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Psychotherapy often deals with cases of fractured love so I will begin this post with a couple of cases in point. They are based loosely on two actual cases, though not on any cases of mine. In fact, I hardly know the people involved at all, but even so I have taken the precaution of changing their names and certain details so that if the subjects of these tales ever happened to read them they would not be able to recognise themselves. Perhaps then these should be regarded more as fictions than factual accounts, though I hope that this entails no loss of their essential truth.
Julie was an only child whose parents divorced when she was five, but nothing was ever explained to her. One day her father simply moved out of her house and her mother had to take a job at the local supermarket. While her mother worked, Julie spent a great deal of time at home alone watching television. Although her dad used to visit once a fortnight, he never mentioned that he had married again or that his second wife had given birth to another daughter. But one day when she was ten, a beautiful five year old girl got out of the car with her dad who explained that this beautiful little girl was actually her little sister. She stared in disbelief and as she watched her half-sister playing contentedly with dolls that she had outgrown, she couldn't quite shake the feeling that this was all a very strange, but rather terrible dream. The feeling intensified as she watched the little girl get back in the car to go back home with her dad--to go to their home, leaving Julie behind. She began to feel angry at her dad and wrote him a letter which said that if he wouldn't see her more often then she didn't want to see him at all. He wrote back and said fine, Julie, you won't see me at all, then. His letter left her with a feeling of nothingness which seemed to engulf her. She felt as if all her feelings had been hollowed out of her, leaving her feeling strangely disembodied. A single mother on benefit now, she has had a succession of relationships with men who invariably mistreat her before leaving in a cold fury. She always feels nullified afterwards, just like she felt when her dad left her. Then she gets together with another man who invariably mistreats her before leaving her, making her feel nullified... and so on. Everyone agreed that there was no trusting Conor. A small, weedy boy of sixteen, he seemed all too eager to please and appeared annoyingly desperate to make friends. Unfortunately, Conor was a petty thief who had a habit of stealing objects that were practically worthless in themselves, but important to the people who owned them. Rulers, pens and other small items all had a way of winding up in his possession, though he would always deny that he took them. He had found them, he would say, as if the items had simply dropped into his hands by accident. No one believed his ridiculous excuses so his reputation as a thief was fatally coupled with his reputation for being a liar. Eventually, he was caught in the act of stealing a pocket calculator and some of the harder lads who had always hated him anyway, decided they had had enough. They would teach him a lesson that he would never forget. Conor sensed that he was in danger and was agile enough to evade his attackers for a time. But finally he was cornered in a secluded place and beaten savagely. Conor didn't show up to school for a week after that and people thought perhaps he would never come back at all. But he returned later as if nothing had happened. In fact, a beating wasn't unusual for Conor. His father used to beat him regularly, usually for small mistakes, but sometimes for no other reason than his mere physical presence. The actual, underlying reason was that Conor wasn't his real son, but was the offspring of a casual night of sex between his drunken mother and a man she had barely known and could not have remembered if she tried. After giving birth to Conor, his mum was usually too drunk to deal with him. So it was his stepfather who looked after Conor, though in a way that was entirely bereft of affection. "Useless bastard," his dad always used to say after a beating. For psychotherapists there would be nothing unusual about these two cases. The difficulty would be to see past the massive damage inflicted on the victims to find emotional possibility from the ruins of their childhood experiences. Indeed, these two stories offer textbook examples of childhood abuse, so much so that we must be careful not to suppose that we know more about the victims' suffering than they do. Nevertheless, it is easy to see what they manifestly do not. A pattern of misery which had been laid down at childhood keeps repeating itself through actions that the victims initiate, yet fail to understand. When Julie goes into yet another abusive relationship, it is both new and strangely familiar to her, though seen objectively its novelty might seem to depend on her wilful blindness. And when Conor antagonises those whose approval he craves, the futility of his behaviour is exceeded only by his lack if self insight. Like everybody else, they too, want love and approval. But it as if in their desperation for love and acceptance Julie and Conor set out to demonstrate that they do not deserve it. The writer and psychotherapist David Smail argues that love is dangerous because people will surrender almost anything to get it. Moreover, a consumerist culture demands that love must always appear to be in short supply and tries to convince us that only the beautiful, the intelligent and the well-adjusted really deserve it. Love and approval can thus appear to be unattainable prizes of a cut-throat competition. In any such competition, people like Julie and Conor would enter the contest condemned to lose. For it is a game they hardly know how to play and whose unspoken rules seem designed to trip them up. Of course, it can be objected that true love is nothing like this and that true love is precisely what they need. But this begs the question: what is true love as distinct