Beyond Afraid II

Frank rushes into my office, words tumbling out of his mouth as he walks. “The doctors keep telling my Mom she’s going to be all right. But she’s still scared. I am too. How do we know fibroids can’t turn into cancer? But now I’m scared about something else, I’m scared you’re going to take my Mom away from me, like you said in our last session.”

“Stop a moment, Frank. Take a breath. I remember saying I have neither the power nor the wish to take your Mom away from you,” I say, feeling as though I’m talking to a young child rather than a 36 year old man.

“But you said we’re too close!”

“And what do you think? It’s way more important what you think than what I think.” 

“That’s impossible. You’re the professional.”

“And you’re a person who gets to think for himself.”

Frank looks at me confusedly. 

I continue. “I think you said last week that your Mom didn’t want you to think differently from her. Is that correct?”

He nods.

“And how do you feel about that?”

“Well, I do usually think the same as my Mom.”

“Can you tell me some of the things you agree on?”

“We both like funny movies, not sad ones. We like Italian food but not Indian food.” Pause. “We believe in being good to people.” Pause. “We wish my sister would come home from India.”

“Can you think of anything you don’t agree on?”

Silence. 

Frank fidgets in his chair. “Aren’t you going to say something? I don’t like just sitting here. Makes me even more nervous.”

“Can you say what you feel nervous about?”

“The silence.”

“What about the silence.”

“I don’t know what you’re thinking.” Pause. “I’m afraid I’m not being a good patient. I’m afraid you won’t like me.”

“You know, Frank, right now I find myself feeling really sad for you, sad that you’re so afraid of not being liked or accepted, that you’ll turn yourself into a pretzel trying to please.”

“And that makes you sad for me?” he asks incredulously.

“It does. Why does that surprise you?”

“I don’t know. I don’t think anyone ever said they were sad for me. Except maybe when my father died.” 

 “Do you ever feel sad for you?”

“No. Except when my father died. But even then I felt more sorry for my mother.”

“When you do feel sad, for yourself or whomever, do you feel less anxious?”

“Gosh, I’d have to think about that. Should I feel less anxious?”

“I can’t tell you how you should feel. Your feelings are all yours and you get to feel however you feel.”

“That’s not what my Mom says. She says there are right and wrong ways to feel and that I should always feel the right way.”

“So would that mean if you didn’t feel the so-called right way you were being bad?”

“Definitely.”

“I imagine that always trying to feel the supposedly right way could make you really anxious since you’d be constantly worried about trying to control feelings you can’t control. There are no right or wrong feelings. We feel whatever we feel. So it’s like you’re trying to do the impossible, trying to make sure you don’t feel anything you think you’re not supposed to.”

“You don’t believe there are good or bad feelings?!” he asks, shocked.

“No, I don’t.”

“What if I … if I … if I felt I wanted to scream at you right now?”

“You can scream at me whenever you like. But that’s not a feeling. Maybe you’re saying what if you felt really, really angry with me.”

“I can’t be angry.”

“So that’s one of those bad feelings according to your mother.”

“Yes. Definitely.”

“Well, I disagree. I think you can feel as angry as you feel, as long as you don’t put those feelings into an action that hurts me, like slapping me.”

“I would never, never do anything like that!!”

“I’m sure you wouldn’t. And because you wouldn’t you’ve just said why feelings aren’t bad. They’re your internal feelings, inside you. No one ever has to know they exist unless you choose to tell them.”

“I feel really nervous right now.”

“I believe you and I apologize for making you so anxious. I’ve said a lot of things today that are very different from what you’re used to hearing and thinking, and that can certainly threaten your sense of both yourself and the world. That can be pretty scary.”

“Thank you.”

“For?”

“For understanding. For not getting mad at me for being anxious.”

“Here, Frank, you get to feel whatever you feel – sad, angry, anxious. I hope we can help you to feel less anxious and I believe that will happen as you become more comfortable with all your other feelings. But change doesn’t happen overnight, so neither of us should expect more from you than you’re comfortable with.”

