Hedda Bolgar PhD: A Life Well Lived!

Hedda Bolgar 1909-2013 (via http://psychoanalyticpost.com)

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My colleague, Hedda Bolgar PhD, practicing psychoanalyst for 80 years, passed away yesterday at age 103. Her mind was vibrant. Her compassion was enormous. Her vision for the future was spot on. She taught, she saw patients, she started a free-standing psychology graduate school and a psychoanalytic institute. Los Angeles Institute for Psychoanalytic Studies (LAISPS), an institute that I am on faculty, came to life because Hedda recognized that psychologists, social workers and MFTs, needed a place to explore psychoanalysis. This was at a time when the American Psychoanalytic did not admit non-MDs (other than academics) into their training programs. LAISPS carries Hedda’s tradition of understanding that although the world is changing rapidly, what does not change is an individual’s need to share their stories, to be listened to, to be understood. No medication, no neuromodulation device, no psychosurgery, will ever change this. She was a wise woman because she realized man’s evil, as she lived through and protested against the Nazis, yet at the same time, she loved life and she loved people. Her home was a constant place for get-togethers to share stories, do book signings, and plan conferences. She was warm, intelligent and caring. She often voiced how she understood that working into her sunset years meant that she would inevitably abandon those who depended on her. She was open and honest about her impending departure from this material world. Her strength of character came through with this brutal honesty and integrity. She was both ambitious and nurturing, a combination that is rarely seen. She wanted to make a mark on the world, while at the same time, helping her colleagues and her patients strive to be the best that they could envision for themselves. She was a visionary, both for herself, and for psychoanalysis, but for those who came in her path. I was fortunate to be in her path, although in a small way, allowing me to feel her goodness, her reliability and her strength. Her loss is huge, but so is her legacy.

See also….http://www.latimes.com/news/obituaries/la-me-hedda-bolgar-20130519,0,2504238.story

Piano Lessons/Psychotherapy: Striking Similarities

 

In this week’s New Yorker, Jeremy Denk writes about his piano teachers, as he also talks about in the video above. He talks about his teachers changing his life, enabling him to hold on to paradoxical advice. One teacher tells him to follow his intuition, whereas another tells him to pay attention to detail. Holding on to these notions is the challenge of creating great music, he says. So, working with the emotional interior requires working with  the same contradiction. One must learn to be free to fantasize, while at the same time, maintain the responsibility and regimentation of a civilized society. What struck me most about this article was how his mentors shaped him,but also humiliated him,  in ways which he struggles to describe, in a parallel fashion to psychotherapists who try to understand their patients, while at the same time, not shame them. Once again the relationship, the attachment, the respect, creates personal and professional growth. Although these connections often cause great inner turmoil, they also create a lasting impression of loving advice and guidance. Music is the window into the soul, so it makes sense that learning music and going to psychotherapy are strikingly similar activities.

The Forgotten Aunt

 

Zoe, from my previous post about siblings, gets the sudden, although not surprising news that her father is in the hospital. Sean, eighty-six, has multiple medical problems, but still, it always catches Zoe by surprise when there is a medical incident. This time, Sean had pneumonia, requiring an inpatient stay. Zoe goes to visit and she begins to wonder about her dad’s sister, an aunt, that she has no memory of ever meeting. Sean tells Zoe to call Aunt Fay, and so within minutes, both Zoe and Fay are crying on the telephone. Fay, ninety-two, tells Zoe that she thinks about her every day and that she has kept up on Zoe’s life by her daily phone calls to Sean. Upon hearing about Sean’s pneumonia, Fay immediately says “it is because he is with all  those women. You have to tell him to slow down.” Fay tells Zoe, as if the two of them are close. Zoe leaves from seeing her dad deteriorate suddenly, with sadness, along with the odd happiness of “meeting” her 92-year-old aunt. Zoe talks to me about her mixed feelings with a heavy heart, both in terms of her dad’s deterioration and in terms of her yearning for a part of her family she never met. Zoe explains to me that her mother, Claudia, did not like Fay. Claudia never allowed her children to spend time with her, and Sean, although very close to Fay, agreed. Zoe, still recovering from her emotional wounds from Berkeley, is further faced with her family dynamics in which there were deep divides. Suddenly Zoe has another memory from her conversation with Fay. “You know she said that my mom never let us meet because we looked alike and we are both really pretty. It was such a strange comment, but I do look like my dad’s side of the family, and that could have something to do with why my mom treated me poorly.” Zoe says, with wonder, as if she does not quite believe her own words. Zoe is now immersed in more family dynamics because she cares for her dad, but this forces her to interact with her siblings. I listen and I imagine Zoe’s subjectivity. I imagine Zoe, with her dad’s illness, thrown back to her childhood memories, which bring up lies, betrayals, and heartless attempts to create children who reflect well on their parents. Once again, listening is a deep experience, like reading a good novel, takes me to a deep place, filled with my thoughts and associations to Zoe, both the Zoe of the present and the Zoe of the past.

