Screen Time

I see my client’s face. A bit pixelated, true, but more centrally framed now that the camera angle cutting her off just above the chin last week has been adjusted. I glimpse my own image and “office” in the small rectangle. Oh, no, has the covering slipped from my daughter’s old dresser? How many times will the screen freeze today?

Still, it’s better than nothing. I’m lucky to have a private space, with no children to homeschool or shush—the daughter whose room I’m in is long grown. Cursed, blessed technology exists now, at least for most people with the wherewithal to find their way into somebody’s private practice. I have been on Zoom support sessions for clinicians, and hear horror stories from those who work with people who are impoverished, undocumented, hungry, homeless, imprisoned, sick, overwhelmed by life even in the best of times. Some people they’ve been unable to reach altogether.

The fact that things are so much worse for others is frequently brought up by my clients who can and want to keep seeing me. They feel grateful and guilty. I feel the same way.

Still, we sit and talk. I talked too much at first, trying to compensate for the feeling of disconnection through excess verbiage. Eventually I remembered the value of listening, with an assist from Zoom, which goes haywire when more than one person (or rectangle) is speaking.

Nothing sounds quite right. I read somewhere that the time lag is part of what makes video calls so tiring. Exhaustion turns to panic when suddenly the client’s voice sounds stretched out and underwater, or every other word is dropped. What if they are revealing something crucial, and I miss it? I briefly wonder if bandwidth, too, engages in repression or dissociation, or if it reflects the client’s usual experience of feeling unheard and my own inattentiveness.

Sometimes, I prefer just the phone. I came into the mental health field more than 40 years ago as a crisis line volunteer, and like a duckling, I imprinted on the first thing I was exposed to. I’ve always been struck by how people can often go deeper, be more vulnerable on the phone.

Still, whether via Zoom, doxy, FaceTime, or phone, psychotherapy in the time of Covid has felt a lot like those many check-in calls I fielded on the crisis line. People say the same thing, over and over. It’s the same conversation we’re all having now, as coronavirus infects not only our cells and the economy but every nook and cranny of mental space. My colleague asked two analytically inclined clients if they wished to explore some of what they were delving into before. “Absolutely not!” they both said. I’ve wondered with clients what we might be talking about if we weren’t talking about the pandemic. “That’s a good question!” they say, before returning to coronavirus. Remote video platforms aren’t the only ones with bandwidth issues.

Time feels so strange, endless and fleeting at once. Clients wonder, How long will this last? When can we return? And even if we do, will I ever feel safe? Wondering the same, we do our best to hold people, not knowing how long we can all hold on.

Titanic

I keep thinking about the film Titanic as we begin to absorb the public health and financial impacts of hitting this coronavirus iceberg.  First there’s the feeling of nothing much happening, or maybe it’s something, but we’ll all be fine. Awareness that the ship is going down creeps in at different paces to different people, and reactions vary. Quick-wittedness, denial, altruism, selfishness, desperation, calm. The entire panoply of human nature unfolds while the orchestra plays on.

What sticks with me the most from the film are the parents in steerage, cuddling with their children in cramped metal cots. Mothers and fathers know they’re all doomed, but they do what they can– speaking in soothing tones to their still-oblivious sons and daughters, telling stories, performing the ritual of nightly prayer, holding them tight. Love creates a cocoon of security: False, but also true.

Psychotherapists call this “felt security.” It reflects not so much the dire dimensions of the actual situation, but the reassuring sustenance drawn from the relationship with a loving, trustworthy, and reliable caregiver. Those parents in steerage send the message, “I am here with you right now, and in this moment together we are okay.”

A lot of us, even those who are not parents, have been doing a lot of that recently as we try to maintain a sense of normalcy and well-being in the midst of a global pandemic and economic meltdown. Posting pictures of sunsets, flowers, the family dog, funny memes; poetry chain letters; neighbors opening their windows to sing, clap, or howl; sewing masks for front-line workers; donating to especially hard-hit groups; buying gift cards from our favorite restaurants and small businesses; moving our normal activities like school, yoga, fitness, book groups, phone banking, work from real life to Zoom—all help knit together a sense of security.

