“The Question of G-d”

This book, by Dr. Nicholi, is the basis for Mark St. Germain’s play “Freud’s Last Session,” in which, as per previous post, I will be one of the “Talkback” speakers. In preparation for my début, I have given myself homework to read this book and watch the PBS series of the same title. I have also purchased the script of the play (available for $8.00 on Amazon), that I plan to read after I have done my background exploration.

As I begin this book, I am struck by the following paragraph:

      “None of us can tolerate the notion that our worldview may be based on a false premise and, thus, our whole life headed in the wrong direction. Because of the far-reaching    implications for our lives, we tend to dismiss and contradict arguments for the worldview we reject. I hope each reader will critically assess the arguments of both Freud and Lewis and follow Sir Francis Bacon’s advice to  ‘Read not to contradict….but to weigh and consider.’ ”

Dr. Nicholi concludes this part of the prologue by saying:  “It is my hope that Freud and Lewis can jointly guide us through just such an examination.”

I will continue to post as I read this book, but my first fear is that Dr. Nicholi has made Freud’s view on religion more central to Freud’s contribution than his theories related to the process of mining the unconscious. If lay people walk away from this play thinking that Freud was set to make people atheists than they will miss the point that Freud’s theory on religion fit into a much broader theory of the human mind. One does not have to accept Freud’s ideas about religion to gain from his ideas about self-sabotage and the primacy of one’s parental relationships. Likewise, I suspect that C. S. Lewis has brought us far more than his views on religion. His writings are so prolific that it would be sad to think of him only in these terms.

Maybe this will be my opening statement. I will have less than five minutes to introduce the “Talkback”. I will probably spend hours thinking about those five minutes. Time well spent, meaningfully spent, I should say, given the gravity of this topic.

See also…http:http://www.latimes.com/entertainment/arts/culture/la-et-cm-freud-last-session-santa-monica-20130106,0,4591570.story–

Edmund White: Great Characters

Edmund White, a writer, professor of Princeton, read at the Hammer Museum last evening  http://hammer.ucla.edu/calendar/detail/type/program/id/1100.  from his new book “Jack Holmes & His Friends” http://www.edmundwhite.com/html/jackholmes.htm.  I have never heard of him, but I had faith that the Hammer programs do not disappoint. I was partly right. His reading introduced us to two characters, named Jack and Will. Jack was single, looking for stability, and Will was married, looking for excitement. Their relationship was both witty and passionate. It was fun to hear about two men, in the way that we usually think of two women. By the time the evening was over,  I felt like Jack and Will became two good friends of mine. The prose was gripping and hilarious, but not poetic. Mr. White is a cultural critic, a commentator on gender and social class.

   He was charming and engaging. He spoke of his psychoanalysis as a “mystical” experience that “one needs to be highly educated to enjoy that kind of masochism.” In my mind, a writer who talks about his psychoanalysis, with whatever valence, is suggesting that his therapeutic experience has contributed to his understanding of human nature and thus to his creation of fictional characters. I appreciated his openness about his experience with my colleagues.  Will I read his book? Maybe. Did I enjoy his company? Absolutely.

Not Loving ‘One Hundred Names For Love’

  Paul, age seventy-five, a writer, has a middle cerebral artery stroke and becomes aphasic, unable to express himself with words. Diane, his wife, seventeen years younger cares for him in a way in which she describes rehabilitates him to return to writing books. She repeats the particularly tragic aspect that a writer, one who expresses himself with words, is now unable to speak a sentence.  It is supposed to be a love story, but it struck me as a narcissistic endeavor, explaining, why her pain was somehow greater than others in the same situation. Sure, all memoirs are narcissistic, by definition, but this one grated on me, since whether one is a writer or not, becoming aphasic is tragic and frustrating for all involved. The book is uneven, at best, as there are some interesting tales of other writers who have also suffered brain insults. Still, the overarching theme is one of tragedy followed by recovery; a theme that is a bit too neat for my reading. It is hard, no matter how much you love someone, to take care of them, particularly when there is no end in sight. She talks about this, but then she reminds the reader about how her devotion to him got her through the difficult times. Again, there were not enough shades of grey for my liking. Love is indeed a powerful motivator for caretaking, but the weight of being responsible for someone who can do very little for themselves, often overrides that, at least sometimes. She talks about this, but only briefly. I am sad for Paul and for Diane, as I would be sad for anyone in that situation: no matter how they spent their time before the blood flow to the brain stopped suddenly. I wish she had more humility about that. Then, maybe, it would have been a decent book that I could share with patients. If you are wondering what my book group thought of the book, they liked it. Go figure!

