Monday, August 10, 2015

FIlm "Inside Out"

Today I went to see a movie "Inside Out," a Disney animation on emotion, and how emotions interact. 
I think Disney depicted the emotions pretty well, still keeping the information understandable.  I would recommend that anyone interested in affect and neuroscience  see this movie.  The movie gives a brief but accurate account of how emotions interact to cause our behavior.  The movie also goes into long and short term memory and lost or forgotten memories and images.  

One thing that the movie depicts is that we are not completely in charge of all our emotions but that emotions are based on circumstances as well as on past memories and experiences.  The movie also pointed out that emotions are also based on future expectations, which in turn involve past and current experiences.  

The characters of happiness and sadness  are initially working separately, each thinking their  ideas are the only important thoughts, and then unite to  create a thought process that is more beneficial. The unity of the characters of happiness and sadness united the other emotions, joy, disgust, fear, anger which  also  evolved.  Disney depicted  the presence of happiness as the most important emotion but the other emotions, once united, as a very necessary contributor to a person's well being.

Sometimes I think that there are those who feel that we have control of our behavior by just understanding what is going on and what may be the correct way of doing things.  In this schema it is hard to  accept that our behavior and actions are controlled by electrical and chemical interactions that form an action potential to initiate stimulation and our actions, which is based on storage of past experiences and other past stimulation.  [But] there is the expression "that which fires together wires together."

by Richard Nikla, LMHC

Thursday, July 23, 2015

Making Meaning Dyadically

Edward Tronick in his talk “The Dyadic Expansion of Consciousness Model of Psychoanalytic Change” noted that there are many “something more”(s) going on between two people in a dyad and that the state between the two contains more information than either has for one’s self. This information can be apprehended by either and used to make meaning. Tronick further noted that one needs to feel secure [At the body level this refers to wholeness, safety,  boundedness] if one is to be flexible, creative, and able to engage in relationship with others.  Conversely, insecurity impairs meaning making, self regulation, and can lead to rigidity, dissociation, defensiveness, etc. as the patient holds on to the organizing patterns he already has.

Information may come at the bodily level, for example, through synchrony of respiratory sinus rhythms by parasympathetic regulation, particularly when each has protracted experience of the other, through ‘matching’ of tone, prosody, etc, as well as emotional matching and shared meaning at the symbolic (linguistic) level. Meaning making occurs bodily, emotionally, and symbolically and one system can bring to light (and help regulate)another.

His comments reminded me of a patient who complained that his “true self” was being “crushed” by the phoniness displayed by friends and family members and induced in him a likewise inauthenticity. I inquired where he felt this sensation of ‘being crushed’ in his body for as he reiterated his complaint I had the image of a baby’s face smashed into its mother’s breast while nursing. He replied that it was his face, like a mask smothering him. When I shared my image aloud, he though it “weird” but was willing, when invited, to consider (or play) with the image I introduced. He came up with a heretofore unrecalled memory of his father musing aloud when the patient cried that “Indians” blew into the face of their crying infants to get them to stop crying, by way of “suffocating” them. [The patient had oft complained of not being able to breathe, not catch his breath fully, since childhood, and of having no one, not even the family doctor, understand his complaint.]

This vignette came to mind as Tronick spoke because it illustrated to me to one particular moment where my patient and I had access to information between us that neither of us might have had access to alone. It was in exploration of the bodily component that the memory was activated and put into words. 

Tuesday, June 23, 2015

A Tiny Note on 2 Moliere plays

Never more clearly than in two French satirical plays by Moliere, Tartuffe and The Misanthrope, do we find the longing to know and be known. Humans are born with the hard wiring to read the intentions of others but many of us have that capacity thwarted during childrearing when caregivers contradict the reality of children with reprimands such as ‘You don’t want that’; or ‘Yes, you are cold’; or ‘You don’t mean that’; the worst case scenario might well be denial of sexual abuse when adults pretend with children that it is not happening. Thus we learn to doubt what we know to be so.  Because children’s survival depends on attachment, children acquiesce their own reality to that of their caregivers.

