Inside/Outside

Thursday, February 28, 2013

Born to Suffer


While seeing a patient today I thought, not for the first time, about my aunt. They’re both elderly, originally from New York, long widowed, and burdened by the loss of their only child. Despite being anxious, perfectionistic worriers they have, over the course of their long lives, shown great strength and a capacity to endure. 

Unfortunately, however, each sees herself as a person who has suffered greater hardship than any other human being; each sees herself as continually singled out by the powers that be to endure unimaginable pain.  Although both have suffered great pains and losses, their view of themselves as the one who suffers the most, makes it impossible for them to enjoy their day-to-day lives, makes it impossible for them to take joy from life’s simple pleasures.

In today’s session, for example, my patient Rose and I had the following interaction.

“They changed the place of my card game tonight. I don’t know why they had to do that. They’re always doing things that make my life more difficult,” she says anxiously. “We’ve always played at Barbara’s house. Now we’re playing at this new girl’s house. They said it’s easy to get to, but it’s dark and I’m afraid I won’t find it. I drove by to see where it was, but that’s in the daylight. What if I can’t find it at night?”

With my patient, I am understanding and empathetic.  She is, after all, not a young woman. She feels alone, vulnerable, unsure of herself.

“I understand that it’s scary to drive someplace new at night. Perhaps you could go with someone,” I add trying to be helpful.

“Phyllis did offer to drive. But she sometimes drinks too much. I wouldn’t want to be in a car with her if she was drinking. We could get in an accident.”

Fighting a bit of exasperation, I point out to Rose how she is spoiling her own pleasure. “You look forward to this game all week. You say what good players they are and how you always end up having a good conversation. I wonder if by worrying so much about finding the place or if Phyllis might get in an accident, you’re spoiling the whole evening for yourself.”

“I’m not spoiling it. They spoiled it by changing the place we’re playing. And now I have to suffer for it.”  

It is at this point I think about my aunt. At 93 my aunt who has emphysema and heart disease underwent abdominal surgery, choosing surgery over hospice when given only those two options, displaying the grit and determination she is so often capable of. She came through it beautifully. After a few days some fluid settled in her lungs making it more difficult for her to breathe. The problem was resolved relatively quickly. 

While she had the breathing problems, however, every time I saw her or spoke with her she bemoaned her fate. “Why does everything always happen to me?” Or, “Somebody up there doesn’t like me.” Or, “What did I do to deserve all this trouble?”

I finally lost all patience. “You’re 93! You just survived abdominal surgery! You should be celebrating, shouting for joy! This is just a blip along the road. You’ll be fine.”  

So the question is, why am I so much more accepting of my patient’s complaints and worries than my aunt’s? Yes, I can become a bit exasperated by my patient, but in general I am far more tolerant and understanding. I could say the answer is simple: when I’m wearing my therapist hat I’m expected to be more tolerant so I am. And there is probably some truth in that. But I think the answer is more complex.

This aunt is my father’s sister, the father I always hoped to change and make different. He had the same doomsday approach to life, the same conviction that he was marked to suffer, that life was all about suffering. So probably, although I don’t consciously think of my father when I’m with my aunt, his ghost stays with me as I continue trying to fix that which has always been and always will be unfixable.

Monday, February 25, 2013

Who’s Googling Whom?


An old patient wrote to me and said that she pre-ordered my book and couldn’t wait to read it. I assumed - actually incorrectly in this case - that she had found out about the book by googling me. It started me thinking again about the whole question of googling. 

There was a time before Google existed – yes, there actually was such a time – that therapists assumed patients came in knowing nothing about them and vice versa. Then came Google. Initially, therapists felt violated and intruded upon if their patients looked them up. Now they’re more resigned. Information is available to everyone and anyone in a matter of seconds. There’s no escaping it. 

So what does all this ready-made information mean for me and for patients? Should I assume that every patient googles me? Should I ask? I certainly can’t assume that a patient would necessarily tell me if he or she had looked me up or what questions the Google search might have raised. 

I have a patient I’ve seen for quite some time who is always online. I’ve wanted to ask him if he’s googled me. But I’ve hesitated. If he hasn’t, would it put the thought in his head? For this particular patient I think googling me could be problematic. Although the truth is if he has googled me and hasn’t told me, that’s even more problematic.   

And then there’s the opposite question, should a therapist google her patients? Should she google every new patient before she sees them? Should she google her existing patients? I’m actually quite clear about this side of the equation. For me, the answer is a resounding “no.” I believe that it is important for me to see the world through my patients’ eyes. I don’t want information that they haven’t yet told me. I don’t want to have a secret about their secret. I don’t want to wait breathlessly every session hoping they’ll tell me they’ve been married six times or that they were in a porn movie when they were sixteen. I want to discover my patients’ histories through their own words.

