Adolescent Enthusiasm: It Can’t Be Beat

  Frankie, twenty-one, female, senior in college is elated today. She is doing well at school. She enjoys her friends. She is eating and sleeping well and by her report she has “watched it with the alcohol.” By contrast, a week ago, Frankie felt her life was in the “dumper”. She hated school. She hated her friends. She did not leave her dormitory. What difference did one week do? I am not sure. She did not like how she was feeling so she reversed her mental state very quickly, such that now she is not quite manic, but close. The beauty of seeing adolescents is to witness this rapidly shifting mood state, which means that sometimes just waiting and being patient, the adolescent pulls herself out of one mood and into another mood with the agility that only young people seem to have. Sure, I could try to take credit for Frankie’s improved mood. She saw me last week and we talked about things she could do to improve her self-regulation. I think this helped, but it also helps to have the biology along with today’s culture which allows for a roller coaster of emotion, as somehow a normal and socially acceptable experience in these adolescent years. This rapid shift in mood in an older person would be seen as strange or suspicious, but within our society, we allow it by attributing these mood swings to “normal adolescent turmoil.” Whether we as a society should or should not accept these mood swings is another question. For now, I feel like the beneficiary, as youthful enthusiasm feels like a nice experience to absorb.

Adolescence: The Dawn of Reproduction

 Moses Laufer says that the key to understanding adolescence is to have a deep appreciation for the ability to make a human being, the ability to reproduce. This dawning creates anxiety and hope which shapes the adolescent mind, he claims. Willow, age twenty-four, has never had a serious relationship and she cannot figure out why. Mr. Laufer would say that she is afraid of the sexual demands in such a relationship and the threat of reproduction. He has an interesting point. As an alcoholic cannot have the first drink, otherwise he/she will get drunk, it is possible that Willow avoids the threat of having a baby by avoiding relationships all together. It does make sense that the appreciation of one’s reproductive potential creates, for some, unbearable anxiety. As one moves through the train of adolescence, and one feels egocentric, the threat of being responsible for another human being can be seen as a challenge to one’s developmentally appropriate selfishness. How one deals with this potential says a lot about personality and personality development. I am sure there are many reasons for Willow’s loneliness. Now, Mr. Laufer has added one that I did not consider before. Thanks.

Bank of Good Feeling

   Wendy and Jo, both age fifty, have been good friends for twenty years. They met when they worked together, but they both separated from that employer nineteen years ago. Still, they remained good friends. They were both married when they met. Now, Jo is remarried. Wendy is single and dating on and off. Wendy and Jo are not getting along, according to Wendy, my patient, who reports with dismay about how Jo disappoints her. Jo seems not to be interested in Wendy’s dating life. “It sounds like you have such a deep bank of good feeling that it is hard for you to reconcile what is in the bank, versus the feelings that are currently in your wallet.” I say, trying to talk about how relationships are complicated because past, present and future feelings are always at play. “That’s right,” Wendy says. ” I don’t know how much that bank should count for things, since Wendy is so not there for me now, but she used to be, when we were both single.” “It is a terrible dilemma,” I reply, understanding that it is hard to give up a relationship that used to be satisfying, even if it has felt empty for many years. “I think the bank is running dry,” Wendy says, working with my metaphor. “That is too bad,” I reply, helping her grieve a relationship that is no longer there for her.

Mirror Neurons

Marello Dapretto PhD http://faculty.bri.ucla.edu/institution/personnel?personnel%5fid=46838 spoke today about how mirror neurons are abnormal in those with ASD-autism spectrum disorder. It was one of those lectures where I felt like I already knew this, and so I was not learning anything, but at the same time, she was demonstrating with pretty fMRI pictures that what I/we have suspected for years, is finally being proven with our imaging technology. That is, we now can demonstrate that those individuals with ASD have a defective wiring in their ability to imagine what others are thinking or imagining. In other words, their “theory of mind” is impaired, and the level of their impairment matches the level of defect in their mirror neurons. In other words, this is a continuum of damage, resulting in the “S” or the spectrum concept. Sure, there are workarounds to the mirror neuron system. Children can learn to understand human behavior and they can learn empathy, but they will have to bring in another neurological system since their mirror neurons do not fire properly. For years, in my training from 1986-1991, we told families of those with ASD that there was a “wiring problem” without any specific knowledge about what that wiring problem might be. We felt certain that parents should not blame themselves for the social awkwardness of their children, but at the same time, parents can help fix the problem. Listening to Dr. Dapretto today, confirmed what we told parents, back in the day. Phew!

