Category Archives: Psychological

Three Identical Strangers

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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

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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

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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

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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

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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?

 

Unpredictability at the Helm

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The personal is political. As we psychotherapists have seen lately, the political is also personal. According to the APA, 52 percent of Americans suffered from significant election-related stress before November 8. Since Donald Trump’s electoral victory, anxiety has escalated, at least in the Bay Area. Clients have come into our offices extremely upset about the president-elect. His bullying, bigotry, boasts about sexual assault, and denigrating remarks have triggered past traumas and intensified fresh fears. Many have experienced deep ruptures with friends and family. Their loved ones’ support for a candidate who behaves so deplorably is reminiscent of non-protective parents who turn a blind eye to abuse.

These are some of the specific wounds. Yet the damage operates on an even deeper and more pervasive level regardless of one’s personal history.  Just as families are heavily influenced by who’s in charge, so is our American family. Trump has capitalized on a yearning for a strong authority figure to take care of us and keep us safe in unsettling times. But what happens when the person most responsible for containing threats to our well-being prides himself on being uncontained and unpredictable?

Therapists know what happens in families governed by an erratic parent. Insecure, even disorganized, attachment styles generally result. Some of the most gravely injured people we treat are those who grew up not knowing from one minute to the next who they would encounter: the loving, playful father, or the impulsive sadist who destroyed through word and deed? So many of our clients were thrown off-balance by a parent sometimes dispensing favors and forgiveness, at other times exacting vengeance, and routinely playing family members off against each other.  We have witnessed these dynamics throughout Trump’s campaign and transition parade. He puts his own interest above all else, toys with the truth and with the American people, and delights in his unpredictability. Such an environment distorts reality and destroys trust, worsening a pre-existing problem of a post-factual politics that enabled Trump’s rise.

This is the stuff of insecurity, not the necessary security people—and countries–deserve. Many therapists have themselves been at a loss to respond because they, too, feel unnerved. Now more than ever, though, we will be called upon to help individuals and the collective withstand the personal and political damage of unpredictability by finding and speaking truth, fostering empowerment, building resiliency, and prevailing despite a volatile head of family—or state.

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Originally published in NCSPP’s Impulse

Persuasion

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A metal toggle switch with plate reading Listen and Ignore, symbolizing how we choose to pay attention to certain messages

Recently I shared an article on Facebook by a Bernie-supporting Hillary skeptic who articulated his reasons for voting for her. He’d decided the volatile political climate and the increasing unreliability of polls made it too risky–even in “safe” states–to stay home or to vote for a third-party candidate.

I had not heard this argument before, and wanted to inject this thoughtful piece into a discourse largely dominated by bashing from both sides of the political divide.

Right away a Facebook friend I haven’t seen since college commented: “Don’t you think that incessantly hectoring people might have the effect opposite to that desired?”

I was taken aback. My posting rate on Facebook hardly qualifies as incessant. Besides, there was nothing remotely hectoring about this article. Still, there’s no denying that my motivation in sharing it was to persuade reluctant voters to choose Hillary.

I decided to engage with rather than ignore my friend. He immediately replied that he didn’t mean me personally, “but that the daily attacks on the folk who are not gung-ho for HRC, including the accusation that we are women-haters, are really counterproductive.” He likened well-meaning attempts at political persuasion to the noxious proselytizing meant to convert people from one religion to another. Besides, it made him think that Hillary’s supporters lacked the faith that she should and could win, and found their apocalyptic pronouncements about not voting for the Un-Trump unhelpful.

His response reminded me of a party I attended right before the 2004 election. Amid a dozen or so Chardonnay-sipping liberals eternally bitter over the selection of W four years earlier was one lone Nader supporter. Unrepentant, he planned to vote for Nader again.

“How COULD you?” everyone exploded in unison. As we all moved in for the oh-so-persuasive kill, I could see this man’s jaw tighten, his posture stiffen. You can probably guess who he voted for.

I’ve learned a lot since that encounter—if you want to preach outside the choir, it’s better not to screech or beseech. Still, there are reasons to try. Or was my Facebook friend a case in point that such attempts invariably backfire?