Tartuffe, a con artist who dupes Orgon of all his property by posing as a Holy Man and turning Orgon against his own family, is seen by all except Orgon and his mother Madam Pernelle for the imposter he is. How did Orgon become so unseeing? Part of the answer surely lies with transgenerational transmission of attacks on the reality of others. Mme Pernelle accuses her grandchildren of not listening to her but it is she who prattles on, insulting her grandchildren and her daughter-in-law Elmire.  She also contradicts them about Tartuffe’s character insisting “all of you Must love him” and “Rubbish!” (Act One,  Scene I). Orgon has learned from his mother that relationship can have only one subject, not accommodating the other’s reality, and so inflicts the same on his daughter Marianne. Wishing to force her to marry Tartuffe, he tells her “Because I am resolved it shall be true. That it’s my wish should be enough for you.” (Act Two, Scene 1)

While Tratuffe is sometimes also named The Hypocrite, we also find great hypocrisy in The Misanthrope, a later play in which Moliere made more subtle his spoofing so as not to so plainly offend the Church and the Aristocracy. Our misanthrope Alceste claims to dislike all the courtly flatterers who, behind the backs of others, gossip and malign. He speaks his opinion, mostly tactlessly, and pleads for authenticity from others. Meanwhile, Alceste loves a young widow Celimene who herself embodies all the disingenuousness against which Alceste rails, an illustration of how we are multiple selves, at times heroically going against the politesse, at times foolishly expecting the ideal to be concretized. Alceste might seek out Celimene perhaps because offstage (behind closed doors) Celimene and Alceste share their ‘true’ selves with one another. Alceste says to her, “Let’s speak with open hearts, then and begin…”  (last line, Act Two, Scene 1)

Tuesday, June 2, 2015

Having Fallen into the Abyss Myself...

A supervisee, praised in her respective psychoanalytic training program for her “calmness and stability,” asked me recently how she could keep herself stable when faced with her very unstable patient whose instability, lamented the supervisee, she could feel inside herself as if her patient were “pushing” her. The therapist complained that she could feel herself “influenced” by her patient’s self states. Her patient was continually running away from the chaos of her own world and now the therapist-supervisee wanted to run away from this patient. A professional therapist, the supervisee claimed, can keep herself stable, work deeply and slowly, and could “stay there” in the room with her patient.

I was pleased to know that the therapist I supervised had the capacity to be influenced by her patient. Now we had to find a safe and comfortable enough way for the therapist to share with her patient that her patient was no longer alone in the chaos. And what a good job the patient was doing communicating her own internal states. [Is this what projective identification is?] If the therapist, too, could feel the chaos, and if the therapist could both survive the chaos and not be shamed by her lack of stability, what might these mean for the patient? That the patient was no longer alone? That it is okay to make mistakes? The supervisee further lamented that when she managed to feel calm and stable with this challenging patient, it was at the cost of feeling “dead” inside, feeling “serious: and unable to “interact” with her patient. The therapist found that paying attention to her own body sensations relieved her some of the deadness. The supervisee asked how she could be both alive and stable with this patient.

That is the big question, isn’t it? Bromberg, in On Knowing One’s Patient Inside Out (1991), wrote about how very difficult it is to be both participant and observer [Sullivan]. I have often wondered how one can hold the patient’s hand and jump into the abyss with the patient, and still hang on to the rim. It must take Herculean strength, and personal mettle. I know I failed gravely at least one patient.

Is the deadness the therapist feels inside not also, at least partially, a joining with a self state of the patient’s? Could the patient’s chaos be a way to protect herself from such deadness? Had the therapist stumbled upon something that the patient had dissociated in attempt for the patient to save herself from deadness? The supervisee asked why I, the supervisor, in multiple venues we had shared, was always so alive. That got me to thinking about from what deadness inside myself did I wish to run? Was avoidance of such deadness what made it impossible for me to truly leap into the abyss with my patient(s) and could it have simultaneously caused me to let go of my observer stance? The supervisee worried that, were she to enter the self states of her patients, they would either not make progress in therapy or they would leave treatment altogether for they would lose hope. I surmise that, should we make friends with our dissociated self states, neither destroyed not shamed, that might open a path for hope.

Sunday, May 17, 2015

Film: The Innocents, Henry James' The Turn of the Screw

The paternal grandfather of Henry James, an Irish immigrant who became quite wealthy, had little time for James’  father Henry James, Sr.  James, Sr. himself was injured in a fire as an adolescent and lost his leg. He remained bedridden for a few years which finally garnered the attention of his parents. He too was a writer (newspapers), dabbled in theology, but was disinherited by his own father after a few years as a wayward youth. Having felt unloved by his father, James, Sr. was determined to shower his first born son William (the American physician, philosopher-- and psychologist who met Freud) with attention. Tragically, his controlling ‘love’ of William, and of his second born son Henry, left both sons feeling oppressed by their father’s attention, something from which both struggled to free themselves, but not without life-long battles with depression. It is thought the suicidal William was bipolar as well. Their younger siblings, Wilkerson, Robertson, and Alice (the recipient of inappropriate courting from William) all suffered mental illness as well, e.g. Bob with alcoholism, Alice with ‘hysteria’.