Helping ‘The Help’: Psychoanalysis Comes Alive

         “The Help,” both the book and the movie are interesting, but not great works of art. However, they are great advertisements for why psychoanalysis and psychotherapy are so important. Aibileen captures this moment when she says to herself, with great wonder, that she can’t believe someone cares about how she feels about her life. Race relations are so painful, partly for this country’s history of cruelty towards African-Americans, but maybe more importantly because of the history of  how large segments of the population ignored their feelings. Psychoanalysis comes alive in these times because it is a field which validates this notion that people need to be heard and understood, as much as they need to have food and shelter. Skeeter, the main character of the story, took an interest in Aibileen’s point of view. Like a patient who enters into psychoanalysis, this interest, at first, made Aibileen anxious, but over time made Aibileen appreciate herself in ways that she had never experienced before. With Skeeter as an attentive audience, Aibileen had permission to reflect on her life; she had permission to think about how she was thinking. She had permission to feel her feelings.

    Prior to Skeeter wanting to interview Aibileen,  Aibileen’s major outlet for her emotional life took place in her relationship with the children she helped to raise. The movie and the book depicted just how important this attachment was, both for the white child and the African-American help. It was in this connection, that feelings could be expressed, and hope could be felt. Psychoanalysis comes alive yet again. Attachment theory supports the notion that this tender relationship between caretaker and developing child becomes the paradigm for important relationships downstream. Further, psychoanalysis gives credibility to the feeling that not only do children benefit from a loving caretaker, but the caretaker grows emotionally as well. Aibileen understood this. Her life was not all about prejudice and maltreatment. It was also about loving children and helping them grow up to be self-confident and loving adults. Aibileen knew that this pleasure far surpassed the materialism of her employers. 

   “The Help” is a sad book/movie. The themes of prejudice and hatred are hard to watch. Yet, like being a psychotherapist, one witnesses the ugly side of human nature, knowing that good things can grow out of seemingly endless cruelty and unfairness. Aibileen and Skeeter, like patient and therapist, both transformed in the course of the story. They did not transform because of their suffering, they transformed because they had each other. The attachment, the connection, the love, the relationship, whatever we call that, was the instrument of change. Psychotherapists know this. We just need to get that message out. Maybe “The Help” helped us.

Book Review; Psychoanalysis: The Impossible Profession

    This 1977 book captures the story of Monte and Marla https://shirahvollmermd.wordpress.com/2010/06/18/were-breaking-up/. The interplay between the professional and the personal makes for an “impossible profession”. Aaron Green, the pseudonym for the psychoanalyst, met with Janet Malcolm weekly, as Ms. Malcolm delved into the psychoanalytic world of New York City. Janet Malcolm reminds us that psychoanalysis created a major cultural shift in understanding the human mind; it also became a popular treatment for anxiety in the 1950’s. Yet, for the professional, psychoanalysis became a world of hierarchy, competition, and endless revitalization of  infantile wishes. The psychoanalytic institutes re-created family relationships where there were “favorite” children, and “unloveable” children. Unlike families of origin, the psychoanalyst, since he stays working in the profession, never has the opportunity to “grow up”.

     Dr. Green, like Monte, works as a middle-aged professional, yet when he walks into the psychoanalytic institute, feels like the child at the dinner table whom no one listens to. This asymmetry between Dr. Green’s public persona  and his internal life around his colleagues creates the stage for pulling up the curtain on the profession. It is not that psychoanalysis does not help people who seek relief from their internal demons; rather, it is that the field of  psychoanalysis has trouble helping the provider work through his infantile  fantasies.