Recently I’ve had many conversations with my friend Linda (who also doesn’t like Hillary but who will vote for her). She has been talking with her son and his friends, most of them young, fervent Bernie supporters who care deeply about racial justice. They now feel totally disillusioned by the political process, seeing little difference between the parties and no point in voting. Linda has a lot of empathy for this viewpoint, and mostly listens. But when she does talk, whatever she has to say doesn’t only fall on deaf ears—it closes those ears further.

Periodically I send things with a fresh or compelling perspective to Linda, saying, “What about this? Could this help?” One was a recent column by Charles Blow. Linda was almost persuaded until the last paragraph:

Protest voting or not voting at all isn’t principled. It’s dumb, and childish, and self-immolating. I know you’re young, but grow up!

With those words, Blow blew it. Of course, Linda never forwarded the article to her son, and has wisely stopped talking to him about the election altogether.

Years ago Republican pollster Frank Luntz quipped, “The trouble with Hillary is she reminds everyone of their first wife.” She also reminds people of their mothers. There are legitimate reasons to be skeptical of Hillary, but this unconscious association has gotten short shrift in understanding the level of antipathy generated by the candidacy of the first woman who has a shot at the presidency. Often what mothers say, no matter how wise and well-intended, has the effect of generating resistance. You should listen to your mother, but do you really want to? Middle-aged mothers like me who are trying to persuade others, especially young people, may only be perpetuating the maternal nag problem.

Is it possible to change people’s minds? We are now inundated with 24/7 information and misinformation, and live in silos that reinforce our worldview while keeping out other perspectives. Social science research demonstrates that when people are shown evidence contradicting their firmly held beliefs, they don’t reconsider; instead, they double down.

If one person’s persuasion is another’s hectoring, what’s a mother to do? What’s a concerned citizen to do?

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 Have you tried to influence anyone’s vote in this election season? Has anyone tried to influence yours? What works and doesn’t work?

 

 

Mental Health and Presidential Politics

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presidents-mental-illnessWith all the furor over the presidential candidates’ physical and mental health, I found myself wondering not about the ethics of armchair analysis or the quality and timing of the information released so far, but another question: What would happen if the medical records of someone running for president revealed any current or past treatment for mental health issues?

In 1972, Democratic Vice Presidential nominee Thomas Eagleton had to step down when news surfaced about his prior hospitalizations and electroshock treatment for depression. What would happen today if there was a notation about ECT, Prozac, Lithium, addiction, or the like in a candidate’s chart? Would it be disqualifying? Should it be?

Given the stigma and discrimination that still surround mental illness, it’s not surprising that very few politicians and no presidential candidates admit to struggling with or seeking treatment for psychological problems. This does not mean there haven’t been plenty of afflicted presidents; a 2006 study found that nearly half of 37 presidents whose historical records were reviewed met the criteria for psychiatric diagnoses. Some, like Lincoln, rank among our greatest presidents.

It’s a shame that stigma and discrimination discourage proactive and responsible responses to many treatable conditions. It’s not the presence or absence of a mental illness (or life circumstance) that counts, but how someone deals with it. As any therapist knows, what’s worrisome is not the person who knows something is wrong and seeks help, but the person who doesn’t.

Not all mental illnesses are the same. Nor are all jobs. Military personnel and commercial airline pilots routinely face the quandary that acknowledging significant psychological distress may derail their careers not only because of stigma, but due to legitimate concerns about risk to self and others.

What about the presidency, a high-stress, high-responsibility job if ever there was one? People often quip that you’d have to be crazy to want to be president. It’s no joking matter, though: for decades there have been serious proposals for an independent and impartial evaluation of the physical and mental health of all presidential candidates. Assuming we could find such examiners and eliminate stigma, though, diagnosis is an imperfect art and poorly predictive of performance. (Thomas Eagleton, for example, went on to have a long and distinguished career in the Senate and academia.)

Anti-social personality disorder, malignant narcissism, and paranoia have been commonly cited as conditions that ought to raise alarm, if not disqualify someone from the presidency. There is often a partisan slant to these opinions. But even if an official and impartial diagnosis could be made, why would it be persuasive when the traits and behaviors in question are already perfectly obvious for all to see? Besides, such characteristics may or may not have anything to do with a candidate’s mental health.

Perhaps we should be more concerned about the ill state of the body politic: We are too often split into polarized camps, divorced from reality, and suffering from anxiety, paranoia, withdrawal, and despair.

These problems are much more difficult to diagnose and treat.

