Inside/Outside

Thursday, May 17, 2018

And Then There Were None

Mary Collins, a 49 year old woman who looks at least 10 tens older, sits across from me, tears streaming down her face, unable to speak. Although I have never seen or spoken to this woman before – her husband made the appointment - I feel the intensity of her pain and find myself similarly at a loss for words. Finally I decide on the most basic of human responses.
“I’m so, so sorry for your loss. I can only imagine the depth of your suffering.”
Mrs. Collins shakes her head again and again, her straight brown hair falling forward over her face. “I can’t …,” she says, continuing to shake her head.
I wait.
“I can’t stand it. I can’t!” she says more loudly. “I can’t stand the pain. I have nothing left, nothing to live for.” Pause. “I know you’re going to say it will get better. My husband says that all the time. But this? How can this get better?”
“Can you tell me about your son, Mrs. Collins?”
“Mary,” she says, still shaking her head.
“Mary, can you tell me about your son?”
“Billy. He was a good boy. A little wild as a kid, but what boy isn’t? He always wanted to be a policeman. I don’t know why.” A blank, distracted look comes across her face. She repeats, “I don’t know why. I don’t know why. I don’t know why.”
“You don’t know why he shot himself?” I ask.
Wailing she beats her fists into her thighs. “Why? Why? Why?”
Without thinking I get up from my chair, kneel in front of her and take hold of her hands. “Hurting yourself won’t bring your son back,” I say softly.
She stops hitting herself and sobs.
After a few moments I return to my chair.
She hides her head in her hands and continues sobbing.
“He didn’t want a divorce. Til death do us part. That’s what he wanted. That’s what he saw in our family. But she, she didn’t want to be married to a policeman, although she knew that’s what he was when she married him.” Pause. “And maybe it was more the boys for Billy, two little boys. Tore Billy to pieces.”  


She pauses. I think about what she said and wonder what her words will trigger for her. I watch the awareness go across her face.
“No! Not both of them! God couldn’t be so cruel. How could he take both my boys? Blown to bits by one of those IEDs. Who cares about that godforsaken place? Why do we keep sending these children to Afghanistan? It’s all so senseless, senseless.”
“I imagine Billy was pretty broken up by his brother’s death.”
“Sure was. And angry. Like me, angry. Ron was his baby brother. Billy kept saying he should have gone first. And now they’re both gone. And I have nothing.”
“Can you say who you’re angry at Mary?”
“Everyone.”
“Can you be more specific?”
“God. The government. The universe. Sue. I’m definitely mad at Sue. That’s Billy’s wife.”
I suspect she’s also angry with Billy for killing himself, but know it’s way too early to broach that topic. “Are you going to maintain contact with Sue? I imagine you’ll need to in order to see your grandchildren.”
She shrugs. “Who knows what she’ll do.”
“You saw each other at the funeral?”
She nods. “But I didn’t know what was going on that day. I don’t think she brought the boys, although I think I saw them later at the house.” Knitting her brow, she pauses. “I don’t know. What difference does it make anyway? Nothing matters anymore.”
“Do your grandsons matter?”
“I guess.” Pause. “Yes, they matter. They carry part of Billy.” Pause. “They’re the only grandchildren I’ll ever have.”
I can see Mary’s despair and rage begin to build, her hands in fists.
“Remember,” I say quickly, “Hurting yourself won’t bring your sons back.”
“But it’s easier. The physical is easier, easier than thinking, easier than remembering.”
“I do understand, Mary. But I don’t want you to hurt yourself. And I’m sure your husband doesn’t want you to hurt yourself either. I know the pain often feels intolerable, but you can survive it. As awful as it is, you can survive it.”
Mary sobs.

“And we can talk about your pain, Mary, your pain and your anger. I know that won’t bring your sons back either, but talking does help. And maybe us talking together will make it easier to bear the pain.”