 “Thanks again. I do feel a little better.”

I Feel Okay

 

“I realized the oddest thing this week,” Anne begins, her voice fairly upbeat as she speaks into the telephone. “I’ve been feeling okay.”

“That’s terrific, Anne,” I say excitedly.

“Yeah, I’ve been talking to you for how many years? And this is probably the first time I’ve ever said I feel okay. I can’t figure out why. Nothing has changed. I’m stuck indoors like everyone else. Our Covid numbers are spiking, I’m as terrified as ever of getting the virus and yet I’m okay.”

Anne is correct. I have been speaking with her for a number of years and this is probably the first time she has not described herself as depressed, anxious and isolated. We began working in person when she relocated to Florida to take care of her aging and always demanding mother, a long and arduous process that called upon all the strength Anne could muster and all the support I could give. After her mother died, Anne returned to New York, saying it felt like home, although she had neither friends nor career to return to. She did, however, now have sufficient money to live comfortably whether or not she could find a career path commensurate with her intelligence and education, leaving behind her unsuccessful attempts in retail or restaurants.

“What are your thoughts?” I ask.

“I don’t know. I’ve done the same thing these past several weeks as I’ve done for months, or even years, and I feel strangely content. No despair, no pressure. Of course I haven’t had any pressure for a while, not since my Mom died.”

“Except for the pressure you put on yourself.”

“That’s true.” Pause. “I still feel I should figure out what to do with the rest of my life. I should be looking at various career possibilities, seeing what piques my interest. But I guess I know what the reality is with Covid. New York is decimated. There are thousands and thousands of people unemployed, stores are boarded up. No one is going to hire a 52 year old woman who has probably never held a job for more than a year. I also feel I should go back to my painting. I was pretty good at it. Why don’t I spend my very excessive amount of free time painting again? I should. But I don’t.”

“So you’re still putting pressure on yourself.”

“Yes” Pause. “And I do still hear your voice telling me I should be spending more time with people. But of course everyone is told not to spend time with people these days. But I know you’d still be telling me I should at least reach out to my sort-of friends by phone.”

“You still feel pressure from both yourself and me, but you feel different, calmer, less despairing.”

“Yes.”

“And you don’t feel isolated?”

“Everyone feels isolated.

“Maybe that’s comforting.”

“What’s comforting?”

“That everyone feels isolated.”

“That’s a good point. I don’t have to feel like such a freak.” Pause. “Yeah, that’s right. Usually this time of year would be the worst. Thanksgiving in November, Christmas and New Year’s in December. Everyone running around buying food and presents and looking forward to seeing family and friends. And then there’s me. Sitting at home stuffing myself with junk food and wondering if I should kill myself. But not this year, this year everyone’s in the same boat as me. I know they still have these ridiculous TV commercials with people sitting around a big table together or drinking themselves sick at parties, but now they look exactly like that – ridiculous. No one should be doing that this year. Everyone should be doing exactly what I’m doing, sitting home alone, no one else there. Yes, it’s a tremendous relief. That’s exactly why I feel okay.”

“Where do I fit in?” I ask.

“You’re my one exception. You’re here. But of course you’re not here. You’re thousands of miles away.”

“And that means what for you?”

“Actually makes me feel a little sad. But not too much, because I know even if you were next door we’d be meeting just as we are now, on the telephone. Yes, that makes me feel better immediately. So I guess that’s another thing Covid has done for me – made me feel less like a freak and made our distance feel less significance. No wonder I feel better.”

Anne may feel better, but I’m left feeling sad, both for the sadness she likely feels underneath her “better,” as well as for the isolation she wears as a protective shield, unable to breach the chasm between herself and others. Covid will eventually end and unless we are able to breach that chasm she will return to feeling like a freak, the forever outsider longing to be part of the lives she only imagines.  