Henry James never married, but he wrote about some of the ‘ghosts in the nursery’ [what therapists know as fear, helplessness, rage]. These ghosts are intergenerationally transmitted, speak to the pain of multiple losses [such as loss of recognition, attunement, love, and actual caregivers]. In The Turn of the Screw, Miles and Flora have lost first their parents, then grandparents, then their beloved governess.  The governess narrator arrives and devotes herself to her wards, reminiscent of Henry James, Sr.’s crippling devotion to his two elder sons. Only after the two children are separated from one another, the governess – unable to bear the sadness of her wards’ many previous losses [much like the hapless therapist]— in the last straw, the turn of the screw, in ‘saving’ Miles from his demons,  contributes to his fatal injury. The governess has failed to hold Miles in mind, having deprived him of healing through relationship. Much like Henry, Sr., she has blurred the distinction between her own needs and those of her charge.

That which is disavowed can return with a vengeance. James deftly leaves us to consider whether the ghosts here are from within or from without, or both.

Monday, April 27, 2015

Conference on Countertransference and Ethics

An erotic transference can stir up anxiety in the analyst. I recently had opportunity to view a teaching film in which a male analyst is asked by a female client whether or not he is attracted to her. 

She begins the session modeling her new dress. The analyst says she must be going somewhere [after]. She sits and looks glum. The analyst asks her ‘what’s the matter?’ She says she had felt so foolish because she had gotten “no response” from him upon revealing in their previous session that she had a “crush” on the analyst. He disagrees that she should feel foolish [attacking her point of view/ the validity of her experience] and she reiterates that she indeed felt foolish. Again he disagrees and tells her that her revelation took courage. The client again complains that the analyst had said nothing about how he felt about her. The analyst gives an explanation about the asymmetry of the therapeutic relationship.The client persists in saying she felt stupid because the analyst did not speak to his feelings about her. He empathizes with her difficulty [saying nothing about his own]. He does state a dilemma: if he tells her he is not attracted to her she will be devastated and feel more like the fool; If he says he is attracted to her, the atmosphere will shift and she will feel less safe to say what she feels [He apparently does not consider the possibility that his honesty might model and engender further honesty from her]. The client stated again [third or fourth time, by now] that she still wanted to know if he finds her attractive.The analyst complains that what he is saying is being ignored. The client persists, “Am I attractive?” and the analyst complains he is being steamrolled in the way that her previous boyfriends have complained she tried to control them and dismissed their POV.  The client persists, wanting an answer to the question asked at the beginning of the session. The analyst [in an attempt to force mentalization, I think] accuses the client of not caring what he feels. The client says the analyst is being “stubborn” by not answering “a simple question.” The analyst says the client does not want him to be her therapist. She denies this and becomes tearful as she complains that he will not do what she wants. The analyst seizes this opportunity to tell her she wants to control men. The client acquiesces [or has insight?] and says she does not know why [controlling men] is so important to her.  The analyst tells her that she fantasizes if she can control men then they won’t leave her. Hanging her head, moving her tongue side to side pressing the insides of her cheeks, she says she can see that. The analyst adds that her father, asserting his independence, left her and her mom, so the client repeats the same thing over and over not getting the outcome she wants [you know, the definition of stupidity]. The client says she sees, but does not like it.

If an analyst’s anxiety can be measured by how much he/she talks and/or intellectualizes, the audience was certainly privy to the anxiety of this analyst in the video who talked significantly more than his patient did and who intellectualized with her instead of speaking to the affective relationship in the room. The audience was divided in their response, some seeing the analyst as deflecting, using ‘neutrality’ and abstinence and accusation [interpretation] as a shield; some seeing the analyst as handling the transference perfectly appropriately and using interpretation to impart insight. In this situation, I, too, have been made anxious. It is difficult for the analyst to stay empathically immersed (as Geist was able to in his 2009 paper on mutually constructed boundaries) when faced with confusion about the best way to proceed. How do we validate the client’s POV and still have a differing one conveyed? How do we speak to the emotions in the room present in both therapist and client and still keep open the potential space [instead of foreclosing space by reifying through action]?  Certainly I have failed multiple times in this regard. What is missing in the therapeutic relationship in the consulting room that the client, or analyst, is willing to throw it over in favor of something else? How do client and therapist alike speak to and mourn what cannot be, and still remain in relationship? Analysis, in addition to everything else it is, after all, is also simply 'two people in a relationship.'