Titanic also depicts a society similar to ours in terms of class and economic inequality. The rich are the most protected while the poor suffer, even though they’re all in the same boat. The unsinkable Molly Brown, a member of the privileged class, decries the entitlement and selfishness of her peers, urging them to make more room on the lifeboats to save far more people. Her plea goes largely unheeded.

We are seeing the same dynamics play out now: just look at the back-and-forth of the recent $2.2 trillion relief bill passed by Congress. Thanks largely to Democrats, more room was created to help the most vulnerable. Far more will be needed.

Just as not everyone perished in the Titanic, we will somehow survive this. But whether or not we view all as deserving a place on the life boats will determine who and how many.

Marriage Story: On the Screen, in Politics, and IRL

I’ve seen the film Marriage Story twice. Following the uproar over a conversation Warren and Sanders had in 2018 about whether a woman can beat Donald Trump feels like watching it a third time.

Two couples: The fictional Nicole and Charlie, an amicable but divorcing duo with an eight-year-old son who want different things, and the real-life Warren and Sanders, like-minded good friends and political colleagues who both want to be president.

Befitting their long histories of mutual admiration and affection and their desire to protect what matters most (a child, a progressive movement), both couples initially observe non-aggression pacts: mediation instead of divorce lawyers for Nicole and Charlie, close policy alignments and no bad-mouthing for the presidential rivals. But as differences emerge and each seeks advantage in order to prevail, initial vows give way to some definite hot-mic moments.

So it goes in movies, in politics, and in life. The same experience is rarely received or recalled in the same way.

Given that a woman’s electability against Donald Trump has featured prominently in so many political conversations over the past three years, it’s entirely plausible that Sanders told Warren that a woman couldn’t win the presidency in 2020. Or maybe he just pointed out how a lying, sexist Trump would weaponize gender in a society riddled with outright misogyny and unconscious bias. It’s also entirely plausible that Warren heard his words correctly. Or that she didn’t, but understood the implicit message, “better not try,” a warning women hear all the time.

In Marriage Story, Nicole hears this warning, too, and for a long time heeds it. Every time she tries to implement their initial agreement to try living on both coasts, Charlie dismisses her wishes. After all, they are a New York family, with a flourishing theater life there. Besides, LA, television . . . Seriously? Nicole continually acquiesces, losing herself in the process until she has had enough. No wonder she is susceptible to the ruthlessly empathic and effective divorce attorney Nora, who knows exactly how to fashion Nicole’s inchoate dissatisfactions and longings into the story of a reclaimed self.

The shift from acquiescence to “Enough!” seems abrupt, excessive. But it comes from tolerating a lengthy accumulation of insensitivities, intended and inadvertent injuries, and the preeminence of others’ needs and desires until finally we reach a tipping point. Suddenly, we’ve had it.

Getting fed up is at the heart of so much conflict and also of so much necessary change, both personally and socio-politically. It drives not only Nicole’s and Warren’s persistence, but also the #MeTooMovement, Black Lives Matter, Sanders’s (and Trump’s) political appeal, and the success of so many women candidates in the 2018 mid-terms.

“Enough!” It drives a great many of us. For better and for worse.

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A slightly different version of this piece initially appeared in NCSPP’s Impulse, a publication for therapists. The topicality of the Oscars and the political spat is past, but the themes are timeless.

The Limits of Tolerance

As the long-time clinical consultant for a crisis hotline, I grapple with an old question that’s arisen with a new and urgent focus: How should we respond to callers who use racist, sexist, homophobic, and other offensive language?

Therapists absorb and metabolize strong affect and hurtful words all the time. Our role is to listen and understand, to find the person behind barriers of hate, fear, and ignorance. We are also taught to meet people where they are.

But what if where they are crosses a line? Ventilation can offer relief, but it can also cause harm to the listener and the speaker. Setting limits is part of good clinical care.

Listening to intensely prejudicial language not only taxes the tolerance of the counselors, but makes them feel complicit in perpetrating trauma and injustice. The staff is skeptical about my talk of metabolizing agents, sometimes simplistically so, but often with good reason.

Hateful speech increases prejudice and dehumanization. Exposure to it has severe and long-lasting effects on both physical and mental health. Not only is it important to protect counselors from burnout and trauma, but also to safeguard those who spew offensive language. “We are not doing our callers any favors by tolerating behaviors that would get them in trouble everywhere else,” a wise African-American long-time staff member always reminds us.