Is Dating About Marketing?

“Maybe dating online is about marketing,” I say to Cara, forty-seven. At first, she looks at me surprised, as if to say that she is in psychotherapy to understand her dynamics and not to get strategic advice about the internet. I understand her look, but I am thinking that the “connections” people make with online dating create a projective experience. At first, there seems to be the tremendous hope that with a few clicks they will meet their “soul mate”. Then, there seems to be the tremendous anger when the “other” disappoints in some way. The associations to each email create tremendous vulnerability. Rejection is felt when this electronic other does not respond promptly or warmly, and yet, this electronic other is not a known entity, merely a fantasy created by electronics. “Many people post who they want to be, not necessarily who they are,” I say, trying to understand how such intense feelings can be generated by such shallow “relationships.” My question is meant to understand the emotional meaning of the search for the “other,” and hence the painful feelings which seem to follow when the email chain breaks down. Cara begins to understand what I mean, but she looks to me for reassurance that she will find someone eventually. Fear runs through the room at those moments. The omnipresent notion that we cannot know or control our future rises, yet again. The anxiety of not knowing is often made better by trusting someone who seems to “know”. In this case, Cara has given me that job. If I tell her she will find someone, she will calm down, as she trusts me. On the other hand, if I tell her that she is looking for reassurance, when, in fact, none can be given, then her anxiety will increase. I explain to her my dilemma and she understands, but she still wants me to tell her that her future is bright. “The more you pay attention to your own needs, the better your life will be.” I say, pointing out that she can control her behavior towards herself. “Maybe marketing yourself bypasses the fear which inhibits your search,” I say, again wondering that perhaps her anxiety is interfering with her openness to new relationships. “Yes, I am almost phobic, at this point,” as she sees how she has limited her search to criteria that almost no one can meet. “OK, I am glad I came today,” she says, as if in the beginning she was not so sure. “You helped me a lot.” she repeats as she walks out the door. Cara appreciated our discussion because she began to see how she was adding in her own fantasies about these people, which then led to pain and self-doubt.

 

 

Seeing Signs: Is Pessimism So Bad?

Relationships evolve, with foreshadowing in the beginning, honeymoon stage, where upon reflection, we are usually not surprised when a dear friend, a loved one, lets us down. Heather and Claire are new girlfriends. They were off to a club, but Heather forgot to write the address so they never made it to their intended destination. Claire was angry and disappointed with Heather and they had a verbal altercation. Weeks later, Heather has “forgotten” the incident and feels that Claire is a deep and close friend, even though they have known each other for two months. “I think you should be thoughtful about Claire and understand her sensitivities,” I say, trying to help Heather have a clear view of the dynamics of this friendship. “Why are you so pessimistic?” Heather asks me, as if I had said that since Claire was intolerant of your mistake then the relationship is going to have problems. “It is interesting that you call me pessimistic, since I was not thinking in those terms, but I do think that seeing a sign that says ‘potholes ahead’ does not make one pessimistic.” Heather understood that, but she also expressed how much she wants to be close friends with Claire. “Wanting a friendship is not the same thing as having a friendship, so you will see how things deepen over time,” I say, trying to help Heather see that relationships are a journey which need to be monitored, but  can’t be controlled.  Heather knows this, but she also is yearning for the security of a loyal relationship. This yearning is both shameful and exciting for her. She is happy to have a new connection, but her neediness makes her feel bad about herself. A part of her wishes she did not need friends, and in this shame, she is hoping she can have a ‘fast friend’ so that her yearning does not scare anyone away. Heather’s  wish and  fear for  connection are fighting internally. Consciousness of this battle will help. Heather, reluctantly, would agree.

