proofonline.org » Shrinks

Andrew Solomon: To an Aesthete Dying Young

Douglas Faneuil — Wed, 29 Sep 2010 04:31:30 +0000

I was always frustrated by one area of impenetrability, which was that Terry never flagged in his enthusiasms. There was beauty in that, but there was also a closedness in it. If something went wrong, he was always immediately thrilled by what he had learned from it. If it rained, he was rapturous about all the indoor things we might never have done had there been sunshine, and if we were arguing, it was always sure to make us closer. I’ve tried for a clearer formulation of this relentless quality; at the time, it seemed like only built-in cheerfulness, but now I know that it was a way of keeping despair always at bay, and reflected not perfect resilience, but a terrified vulnerability, as though he knew that the slightest incursion of darkness would be enough to swallow him whole. It was a pleasant quality in doses, but it precluded certain depths of intimacy. You couldn’t see Terry and not have fun, and sometimes, you wanted him to be bored, or tired, just for a minute. There had to be sadness in him, but you couldn’t reach it except when it came out of him in quick, rare flashes of anger, and it’s hard to be friends with someone who will never be sad with you.

Read Full Article

[This is a gorgeous essay. I hate to excerpt it at all. -Ed.]

Civilization and Its Couch Potatoes

Douglas Faneuil — Mon, 27 Sep 2010 22:49:44 +0000

The breadth of Freud’s influence always gives him the last laugh. His theories may be debatable, but their reach suggests more than a grain of truth.

I’m a fan of Freud. Despite a lot of funny ideas, his investment in self-awareness – and his method of attaining it, free association – makes him a crucial figure in the enlightenment of our species. Nonetheless, we live in dark times. I’m not a pessimist about nature, but I don’t believe in the progressive arc of history. As Freud himself asserts, human beings have to work to improve themselves. I take this to be true writ large. Without a vast, shared commitment to better our world, we will doom ourselves to horrors old and new. And a sentiment of shared commitment seems to be waning.

As always, though, bad news spells opportunity. In times of darkness, great minds usually arise to challenge the status quo; Freud himself is an example of this. Surprisingly, then, Freud’s philosophy is at the heart of the most scathing critique of modern society I have seen in some time: Adam Curtis’ The Century of the Self.

Curtis doesn’t take issue with Freud’s ideas directly. He attacks them for their consequences. If you have any interest in Freud whatsoever, you MUST watch this documentary. Here is Curtis in his own words:

I don’t say there was a conspiracy but that consumerism had an ideology just as much as fascism or communism did. It was another way of managing the masses in an age of mass democracy. People like [Edward] Bernays were the first architects of that. And the model they used was fundamentally the pessimistic Freudian view that we are just emotional, irrational creatures and nothing more…

Bernays [Freud's nephew] provided the ideas that were used by the US government, big business, and the CIA to develop techniques to manage and control the minds of the American people. But this was not a cynical exercise in manipulation. Those in power believed that the only way to make democracy work and create a stable society was to repress the savage barbarism that the psychoanalysts told them lurked just under the surface of normal American life…

What happened was that a group of psychoanalysts took what Bernays had begun and invented a whole range of techniques to get inside and manage the unconscious mind of the consumer. By the early 50s the ideas of psychoanalysis had penetrated deep into American life. The psychoanalysts themselves became rich and powerful and had many famous politicians, writers and show business celebrities as patients. And, as their ideas took hold, a new elite began to emerge — in politics, social planning, and the business world. What linked them was the assumption that the masses were fundamentally irrational. The way to manage a free market democracy, like America, was to use their psychological understanding to control this irrationality in the interests of everyone.

This may sound a bit marxist for your tastes, with its powerful elite controlling the minds of many. But Curtis is really the opposite of a conspiracy theorist – he’s interested in the consequences of good intentions. With an eye and ear for breathtaking historical detail, he illustrates how Freud’s followers undermine the notion of public good.