This dilemma extends far beyond the counseling relationship. We are living in an era of vitriol unleashed by the President to devastating effect. Many counselors see it as their duty to challenge such venom on the crisis lines.

No one is proposing cancel or call-out culture, which the black feminist and activist Loretta Ross describes as toxic, a system of “punishment and exile that mirror[s] the prison industrial complex.” Ross goes on to say, “Call-outs are justified to challenge provocateurs who deliberately hurt others, or for powerful people beyond our reach.” This does not describe our callers, who generally come from the least powerful margins of society. The point of our work is to try to reach, not drive people further underground into isolated and silent bunkers of reinforced conviction.

Ross proposes instead a culture of calling-in: “a call-out done with love.” This is what we strive for on the crisis lines. We discuss in our meetings the balance between opening up and shutting down, countertransference, self-care, pitfalls of shame and self-righteousness, ways to limit-set that are constructive rather than retaliatory, the limits of tolerance.

Over the years I’ve reminded the staff of an old African proverb: “Sometimes your mind can be so open that your brains fall out.” Now, they remind me of the same thing, and we stumble on together.

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Originally published in NCSPP’s Impulse

Ties that Bind

Tara Westover’s acclaimed memoir, Educated, is about many things: growing up in an extreme fundamentalist family under the thrall of a paranoid father, in an environment both idyllic and abusive; her attempts to break free; and education in both the sense of formal learning and its more expansive meaning–the process of self-discovery.

I happened to listen to Educated after finishing a monthly case conference led by Dr. Jane Rubin about working as a psychotherapist with developmental trauma. The memoir is a compelling example of the complexities we explored: the traumas themselves; the additional and more severe consequences of misattuned responsiveness from a child’s primary caregivers; and the terror of change that makes the dread not to repeat as powerful as the dread to repeat.  

A reviewer summarizes Westover’s dilemma: “Will she come home? Can she come home? Or will home be more damaging to her spirit than the broader dangerous world her father fears?”

A better question is can she leave home? Educated illustrates repeatedly the psychological difficulty and cost of doing so.

In “To Free the Spirit from its Cell,” Bernard Brandschaft (1993) writes of the danger change poses to attachment, and the pathological accommodations necessary to preserve “emotionally enslaving early ties.”

Therapists encounter these dimensions of trauma all the time. Patients who have seemingly progressed but who cannot go further remain, in Brandschaft’s words, “imprisoned in the gulags of their minds.” What might seem a baffling resistance is an expression of identity grounded in fierce loyalty and love.

In a Fresh Air interview, Westover says, “Abuse is foremost an assault on the mind. If you’re going to abuse someone, you have to invade their reality and you have to distort it.” She describes how abuse is normalized and depicted as deserved, how shame is internalized. She was only able to break away after she had “grown her own mind,” become a different self—one who still hopes for, but no longer awaits, signs that her family has changed.

A patient once gave me “The City,’ by C.P. Cavafy (1894), which reads in part:

You said: “I’ll go to another country, go to another shore,

find another city better than this one.

Whatever I try to do is fated to turn out wrong . . .

You won’t find a new country, won’t find another shore.

This city will always pursue you. . .

 As Educated so beautifully attests, it is not impossible to free the spirit from its cell, but it is heartbreakingly difficult.

Three Identical Strangers

I was sure that the documentary “Three Identical Strangers” would be nominated for an Oscar, but it wasn’t. Now that Oscar week and the month of February are slipping away, here are my thoughts about the film. Warning: Spoilers Abound. This piece was originally published in NCSPP’s “Impulse.

Twin studies, particularly those of babies separated at birth, have long provided important information about genetic and environmental influences. But how is such research conducted? How do infants come to be separated in the first place? What is the long-term impact?

The riveting documentary Three Identical Strangers puts these questions front and center as it explores the accidental discovery of one another at age 19 by Bobby, Eddy, and David: three identical triplets separated at birth in 1961 and adopted into different families who had no knowledge of their new baby’s multiplicity. Or of the duplicity of the adoption agency and researchers at Yale’s Child Development Center under the direction of pscychoanalyst Peter Neubauer.

We feel the triplets’ experience: the initial joy of their reunion, the shadow of early attachment wounds, the longing for union, and the reality of difference. The film also focuses on the arrogance of powerful people and institutions who withhold vital information without regard for the impact on unwittingly conscripted research subjects.