Tag words: Psychotherapy, mental health, patient-therapist relationship, projective identification, isolation, sadness, despair, aloneness, Covid19.

The Dream

“I had a dream last night,” Justin begins, squirming nervously in his chair. “I can’t remember any of it, but I feel haunted by it. I know that doesn’t make much sense, but it’s like I woke up scared, like something terrible is going to happen, like something or someone is going to get me. I kind of want to keep looking over my shoulder. Even here, I wonder if there’s someone else in the room, although I know that’s ridiculous.”

Justin, a 45 year old accountant, has been my patient for several years and, as far as I can remember, has never before spoken about a dream.

“Well,” I respond, “the dream obviously affected you, so maybe you can talk about your feelings and what those feelings bring to mind.”

“You’re charging your phone,” he says.

“Yes,” I say, surprised. It’s not unusual for me to charge my cell phone while patients are in the office.

“How do I know you’re not recording me?”

Justin can sometimes be a bit paranoid, but his question is beyond anything I would expect. “I guess you are feeling frightened, Justin. Your world suddenly feels very unsafe so even innocuous things can feel threatening."

"You didn’t answer my question.”

I’m taken aback, perhaps even a little frightened myself. Hmm, I imagine Justin is unconsciously inducing his feelings in me. “No, I’m not recording you. You’ve seen me charge my phone before, so I’m assuming that your concern is being triggered by your fear.”

Justin stares at me. My fear builds.

“Would you like me to unplug my phone?” I ask.

“I’d like you to turn it off,” he replies woodenly.

“Okay,” I say as I lean to my left, pick up my phone and turn it off.

The silence that ensues is deafening.

Finally, Justin drops his head in his hands, shakes his head and mumbles, “I’m sorry, I don’t know what’s wrong with me.

I breathe a sigh of relief. “So let’s see if we can figure out what’s going on, perhaps what triggered the dream, what might have led you to feel so frightened.”

“It’s such a terrible time of year. Tax time you know. Some days I’m working 5AM to 10PM at night. And everyone wants a piece of me. My ex-wife’s mad because I haven’t taken the kids. My older son says he needs money for college. My clients are driving me crazy. Everyone wants their taxes last week. I keep telling them it’s no big deal if we have to file an extension. But, no, that’s not good enough.”

“When you say everyone wants a piece of you, what comes to mind?”

“That’s it!” he says excitedly. “That’s what was happening in the dream. Everyone was pulling at my skin, like they were trying to rip me apart. I know there was more after that but …” He stops. “I think there was like a monster there. Maybe like a monster waiting to eat the pieces of me that they threw to it.”

I grimace internally. “That does sound terrifying.”

Silence.

After a few moments I ask, “What’s going on in your head?”

“I don’t know. I sort of feel I used to have that nightmare as a kid. A lot.”

“Any thoughts about it?”

Silence.

“I’m sorry,” he says after a few moments. “I suddenly felt frozen. Like I couldn’t move. And… I know this is ridiculous, but you seem menacing again.”     

“What is it that you’re afraid I’ll do?”

“I know this is crazy, but what jumped into my head was, eat me.”

“Like in the dream.”

He nods.

“Any thoughts?” I ask, although I have a pretty good idea of the answer.

He nods again. “Yeah, my mother. I used to say she loved me to death. But I guess I meant that literally. She wanted all of me. She didn’t want me to have anyone else in my life. She didn’t do that to my sisters, just me. They hated me, thought as the boy I got all of my mother. But I didn’t want all of her! And I sure didn’t want her to have all of me! Yuck! I feel beyond creeped out. I mean, I know we’ve talked about all this before, but having that dream made it so much more real.”

“The dream actually brought you back to the feelings you had as a child, the terror of being eaten, of being swallowed up.”

“Stop! I can’t deal with any more today.”

“Of course. Whatever feels comfortable for you.”

