“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.”

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[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.]

Here’s a passage from her scathing critique of Freud, whom she obviously admires yet nonetheless finds hyped (bear with me):

If there is one thing that Freud asserts consistently… it is just this–that the mind is not to be trusted. Freud’s self is encapsulated, engrossed by an interior drama of which it cannot be consciously aware–unless instructed in self-awareness by means of psychoanalysis. That is to say, the center of emotional experience, the source of motive and inhibition, is inaccessible to the self as experience [my emphasis]…

If this conclusion was shocking to Jung, it is, nevertheless, a Freudian understanding of a state of things very widely attested to, an understanding that saw a painfully achieved equilibrium [Freud's civilization and its discontents] where others saw decline and dissolution [the Nazi's Jewish problem], that saw in unrest the inescapable fate that is individual and collective human nature [again, Freud's view] rather than corruption, evil, and subversion, which were taken to be alien or Jewish in their sources.

Why a vision of man and society so specific to an extraordinary historical circumstance should have been universalized as for many years it was is an interesting question… Considered aright, his metapsychology might be seen as the testimony of a singular observer to the emotional stresses of life in a fracturing civilization. It might be seen as a gloss on the fact that grand theories of human nature, however magisterial, can be based only on encounters with the world in circumstances that are always exceptional because the factors in play are always too novel, numerous, and volatile to permit generalization.

…Freud tried to bring the assumptions of rationalism to bear on the myths and frenzies that were carrying Europe toward catastrophe. In the event, he brought to bear not reason but rationalization, treating the Europe of his time as timeless and normative [my emphasis], and therefore, in its fractious way, stable. Notably, he attempted to redefine the unconscious, a concept then broadly associated with primitive racial and national identity, making it instead a force in a universal yet radically interior dynamic of self. Granting the perils of delusion, fear, denial, and all the other excesses to which the mind is prone, this severely narrow construction of the mind, suspicious of every impulse and motive that does not seem to express the few but potent urges of the primitive self, bear the mark of its time. Yet… it continues to hold its place among the great, sad, epochal insights that we say have made us modern.

Uhm, whoa. I’m not going to try and unpack this whole passage. While I find it pretty convincing (more on that in a moment), I do think there are some holes in her argument. First of all, Freud didn’t conceive of everyone as a patient. Yes, he devised a universal theory of unconscious conflict; and yes, he broadened the scope of psychiatric treatment immensely. Nonetheless, I don’t think Freud insisted that man “cannot be consciously aware” of himself without psychoanalysis. After all, how would Freud have arisen if that were true? Freud’s genius, and his lasting contribution, is his method, free association. His narratives of psychological conflict (the Oedipal conflict, penis envy) may go in and out of style, but folks will be sitting on couches forevermore.

Freud may seem obsessed with the negative influence of the unconscious mind. But first and foremost he was a doctor, and not in the academic sense. He was treating disease (or pain at least). Should it be so shocking that he sees conflict everywhere? That he is skeptical of self-treatment? Certainly his time and culture influenced his thinking – but his roster of subjects (i.e., patients in distress) may have influenced him just as much. Freud studied hysterics, not Buddhist monks.

My other gripe with Robinson’s passage is her suggestion that Freud’s time, and by extension any time, is utterly unique. Specifically, she seems miffed that Freud commands so much respect these days. But doesn’t it make sense that we should pay such close attention to Freud? If one agrees with Robinson, as I do, that Freud’s theories attempt to extrapolate from from a particular time and place – that they seek to explain and contain the anxieties surrounding the “myths and frenzies that were carrying Europe toward catastrophe” – then wouldn’t we be wise to listen to him intently? The world agrees: the horrors of WWII are too horrifying to repeat. Is it so odd that we’ve lionized Freud under these circumstances? Perhaps his perspective is tainted, but Freud’s relevance may persist for this very reason. In other words, the horrors of WWII have tainted us. How could we not fear our worst tendencies after Naziism? To undermine Freud’s theories as the “testimony of a singular observer” indicates, in my mind, a lack of shared anxiety with Freud, a lack of anxiety about our own capabilities. Like it or not, this anxiety may be the defining feature of modern life – and with good reason. We have proven ourselves capable of unimaginable cruelty and annihilation. Of course each moment in time is unique, but some are more unique than others; or as Mark Twain put it: “All generalizations are false, including this one.”