Thursday, April 26, 2018

Tradition

Art sits dejectedly in my office, his elbows on his thighs, his head, shaking side to side, cradled by his hands. “I told you it would never work. She’s unrelenting. Tradition is everything to her. But it’s ridiculous! I’ve been in this country most of my life. How can she expect me to accept an arranged marriage? Go back to India and marry the girl her sister finds for me? It’s crazy.”
“I’m so sorry, Art. I can only imagine how difficult this must be for you.”
Lifting his head, he says, “And that’s another thing. She said she absolutely forbid me to have anyone call me anything but my given name, Arjun. She repeated it, yelling, ‘Arjun, Arjun, Arjun. That’s your name and I don’t expect to hear you called anything else.’ Of course I’m not about to do that. My friends haven’t called me Arjun since the first or second grade. And they made fun of me even then. She has no idea what it’s like, how difficult it is for a kid to fit into this culture. And particularly today. Even my brown skin can bring those looks – are you one of those?; are you illegal?; are you stealing our jobs?” He covers his face with one hand. “But there’s no point discussing all that.” Pause. “What am I going to do?” he asks beseechingly?
“I was just going to ask you the same thing.”
“I don’t know. I love Jessica. I want to marry her. We like the same things – hiking, kayaking, watching old movies. We think the same way, have the same values, love kids. My mother just doesn’t get it. We don’t have to be from the same culture, although we basically are. I’m probably more American than Indian.”
“Is that true? I mean you have grown up here most of your life, educated here, working here, but is it true that your Indian culture means so little to you?”
“Right now I just wish I could disown the whole culture.”
“But that’s your anger speaking, right?”
“I don’t know,” he says dismissively.
“I remember how joyfully you’ve described the Hindu weddings you’ve attended, how you know all about your gods, how you say you sometimes pray to one god or another.”
“But that’s just habit. It’s all a bunch of superstition. I don’t believe any of that stuff.”
I realize I’m pushing too hard to have Art take ownership of the Indian part of himself and wonder if that’s because he’s projecting those feelings onto me rather than feeling them himself. I need to step back.
“What are your thoughts?”
“I know I’m not going let my mother bully me. And I also know she won’t retreat. She said Jessica – no, actually she said ‘that girl’ – would never be welcome in her house, that she would never see our children. That hurts. And I know she’ll stick to it. There’s not going to be any Hollywood ending like in The Big Sick.”
Silence.
“I wish my father would say something.”
Is he also wishing I’d say something? I wonder.
“I know my father agrees with me. Or at least he’d accept my decision. But he always bows to her.” Pause. “And that’s another thing she said, ‘Your father and I had an arranged marriage. It turned out well for us.’ I had to bite my tongue there. It turned out well for her. She got to move to the US, be a doctor’s wife and stay enclosed in the Indian community. I don’t think that’s what my father would have wanted, but he’d never say.”
“So you’re angry at your mother for being too dominant and at your father for being too passive.”
“Exactly!”
Silence.
“I was thinking about Jessica and my relationship. Wondering who’s the more dominant one.” Pause. “I guess I’d say she is.” Pause. “I wonder how I feel about that.”
“Good question.”
“Not so good actually.”
“So are you implying that you were raised by a dominant woman and that perhaps now you’re attracted to a similarly dominant women?”
“Oh no! I came in here thinking I had one problem – how to deal with my mother – and now I have two problems – how to deal with my mother and Jessica.”
“Perhaps it’s not so much how you deal with either of them, but how you deal with yourself, the person you want to be, the person you are now given the family and the culture you were raised in. Is there a place between complying and rebelling? Are you unwittingly driven to repeat patterns from your past that you may not consciously want to repeat?”
“Stop! Too much. It’s giving me a headache.”

“There is a lot , but I was just trying to say that we humans are very complex beings and that it’s helpful for us to try and understand ourselves as best as possible.”