It’s safe to assume Freud would be horrified by Curtis’ picture. Freud meant to demystify the unconscious, as a way of freeing us from pain and misery. But his savviest disciples proved to be master manipulators. More shillers than healers, they used Freud’s theories to toy with the unconscious instead.

Curtis’ history is beyond shocking, if only because none of it is secret. He weaves together a grand narrative that seems utterly obvious and yet painfully fresh. Yes, it is true: Freud is the great uncle of public relations, the grandaddy of consumer culture. Watch The Century of the Self and you’ll be convinced.

Part One: Happiness Machines

Part Two: The Engineering of Consent

Part Three: There Is a Policeman Inside All Our Heads He Must Be Destroyed

Part Four: Eight People Sipping Wine in Kettering

Daphne Merkin’s ‘My Life In Therapy’

Douglas Faneuil — Sun, 08 Aug 2010 19:48:27 +0000

To this day, I’m not sure that I am in possession of substantially greater self-knowledge than someone who has never been inside a therapist’s office. What I do know, aside from the fact that the unconscious plays strange tricks and that the past stalks the present in ways we can’t begin to imagine, is a certain language, a certain style of thinking that, in its capacity for reframing your life story, becomes — how should I put this? — addictive…

“And yet it seems to me that the process itself, in its very commitment to interiority — its attempt to ferret out prime causes and pivotal events from the psychic rubble of the past and the unwieldy conflicts of the present — can be intriguing enough to stand in as its own reward.”

Read Full Article

[This is a doozy of an article: long-winded, self-involved, not entirely pleasant to read. The obligatory horror stories of pathologically insensitive therapists make me cringe; I believe them but feel they're sensationalized and unbalanced. With the utmost sympathy, Daphne Merkin does seem like a person destined for therapy. I don't mean this as an insult – I wouldn't be featuring this article if I did. (I wouldn't be here if I did!) Merkin's struggles are real, and she's honest about them. As a result, she doesn't offer up the most likable self-portrait. I don't know if that's her objective, but in any case she bravely illustrates a core tenant of therapy: we evade the truth of ourselves at extremely high cost. If you read this article, read it with an open mind. Daphne Merkin may not be "your kind of person," but the sympathy that she feels for herself in the face of obviously frustrating emotions is, I'm sure, a consequence of her life in therapy – a consequence and a great accomplishment. -Ed.]

AA and Psychotherapy: Reconciling the Clash

Douglas Faneuil — Wed, 21 Apr 2010 19:30:37 +0000

For a therapist to adopt fully the AA practice of help by self-disclosure is seen as a problematic area by many schools of psychotherapy. However, experienced therapists have written about the value of self-disclosure under circumstances where: clients have difficulty in grasping and articulating their experience, the therapist uses it selectively, and the client can make use of it.”

Read Full Article

[I have a friend in medical school – a psychiatrist in training – who tells me that AA gets tremendous credit for being the most effective addiction recovery program in existence. This surprised me, because a) I didn't know that AA's success rate is the gold standard, and b) I thought that many of AA's strategies were at odds with certain classic, psycho-therapuetic mores. The latter appears to be true, although this article suggests a welcome shift in attitude. If AA offers the best chance for recovery, than psychotherapy should follow its lead. Therapists, say the authors, should break out of their comfort zones when the failure of addiction looms; the successful treatment of alcoholism may require more communion with patients than is commonly advised.

This makes a lot of sense to me. In my own treatment (not for addiction, admittedly), my therapist never shared her own stories. I knew next to nothing about her life, and I assumed it would stay that way. But in one instance, she shattered this well-established practice – it was shocking to both of us – by sharing an incredibly intimate story about a death in her family. I could see this made her nervous. Clearly she was going out on a limb, defying her own notion of "best practices." Yet her intuition paid off. Her story changed my life, not because it made me feel any closer to her, but because it made me feel closer to others (certain others at first, and then more generally). I went from feeling confused and frustrated to feeling sympathetic and forgiving.