Justin looks at me with tears in his eyes. “I wish my mother could have been concerned about my comfort. And I’m sorry I thought you were recording me.”

“Nothing to apologize for. Totally understandable given what you were feeling.”

Guilt

“I feel so awful, I can’t believe that I had to disappoint my parents. I can’t believe I couldn’t handle college, that I had to come home. My parents have always been there for me, always wanted the best for and all I do is screw up.”

This is my first session with Tiffany, a slender, attractive young woman with blue eyes and long blonde hair. Her mother, sounding concerned, had called to make the appointment, saying that Tiffany was having difficulty at Duke and needed to come home.

“I hate myself!” Tiffany continues.

“Wow! That’s pretty strong. Can you say why you hate yourself?”

“All I’ve done is give my parents problems my whole life, even before I was born. My mother had to be in bed for two months before she had me! She’s a physician – so’s my father – she can’t just take two months off. But she had to because of me.”

“That hardly sounds like your fault, Tiffany. I assume it was some medical condition your mother had.”

“She never had that problem with my brother. My brother never gives them problems. He’s graduating from Yale and going on to medical school. Of course!”

Clearly hearing her sense of competition and failure in relationship to her brother, I decide, for the moment, to focus more on her current situation. “Can you tell me what was going on for you at college?”     

“All those science courses! I can’t handle them. I’m just not smart enough. I started crying at every little thing. And I think I pretty much stopped eating. And then I couldn’t even get myself out of bed to go to class. Especially Chemistry class.  I don’t understand it. It makes me feel stupider than I already feel.”

“Are there classes that you enjoy, that you do well in?”

“Oh yes,” she says, brightening. “I love anthropology and I’m…hmm…I’m a pretty good writer.”

“So you take science courses because…?”

“What do you mean? I have to take science courses to get into medical school.”

“And do you want to go to medical school?”

“I’ve always known I’d go to medical school.”

“That’s not the same thing as wanting to go.”

“Yes, I want to go to medical school. I put my parents through a lot when I was a kid. I got rheumatic fever and ended up in the hospital for quite a while. I could tell how scared they were.”

“You must have been pretty scared too.”

“I was, particularly when I was alone. But the doctors and nurses were great. And I kind of enjoyed watching all the machines and monitors. That’s the kind of doctor I want to be, a pediatrician, to help kids like me.”

“And do your parents want you to be a doctor?”

“Definitely. It’s like a given.”

“So what if it wasn’t a given? What if you could decide to do anything you wanted to do?”

“I’d go on archeological digs and write about them or even write made-up stuff about the digs, like mysteries. But that’s not at all practical. No way to make a living.”  

“Have you ever wondered, Tiffany, why you feel so guilty in relation to your parents?”

“I told you why, I’ve always given them problems.  Besides rheumatic fever I was a sickly kid. And I broke my arm doing gymnastics. They always had to worry about me.”

“It seems that a lot of the things you feel guilty about you had absolutely no control over, like your mother needing bed rest or your having rheumatic fever or breaking your arm.”

“I was fooling around on the bar, that’s how I broke my arm.”

“You sound determined to have things be your fault. Do you think, Tiffany, if you felt things weren’t your fault, you’d end up feeling powerless and scared?”

“I don’t know. I’m not sure I know what you mean.”

Too soon for that interpretation I tell myself. I decide to pursue a different path. “Do you ever feel angry at all the pressure you’re under?”

“Angry? I don’t think so. I feel mad at myself for not being able to keep up and, like I said, worrying my parents.”

“So, now that you’re home, do you think you’re going to be able to relax and take it easy for the rest of the semester?”

“Oh no. My parents are going to get me a chemistry tutor so I can go back to school more prepared.”

At this point I find myself feeling angry at Tiffany’s parents and wonder if I’m feeling Tiffany’s unacknowledged  anger. That could explain the tremendous guilt she feels – guilt for the anger she doesn’t even know she has. But those interpretations are also premature.  