Sunday, April 19, 2015

Frankenstein's Monster

Alternately titled Modern Prometheus, we are led to think that Dr. Frankenstein wished to rival the gods (or women) by creating life. For a woman in 1817 to write a masterpiece was not simply unusual, it was considered, like Prometheus' stealing of fire, an act of hubris. But more than hubris, Frankenstein is a story about attachment and the longing for restoration of lost relationship.

Mary Wollstonecraft Shelley, the author of Frankenstein (1818, 1831), lost her own mother at only eleven days old from complications (infection) of childbirth. Her parents had hoped for a boy. Childbirth was perilous in Shelly's day. Shelley herself, as a teen, lost her first child within days of her daughter's premature birth. Her second, named after her father, and third child, also died very young. Shelley experienced multiple miscarriages and only one son lived to adulthood. Shelley was a widow by age 25.

Did Mary grow up believing she had killed her mother? That her mother had abandoned her because Mary was an unlovable monster just as Dr. Frankenstein abandoned his creation at its birth? It is immensely plausible to speculate that a small child would wish for restoration of the lost mother. Not only had Shelley lost her mother, so does Victor Frankenstein, and his bride, as did Shelley's husband Percy, upon whom Victor was partially modeled. Shelley, who dedicated the book to her father, might have wished as well for reparation with him for he had cut off all ties with her when she ran way with the already married Percy. 

Victor, unseen or misrecognized by his parents, misrecognizes his creation. Dr. Frankenstein's monster becomes the Brombergian 'not-me': the loss, the envy, the rage of the abandoned child, and it vengefully and relentlessly pursues its creator-mother just as Mary, as a child, spent countless hours at her mother's grave (and it was there that she and Percy fell in love). 

A child learns to see itself first in its mothers face, her gaze, her mind, and learns to regulate its emotions from its mother's lending of soothing and containment of distressing emotions and sensations. 

Frankenstein's creation had none of these advantages, a monstrous child, indeed, left to long ragefully for connection. 

Film with Boris Karloff shown today at 200pm.

Sunday, February 15, 2015


If The Grand Budapest Hotel created a magical like wonderland for the viewer, Boyhood, written and directed by Richard Linklater, makes magic out of the everyday, much like Turner taught us to see fog or Hockney the light on the surface of a swimming pool. Peter Travers of Rolling Stone called it “an unassuming masterpiece.”

Boyhood is another coming of age film, but it is unique in using the same actors over twelve years of intermittent filming  (Ellar Coltrane as Mason, Patricia Arquette as his mother, Ethan Hawke as his father, Lorelei Linklater as his sister) so that we see their real aging and changing, which gives the viewer a sense of ...  inclusion, peace, authenticity. We are caught up in the change, compelled by time slipping by so fast, this knowledge so poignant in our own lives. This use of real time creates a kind of transcendence that has, for me, an ineffable quality.

Patricia Arquette (on 2-9-15 on The Daily Show) said  of director Linklater that he “believed what is beautiful is life. Normal life. Love. Mistakes. That we are here on Earth, a real celebration of just human beings.”

Linklater himself recounted how, in his own childhood with divorced parents, a father who lived over an hour away, he spent, with his dad, that three hour round trip trying to forge a connection. Hawke tries to do the same with the Coltrane and Linklater characters, striving to know one another as best as they can. I think it is a marvel to behold. Nominated for six Oscars, it has already won the Golden Globe and the British Academy Film Award for Best Picture, Best Director, and Best Supporting Actor (Arquette). 

Tuesday, February 10, 2015

The Grand Budapest Hotel

Perhaps quirkiest of all of this year’s nominees is The Grand Budapest Hotel directed by the quirky Wes Anderson (Moonrise Kingdom, Rushmore) and starring Ralph Fiennes (Harry Potter, The English Patient) as concierge extraordinaire Gustave H. who seeks to provide, on the brink of WWII, unparalleled service to the guests of this magnificent hotel. 

In his nightly ‘sermon’ to the hotel staff, Gustave H. instructs his staff on how to deal with rude guests [reminiscent of the therapist’s understanding of hostile patients]: Rudeness is fear, proclaims Gustave, fear that one will not get what one wants. Thus, he explains, the staff must provide what is missing in order to disabuse the rude guests of their expectation of going unsatisfied. And Gustave H. always satisfies, both male and especially older, lonely female guests. One such guest, Tilda Swinton, bequeaths him a priceless painting which her family, of course, contests. Gustave H. steals the painting and a series of comic, and then not so comic, mishaps ensue. 

The banter in this film is unexpected and, sometimes,twitterpating, delivered so dryly at times that my brain needed a moment to register the laughter. One of the most amusing scenes to me is the enduring politeness and hospitality of the imprisoned Gustave H. as he graciously offers mush to the other prisoners, treating them as if they were his honored hotel guests. 