Late Adolescence: A Lesson Of Compromise

Stability of self-esteem is the hallmark of the closure of adolescence. As self-esteem improves, compromise is possible. The adolescent can compromise on their ideals and begin to see all humans as flawed beings who are trying their best to succeed. The arrogance often recedes such that the emerging adult develops a more sanguine approach to the compromises demanded by life’s circumstances.

Zara, twenty-four, exemplifies this transition period from late adolescence to young adult. Whereas in the past, all the adults in her life had “sold out” to corporate interests, now she sees the value of a steady paycheck and the compromises inherent in starting a family. Her stormy period of self-harm, substance abuse, school refusal and school failure are behind her. Now, she is a reliable and responsible person, anxious to become more financially and emotionally independent from her parents. Although she still has issues with how her parents’ conduct their lives, she also sees that choices in life can be agonizing, and so there needs to be some forgiveness for compromising one’s value system. Her judgmental attitude has diminished considerably.

It would be easy for me to take credit for Zara’s emotional growth, and although I do think I should take some, it is also true that the pressure of development, the neurologically pre-programmed wiring to become independent beings, is also at play. As Zara’s brain matures, she feels more of a need to start her own life, and hence be less focused on the flaws of her parental figures. Psychotherapy and development work together to shape Zara’s emerging self. This is a common theme in my blog. Forgive the repetition, but my amazement about the power of development never ceases.

Marina Abramovic: Artist or Psychotherapist?

Marina Abramovic, http://en.wikipedia.org/wiki/Marina_Abramovi%C4%87 a sixty-four year old performing artist, sat for three months at the Museum of Modern Art in an exhibit she called “The Artist is Present” which has been made into an independent film of the same title http://www.imdb.com/title/tt2073029/ . People lined up for hours to sit in her presence, without words. Some cried. Some felt love. Others were confused. I think she simulated the first psychotherapy session. The expectations of the individual “customer” were met with the physical appearance along with her nonverbal communication. This situation brought up surprising emotions for both Marina and the consumer. Since she worked in an art museum, her work is called performance art. Had she had an office in a building, her work would be called psychotherapy. This overlap between art and psychotherapy intrigues me. It is only the setting which changes the frame. Psychotherapy is often a creative process and art is frequently therapeutic.  Yet, no one thinks of Marina like a therapist, and no one calls me an artist. Yet, maybe the beauty of her work is that she has hit the outer edge of both processes. When her movie hits the local theatres, let me know what you think.

Shame: The Hallmark of Early Adolescence

Douglas and Barbara Schave proposed that early adolescence, ages eleven to fourteen is a distinct developmental stage, marked by shame as the main disruptive affect, which can be further differentiated into affects of dishonor, ridicule, humiliation, mortification, chagrin, embarrassment or disgust. Reading their paper made me think of Lela, fifty-two, who did not follow-up with her primary care physician in getting her mammogram and her colonoscopy, such that she felt such shame that although she had a relationship with this physician for fifteen years, she felt she could no longer go back. She was convinced that because she did not do what he recommended that he would think so poorly of her that their relationship could not continue. “What if you explained to him that you were nervous to get these screening tests done and so you procrastinated?” I asked, knowing that the issue is not one subject to logic, but to deep-seated feelings of shame and humiliation, leading Lela to need to hide and withdraw. Lela said “well, I just could not face him.” “That reminds me of how twelve-year-old girls feel when they get a pimple. They feel that everyone is looking at their face, so they just cannot go out in public,” I say, trying to tie Lela’s feelings to a developmental phase without further humiliating her. “Yes, it may be like that,” she says without getting defensive, “but I am trying to explain to you how I feel.” “Yes, I appreciate that. I think I understand the deep feelings of shame because I can relate it to that phase in life in which shame is felt so much of the time.” Lela looks at me a little calmer now. “Compared to my mom, I have a lot less shame,” she says, with a touch of defensiveness. “Well, I am sure that your mom’s sense of shame has a lot to do with yours as well,” trying to tie the two together, rather than making it a competition. “Yea, of course, but I am glad I am not as bad as she is,” Lela says to comfort herself. “Maybe you can go back to your physician. Maybe it is important to maintain the relationship, since he has known you for so long,” I say, encouraging her to re-examine her resistance. “I will think about it,” she says, convincing me that our session meant something to her.