She told me her story, she said later, in an attempt to give me facts that she never thought I'd get, i.e. I wanted explanations from people who couldn't give them to me. The revelation of her family's secret became a stand-in for the experience I'd been missing, both literally – she told me something I never thought I'd hear – and figuratively – her story gave shape to the actions of people in my own life. She drew a parallel, but she also broke a boundary. Both helped my treatment; I can't say which helped more. This is the art of psychotherapy: the acknowledgment that, despite an appropriately clinical approach, any rules-based system is bound to fall short in the face of us. -Ed.]

What Kind of Thinker Are You?

Douglas Faneuil — Wed, 23 Dec 2009 12:40:22 +0000

My research says that there are a lot of people who don’t ever naturally form images, and then there are other people who form very florid, high-fidelity, Technicolor, moving images,’ [psychologist Russell T. Hurlburt] said. ‘Some people have inner lives dominated by speech, body sensations or emotions… and yet others by “unsymbolized thinking” that can take the form of wordless questions like, “Should I have the ham sandwich or the roast beef?”’

In a 2006 book, ‘Exploring Inner Experience,’ Dr. Hurlburt suggests that these differences may be linked to personality and behavior. Inner speakers tend to be more confident, for example, and those who think in pictures tend to have trouble empathizing with others.

Differences in thinking style may also help explain some aspects of mental illness. In studies conducted with Sharon Jones-Forrester and Stephanie Doucette, Dr. Hurlburt found that bulimic women experienced a clutter of simultaneous thoughts that could often be cleared by purging.

‘Why is that? I have no idea,’ Dr. Hurlburt said. ‘But I haven’t found anything about it in the bulimia literature.’”

Read Full Article

[photo credit: a quick take on "lateral thinking" – or how to think like no one else]

Watch ‘FRONTLINE: The Medicated Child’

Douglas Faneuil — Mon, 21 Dec 2009 19:15:00 +0000

This is an astonishing video – not to be missed by anyone who cares about psychiatric diagnoses in children.

I pride myself in keeping an open mind about mental illness, but I have to admit that it’s tough to watch this video without feeling a pang of conservative rage. Where are we going with all of this? Are we so desperate and starry-eyed that we’re willing to experiment on our own children?? Don’t they deserve a more cautious approach?!??!?!

I’m not quick to judge any of the parents. My heart goes out to them. I’ve never had a kid, let alone one with mental illness. But I do know something of the helplessness that surrounds families in the midst of these crises. It’s a God-awful experience – and a dangerous one, too. Feelings of abject helplessness lead to extreme vulnerability. And that’s exactly what you see in this video: vulnerable families being pressured into troubling treatment, all at the behest of powerful institutions with their own interests to weigh. I’m not skeptical of doctors or “experts” (that’s a strain of American fundamentalism I could live without), but at the same time we have to recognize our respective roles. A child’s care is the sole responsibility of his or her parents. The educational system and the health care industry, despite what they advertise, were not designed to care for any particular child. Those institutions have competing priorities (the profit initiative, organizational flow, etc.), including millions of other kids. What is good for a school or a doctor’s office might be at odds with what is good for a child. When it comes to medicating our youth, we should be especially vigilant about these conflicts of interest, and wise to how good people’s judgment can go bad.

Watch Full Video

[Note the segment tiles above the video display; to watch the whole program, click on each segment.]

Help Is Not Bling

Douglas Faneuil — Tue, 08 Dec 2009 17:34:03 +0000

As I’ve said before, I spent nearly a decade in therapy. I shudder to think just how much it cost me. For most of us, I’d guess, money complicates our commitment to getting help. It forces us to compromise, to make sacrifices for our own benefit. Lots of people may be open to seeing a shrink – until they consider the monthly charges.

Therapy is expensive. Even on a sliding scale, one can expect to pay anywhere from $40-$75 per session (though better deals can be had). And the question of cost isn’t merely tricky because of tight funds. Who wants to pay for emotional support? I’m sure people grapple with this question all the time – I know I did. It took me years to address my misgivings about money with my therapist in an open and honest way.