That’s not to say, however, that I’ve never had to fight against the temptation. In the early years of one patient’s analysis, I found myself thinking frequently about googling her. But I resisted, thinking instead about why this was a problem for me with this particular patient. Yes, she was particularly interesting, maybe even somewhat famous, but that didn’t seem a sufficient explanation. I’d had many interesting and sort of famous patients before. Then I realized it was because I felt that there was so much this patient wasn’t telling me. As time progressed, as she became more able to reveal herself in her sessions, my desire to google her completely vanished.

And maybe that’s why patients can be so invested in googling therapists. There is so much they don’t know, so much they want to know. All they have to do is log onto Google and type in their therapist’s name and their curiosity is satisfied.

What are your thoughts? Do you want to know more about your therapist? Do you Google your patients? I’d be interested in hearing your responses.

Thursday, February 21, 2013

"Amour"




I’m talking a lot about “Amour” in my office these days. I don’t mean love, per se, which is also a frequently discussed topic, but the French movie that has been so highly acclaimed.

It is an excellent movie. And a depressing one. A colleague of mine said that one of his patients suggested that the movie come with a warning, “See at your own risk.”

Although I had been planning to see the movie, I was urged to do so by a patient who said that she found it haunting, that a heaviness enveloped her for the entire day. Since she is a patient who often has difficulty feeling sadness, I was eager to see the movie and discuss it with her.

She was right. “Amour” is indeed a movie that leaves the viewer feeling weighted down by the grimness of aging and life’s unexpected misfortunes. But the movie, as its title implies, is also a love story, the story about an aging couple and the man’s determination to care for his increasingly incapacitated wife.

For me, the movie brought up many personal reflections and memories. The love story reminded me of my relationship with my late husband, the intensity of the love we shared, and the incredible bond between us. As the wife begins her downward descent and has increasing difficulty walking, I was thrown back into my husband’s struggles, how he had gone from a strong, vibrant man who could walk on roofs to someone whose exercise involved walking twice around our living room with a walker.


And then, as if all these memories weren’t weighty enough, I found that as the woman’s deterioration continued, I was struck by how much she reminded me of my mother, who died just one month shy of her 99th birthday. Extraordinarily vibrant and healthy for most of her life, my mother’s last year had been a painful one to watch. And here I was, watching it unfold again on the screen. 

When I saw the patient who had originally asked me to see the movie, I agreed with her. It was a difficult movie to watch, but a very beautiful one. I knew she had also cared for her husband during his illness and asked if the movie brought back his illness and death.

“No. It wasn’t like that,” she said. “He didn’t suffer in that way. It was just at the end after they started the chemotherapy that he deteriorated. And his mind remained sharp ‘til the end. No, it was just so hard to watch her suffering. I couldn’t get it out of my mind.”

“Do you think it brought up fears of your own mortality, of your own aging process?”

“Not the mortality part. I’m not afraid of dying. But I’d hate to linger. I wouldn’t want to suffer like that.”

Other patients have said there was no way they were seeing “Amour.”

“Life is difficult enough. Why would I subject myself to added suffering,” said one patient. Others echoed similar sentiments.

For me, I’m glad I saw the movie. Despite the pain, I like to remember. I feel closer, more connected to those I now hold close only in my memories.

What about you? Have you seen the movie? Do you plan to see it? Do you want to avoid it? I’m interested in hearing your responses.

Monday, February 18, 2013

The State of the Psyche



Kevin settles his lanky frame into the confines of my chair. “Did you see the State of the Union?” he asks immediately?

If you’ve been following my blogs, you know that Kevin is the patient who can’t allow himself to feel, the man who told me he was obsessing endlessly about the Newtown shootings.

Aware of his focus on newsworthy events and wondering what the speech brought up for him, I reply, “Yes, why do you ask?”  

“It was those parents, those parents whose 15 year old daughter was just killed not far from Obama’s home in Chicago. I didn’t get them. How could they have been there? Their daughter had just been killed.”


Watching the State of the Union, I had wondered the same thing. My thoughts led me to imagine that these African-American parents were, unfortunately, accustomed to the horrors of violence and its impact on their lives and had put aside their feelings in an effort to make a strong statement against gun violence. I suspected Kevin experienced it differently.

 “What did it mean to you to see the parents there? How did you feel about it?” I ask.

