the clothing. I loved the beading, plunging backs, and tight bodices. Soft, sensuous folds clung so enticingly to the mannequins–mannequins who were faceless, sometimes limbless, disappearing into nothingness. And so slim!

As I drank it all in, I became increasingly uneasy, aware that anorexia was integral to the look I so loved. According to the New York Times, more than 36,000 French women suffer from anorexia. In America, it’s estimated that 0.5 to 3.7 percent of women suffer from the disorder in their lifetime. That’s a lot of women disappearing into nothingness, sometimes fatally so–eating disorders have the highest mortality rates of any mental illness.

The birthplace of haute couture is seeing progress, however. Recently the French Assembly passed amendments that would help combat anorexia promulgated by the fashion industry. As a laudatory editorial in the New York Times points out, “The amendments send a powerful message from the global capital of fashion that severe malnutrition should never be considered fashionable.”

In the same week I saw High Style, my Facebook feed featured an image that originally went viral in 2013–“real women” mannequins in a Swedish department store. They’re a lot different from the alabaster ghosts of High Style:

Real Women mannequins

So go, enjoy the show (it runs through July 19). Then enjoy a nice lunch afterwards. Most important, always enjoy being a real woman.

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How has the fashion industry’s depiction of women affected you?

Y is for You Look Fine

You Look Fine (El Toro County Park, April 2015)

Recently my husband and I came across this signpost after hauling ourselves up a steep hill in Toro County Park, a vast region of rolling hills, trails, and recreational facilities on the outskirts of Salinas.

Was it social commentary on our fat-shaming and appearance-obsessed culture? Or just the frustrated lament of someone waiting for hiking companions to tidy up their wind-blown and hat-crushed hair for a quick smartphone photo? (More important, would there be another signpost at the end of our long, hot, trek pronouncing, “You Look Like Hell?”)

The message was welcome, if oddly placed, and one that got me thinking (which helped propel me up the many arduous and dusty miles to come, not to mention providing me with a “Y” post that is not a bunch of Yosemite photos or a “Y Am I Doing this Challenge?” lament).

Mostly I think of “You Look Fine” as the bare-minimum response that gets a man out of trouble when asked the world’s most dangerous question: “Does this make me look fat?”

(In case that unforgivably gender-stereotyped sentence makes your blood boil, rest assured that just this morning, my husband, who is red-green color-blind, asked as he was rushing out the door if his jacket looked okay with his pants. “No, it doesn’t,” I said. “You should wear something else.” He looked upset and hurried off as I unconvincingly called after him, “It’s fine. Really.” Later I emailed him the “You Look Fine” photo, amending my early morning candor.)

Wouldn’t it be nice if “You Look Fine” signposts proliferated? Imagine them replacing mirrors, or showing up in mirrors, alongside your reflection! What if they were on street corners, subways, doctors’ offices? Even better, what if we could get away from feeling influenced by any assessment of our appearance, whether positive or negative?

What we really need are signposts that say “You Are Fine.”

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What’s your theory about how the mysterious YLF signpost got there? What signposts would you like to see proliferating in unexpected places?

X is for X-BFF

X BFFsI’ve been in and out of love with men many times over the decades, but breaking up with my best friend, Sharon, was worse than any failed romantic relationship. It knocked the wind out of me for years, consuming me as I tried to figure out what went wrong. How could someone who was so much a part of me be gone from my life? I felt like a crazy person, unable to move on from my guilty, shameful obsession.

I’m not the only one. Almost every adult woman I’ve talked with has a similar story. The details and personalities differ, but the women I’ve spoken with all feel equally crazy and obsessed by a deep hurt that at best leaves a lot of scar tissue, but often never heals. (I was lucky—Sharon and I eventually reconciled.)

I wonder if the hyper-idealization of friendship between girls and women is part of the problem. Our friends are supposed to be everything to us—super supportive, always there for us, able to finish our sentences, someone who gets us inside and out. In fact, sometimes we seem like the same person, inside and out! That urge to merge is so delicious—and so deadly.

We know how to be close, but difference often feels like an unbearable distance. That’s often when trouble starts. Worse, women seldom know how to deal in a healthy way with all those “not nice” feelings: conflict, aggression, envy, and competition. So we sweep problems under the rug, hoping they’ll go away. Or act out big time. Or exhaust ourselves with endless processing. (No wonder the movie Bridesmaids  always strikes a nerve for me—I’ve seen it four times!)