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What are your thoughts about this?

 

Political Rupture

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woman burning in hell (2)At a rally for Hillary Clinton, Madeleine Albright declared, “There’s a special place in hell for women who don’t help each other.” A fierce debate about gender, the generational divide, and feminism in presidential politics ensued. There’s a fundamental psychological dynamic at play as well: the idealization of female solidarity and the corollary difficulties women often experience when differences emerge.

Women are celebrated for their emotional intimacy. Statements like, “We get one another completely”; the sharing of secrets, clothes, and gossip; even jokes about women going en masse to the bathroom make clear how much women prize connection.  This “urge to merge” can be viewed as an aspect of female identity formation and the longed-for return to the blissful state of maternal-infant union. Nothing is quite as delicious.

But it’s also a set up. When women are not supposed to feel, let alone talk, about their differences, there’s no room for conflict, and no vocabulary or practice for resolving it. Difficulties go underground, leaking out in ways that often lead to rupture. Thus differentiation is experienced as betrayal, and standing apart from the group risks social suicide. My daughter discovered this in college when, tired of looking for housing with eight (!) other women, she considered leaving the group. The anger and accusations of disloyalty quickly convinced her otherwise. It turned out that none of the women really wanted to live in such a large household, but no one knew how to say so without hurting anyone’s feelings or being seen as a traitor.

This loyalty/betrayal split is now being played out in presidential politics. Albright’s remarks typify idealized notions of female connection that make no room for difference. She reminds us of the dangers women face if they stray from the fold. (Never mind that the halcyon days of blissful union have never really existed: the very women’s movement Albright exalts was itself torn apart by conflict.)

Predictably, when Albright consigned to hell women who disagree with her, all hell broke loose. As long as those who differ are seen as traitors, with only a narrow range of women’s emotions and choices deemed acceptable, all hell will continue to break loose.

But perhaps there’s hope. As younger women reap the benefits of their foremothers and are able to speak up, speak their minds, and stand apart, strong feelings and disagreements won’t be quite so likely to go underground, then erupt. Instead, polarization might give way to dealing directly and respectfully with the differences that enrich women’s complex and very human experiences.

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What have your experiences been with female solidarity and its discontents?

 

 

The Paradox of Hope

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HopeAt a recent storytelling event ushering in the New Year, audience members were asked about their resolutions: “To give up hope only to regain it,” one woman said.

This echoed something I’d heard just weeks before at a clinical meeting I facilitate, when I asked the staff to share something they were doing for self-care. A colleague who unfailingly sees the best in everyone surprised us all by saying she had given up hope, and was thus no longer so prone to disappointment.

Hope, we are told, springs eternal, so such dissents from the cultural imperative to uphold it are rare. Nowadays it often seems the more difficult things become, the more we are forbidden to feel hopeless. We are urged to look on the bright side, keep gratitude journals, embrace the lessons of hardship. And no wonder: It is difficult to live in despair.

Exercises cultivating resilience and hope can bring genuine relief, broaden perspective, even pull one back from the brink. They can also preserve relationships. Being around someone who despairs is also difficult, and in lieu of outright fleeing, it is tempting to extend a lifeline. Yet who really escapes—the person feeling hopeless, or the person who cannot bear to listen? Those who are unable or unwilling to be coaxed out of sorrow might soon find themselves alone.

Our clients know this (or at least the lucky ones do). They worry about burdening or alienating others, fear wallowing in hopelessness. So they bravely try to focus on the positive, often with felicitous results. Yet the more people feel compelled through internal or external expectations to disguise despair, the more pinched they become. It is as if they squeeze themselves into emotional Spanx to keep everything contained and looking good.

Psychotherapy offers the relief that comes from shedding such constraints, breathing freely, and being one’s natural self. The terrain of hope and despair is tricky, though: therapists must help clients navigate the depths of unbearable pain without stranding them there. Often we see ourselves as the guardians of hope. Yet we must never impose it. We would do well to remember the famous story of a patient in analysis who said that the only time he felt hope was when his analyst agreed with him that it was hopeless, but that they would carry on together anyway.

It is when we make room for hopelessness that hope, too, might find a little space.

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What are your thoughts on the balance between hope and hopelessness?
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Originally published in Impulse, an online publication of the Northern California Society for Psychoanalytic Psychotherapy

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