“I was surprised,” Kevin says. “I don’t understand how they could do that. How they could appear before millions of people and be on display just a week after their daughter was killed.”

“I understand what you’re saying,” I respond, “But I wonder what it brought up for you.”

“At the time I was only surprised, but now that you’re asking me about it, I can tell it goes deeper than that. You think it’s my parents, don’t you.”

“What do you think, Kevin?”

“It seemed so unfeeling. Like it didn’t matter to them. Like they didn’t care. Like it was fine for them if their daughter was dead as long as they got to rub elbows with the first lady and be in the spotlight.”

“So you felt angry,” I reflect. “Like you might be angry with your own parents.”

“Yeah, I guess so, although my father died so I couldn’t be angry with him. But, you know, I’m not sure I really FELT angry. When we’re talking about it now I can see that what I’m saying sounds as though I’m angry. But I’m not sure I really felt it.”

I feel sadness wash over me, my sadness for the abandoned child Kevin was, the abandoned child who cannot allow himself to feel for fear of being overwhelmed by a lifetime of unfelt feelings.

“Maybe this isn’t an appropriate question,” Kevin begins, “But what did you feel?”

“I’ll answer that, but can I ask why you asked that right then?”

“I thought you looked kind of sad and a wondered if you felt bad for the girl who was killed.”

“Right then, Kevin, I actually felt sad for the child who lived – you.”

Kevin looks shocked. “What do you mean?” he asks.

“You experienced such early losses – the death of your father and then the abandonment of your mother – it’s had such a tremendous impact on your life, it’s made it so hard for you to feel.”

“So you feel sad for me?” he asks incredulously.  

“Yes, I do.”

Kevin squirms uncomfortably in the chair. Silence and sadness fills the room. “I don’t know what to say to that,” Kevin finally says. “I don’t know what to feel about it.”

“That’s okay,” I say. “You don’t have to say anything. And you can only feel what you feel. There’s no pressure here for you to be anyone other than who you are.” 

Thursday, February 14, 2013

Valentine’s Day



On Valentine’s Day, a day in which lovers rejoice and widows mourn more than usual, I return to Molly, and to an excerpt from my soon to be published book, Love and Loss in Life and in Treatment. In an earlier blog I explained that Molly was the first widow I saw after my husband’s death and that despite the many differences between us – age, education, economic circumstances - she and I mourned similarly. We were both consumed by pain, but determined to go on with our lives while taking our deceased spouses with us in our minds.

An adapted version of the vignette follows:

Valentine’s Day approaches, as does the second anniversary of her husband Mitch’s death. Molly’s pain returns as acutely as ever.

“Saturday [the day Mitch died suddenly of a heart attack] was really hard,” she says. “I was going through his death hour by hour, wondering about all the ‘if onlys.’ I know Mitch didn’t take care of himself, but I shouldn’t have left him. I bought him a Valentine’s card and took out all his cards and poems and read them.”

My throat tightens. My stomach clenches. My eyes well with tears. For months, even years, just passing the card section in supermarkets, in drugstores, wherever, left me in a bucket of tears. “Birthday for Husband.” I have no husband. “Birthday for Wife.” I am no longer anyone’s wife. “ “Anniversary.” There will be no more anniversaries. “Valentine’s Day.”  There is no one to be my Valentine.

“Is it comforting for you to read the cards or are you torturing yourself?” I ask, knowing that I couldn’t bear to read the cards from my husband that I have so diligently saved.

“I’m not torturing myself. It’s more comforting,” Molly responds, reminding me that despite the similarities in our grieving process, there are stark differences between us.

I’m also reminded of the importance of humility, that a therapist can never assume she knows what a patient thinks or feels, even when she’s had feelings or experiences that are similar.

So today, on Valentine’s Day, over five years after my husband’s death, unlike Molly, I still have no one to be my Valentine. And I still can’t bear the thought of reading my husband’s cards. But I do cry less often; the weight of his loss has diminished. And I can still hear him say to me, in his soft, melodious voice, “My love.”

Thursday, February 7, 2013

Revealed


As the publication for my book Love and Loss in Life and in Treatment nears, patients are beginning to learn of its existence via the internet and various professional circles. And, just as occurred when I dealt with the illness and death of my husband, different patients respond differently, depending upon who they are as people. Some patients tell me they can’t wait to read the book and have little willingness to explore what the reading might mean for them. Some who have worked with me for a considerable period of time, are curious and believe that we will be able to work through whatever they discover.

Other patients are clear that they don’t want to read my book. One told me she was afraid it would tarnish the doctor/patient relationship. She didn’t want to read something about me that might result in her thinking less of me. Yet another said that she was afraid reading the book would put us more on a peer level and that she preferred to see me as the good mother who took care of her.