from its baser variants in desire and gratification? Irving Yalom describes himself as love's executioner, meaning that as a psychotherapist he sees it as his task to shatter the illusions on which romantic love thrives. I admire Yalom and agree with him. Yet a therapist must wield the executioner's axe with caution, as illusions, especially about those whom the client claims to love, may offer precious insights into the self experience of the client. Julie, for instance, always feels hesitant before going into another abusive relationship. Her lack of self insight suggests the intensity of her self needs and conversely, the intensity of her self needs thwarts the development of her self insight. All of this might be dismissed as little more than the rat run of a pathological process. Yet Julie's moment of hesitation may hold the key to the self insight that would prevent her from going into yet another bad relationship. To be sure, her hesitation will likely be unarticulated and filled with anxiety. But it is in expressing her anxiety, in giving voice to her dark intuitions about her future, that Julie may discover why her relationships always replicate the pattern of failed love that she first experienced with her father. This, however, may only tell her why desire fails to become realised as love. It gives no clear answer as to how love might actually be found. Buddhist psychology has very little to say about love and relationships in the modern sense. But it does offer a rich abundance of wisdom on the cultivation of positive emotions by practising equanimity, kindness and compassion. Buddhism also tells us that craving is the primary cause of all suffering, even the craving for love in its most chaste forms. But for people such as Julie and Conor, love does not so much represent the satisfaction of craving as it seems to offer rescue from the emotional isolation that they have suffered from childhood. Psychotherapy can, in fact, offer the possibility of rescue, but an ethical therapist will be careful not to cast himself as a saviour. "Why can't I find love?" is the burning question that takes many people into therapy, often with the belief that the therapist can provide an easy answer. That there are no easy answers, certainly none that the therapist can provide, is the place for therapy to begin. But gradually, as the therapeutic alliance develops, a deeper self awareness may develop in the client which not only makes finding a loving relationship more likely; it also frees love of its compulsive force and its self alienating urgency. Love is no longer seen as a possession. It becomes way of knowing oneself and wanting to know others.
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I have had some thoughtful responses to my last post, particularly from Glenn Macauley which can be read by following the "Comments" link to that post. I won't try to paraphrase Glenn's argument here, but he points out some important objections to the argument that I made about the harmful influence of medical terminology on the development of the self insight which allows us to make sense of a painful psychological condition. It is all very well to argue that medical jargon is inadequate for expressing anyone's emotional life. But what if a psychological problem actually is something that can be effectively treated by medication alone? Would there be anything wrong with that? And isn't a blanket disapproval of psycho-pharmaceuticals rather like suggesting that it is bad form to resort to medication? Finally, wouldn't it be positively harmful to insist on psychotherapy if the only true remedy is medication?
I think there are a couple perspectives on this issue that are not easy to separate. Firstly, there is a personal perspective, that is each individual's experience of a particular psychological condition. Then, there is a medical or scientific overview of that condition which provides all sorts of useful information (or data, as scientists prefer to call it) of a more general nature. The first perspective is based on the testimony of the client's experience while the second provides relevant information about some of the factors that often, if not invariably give rise to the experience of a psychological condition. As a psychotherapist, I must focus primarily on the personal, experiential perspective of the client rather than on a more general medical overview of his condition. Nevertheless, I must also be informed by a medical perspective on whatever condition my client happens to be suffering from. So when a client comes in suffering from depression, say, I will listen carefully to what he reports and presents, while keeping in mind that depression often possesses features that he might not be aware of. He may not, for example, be aware of the episodic nature of depression or know that what feels to him like a permanent condition will often remit after six months. I must also keep in mind that medication can be a literal life saver for a client who may be at risk of committing suicide, even while I try to help him deal with his problems which make him feel suicidal. But if medication rids a client of the symptoms of his depression, why bother with psychotherapy at all? For if a psychological condition is all just a matter of biochemistry, psychotherapy would seem little more than a pointless, if not harmful indulgence. But here we have to be careful about what the medical evidence suggests. While it is true that medication can help people maintain equilibrium for a variety of psychological afflictions, this is not quite the same as getting rid of their symptoms. Perhaps it would be better to say that medication offers relief from symptoms, though such relief, as I said before, can be literally life saving. But does that relief endure over the long term? Here the evidence is inconclusive, but does reveal some undesirable side effects of long term medication. It is not uncommon, for example, for people who take anti-depressants to suffer a loss of libido as a side effect of their medication. And the long term use of anti-psychotic