In the end, I found that my reluctance to “shell out” cash for therapy had a lot to do with fears: of being self-involved, of being silly, of being wasteful. In other words, I questioned the relevancy of my own peace of mind.

For getting me to consider questions like that, therapy was worth every penny.

[PS: Here are some tips for care on a budget. See also my comments here (at bottom); the emergency room is always an option.]

Does Sarah Palin Have Narcissistic Personality Disorder?

Douglas Faneuil — Fri, 04 Sep 2009 17:58:12 +0000

What is that phrase ‘clinically significant’ doing in the American Psychiatric Association’s definition? It’s there to show that a disorder is the sort of thing that causes people to ask for help and that then moves doctors to offer it. That requirement makes sense—we want disorders to be severe at a level deemed worthy of attention—but it also makes the whole system of psychiatric diagnosis less useful. A condition is a disorder if we agree that it is. And there’s something unsatisfying in that sort of criterion: If two people react to challenges in the same defensive way, but one person happens to succeed in life and the other to fail, can it be that one is medically impaired and the other not?

Perhaps that conundrum of psychiatry should be the subject of a separate, longer discussion; for now, the purported diagnosis serves mainly to put an insult to Palin in a fancy wrapper. If I were like you, I’d seek treatment, may be the underlying sentiment. Or simply: You should.

Palin may duck the narcissism rap on another basis as well. The APA criteria for personality disorder also refer to “experience and behavior deviating markedly from the expectations of the individual’s culture.” On her home turf, Palin fits in fine. Citizens of her hometown Wasilla get her. As Purdum writes, “In the same way that Lyndon Johnson could only have come from Texas, or Bill Clinton from Arkansas, Palin and all that she is could only have come from Wasilla.” And also, “Sarah Palin herself is a microcosm of Alaska.” If you come from a society in which backbiting and dogmatism are apparently acceptable political behaviors, then those acts or postures cannot contribute to a psychiatric diagnosis.

On a more serious note, it strikes me that what may be at play in the pop psychologizing about Palin is class prejudice. New York Times columnist Ross Douthat makes this point; Palin suffers from not having gone to Columbia College or Harvard Law School and, very likely, not having wanted to.

Read Full Article

[I'll try to avoid politics in general on this blog – but this is a thoughtful take on the silliness of pathologizing our enemies. -Ed.]

The New Diagnostic Manual: Medicalizing Normality?

Douglas Faneuil — Wed, 26 Aug 2009 18:09:50 +0000

The association has no clear definition of the cutoff between normal and pathological responses to life’s letdowns. To those of us following the debates as closely as the association will allow, it’s apparent that the DSM revisions have become a train wreck. The problem is, everyone involved has signed a contract promising not to share publicly what’s going on.

Back in 1952, when the APA’s diagnostic manual first appeared, it was a thin, spiral-bound edition that offered sketches of such ’50s-sounding traits as passive-aggressive personality disorder, emotionally unstable personality disorder, and inadequate personality disorder. It was seen more as a guide to psychiatry than as a chapter-and-verse authority on everything pertaining to mental health…

“In its effort to increase diagnostic sensitivity,” Spitzer and Frances conclude, the DSM-V task force “has been insensitive to the great risks of false positives, of medicalizing normality, and of trivializing the whole concept of psychiatric diagnosis.”

Read Full Article

[Every behavior known to man can be taken to a pathological extreme. The drive to name them all (then classify and publicize) strikes me as a professional preoccupation. "I'm an expert in Associative Rhetorical Disorder." Who cares if shrinks want to name everything under the sun, and then some? The Manual may become less useful, but psychiatry is nothing if not a personal profession. We can allow the Manual to get out of hand, so long as its readers don't take it too seriously, don't try to fit us too neatly into predetermined disorders. As usual, Jonah Lehrer says it best: "The brain... rarely obeys our neat schematics and categories. Human behavior is a smear, a spectrum." I'm inclined to believe that most psychiatrists appreciate this, even the ones who specialize in treating shopaholics. -Ed.]