Neubauer and the adoption agency are depicted as sinister. But are they uniquely so, or was it then typical for adoption agencies to withhold information about birth families? Were identical siblings separated for nefarious research purposes, or because it was easier to place one baby in a family? The not-quite-explicit attribution of unique villainy too easily glides over conventions of the time, including lack of human subject protocols. It also lets us off the hook from examining our own and ongoing misguidedness and unconscious bias.

After skillfully handling many complexities, the film disappointingly takes a sharp turn into more simplistic supposition.

By then we’ve gradually learned that the boys all showed early signs of separation anxiety and psychological troubles. Eddy was diagnosed as manic-depressive and took his own life in 1995. As Bobby cogently asks, “Why him and why not me?”

It’s a good question, and one that lends itself to a deeper exploration of what facilitates the expression or suppression of a genetic vulnerability, the high heritability of bipolar disorder, and the high risk of suicide such a diagnosis signifies. Instead, we’re provided a definitive answer:

“It’s all about nurture,” declares a family friend.

David’s aunt, who at least acknowledges that nature plays a role, also concludes that “nurture can overcome nearly everything.” She does so after describing Eddy’s father as a strict disciplinarian and a traditional, quiet man who didn’t discuss problems. Because Eddy never talked about their relationship, she decides that it couldn’t have been good. Maybe. It’s worth noting, however, that there’s a very large pool of fathers and sons, especially from back then, who could be described this way.

We would be as foolish to dismiss the impact of parenting as that of biology. Still, it’s jarring when a film whose strength is complexity overlooks its own evidence about biology’s role to conclude with parent-blaming.

I began my training as a therapist at a time when “refrigerator mothers” and schizophrenogenic mothers–blamed for their offsprings’ autism or schizophrenia–were still very much in the literature. Thankfully, those views were challenged, and we have developed greater respect for the intertwining influences of nature AND nurture. Yet the residue persists. We must remain vigilant about examining our own unconscious inheritances and assumptions.

Then and Now

A little more than eight years ago, I made my debut as a staff writer for Impulse, the monthly electronic newsletter of the Northern California Society for Psychoanalytic Psychotherapies. The piece was titled “Psychological Post-Mortem of the Midterm Elections.” It viewed the topsy-turvy political environment from President Obama’s election to his midterm “shellacking” just two years later through a psychological prism.

Interweaving attachment theory, neuroscience, and Melanie Klein’s notion of development, I noted that it was as if President Obama were trying to govern a paranoid-schizoid nation from a depressive position (non-therapists will have some idea what I mean by this by clicking on the link to the earlier piece).


Based on Nancy McWilliam’s commentary on the pitfalls befalling therapists who operate from their own depressive personality styles, I also drew parallels between how President Obama related to congressional Republicans and well-meaning therapists who attempt to work too flexibly with hostile clients.


My debut caused a minor furor within NCSPP, some of whose members wanted me and the editor to resign. Instead, the powers that be quickly removed my 400+ words from the site and issued an apology. Back then, electoral politics was largely viewed as having no place in psychotherapy. Fast forward to today. Is there a psychotherapeutic organization or office that hasn’t been infused with politics?


The enormous uptick in anxiety and depression therapists encounter has been dubbed “Post-Election Stress Disorder.” Clients routinely talk about re-triggered personal traumas such as sexual assault, family ruptures brought on by political disagreements, or how they can no longer bear their like-minded loved ones’ incessant obsession with Trump. A client who had never breathed a word about politics sent me a photo of a bumper sticker that said, “Elect a Clown, Expect a Circus.”


Outside of our consulting rooms, heated debates rage among mental health practitioners over the ethics of opining about Donald Trump’s mental health, and whether a duty to warn trumps formerly sacrosanct neutrality. The American Psychoanalytic Association renounced the “Goldwater Rule” (the American Psychiatric Association still upholds it). The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President was a New York Times bestseller. When William Doherty, professor, therapist, and founder of Citizen Therapists for Democracy, published an online manifesto declaring Trump a unique threat to America’s mental health, more than 3,800 therapists signed it. Classes and seminars about practicing in the current political climate and combining activism with psychotherapy have proliferated.