“Our time is almost up for today. But I hope I’ll be able to get to know you more and I hope you’ll tell me more about your wishes and your dreams, even if they aren’t always practical.”

“I wish you could make me smarter.”

“I don’t know if I can do that, but perhaps I can help you to be more accepting of yourself.”

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.”

Misery

Beth smiles wanly at me as I open the waiting room door. I anticipate a long, dreary session.

“I’m still miserable,” she says, sitting down, immediately confirming my worst fears. I do understand that Beth has good reason to be miserable. Her husband divorced her after 20 years of marriage, leaving her with two teenagers, three dogs and a six bedroom house. It’s a lot to deal with. And we’ve been dealing with her misery for almost two years.

“Of course I had another problem this week. The kitchen sink started leaking. I freaked out. I went running around to my neighbors to ask if they knew a plumber. Luckily one of them did.”

Knowing I am about to make a futile statement, I say, “So that’s something that worked out well.”

“Not really. It took me days to reach the plumber and then more days before he could come. And in the meantime the kids and I had to eat out which certainly doesn’t help my budget.” She sighs. “It’s all so complicated. I don’t know why life has to be so difficult.”

I wonder how many times I have said things such as, ‘life can be difficult and you’ve certainly had a difficult time, but life can bring lots of joy as well.’  I remain silent.

“Well …?” she says.

My stomach tightens. I feel as though she is commanding me to respond.

“What is it that you want from me right now?” I ask. I hear my choice of words, the tone of my voice and realize that Beth is making me feel as she feels – burdened, put upon, ineffectual, despairing. Ineffectual. That’s an interesting word to flit through my mind. Perhaps that’s what Beth feels. Now alone, she feels unable to competently contend with life.

“I need you to reassure me, to tell me that it will all work out okay.”

“Would you believe me?”

Beth opens her mouth to speak and then stops. After a pause she says, “Well if you said it, it might reassure me.”   

This time I don’t hear Beth’s words as a command to speak, but rather a wish that I take care of her. “I understand that you want reassurance, but you often hear that reassurance as empty words.”

“But I don’t know what to do. I have all these responsibilities. The kids. They’re certainly becoming more than a handful. How am I supposed to handle two teenagers by myself?” She takes a breath. “And what if I get sick? That’s all I’d need. How could I take care of all the things I need to take care of if I got sick? Who would take care of me?”

“I definitely hear how overwhelmed you feel, Beth. Like there are all these things that happen on a day to day basis and then there are all the things that might happen. How are you going to cope?”

“Exactly.”

“But I wonder, Beth, if it would be more helpful to you if you were able to see your own strength, if you were able to realize that you’re far more capable than you think you are.”

“But I’m not!”

“Do you really feel as though you’re not a competent, capable adult or are you afraid to let yourself know you’re a competent, capable adult?”

“They always said I wasn’t.”

“Who’s they?”

“My parents, my sisters, my husband. Even my children. They say I’m a wreck, that I can’t do anything right, that I’m always running around in circles. And I am. I’ve been doing that my whole life.”

“So what would it feel like to be competent?”

“How do I know? I’ve never felt it.”

“Would you like to?”

“Of course!”

“Beth, can you think about that a bit more? I wonder two things: If feeling competent feels so foreign to you that it would be like you’re becoming another person and that in itself would feel pretty scary. And two, you’re not sure you want to be all grown up before you find someone who’ll take care of you.”

“My husband said he’d take care of me. But he never did. He just nagged at me for what I didn’t do right. Even my parents. I was the fifth girl. They’d had enough by that time. I was kind of an add-on.”

“I understand, Beth, that it’s very difficult to give up on wanting the love and caretaking you never had, but there’s no way to get that kind of caretaking as an adult. It doesn’t mean you can’t be loved and cherished, but you can’t go back to being the child and, in the end, it does feel much better to have confidence in your ability to take care of your adult self.”