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Having said all that, Marilynne Robinson’s mission feels plenty apt, and I’m wholly on board with her. In short, she wants to lift us up. “I believe it is only prudent to make a very high estimate of human nature,” she writes, “first of all in order to contain the worst impulses of human nature, and then to liberate its best impulses.” Our contemporary urge to commemorate the Holocaust, and our appreciation of Freud, dawns from a desire to curb our worst impulses, to be sure. Robinson, however, is far more focused on liberating our best impulses. In broad terms, she takes issue with what she calls “parascientific” literature, a “genre of social or political theory or anthropology” that, “using the science of its moment” and with a “characteristic certainty,” reduces human nature to a set of primordial first principles and, from there, claims to settle life’s deepest questions. (Why is blood thicker than water? Genes. Why am I depressed? A chemical imbalance.)

Scientists are inclined to conquer mystery, not revel in it; the pleasure, for them, comes in finding things out (to borrow from Richard Feynman’s famous title). Parascientific arguments go beyond this. They debase alternative modes of inquiry, especially those with an inward, subjective bent. (Ironically, Freud gets plenty of flack for his subjective methods.) Robinson finds these arguments both grandiose and soul-deadening.

I’m inclined to agree. Science in the modern era argues for itself alone; it not only promotes its own findings – it promotes those findings as Truth. But Robinson reminds us how real science actually upends such confidence:

These phenomena [the discoveries of dark matter and energy] demonstrate, as physics and cosmology tend to do, that the strangeness of reality consistently exceeds the expectations of science, and that the assumptions of science, however tried and rational, are very inclined to encourage false expectations. As a notable example, no one expected to find that the expansion of the universe is accelerating, and that the rate of its acceleration is accelerating. It is a tribute to the brilliance of science that we know such things. And it is also an illustration of the fact that science… is not a final statement about reality but a highly fruitful mode of inquiry into it.

Robinson wants us to abandon our fetish for final statements, in order to reacquaint ourselves with inward contemplation – and ultimately “encourage an imagination of humankind large enough to acknowledge some small fragment of the mystery we are.” She blames the language of modern science, more than our epochal advancements in cruelty and suffering, for a lack of soul-searching and wonder over the miracle of our own being. Whichever the culprit, I relate to her yearning.

The 20th century, more than all others combined, reflects our staggering capacities for good and evil. Like a small boy who accidentally injures his father, the realization of our own power has scared us, and scarred us, deeply. Perhaps Freud’s genius was more attuned to our time than his own. His grand project – “turning hysterical misery into common unhappiness,” in his words – can be read as a kind of survival manual for a traumatized planet. Absence of Mind strikes me as an early step beyond this trauma, into a richer appraisal of who we are.

Human existence is an impossible mystery. “Something terrible and glorious befell us,” Robinson writes. It is time, she suggests, to wonder deeply in and about our gifts, rather than reduce ourselves to primitive urges and selfish genes. After all, what stops us from annihilating ourselves is exactly the opposite of the reductionist’s view: the intuition that we, and the world that gave rise to us, are too beautiful and mysterious to finish being.

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[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.]

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[A wonderful follow-up to this post. Props to Cathy Horyn, who really hits all the bases in writing responsibly about a suicide.]

Because the relationship with the therapist is so essential to the process, it is important to find a therapist to whom you feel connected, with whom you feel safe. In psychotherapy, you intentionally make yourself deeply vulnerable to another human being. That is a very frightening assignment indeed. But you must realize it is this very process of self revealing and trust building that can be the means of your healing.”

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[If you're curious about talk therapy, don't stay that way. This is an excellent introduction to concepts and methods – an account of what to expect from therapy, as well as a detailed guide to making your first appointment. Go for it! -Ed.]

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.’”

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

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.

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

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.]

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