Does Therapy Ruin A Marriage?

Ten students, two absent, made for a vibrant class discussion last evening. My class is titled  “Psychoanalytic Technique”. My students have engaged in a two-year Psychoanalytic Psychotherapy program, in which they attend class from 5:30 pm to 10:00 pm every Wednesday night for two years, with a two month break in the summer.  There are psychiatrists, social workers, MFTs and psychologists, all together with a common purpose: trying to understand how to help folks who suffer. As per my previous posts, our class began with understanding Transference. Yet, as the conversation unfolded, in ways that are interesting to reconstruct, we went down a path in which we outlined how if one person in a couple goes into treatment, that it could, cause significant relationship tension for a variety of reasons. If, for example, there is a ‘idealizing transference’ then the partner in the relationship could begin to feel competitive with the therapist. Alternatively, if the patient experiences significant personal growth, then he/she may turn to his/her partner and feel a large emotional disparity in terms of their maturity levels. Of course, this change in maturity level can happen in any relationship, but psychotherapy is one way in which that can happen. “Should the therapist feel good or feel bad if patients who come to therapy without conscious issues with their life-partner, but over time, develop these issues?” One student asks, highlighting the dilemma, that therapy, as the movie suggests is a “Dangerous Method”. “Therapy is a journey,” I say, “and so we never quite know where we are headed. As Freud instructed his patients, therapy is like a train ride where we narrate what we see out the window, not knowing what is coming next.” My students were sophisticated and intelligent, and clearly dedicated to their work. These classes don’t increase their prestige or their fees. This is a labor of love, for all involved. Yet, at the same time, all of us in the room are aware that our good intentions sometimes cause others, either in the consultation room, and/or their collaterals, significant distress. “Personal growth is a challenging experience,” I say, “and next week we will talk about ‘resistance,’ the unconscious fight against such a challenge.” I do learn by teaching. The adage holds up.

The Cost of Therapy

Alexander, seventy-two is spending his retirement money on therapy. His friends and family tell him he is “crazy”. “They don’t understand that I have very strange and bothersome thoughts and I have no one to talk to about that.” Alex explains to me, even though I know that. He is feeling defensive and misunderstood by his village. “On the one hand I know these people care and they are trying to help me so that I don’t run out of money, but on the other hand, they have no idea what I struggle with internally.” He tells me, again, even though we have discussed this many times. I hear the loneliness of someone who has such invisible suffering that no one, other than a mental health professional, can understand. The torture of brain suffering is beyond the comprehension of most people, even beyond some trained in the helping profession. Plus, friends and family presume to know his financial situation and this presumption hurts Alex’s feelings since he feels demeaned that they do not respect his decision-making. “Maybe you have lead them to believe that you have financial problems so they are confused why you invest so much of your resources into psychotherapy.” I say, knowing that he does need to be careful with his money, but at the same time, therapy, for Alex, is a life-line. “Yes, I do complain about money, but this expense is not optional for me. At least it does not feel that way.” Alex explains, mostly to himself. I am left feeling privileged with my medical training. Years of seeing how the brain can cause so much invisible misery has sensitized me to Alex’s issue. He suffers in ways, if he were to explain to his loved ones, would only alienate them and scare them away. Understanding goes a really long way, particularly for Alex.

Liquid Courage

As we enter into 2013, the party season winds down, and the social demands diminish. I am left to reflect on how people connect with one another, and how alcohol, for some, provides much needed disinhibition in order to allow for a certain amount of emotional intimacy. The fear of rejection is so powerful, for some, that talking to people, especially those that are not part of daily existence, can be frightening. Yet, with a glass of wine, social ease can be  available. This intrigues me. Does the alcohol suppress the frontal lobe, such that a more authentic self comes through? Would Freud say that the wine diminishes the harsh superego which judges every word? Or, is there a social pressure to drink, just to be one of the gang?