medication can severely disrupt the nervous system, leaving the sufferer with tardive dyskinesia, a condition that both affects his movements and makes him feel like a zombie (this, incidentally, solves the mystery about why schizophrenics often refuse to take their medication). But even in suffering from such unwanted side effects, many people may still prefer to remain on medication. I believe their decisions should be respected, though I would stipulate that they should be fully informed of the pros and cons of medication. But I also believe that, notwithstanding the widespread medical faith in psycho-pharmaceuticals, there is a case to be made for psychotherapy in treating seemingly intractable psychological conditions. Except, of course, when psychotherapy is harmful. This too, is an issue that I have addressed before in a previous post, but the point deserves to be made again. If a therapist is inept or unethical a client's situation will likely be made much worse by psychotherapy. The point should be obvious, but I have listened to too many arguments in favour of psychotherapy without any consideration of what makes therapy succeed or fail. But even an ethical and skilled therapist may not succeed in helping his client. At some point the client must also accept responsibility for the therapeutic process. So again we come to the single most important factor for the success of psychotherapy, the relationship between therapist and client. In my previous post I talked about how important self expression is for therapy and argued that a medicalised discourse of self experience presents formidable impediments to self understanding (I am well aware that a similar case can and should be made against therapy-speak and psycho-babble). But I neglected to say that a therapeutic relationship involves far more than the self expression of the client. It also demands the effective and meaningful communication of his experience in whatever form of expression feels natural to him. Indeed, the client's self expressive capacity develops though the therapeutic encounter which depends on the therapist's receptive capacity and ability to understand what the client is trying to communicate. My argument here may seem like an attempt to reinvent the wheel. Isn't it true, after all, that psychotherapists have always known that therapy depends on a therapeutic alliance which is established by its depth of communication? As an article of faith, perhaps. But that faith has to be redeemed in every course of psychotherapy and there will always be cases that will test, if not entirely disprove it. For such faith is not an established fact like the law of gravity. It is a possibility or a promise that may or may not be realised. Once more I come back to Laing's quotation about psychotherapy being a stubborn attempt to communicate the experience of being human by two people through the relationship between them. They discover the truth of being human by communicating it. I have already talked about the myth of mental illness in a previous post, but there are other aspects to this issue that I failed to address earlier. In fact, I am not sure the issue can ever be settled definitively as there are so many factors to consider. But perhaps at bottom the question is about the nature of psychological suffering , a matter which has vexed the consciousness of humankind as long as people have been reflectively self aware. But what I am interested in here is how the language or discourse of mental illness affects the self understanding of people who experience mental and emotional suffering. This is not merely a question of semantics, but relates to something far more fundamental to our understanding of what it is to be human. But let me begin by restating what I said before about the concept of mental illness. First, if there is a myth of mental illness there is no doubting the reality of the mental agony which is very similar to an illness in the suffering that it causes. Second, the idea of mental illness as an affliction has an extremely ancient heritage. Indeed, the Buddha himself used the trope and he was certainly not the first to use it. Finally, severe mental illness may require medical treatment and can, in the short term at least, be effectively treated, if not cured by the judicious use of psycho-pharmaceuticals. I think all three points are fairly incontestable, though there might be some people who remain adamantly opposed in principle to the use of psycho-pharmaceuticals under any circumstances. But of the three points the first is surely the most important.
A friend of mine and I were talking some time ago when the question of the meaning of dreams came up. I told him that I was trying to record my dreams each night and was sending them by e-mail to my psychotherapist, Brian Stevenson, who is that increasingly rare bird, a Jungian therapist who is also a psychiatrist. My friend was curious about this process, but sceptical about the possibility of finding anything truly meaningful in dreams. "If you want my opinion," he said frankly," I don't think dreams are anything more than random firings of neurones in the brain." I was about to point out that whether that neuronal activity was random or not, the dream itself could still be significant to the dreamer. But he beat me to the punch. "I did have this one interesting dream, though," he admitted. He then related a long, complex dream that conflated the identities of two of his former girlfriends, which seemed to reveal something about what he always experienced in his relationships with women. For that dream, at least, my friend was willing to concede that something significant did somehow arise out of dreaming which might have been expected to undermine his sweeping generalisation about the meaninglessness of dreams. But what of all the apparently random, nonsensical, half-remembered or completely forgotten stuff that churns away every night without the volition or even interest of the dreamer? Surely such stuff can be dismissed as mere neuronal activity, as empty of meaning as the growth of toenails.