As is often said in the new era, “This is not normal.” The same could be said for the changes in the field of psychotherapy in the years since I wrote my piece. We have fruitfully begun to question the whole concept of “normal,” societally and professionally. There are dangers and opportunities. But one thing is clear: The personal is not only political–it is also psychological.

Life and Death Matters

California’s End of Life Options Act, which allows doctors to write life-ending prescriptions for terminally ill adults who meet strict eligibility requirements, went into effect two years ago. In May, a judge halted the law on a technicality; an appeals court recently reversed that decision. As complicated and lengthy court processes continue to unfold, emotional and legal limbo remains.

“It is an American habit to turn complex moral problems into technical legal reasons,” writes Andrew Solomon in A Death of One’s Own (1995), about his mother’s decision to end her life rather than endure the final excruciating stages of ovarian cancer. Solomon weaves his personal story with an in-depth history of the euthanasia movement before aid-in-dying was legal anywhere in the United States. With unfailing empathy and candor, he explores every nuance of the issue, including how relegating it to the shadows compounds the difficulty. He describes the coded euphemisms his mother used with her doctors to secure what she needed. Solomon, his brother, and their father all whole-if-broken-heartedly supported her choice to die on her own terms at home, surrounded by loved ones. The necessity of secrecy heightened their intense isolation and sadness.

An unequivocal supporter of the right to choose, Solomon is also an unblinking chronicler of the ambivalence, sorrow, and potential risk such choice entails. “There is no question that if euthanasia is legalized it will be abused . . . The question is whether these abuses represent a greater crime against life than does keeping alive people who want to die.”

In the 23 years since A Death of One’s Own was published, much has changed. Seven states (including California) and the District of Columbia now allow some sort of physician-assisted dying. The terminology has also changed: “Death with Dignity” and similar monikers have largely replaced “assisted suicide” or “euthanasia.” Although there are still those who prefer the term “murder,” there is a growing consensus among proponents that existing laws are too narrow, excluding those with conditions such as Alzheimer’s and ALS from seeking legal relief.

What of those who suffer from unremitting psychic distress? Why are people with terminal cancer deemed to have good reason to end their suffering, but people afflicted with chronic depression are not? Here the slippery slope steepens.

Rachel Aviv delves deeply into this disquieting territory in The Death Treatment (2015), about Belgium’s law permitting euthanasia for those suffering from severe and unrelenting psychological distress.

Both Solomon and Aviv are beautiful and compelling writers. Each account illuminates the shadows we must explore to grapple with the awesome complexities of life and death decisions. As California’s End of Life Options Act continues on its topsy-turvy legal course, the imperative to bring into the light what it means to be alive and to die—and who gets to decide–continues.

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What are your thoughts and experiences about this topic? What would you want for yourself?

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(Originally published in the Northern California Society for Psychoanalytic Psychotherapy’s “Impulse”

Disorganized Attachment in the Oval Office and Beyond

In March, Joel Whitebook, Director of Columbia University’s Psychoanalytic Studies Program, published Trump’s Method, Our Madness in the New York Times. Whitebook likened the disorientation many feel in trying to make sense of the new president to a clinician’s experience of working with psychosis. As the title of his piece suggests, Whitebook saw Trump as employing a deliberate strategy designed to sow confusion, anxiety, and exhaustion.

Now the president’s chaotic and self-defeating gyrations suggest less method than supposed. It may not be madness, but what we are witnessing bears the hallmarks of disorganized attachment.

Disorganized attachment can result when a child’s primary caregivers are simultaneously a source of safety and danger. Such parents are often abusive, frightened themselves, or operating in a dissociated manner from their own unresolved traumas. What attachment researcher Mary Main describes as the child’s dilemma of “fright without solution” leads to a collapse of strategy. This and other characteristics of disorganized attachment–erratic behavior, hostility, aggression, lack of empathy, problems with trust and truth, an incoherent narrative, and viewing the world as an unsafe place–describe the president.

Trump grew up amid material indulgence and emotional harshness. His father, notoriously demanding, critical, and controlling, mercilessly targeted vulnerability. The young Donald Trump, already constitutionally inclined toward aggression, so thoroughly identified with the aggressor that he was sent away to military school at age 13. Trump describes the tough and often physically abusive treatment there admiringly. Recapitulating the dynamic of turning to those who literally and figuratively whip him into shape, he’s now stocked his administration with generals.