Desiree, a fifty-year old patient (fictional, of course), said she could not bring herself to go to her best friend’s holiday party because her dog passed away three months ago, and so she “just could not face anyone.” The grief, I imagine, took away her access to her social courage. She did not imagine alcohol could fix this problem. Her melancholia turned her inward. She knew her friend would be deeply hurt if she did not go, but she also knew that this time of mourning, was a time for the self to trump the friendship. She felt guilty for not going, but she also felt entitled to take time for herself. If I think to myself that her child died, then I am sympathetic to Desiree’s perspective. Desiree does not forecast that going to this holiday party will not only support her dear friend, but in turn, she will feel loved and supported as well. By contrast, Desiree sees the party as a drain of her already depleted self. This mourning period is no time to muster up courage; she convinces herself. I continue to be intrigued. Liquid courage only goes so far.

Vague Speech: What’s Up With That?

“I talked to some people, about some things,”Whit, fifty-five, says to his wife after they gave a big holiday party. “Could you be more vague?” she responds with complete frustration, as Whit relates this interaction to me.  “Communication is so important to relationships, that vague communication can feel like a distancing move,” I say, sympathizing with Whit’s wife’s point. ” I just do not think in specific terms,” Whit explains to me. “I could tell you all about the food at the party, but I don’t remember people’s names, and I don’t always remember what we talk about.” Whit says, showing me that his brain works very differently than his wife’s brain, in that she remembers conversation and people, but not necessarily the specifics of the food or the wine. “Yes, but you need to be sensitive to your audience,” I say, reminding Whit that he should know his wife will get frustrated if he speaks in vague language. “Yes, my default position is to feel like a ghost, even at my own parties,” Whit explains to me. “So the vagueness mirrors your feeling that you are not a part of things.” I say, deepening my understanding of Whit’s struggles with fitting in. Suddenly I feel for Whit. I imagine what it is like to throw a party and not feel like a valued participant. I switch from empathizing with his wife, to feeling for Whit and his lifelong experience of being on the periphery. “Learning communication skills is valuable, but perhaps the bigger issue for you Whit, is to enhance your sense of confidence and value. Maybe this will improve your relationship with your wife.” I say, pointing out that confidence will not only help Whit individually, but it will help his relationship, and in turn, that will help Whit even further. “Language is the window to the soul.” I say, using a cliché, but at the same time, understanding how Whit’s vagueness spoke volumes about his emotional interior. Once again I am reminded of the importance of working both outside in, and inside out.

 

Parental Guilt

“I want you to know we have a normal family,” Maureen says to me, as she admits her twelve-year old to the psychiatric hospital for serious substance abuse issues. I did not ask her about her family, so her comment made me pause. You mean, you feel very guilty, I wanted to say, but I did not have the history with Maureen which would have enabled me to speak my mind. “Parental guilt is overwhelming,” I say to my students, thinking about Maureen. “Parents feel guilty, generally speaking, no matter what happens to their children, and when this guilt is added on to things they really feel they did wrong, then they have guilt squared,” I say, trying to explain that a part of parental guilt is about understanding the enormous  responsibility of another human being, whereas another part of guilt could be a knowing negligence when it comes to parenting. “When the guilt can come to the light of day, parents often feel uniquely understood,” I say to my students. “No one wants to talk to them about their guilt. Most well-meaning friends and family want to jump in and quickly reassure the mom that she did the best she could.” I say, emphasizing that the role of a mental health professional who works with children and families, is to demonstrate the understanding of the really difficult feelings which can bubble up during a mental health crises. Reassurance does not help because the parent often feels like their friends do not really understand how deeply bad they feel. Further, the loved ones often do not want to acknowledge the depth of the guilt because it can trigger in the listener their own sense of guilt towards their children. “The default assumption, until you get more information, is that the parent is feeling guilty when they see you.” I say to my students who are  rookie child psychiatrists. ”Probing for that guilt is the art of our profession,” I say, thinking to myself that in some ways, this is a lost art, but also hoping that maybe, I and many of my colleagues, are slowly bringing this art back to the field. “No one wants to feel guilty, but worse than that, no one wants to feel alone in their guilt.” I say, pointing out that feeling misunderstood is worse than feeling guilty. “Understanding guilt is tricky, because you need to empathize without agreeing or disagreeing with their own sense of negligence.” I say, emphasizing that understanding guilt is a challenge.  “I hear you,” I respond to Maureen, acknowledging that I hear her statement about her family, but I am also hinting that I understand that there could be a subtext.