Thursday, April 12, 2018

There’s Something Wrong With Me

Staring down, Cristina pulls at the fingers of her hands. She has been unable to say anything since entering my office.
As Cristina’s silence continues and her tears fall silently from her eyes, her pain becomes palpable. “I can see how much pain you’re in, Cristina. Can you tell me what’s wrong?”
She shakes me head. But then she practically whispers, “Me. I’m wrong. I’m all wrong.”
Although I have no idea what Cristina’s referring to, I feel the heaviness of her burden.
“I’m sorry you’re in so much pain, Cristina. Can you tell me what’s causing your pain?”
“There’s something wrong with me,” she replies, barely audible.
“Can you say what makes you feel there’s something wrong with you?”
Tears pour down her cheeks. She makes no attempt to wipe them away.  
“I can’t love her,” she says looking up at me beseechingly. “What normal mother can’t love her child?” She pulls harder at her fingers. “They said it was post-partum depression. And maybe it was. But no one has post-partum depression for two years. And, besides, I didn’t feel that way with my son. Peter was my precious baby. I couldn’t stop holding him and cooing at him. I loved him instantly. And I still do. But with her, it’s different. It was different from the start. And it hasn’t gotten any better.”
“So your daughter is two and your son is …?”
“Five.”
“And her name is …?” I ask, aware that she spoke her son’s name, but not her daughter’s.
“Caroline. I want to love her. I do. But it’s not there.” Pause. “Can you help me? Can you cure me? Can you make me normal again?”
“I can certainly help, but it isn’t like you have a disease, Cristina. I understand that you want to love Caroline, but perhaps first we have to understand why your feelings about Caroline are different from your feelings about Peter. And if you could try to understand what you feel rather than beating yourself up for your feelings, that would be really helpful.”
Cristina shakes her head empathically. “It’s not normal. I’m not normal.”
“Is anyone telling you you’re not normal?”
“Oh, yeah. My mother. She’s told me I’m not normal my whole life.”
“Because?”
“Because I’m not like her. My mother is one of these brash, strong, outdoorsy types who won’t take anything from anybody. And me, well today’s not a great example of how I usually look, but I’m usually pretty well put together. People tell me I’m pretty. I care about clothes and my nails, kind of a girlie girl. My mother couldn’t stand that about me.” Pause. “The truth is she wanted another boy, boy number four, but she got me instead. Unfortunately for both of us.”
“Do you think there’s a connection between how your mother felt about you and you feel about Cristina?” I ask.
Cristina looks at me blankly. “In what way?”
“Well, your mother didn’t like you because you were a girl and it sounds like you’re saying it’s much easier for you to love Peter, your boy, than Caroline, your girl.”
“You’d think I’d love Caroline all the more because I know how awful it feels not to be loved.”
“Well, rationally that may be true, but we humans don’t always act on the basis of rationality. There’s our unconscious to consider. There’s, for example, identifying with the parent who hurt us and then despite our best intentions behaving like them. I’m not saying that’s what’s going on for you, but it does sound as though your feelings about your daughter are similar to your mother’s feelings about you.”
“But I don’t know if Caroline is going to turn out to be a girlie girl.” Pause. “But she is tiny. And she seems so vulnerable.” Crying, Cristina adds, “My mother hated vulnerable. I think that’s what she hated more than anything. She hated when I cried. She hated that I cried. Said I wasn’t normal to cry so much. I guess I’m proving her right.”
“No, you’re not proving her right. You’re proving that you’re human. There’s nothing wrong with crying. And there’s nothing wrong with feeling vulnerable. We all feel vulnerable. And children feel most vulnerable of all.”
“You know, that is one of the things that bothers me about Caroline. She seems so fragile. And for some reason rather than being drawn to that fragility and wanting to protect her, I want her to get it together and be strong.” Pause. “You’re right! I sound like my mother. That’s awful. I never wanted to be like my mother. Now I have something else to hate myself for.”

“You’ve brought in a lot of material today, Cristina, and we’ll have plenty of time to work on it, but the more you could wonder why you do or feel what you do, rather than judging yourself, the easier it would be.”