Miscarried Adolescence

P

Pubescence is an act of nature. Adolescence is an act of man. It is only in the last century that “children” are given a time to mature into adulthood. That is, they are given an opportunity to “find themselves” or have “identity formation” as Erik Erikson would say. This is a time where the emerging adult must reconcile his wished for self with his actual self. Peter Blos, a psychoanalyst who was interested in adolescence, coined the phrase a “miscarried adolescence” to suggest that this is a vulnerable time of life, such that when the psychological development unfolds poorly, then this can have life-long implications. In other words, one has to master adolescent challenges of finding love and finding work in order to set up a life which yields fulfillment and pleasure.

  Micky, a seventeen year-old female, might be an example of this “miscarried adolescent.” She fought with her parents over which high school to go to. She wanted to go to the local public school. The parents insisted on a private arts-oriented high school. They won. She got mad. She failed out of high school and she started hanging out with the local kids who were going to the public school. They bonded, such that much to the parent’s dismay, Micky showed no interest in college, any college. Mickey did not use drugs, she did not drink, but she did like to spend a lot of time hanging with her friends. It was not clear what they were doing with their time. Mickey is not unhappy, but her parents fear that her life will never get on track. They might be right. Micky has no plans or worries about her future. She has no desire to be forward-thinking. She is stuck, or “fixated,” as analysts like to say in a childlike state of mind. This is not to say there is no hope for Micky, only that she needs to progress through an adolescent period of finding her wants and desires, leading to an independent way to make a living, and meaningful relationships,  so that she can psychologically separate from her parents. She has a long journey ahead. I hope she opts in.

Anna Freud and Adolescence: Continued

   Can someone remember their adolescence and report that to their therapist/analyst? That is the question that Anna Freud poses in her 1958 paper entitled “Adolescence”. There is a well-known amnesia for early childhood, likely because the hippocampus has not fully formed, and as such, narrative, or linear memory is not possible. The amnesia in adolescence is different, Anna Freud says. She points out that the “height of elation or depth of despair, the quickly rising enthusiasms, the utter hopelessness, the burning-or at other times sterile-intellectual and philosophical preoccupations, the yearning for freedom, the sense of loneliness, the feeling of oppression by the parents, the impotent rages or active hates directed against the adult world, the erotic crushes….the suicidal fantasies” are largely forgotten, or “difficult to revive.” In a humble way, she continues “this partial failure to reconstruct adolescence might account for some of the gaps in our appraisal of the mental processes during this period.”

   Once again, I am reminded of the privilege of seeing adolescents first hand, in addition to relying on the reconstruction of adolescence by my adult patients. Marlo, a fifteen-year old girl, “hates” her parents and she wants to “run away.” She continues, “my dad is clueless and my mom is intrusive. That is a bad combination. I want my mom to get out of my business, and my dad is so detached, I can’t stand him.” “It sounds like you have no comfort at home,” I say, trying to grasp the loneliness she feels with her parents. “Yes, if it were not for my friends, I would not know how I could survive,” she says, grateful for her peer support. “It is great that you have friends who understand you,” I say, wondering where I fit into her mental life. Am I thought of as a peer who understands her, or a parent who has poor boundaries, or does this vary from session to session? “So, do you feel like I understand you?” I ask, treading lightly so as not to sound like I am competing with the love she has for her mom, but at the same time, wanting to see how she works therapy into her inner world. “I really appreciate the opportunity to talk about how I feel. My friends are great, but sometimes I get annoyed with them, and it is nice to talk to you about that,” Marlo says with honesty and directness.