But this is to confuse the phenomenal nature of dreams with the neurological basis for them. Dreaming is a natural, biological activity which is essential for the healthy functioning of the brain. To be deprived of it is a sure way to induce psychosis. But quite apart from helping the brain maintain equilibrium, dreaming has a more personal, psychological function that is unique to every dreamer. That is to say that though dreams perform vital functions for both the brain and the psyche, it would be a mistake to confuse those two functions, even though they are intimately related. Every night we dream out of biological necessity. More rarely, we have memorable dreams such as my friend had, which are striking for their personal significance. So does this mean that only memorable, personally significant dreams have psychological importance? Of course not. For dreams are laden with signifiers drawn from the waking experience of the dreamer which possess a potential for becoming meaningful even if they are ignored or forgotten. Dreams arise from an autonomous activity of the imagination as well as from a particular neuronal activity of the brain. They are richly endowed products of consciousness even if we ignore their potential for meaning. Our dreams speak, even if we don't bother to listen. But calling dreams products of consciousness may be misleading, particularly if we assume that consciousness must be intentional and self aware. Of necessity, then, we need to regard dreams as products of a dynamic unconscious--that is to say of non-intentional and self unaware consciousness--to appreciate what they are and how they function in the mind of the dreamer. This is a point I am careful to emphasise to clients whenever we look at dreams. In this respect the common expression " I had a dream" would be better expressed as "a dream had me." For when we are in a dream we are spellbound and cannot be held responsible for how we react within it to a powerful force of the imagination that springs to life independent of the reason or morality of the dreamer. The point may seem obvious, yet it often happens that a dream will provoke shame or guilt in the dreamer as most therapists know from their client work. The comforting assurance that what was disturbing the dreamer was only a dream may overlook the deeper character of the disturbance. Most likely, it wasn't just the violent, terrifying or perverse nature of a dream that was so disturbing. It was also that the dream was in some way self generated and may seem to have revealed something shameful or painfully vulnerable about the character of the dreamer. And this would be half-right. Although dreams should never be grounds for self reproach, they may indeed reveal something hidden and even shameful about the life of the dreamer. So a wise therapist will always treat dreams with sensitivity and care. "The interpretation of dreams is the royal road to a knowledge of the unconscious activities of the mind," Freud wrote. I think that is true, but unlike Freud I am not convinced that the road must always lead to personal complexes. Nor do I subscribe to Freud's dictum that dreams are the disguised expressions of unfulfilled wishes. Dreams can express any number of things and possess at least the same emotional range--and perhaps even a far greater one--as waking consciousness. And when Freud claimed that a dream was most profound when it seemed the most crazy, I have to suspect that he was attempting to extend his licence for interpretation. But dreams are mysterious and have called for specialists in interpretation for as long as there have been human communities. Dreams have been, and in some cultures, still are regarded as messages from the dreamer's ancestors, gods or other spirits. Seen in this way, dreams would indicate psychic sensitivity rather than the neurotic disposition of the dreamer. There are even lucid dreamers who are able to exercise conscious control over their faculties of dreaming and direct their dreams at will. But dreams as the artefacts of a self in conflict fall into the province of psychotherapy, at least for contemporary culture. "Bring me a dream," I sometimes suggest whenever things stall in therapy. It is more an invitation than a request, but it usually follows my hunch that a dream will offer a strong clue as to why things have become stuck. Yet I can't demand that a dream be presented for my inspection in order to confirm any hypothesis I might be entertaining. The memory of any dream is only a reflection of an actual dream experience which inevitably becomes modified by the way the memory is held. Keeping the memory of a dream in a light, but firm hold, as if a bird were being held gently captive in one's hands, is a way to assure that its meaning won't fly off into a forgetful sky or be squeezed lifeless in an interrogator's grip. But it must always be borne in mind by both parties that is it is the dreamer who holds the bird of a dream, not the therapist. In my work with Brian, my therapist, there was such an abundance of dream material to deal with that we had to be selective about what we would look at. But once we settled on a dream for examination I would begin to tune in on its feeling tone before turning my attention to the elements of its composition. There would be people and places--some I might know well, but others I might not know at all--as well as situations from which either a coherent or incoherent narrative might emerge. But objects could never be pinned down by their objective properties, as in waking consciousness. They would become transformed by the mysterious logic of the dream. "What does this remind me of?" I would often wonder to Brian about some aspect of a dream that eluded my understanding. He hardly ever ventured an answer, but would always encourage me to remain with the question. For only by staying with it, or rather by letting it occupy a space in mind without demanding that it accord with reason or expectation would the dream reveal its meaning. Even so, often the meaning would be ambiguous or multiple and would defeat any attempt to make a clear interpretation. The meaning of a dream lives as we do, as much in anticipation of what meaning will later emerge from the dream as what we find in it at any given moment. It is by learning to abide in the uncertainty of a dream that we may learn to feel more comfortable with the uncertainty of waking life. We are apt to think that most of the uncertainty of waking consciousness hinges on events that lie beyond our control: what other people do, politics, the state of the economy, the weather. If only these things would conform to our understanding the world would be as it should. Only by looking inward can we see that our understanding of the world directly influences our experience of it. And only by looking at the desires that shape our outlook and underwrite our expectations can we see how the worlds we experience are constructed. They are made of dreams. |
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