Friday, March 23, 2018

Panic

“I couldn’t wait to get here,” Ray says, almost breathless. “Pamela asked me for a divorce. She said we’ve been working on our relationship for years and it just doesn’t get any better. She wants out. She wants a chance to find greater happiness with someone else.”
“I’m sorry, Ray,” I say empathically.
“I…I’m a mess. I don’t think I’ve slept two hours since she told me. I never thought she’d leave me. I don’t know what to do. I can’t think straight. I’m like beyond panicked.”
“What’s fueling your panic?”
“What? What do you mean?”
“I can certainly understand you’re feeling sad and scared and maybe even angry, but what’s underneath your panic?”
“I’ll be alone. She’ll leave and take the kids and I’ll be alone. Oh my God, I can hardly say that. I can’t breathe.”
“I’m here. You’re not alone now. Take a few deep breaths and then let’s try to look at what feels so terrifying to you about being alone.”
Ray looks at me incredulously. He buries his head in his hands and tries to slow his breathing. He bursts into tears.
I sit silently while Ray cries, hoping he has broken through some of the anxiety to feel his sadness underneath.
“Why? Why? Why did she do this?”
Ray’s shock about his wife’s decision is rather surprising to me since they have indeed been working on their relationship for years. Ray told me she had repeatedly said she was unhappy in the relationship, feeling him unable to give to her emotionally or sexually.   
“What did prompt her decision?” I ask.
“I don’t know. Maybe because we didn’t have sex?” he says questioningly.
“You’ve told me that has been one of Pamela’s consistent complaints. That you withhold from her.”
“Do you break up a 15 year relationship because of sex?”
Ray’s consistent disbelief feels incredibly na├»ve to me. I even wonder if it’s disingenuous. Then I have another thought.
“You feel very much like a scared, hurt child to me,” I say gently.
Crying again, Ray mumbles, “That’s exactly how I feel.”
“So perhaps that’s why you’re panicked. When a child is left he feels panicked because he can’t survive without his mother - or some caretaker.”
“So you think Pamela’s leaving me feels like my mother leaving me?”
I nod.
“But my mother never left me.”
“That’s not exactly true Ray. You’ve told me how she reacted after your father died.”
“Yeah, that’s true. Before I was seven – when my father died – we had a very close relationship. In fact, she was all over me. Sometimes I just wanted to get away from her. It was too much. But after he died, I don’t know, it was like she died too. She got so depressed and didn’t want me anywhere around. In fact she shipped me off to her sister’s for a while. It was awful. My cousins hated me. I’m sure they didn’t want another kid in the family. I had to change schools and that was awful. The whole thing was awful.” Pause. “And when I went back home, my mother still rejected me.” Pause. “And then she started dating. That was worse. All those men. And then my step-father. The whole thing was a nightmare.” Pause. “You know what just went through my mind? I wanted my Mommy back.”
Crying, Ray adds, “And that’s how I feel right now. I want my Mommy. Except it’s Pamela.”   
I remain silent, thinking this is not the time to explore the meaning behind Ray’s similar feelings about his mother and Pamela.
“I guess that helps explain my panic,” he continues. “But it doesn’t take it away,” he adds, looking at me beseechingly. “Can’t you take it away?”
“So perhaps now I’m the Mommy who you want to take away all your fears and sadness.”
“Can you?”
“That’s clearly your wish, but I’m afraid I have no magic wand.”
“No?”
“No, but we can look at your desire for that magic wand, for the all-powerful, all-perfect mother who can take away all your fears, all your sadness so that you feel nothing but perpetual bliss.”
“Sounds wonderful.”
“But I wonder if it would feel wonderful or, as you said before about your early mother, whether it would feel too much and you’d want to get away.”
“I don’t know. Right now it sounds wonderful.”
“When faced with abandonment you yearn for closeness, but when there’s closeness it can feel like too much and you yearn to get away.”
“I don’t know. I can’t deal with all that now.”

“I understand. We’ll have plenty of time.”