  Will Marlo remember her intense feelings towards her parents as she develops into an adult? Anna Freud says no. She might report those feelings, but she is unlikely to re-live those emotional highs and lows. Therapy brings out infantile feelings, she reminds us, but it does not bring back adolescent feelings. That is so interesting. There is a protected time where the passions of youth come and go, and are not remembered or re-experienced in full color. This notion makes me hope that I get to see Marlo again as an adult. I suspect her relationship with her parents will be comfortable, with good boundaries. I suspect she will only have vague memories of her discomfort in her teenage years. I hope I get the opportunity to see that for myself.

Adolescence: Anna Freud Style

 

Thinking about adolescence from a psychoanalytic point of view, brings us to Sigmund’s Freud’s paper on the “Three Essays on Sexuality.”http://shirahvollmermd.wordpress.com/2010/01/23/three-essays-on-the-theory-of-sexuality-freud-1905-revisited/. Essentially, infantile sexuality which is focused on the erotogenic zones (oral, anal and phallic) become transferred to new sexual aims, meaning that in adolescence, the emerging adult begins to focus on “objects” or love interests outside of his/her family. Sigmund Freud wrote about what every mother talks about on the playground. That is that the behavior moms look at in their toddlers between the ages of two and five, are likely predictors of adolescent behavior. The stubborn toddler is thought of as “oh, my goodness, he is going to be a difficult adolescent,” the mother fears as she takes his toys away. There is a notion, perhaps started by Sigmund Freud in 1905, that after age six, there will be a quiet period until puberty, but then the difficulties will re-emerge, only this time, with the force and power of an adult-sized being.

   Anna Freud, the youngest child of Sigmund Freud, added on to our understanding of adolescence in that she focused on the ego’s job in adolescence to master the inner drive tensions. In other words, she helped us to understand that adolescent turmoil was normal and necessary for adult development. The inner tensions of the drives (push forward in development) which seem to quiet down in latency (ages six to ten), resurge in adolescence. To put it another way, adolescence represents a time when depth of thought is born. The young adult must contend with sexual pressures which drive him towards love relationships and professional development to support his independence from his familial bonds. Failure of adolescence causes persistent immaturity which can take the form of sociopathy, poor relationships, or a psychological merging with the family of origin, thereby preventing a psychological separation and the development of a more sophisticated being.

    I like thinking about adolescence because not only do I teach about it, I also live with the struggles every day, both through my adolescent patients, and through my older clients who have gotten stuck in adolescence, giving them tremendous anxiety about moving forward in their lives. For example, an increase in narcissism is inevitable and helpful in the beginning of adolescence, but one hopes that as time goes on, the person begins to have deeper empathy for others. This cannot always happen because for some, the security necessary to leave oneself behind as he/she begins to deeply care for another is simply too scary. The person feels too emotionally deprived to intensely care for others.

  Lee, age forty-one, never married is a good example. He is lonely, on the one hand, but the thought of thinking about someone else gives him anxiety to the point of panic. He is “sure” that if he lived with a woman, his life would be ruined. She might expect him to make more money, keep a cleaner house, go out to social events, and those expectations, according to Lee, might “ruin” his life, such that he is too scared to even date women. At the same time, Lee is deeply caring for his parents, to the point where he vacations with them, and he spends every Sunday night at their house having dinner. I would say that Lee is stuck in latency. He cannot seem to move beyond his childlike life of having his parents as his primary love objects. The thought of psychological separation gives him panic. My more biologically minded colleagues might suggest that Lee has Panic Disorder, or some sort of Anxiety Disorder, and although I can see that point of view, I also see that Lee needs to work on his inner tensions of struggling with his ego. That is, he needs to take care of his ego such that he can manage his own needs and the needs of another, outside of his family of origin, in a way that is both satisfying and fulfilling. As he learns to do that, he will no longer experience anxiety at the thought of going out on a date. I am in favor of Lee taking medication to help him with his anxiety, as long as he also understands that as he masters his internal world, the expectation is that he will no longer need his medication. Anna Freud helped us to understand Lee. Thanks, Anna.