The sets are as delicious as the pastries and confections from Mendl’s Bakehop used to influence (maybe even bribe) prisoners and guards alike. As Nazis emerge on the horizon, Gustave H. clings to the belief that etiquette and elegance, masking his own occasional crudeness, might maintain a vanishing civilization. His sidekick, the lobby boy Zero Moustafa (Tony Revolori; later F. Murray Abraham), says of Gustave H. many years later, “He certainly maintained the illusion with remarkable grace.”

The Grand Budapest Hotel touts an extraordinary cast as well, with Adrien Brody, Willem Dafoe, Jeff Goldblum, Harvey Keitel, Jude Law, Bill Murray, Edward Norton, Tom Wilkerson and Owen Wilson, to name a few.

Friday, February 6, 2015

Oscar Nominations:Birdman (the unexpected virtue of ignorance)

Many of the films nominated this year for Best Picture are unusual in their quirkiness and singularity of subject. One such quirky film is Birdman, directed and co-written by Alejandro Gonzalez Inarritu [Babel and Biutiful] and starring Michael Keaton as Riggan Thomson. Birdman is a film about painful transformation and the search for meaning.  Thomson, a once Hollywood blockbuster superhero (Birdman), is trying his hand at Broadway and at a comeback by writing, directing and starring in a play which is an homage to author-poet Raymond Carver’s short story “What We Talk About When We Talk About Love.” This short story, now play, features two couples, Mel (Keaton) and Terri (Naomi Watts) and Nick (Edward Norton) and Laura (Andra Riseborough), who sit drinking around a kitchen table discussing what is real love. [I, among others, believe that only through love is transformation possible.Only through communion is meaning created and do we come to know we matter.] Later, Thomson asks the existential question, “Do I matter?”

Thomson searches for an “honest performance” and finds it in Mike Shiner (Norton) who otherwise, and ironically, lives inauthentically, even stealing Thomson’s back story for his own to use in a New York Times interview; and Shiner can only achieve an erection when on stage. Thomson hopes to find relevance, but theatre critic Tabitha Dickenson (Lindsay Duncan) has promised to destroy his play because, she claims,  celebrities of “cartoons and porn” aren’t legitimate actors, to which Thomson retorts with indignation that critics, unlike actors, “don’t risk anything!”

Thomson is divorced, but seems to regret it, and is attempting to reconnect with his drug-rehab’ed daughter Sam (Emma Stone). He is followed about by his alter ego Birdman who both torments [People “love action, not talking, depressing, philosophical shit”] and encourages Thomson. Birdman also allows Thomson the power of telekinesis and, at his lowest points of suicidal thoughts, lets him fly above everyone else. The final lines of the play-within-the-film, reminiscent of those which may be oft spoke by certain of our own patients, and, if we are honest, ourselves, occur just after Thomson in the play playing Mel discovers his wife Terri in bed with another man (Nick played by Shiner) and just before Mel shoots himself:  “What’s the matter with me? Why do I always have to end up begging someone to love me… I don’t exist.”

On opening night, Thomson exchanges the prop for a real gun, causing the critic Dickenson to glowingly opine that “blood spilled literally and figuratively” had been “long missing from the veins of theater,” and calling it “SuperRealism.” As Thomson recovers in the hospital, his bandaged face, reminiscent of Birdman’s mask, he and his daughter finally connect. Thomson struggles with suicidal thoughts and he experiences transformation through flying as Birdman. But we know from psychoanalyst Philip Bromberg’s work that death of our previous selves accompanies transformation. Sam, who looks out the open hospital window, and up, sees her father fly and this could as easily be metaphorical.

Some of the amusing tidbits include, Mike Shiner getting a shiner; Thomson ‘going viral’ [by living the common anxiety dream of everyone at work seeing you in your underwear] despite eschewing social media; a reference to Ryan Gosling’s failed directorial debut; and imagining Emma Stone could ever be invisible. The biggest laugh for me came when a man on the street was shouting about the “sound and the fury, signifying nothing.”  Schizophrenia? No. An aspiring actor, auditioning,  And there is a luminosity [literally] in a liquor store where the hot pepper shaped, copiously strung lights look like a festive Christmas or the stained glass of a church. But the heart of the film is about meaning, meaning co-created within an authentic relationship. Sam says the hardest thing to bear from her father is that he is always trying to make up for not having been in her life by “constantly trying to convince me I [am] special.” Thomson admits he “wasn’t present at his own life.” How fortuitous then that the stage manager calls out over the loudspeaker, “Last chance for places.”