Friday, March 2, 2018

I'm Afraid

Jennifer sits in the chair across from me and cries. Tall and thin, with straight blonde hair, at 18 years old she is younger than most of the patients I see. I suspect her distress is about the school shooting at Marjory Stoneman Douglas High School on Valentine’s Day.
“Did you lose friends in the shooting, Jennifer?”
She shakes her head.
“Are you scared it will happen in your school?”
She shakes her head.
“You know, Jennifer, I saw your Mom a number of years ago and she called and asked that I see you. Does the fact that I saw your Mom feel all right to you?
She nods, then startles. “But what I say here is just between us, right?”
“Your Mom said you just turned 18, so yes, what we say here is confidential, unless I’m afraid you’re going to hurt yourself.”
“I won’t. I’m too much of a coward to do anything like that,” she adds sobbing.
“I lot of people are really scared right now, Jennifer. That doesn’t make you a coward.”
“No, they’re not. They’re marching. They’re going to Tallahassee. To Washington. They’re confronting the NRA, the President.”
“Yes, that’s true.”
“I can’t,” she says sobbing. “I can’t do it. I’m a coward. A coward!” she says with clenched teeth, her fists covering her tightly closed eyes. “Why can’t I do it? They can.”
I immediately flash on my younger self. I so admired my grandmother, willing to fight for what she believed, while I fearfully hung back. I don’t know that I saw myself as a coward, but I did feel disappointed in myself and wished I could be different. It was a wish that was at least partially fulfilled when I was able to confront my demons from the past. But none of this will help Jennifer right now.
“That’s actually a very good question, Jennifer,  especially if you could ask it without beating yourself up. What do you think makes it so frightening for you to think about protesting like some of the other students?”
Jennifer stops crying. She looks up at me like a deer caught in the headlights. She pauses then shakes her head and says, “I can’t. I can’t say.”
“Can you tell me why you can’t?”
“I’m scared. And… and I don’t want to make it a big deal.”
“Anything that scares you so much is a big deal.”
Silence.
“Can you tell me a little about your life, Jennifer? You’re an only child, right? Do you live with both your parents?”
“Yeah, it’s just me. My parents divorced. It must be a long time since you saw my Mom. They’ve been divorced since I’m nine. They had joint custody. But now that I’m 18 I’ll live with my Mom until I go to college.”
“So you prefer living with your Mom?”
“Oh yeah.”
“What’s your relationship like with each of your parents?”
“I’m real close with my Mom. My Dad, not so much.”
“Can you say why?”
“He always criticizes me. Nothing I do is ever good enough.” She hangs her head.
“Anything else?” I ask.
“He has PTSD. He was in Vietnam.”
I had forgotten that, but I remember now that Jennifer’s Mom said he could be explosive and erratic.
“Are you afraid of your Dad?” I ask gently.
“I didn’t say that!” she says, sounding panicked. “Besides, what does my Dad have to do with my being afraid to stand up for what I believe?”
“And what do you believe, Jennifer?”
“That guns kill. That we should have way more restrictions on who can get guns and what kind of guns are available.”
“What does your father believe?”
“He believes people have the right to have guns, but he doesn’t think a 19 year old should have an assault rifle.”
“What does he think about the protests?”
“He hates them. Reminds him of the Vietnam protests.”
“How would he feel if you participated?”   
“He wouldn’t allow it.”
“And what would he do if you participated anyway?”
Jennifer looks down and keeps shaking her head. “He’d scream and scream and scream. But not like normal people scream, like way, way out of control. He might also slap me or lock me in my room. He’s really scary,” she says, her words coming out in a rush.
“And you’ve been living with this all your life, Jennifer?”
“Yeah, although it got worse after the divorce. Before my mother could protect me a little. Afterwards he just got meaner. I never wanted my Mom to know. I didn’t want to upset her.”  
“Well, Jennifer, I think we know why you can’t protest as many of your friends do. But I don’t think it’s only because your father disapproves of the protests. He’s scared you your whole life, so to stand up to any authority is terrifying, just like standing up to him as a little girl was terrifying.”
“Really? You think that’s true?”