      Psychoanalysis established the unconscious as an operative mode in the human psyche. The field also helped many people understand themselves in ways in which they can grow and open up new possibilities for ways to exist in their worlds. Mental health providers hit up against one limitation; it is hard to heal a wound, if the family never lets you leave the dinner table. A developmental principle is echoed; separation is the key to growth and psychological autonomy. Alas, the field of psychoanalysis needs to put into operation that principle. Hopefully, a new model of psychoanalytic training awaits; a model in which psychoanalysts do not associate professionally with their colleagues whom they have sought mental health treatment in the past. The field needs to grow up and go off to college; the providers need to find new colleagues when their training is done. Senior members, although it is hard for them to let go, must encourage this transition. The profession needs to become possible.

Mindsight

         Dan Siegel trained with me at UCLA in the late 1980s. By that I mean he was two years ahead of me on the long train of professional development. I followed him in my adult psychiatry residency and then I followed him in my child psychiatry fellowship, but by that time, he had graduated and entered into the “real world”. I always liked him and I always knew that one day Dan Siegel would become Dan Siegel. I knew, like many of my colleagues knew, that he would become a household name, at least in certain households. Dan had the  constellation of qualities which are characteristic of leaders:   high intelligence, charisma and thoughtfulness, along with a strong drive to contribute to the field of adult and child psychiatry. 

      “Mindsight”, the name of his latest book,  is a word he coined to describe the observing ego, the part of the brain which observes other parts of the brain in action. The word feels like a combination of mindfulness and insight, which I think is what Dr. Siegel had in mind when he invented it. The book is part neuroanatomy lesson, part entry into the psychotherapists’ space (similar to this blog, I think) and part paving a new path towards the integration of psychotherapy, neurobiology and Hindu ideology.

   The type of contribution that he is making is intriguing to me. He has studied neurobiology, psychiatry, child psychiatry and mindfulness.  He has fused these fields together in a way in which the public can see how psychiatrists contribute to the world, above and beyond psychopharmacology. For that, I am grateful. He reminds his readers that psychiatry is a field of the brain in that the more we understand how the brain works, the better we can help people help themselves. I am grateful again. Dr. Siegel reminds us that the brain is a social organ. It is wired for connection. Many of us  know that we feel better when we are part of a larger social structure, whether it is a family, a church or a political organization. Dan tells us that the reason for this is that our brain fires good feelings when it is around other brains with similar points of view. In other words, affiliation is a brain thing. We hunger for other people in a similar way that the stomach growls when it needs food. Our organs “yell” at us when needs are not being met. The brain is no different.

     Dr. Siegel describes mirror neurons. A mirror neuron is a neuron that fires both when an animal acts and when the animal observes the same action performed by another. In humans, brain activity consistent with that of mirror neurons has been found in the premotor cortex and the inferior parietal cortex. Some people, including Dr. Siegel, speculate that mirror systems may simulate observed actions, and thus contribute to theory of mind skills. The idea is that we can experience joy when we see others experiencing joy because we have mirror neurons and we can imagine ourselves feeling what the other person is feeling. To put it another way, empathy is wired. Dr. Siegel argues that the more one is encouraged to empathize, the more extensive these neural connections will be, and so practicing empathy develops the mirror neurons in our brain. Neuronal firing means neuronal re-wiring.

   Being present, learning to pay attention to the here and now,  can be part of psychotherapy, can lead to more integrated, and hence better mental health, Dr. Siegel says. Dan takes us from thinking about interpersonal neurobiology to the Eastern teachings of observing oneself in a detached and attached way at the same time. That is, a psychotherapist can help a patient think about what is going on with his thought processes at the same time that the patient experiences his thought processes. As I read this part of the book, I thought about yoga, about focusing on the breath, about how this simple message is so helpful for so many ailments. I agree with Dr. Siegel that mindfulness adds to psychotherapy. I agree with him that incorporating mindfulness into treatment adds to the therapeutic process. I think most clinicians have done this for years. I salute Dan for bringing together psychiatry and Buddhist philosophy. The cooperation between these two fields is obvious, but it needed to be said. Dan knew this. He took a big step to bring his name together with these two fields to teach people that psychiatry is more than psychotropic medication and it is more than neurobiology.

      As I read “Mindsight’ I appreciated Dan’s efforts to demystify the mental health profession. I continue to follow Dan on his path towards making psychotherapy a known entity. I follow him on his path to integrate the mind, the brain and relationships. Some relationships last a long time, even without words exchanged. In particular, there is the relationship of deep admiration and following.   Dan and I have that kind of bond.