My greatest lesson so far, however, came from Phil, a patient who asked me if he was in my book. “No,” I replied immediately, not asking him first how he’d feel if he was in the book or not. I jumped right in, as if I were afraid he might accuse me of violating his confidentiality.

But, as I might have predicted, he was hurt, feeling that I had rejected him as insufficiently important, interesting or worthy.

Once Phil left, I thought about my reaction and brought it up in our next session.

“I’ve thought a lot about how quickly and matter-of-factly I answered your question about being in my book,” I say. “This is difficult for me to explain because I most definitely take responsibility for being so quick to respond and insensitive to your feelings. But I also think my response reflects how I tend to collude with you in your defensiveness, how you present in a clipped and almost indifferent manner, as if you had no feelings at all, when we both know that you’re extremely sensitive and easily hurt.”

He squirms in the chair, looking embarrassed. “That’s my defense,” he says. “I make a joke out of everything or pretend nothing matters.”

“That’s exactly right,” I say. “But it’s my job to point that out to you, not to respond in kind. So I apologize. I’m sorry that I was insensitive to your feelings.”

My apology makes Phil even more uncomfortable. He’s not accustomed to non-attacking, non-defensive responses.

And I have to remember – not for the first time – that Phil and I both had critical, attacking fathers. So, when Phil is confronting or provocative in our sessions, in other words, when he responds as his father did, my reaction can be self-protective, as it was on this occasion. Instead, I need to remain open to the scared, vulnerable child who exists in Phil as well as in myself.

Once again, I am again revealed to myself as I continue my work with patients.

Monday, February 4, 2013

Is Two One Too Many?

Marianne has asked to bring her partner in today. It’s a request I usually discourage, believing it can cloud the relationship between myself and my patient, sometimes leaving the patient feeling unheard, ignored or even rejected. But Marianne has persisted. She has a specific issue she wants my help with. She wants Beth to know and believe that she’s working on her reluctance to be a mother.
 

So Beth comes to the session. Within ten minutes I remember yet another reason for not seeing a patient’s partner. It is always best to see the world and the people that inhabit that world through the patient’s eyes. Marianne loves Beth. She sees her as intelligent, intense, and caring. I see her as bombastic, dogmatic, controlling and distancing. Marianne’s fear of being a mother stems from her own abusive background and her fear that she could not love a child as she would wish. I have more concern about Beth’s capacity to mother than Marianne’s, but that’s not the question on the table. 
Before too long, through clenched teeth, Beth says accusingly to Marianne, “It’s just your way of being controlling, just your way of trying to withhold from me. You don’t love me enough! You never have!”
 

Marianne is crying. “You know I love you! You haven’t heard what Linda said. I’m trying really, really hard to work through all the pain of my background, to feel good about myself, to feel like I am loveable so that I can love a child, our child. I am trying! I am!”
I know exactly what I want to say. I know exactly what I would say if I were sitting alone with Marianne and she was relaying this scene to me. I’d say, “I wonder if you’re still trying to win with your mother, if you’ve again gotten yourself involved with someone like your mother, someone who always makes everything your fault.” But I’m not sitting alone with Marianne. I don’t like this position at all.
 

And then it crosses my mind to wonder why I feel so much more constrained by the couple than I would with Marianne alone.  Am I feeling intimidated? By whom? By Beth? By my ideas of what’s expected in couple’s therapy? Or is it more complicated? Have I returned to being the child in this threesome where I want to support my beleaguered mother and feel intimidated by my angry father? All of the above? Regardless, it’s time for me to return to my role as therapist.
 

“Don’t you think you’re being rather hard on Marianne?” I ask Beth.
 

“You would say that,” she replies contemptuously. “You’re her therapist.”
 

“Yes, I am,” I say determinedly. “I wonder, are these the kinds of discussions you have at home, because it doesn’t sound as though you’re really listening to Marianne, Beth. It sounds as though you’re browbeating her and insisting that she give you what you want.”
 

Beth sighs with exasperation and rolls her eyes.
 

Marianne looks at me, her eyes wide open through her tears. “Is that really what you see as happening here?” she asks. “You see her as beating up on me and demanding what she wants for herself?”
 

“Yes, it is,” I say gently.
 

I can see Marianne struggling. She feels my support. She sees me as offering a view of the world that’s very different from her own experience. But she’s not sure she can take it in. To take it in would mean moving beyond her abusive relationship with her mother, and perhaps even beyond her abusive relationship with Beth.
 

Our work continues.