Paradoxically, Trump the boy—for whom safety and danger were fused—became President Trump in part by promising security to those fearful of economic and cultural displacement in a changing and often frightening world. Under the authoritarian’s guise of powerful protector, he fans and quells fear simultaneously, pitting one group against another. Just as he seeks but can never find safety, he promises but never delivers it.

Examples abound: pledging healthcare to all by depriving millions of it; loving coal miners while defunding programs that support them; undermining his allies; protecting us from North Korea by bullying us to the brink of nuclear war.

Nowhere is this contradictory dynamic more apparent than Trump’s recent treatment of the Dreamers. He is neither the first nor last politician to sell out vulnerable populations. What’s unusual is how much Trump’s actions reflect his erratic internal state. Harsh rhetoric intertwines with proclamations of love and care-taking for the Dreamers. Then Trump rescinds DACA, sending his less conflicted Attorney General to announce it. The president has since issued a stream of contradictory messages. The Trump/Sessions duo splits into two the one who cares yet cowers behind the one who bullies. But it is our singular president in whom safety and danger are incoherently fused, creating uncertainty and anxiety. With Trump’s punt to Congress, maybe the Dreamers will be safe, maybe they’ll be hung out to dry. Maybe it’s method; more likely it’s a collapse of strategy. How fitting that this most poignant example involves vulnerable children dependent on authorities who have the duty and capacity to protect, but instead endanger.

My fellow therapists and I see the effects of such traumas in our practices, and know how commonly they are acted out, how difficult they are to heal. We also know that the arduous road to recovery comes from being able to feel the pain of the past and integrate it into a cohesive, complex narrative.

This holds no interest for Trump.  “I don’t like to analyze myself because I might not like what I see,” he’s told his biographer, who notes: “This combination of love and hate is Donald Trump’s psyche turned inside out. . . .He’s making us experience what he experiences inside of himself.”

The effects of disorganized attachment are writ large in this man and across the globe.

Sad. For him, and for us.

 

Trauma and Escape: A Night at the Oscars

Our movies, ourselves: The Oscars invariably reflect the American zeitgeist. This year’s ceremony is no exception, especially given its topsy-turvy ending in which the presumed winner unexpectedly loses.

La La Land had been the clear favorite of the four top contenders for best picture. It’s the type of film Hollywood always loves because it’s about—well, Hollywood. It’s also been welcomed as an escape from the dismal reality of the current political landscape. Deliverance comes through saturated colors and a love story about attractive people who don’t sing and dance all that well. La La Land embodies the American fantasy that life works out if you follow your dreams.

Hidden Figures, too, is a feel-good narrative, depicting three brilliant African-American women who endured racism and sexism at NASA in the early years of the space program. The film is a bridge between the sheer escapism of La La Land and the more depressing realities depicted in Moonlight and Manchester by the Sea. Set in the early 1960s, Hidden Figures almost tricks us into believing that individual grit matters more than institutional oppression, and that the days of rank prejudice are behind us. These wishes, too, are part of our national fantasy. But as Faulkner and the recent election remind us, “The past is never dead. It’s not even past.”

This theme is woven throughout Moonlight and Manchester by the Sea. While La La Land and Hidden Figures offer escape (and very little back story), these two films are in the clutches of trauma. Neither Chiron, of Moonlight, nor Lee, from Manchester, can escape the past.

Chiron, a sensitive young, gay, black boy born into poverty to a crack-addicted mother, grows into a hardened drug dealer. He is a broken survivor who nonetheless finds a bit of peace and tenderness.

Lee is also broken, but barely surviving. He is not born into trauma, but causes one that quickly engulfs him. Lee can escape the town—at least until his brother’s death forces him back–but not the guilt and harm he’s inflicted on himself and others.

Moonlight and Manchester by the Sea do not feel good. But they feel honest. They affirm the harder truths: Some damage cannot be undone. Triumphant Hollywood endings are rare. There is no escaping the past. Yet revisiting it and coming to terms with it—as Chiron chooses, as Lee must, as we do in our everyday lives—creates small shifts, more understanding, and perhaps a tender cradling or a little extra room where none existed before.

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Which film were you rooting for?