“Yes, I definitely think that’s true.”

Thursday, February 15, 2018

Disgruntled

“I had this unbelievably horrible day yesterday,” 76 year old Joan Green begins. With dyed red hair and raised eyebrows penciled to match, she challenges everyone around her and looks perpetually amazed by their response. She is my patient only because a psychologist colleague of mine begged that I see her. She had moved to Boca Raton, Florida a year ago after her daughter who lives in Phoenix could no longer tolerate her and feared her mother would destroy her marriage. Her son, my colleague, was not faring much better and told his mother that he would no longer have anything to do with her unless she went into therapy.
She continues. “I spent my whole afternoon in the pain doctor’s office and didn’t even get everything done. The pain is terrible. Everything hurts me – my back, my hips, my neck, even my feet. I can’t take it anymore.”
“Did anything go well yesterday?” I ask, perpetually trying to find something positive in Mrs. Green’s constant tales of woe. I doubt I’m the best therapist for this patient. Constant complaining is not my forte, especially when someone is so resistant to looking at her part in the interaction.
“I liked the doctor.”
My eyebrows shoot up in surprise. “Well that’s important. And positive.”
“Well, he was nice, but I don’t see why he couldn’t give me an injection yesterday and not make me come back.”
“Did he tell you why?”
“He needed me to get an MRI first. And he couldn’t do it in his office – I guess he doesn’t have the equipment. That wasn’t good either. And he said I had to call for an appointment. I don’t know why they couldn’t call for me. I don’t carry my phone with me. It’s way too heavy. I didn’t want to have to go all the way home and then go out for an MRI another day. I’m in pain! Obviously or I wouldn’t be in his office. I told them – I was in the waiting room by then, arguing with the office staff - I’d be willing to sit wherever and wait until they could take me.”
“Mrs. Green, does it seem to you that you have lots of expectations of other people, expectations that might be impossible to fulfill?”
“What! What expectations?”
“Well, what are your thoughts about that?”
“Why should I have any thoughts about that? You’re the one who brought it up. You should be the one telling me.”
Annoyed at this constantly demanding patient, I try to step back. “I wonder if you feel so un-given to, so lacking in nurturing that you have a profound need to be taken care of, whether that’s me answering your question rather than your thinking about it yourself or wanting a doctor to have every possible piece of machinery  available in his office, or needing others to make phone calls for you.”
“That’s just stupid psychobabble. Probably because you can’t answer your own dumb question.”
Feeling angry, I’m silent, trying to figure out what I want to say next.”
“What? Cat got your tongue?
“I wonder what you get out of being so difficult and demanding. I know that it can’t possibly get you what you want. Your daughter didn’t want you in the same city as her. Your son won’t deal with you unless you’re in therapy. But therapy is about looking at yourself. And if you’re not willing to look at yourself instead of blaming everyone else for their insufficiencies, we’re not going to get very far.”
“And that would be my fault?! How about your looking at you?”
“I’m happy to look at how I may be contributing to the difficulty we’re having, but that means you’ll need to look at how you might be contributing to the difficulty too.”
“Okay. So tell me. Both sides.”
“I’m going to answer that question, Mrs. Green, but I want to point out that you’ve again issued a demand and as a result of that demand I don’t really want to answer the question. I am going to answer the question, but I suspect that most people who aren’t therapists wouldn’t. They’d see you as an entitled, demanding, angry, embittered woman. And, from my perspective, that’s all true. But I do think there’s a reason you’re that way and I’m willing to work on us trying to figure out what that reason is which might help you to make some changes.”
“And what’s your part?”
“I think it may be particularly difficult for me to have people make demands on me without my wanting to resist their demands and that might make our work together more difficult.”
“So should I find someone else?”
“That’s certainly your choice. I’d be happy to give you some referrals if that’s what you decide.”
“You’re probably all alike. I’ll stick with you for a while and see what happens.”

“Okay. Fair enough.”