What makes female friendship so susceptible to ruptures? Can we enjoy tight bonds without cutting off the circulation?

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What do you think? What are your experiences with X-BFFs? Were you ever able to drop the “X” even if regaining “BFF” proved elusive?

V is for Vaccination Village

herd immunityI live in Marin County, California—ground zero of the vaccination wars that erupted after this winter’s measles outbreak in Disneyland. Marin County is one of the most affluent, best-educated, and progressive enclaves in America. It also has some of the highest rates of personal belief exemptions for standard childhood vaccinations. Left-wing parents here who do not want to vaccinate their children cry “Freedom!” just as loudly as their right-wing counterparts. Some have quipped that Marin County is the place where the Tea Party and the Green Tea Party come together.

I support SB277, a bill currently making its way through California’s Senate that would eliminate all but medical exemptions for vaccinations for school-aged children whose parents wish to enroll them in public schools.

Yet I hesitate to wade into the battleground, knowing how firmly held beliefs become even more entrenched when disputed, even in the face of scientific evidence. Although a false claim linking autism to vaccines has been thoroughly debunked, fear persists. I do not know how to approach parents who fervently defend their right to choose what is best for their children when I know it is not best—for their kids, or for anyone else’s. Maybe if my friend Mark Paul’s essay, “My Polio, My Mother’s Choice,” were required reading, it would be more persuasive than my impatient incredulity.

These days, though, I fear that perhaps we’re suffering from something even worse than the easily preventable outbreak of disease. The vaccination wars speak to deeper problems in our country: distrust in the government, both earned and unearned; too many who turn away from science; and, most gravely, the abandonment of the village. The near-universal practice of vaccination confers herd immunity, protecting those who are too young, too old, or too immuno-compromised to be vaccinated. But if enough people seek “freedom”—freedom from their responsibility to the herd–where does that leave us? We are too much in it for ourselves now, no longer interested in contributing to the common good. This worrisome trend affects many issues beyond vaccination

It does, indeed, takes a village. But what if people want only the rights, and not the responsibilities, of being a villager?

 

U is for Undercommit, Overachieve

 undercommit, overachieve

“Undercommit, overachieve.”

It’s not exactly what we’re used to hearing in our hyper-striving culture, but it’s advice I treasure from a writing teacher.

Every week when we went around the room to commit to what we’d do before the next writing class, our teacher would encourage realism: “How much time are you spending writing now? None? OK, how about one hour once instead of several hours every day in the next week?”

My Weight Watchers leader does the same: “If you’re not exercising at all currently, will you really go to the gym on a daily basis?”

One small commitment can grow into so much more.  A massive overhaul, though? That’s just a set-up for failure. If you don’t believe me, just ponder what happens with all those New Year’s resolutions!

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 “Give it your all!” or “Undercommit, overachieve” —

Which speaks more loudly to you?

K is for Kitchen Table

tableMy youngest daughter, Ally, who had our old kitchen table at college, wanted to sell it before studying abroad for a year. I, however, insisted on storing the table during her absence, certain she would need it upon her return.

But it was really my need: for Ally to still want to keep a part of home, and for her to remain with us, “in storage,” during the temporary absence that foreshadowed the permanent separation of growing up. Although the table would be cumbersome to move and store, I wasn’t ready to let go.

After all, it was so much more than a table. I remembered how my future husband set it with yellow roses and homemade spaghetti soon after we met, and the subsequent family dinners once we had kids. I recalled the homework, the crafts, the cookie decorating, how the table contained the overflow of books, mail, and all the stuff of family life throughout the years. I had held on to the table to forestall feeling the loss of these cherished times, the ache of the empty nest.

Transitional objects are not just the loved-to-bits blankies and stuffed animals of childhood; they help us cope throughout life. We hang on to them until we do the work of integrating and grieving what they signify, and can relinquish them once they become just the thing itelf.

So after remembering, and mourning, I called Ally and said, “Sell the table.” It had become just a piece of furniture to me, and a ratty one at that. I could bear its loss, and even look forward to what might open up in letting go.

In the end Ally decided to keep the table. Perhaps she still needed a token of home while growing up. Or just a place to eat dinner and throw her books.

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What have you hung on to, and what has helped you relinquish it?