Monday, February 28, 2011

Eternal Sunshine of the Spotless Mind

Eternal Sunshine of the Spotless Mind (ESSM) was voted the best movie of the decade by the Onion AV club [Source:,35931/] as well as the Austin Film Critics Association.


Reviewers tend to mention the film's "emotional core" as the reason for its success. I have read many reviews of ESSM and have been more than a little bewildered by the lack of explicit reference to one particularly pivotal and precious scene.*

Joel is desperately trying to salvage his memories of Clementine from destruction. Clementine advises Joel to hide her "somewhere really buried!" We are then presented with a scene from Joel's memory of deep humiliation and shame, a memory where Joel is completely alone being bullied into submission. We see him smashing a bird with a hammer, the camera cuts away to a bird flying away from a tree. It is not the act that is so much important, but the utter loneliness and desperation of a kid with no one on his side. A scene of innocence lost. However, Joel reconstructs the memory with Clementine on his side, in the words of Alice Miller, a helping witness. Little Clementine redirects Joel firmly stating "Joel, it's not worth it, they're not worth it, come on!"

Little Joel: "I'm so ashamed."

Little Clementine:"It's OK. You're a little kid."

Joel: "I wish I knew you when I was a kid."

It is painful, humiliating memories that often keep us from connecting with others and sharing our true selves. I think its safe to say that most of us have humiliating memories, or can at least identify with the terrible act of being humiliated.

The reconstruction of the memory helps Joel let go of it. Clementine reminds him that his innocence was never really lost, after all he was only a kid.

I think this gets at the emotional core of every human being. No one likes being humiliated, and no one likes having their innocence taken away.

Sharing pain and recasting past events to restore our natural innocence is essential to healing in life and to moving forward. Even if we didn't have helping witnesses as children, we can still find them as adults, they can still witness our past -- if we are willing and able to share it -- and show us our true innocence, a feeling of which every human needs and deserves.

(* during this scene one of the most beautiful piano pieces from the film score is played, called "Peer Pressure").

by Tim LaDuca

"How happy are the blameless vestal's lot,
The world forgetting, by the world forgot.
Eternal sunshine of the spotless mind,
Every prayer answered, every wish resigned."

- Alexander Pope

"How happy the innocents' life, devoted to God.
Unknowing of the world, and of the world is not.
Ne'er tragedy visited, immortality awaits.
In naïveté, here come the pearly gates."

-Timothy LaDuca

Thursday, February 24, 2011

Oscar Countdown: The Kids Are All Right

Recently, in a high school Congressional forum, my daughter proposed a bill that Florida allow same sex couples to adopt children. It was soundly defeated by her peers. This, despite that study after study show that children raised by same sex parents turn out to be no worse, no better adjusted, and no more or less often gay, than those raised by heterosexual couples (with the exception that children raised by lesbian couples -- probably because men are more likely to abuse children -- are less likely to be abused). The AMA, American Psychiatric Association, and the American Academy of Pediatrics all agree that a parent's sexual orientation is irrelevant to his or her ability to raise a child. It is also irrelevant to the child's mental health, self esteem, academic performance, and social development.

So, since children raised by same sex couples do come out alright, why then shout it out with the title The Kids Are All Right? (It is not tongue in cheek as in White Men Can’t Jump). I missed the critical acclaim boat with this film, and so do not quite understand its nomination for Best Picture. Had I not wanted to socialize with the likes of friends who like dumb movies (some even liked the incredibly boring Eat, Pray, Love), I don’t think I would ever have seen The Kids Are All Right. Some of my friends who are lesbian were incensed that Jules would cheat with a man, of all things, and, especially, that Nic and Jules would view (and so the film mention) gay sex, but not lesbian sex. Go figure.

Annette Bening (Nic) certainly is a great actress (American Beauty, 1999, unfortuitously came out the same year as Boys Don’t Cry or Bening would have won the Oscar for Best Actress) and Julianne Moore (Jules) is always lovely, but the nomination seems a token P.C. nod to same sex couples with children. This nod is despite that the movie is about forging and maintaining a precarious entity: monogamous relationships, no matter whose marriage we scrutinize. To nominate this so called “postmodern” (families now have same sex parents-- who knew?) film, directed by Lisa Cholodenko (Laurel Canyon, another film about parenting outside the mainstream, which held my interest a longer), reminds me of when Kramer vs. Kramer won Best Picture (and Director and Actress and Actor…) because Kramer vs. Kramer depicted in 1979 such a “modern” topic of divorce and working women who might not find motherhood so wholly embracing. Welcome to the real world. That The Kids Are All Right, or even Kramer vs. Kramer, sensitively or beautifully or provocatively or skillfully deal with the topics to which the Academy gives its nod, is perhaps too subtle for me, but I felt hit over the head.

Monday, February 21, 2011

Poem: Plea to the Water

Reveal your secret to us, water!

Tell us about the fine moss
that borders your margins;
about those dreams of ours
that navigated your liquids;
about all the words of the dead
and all the words of the children.

But tell us, most of all,
why was our life wrecked
and lies now submerged
in your unhurried flow of mirrors?
Why is the anguished spasm
of our screams now settled in your felt?

Ernesto Vasquez, M.D.

Thursday, February 17, 2011

Oscar Countdown: The Fighter

It is not exactly Rocky, and though ostensibly about the fighting in the ring, The Fighter, a brilliantly understated film directed by David O. Russell, is about the fight within one's self and within the matrix of our most important relationships. It is a movie about resilience. Mickey Ward, in a similarly brilliantly understated performance by the very fine Mark Wahlberg (who was also the driving force behind the film, and one of its producers), has lived his whole life in the shadow of his older half-brother Dicky Eglund (Christian Bale), his overpowering mother Alice (unrelentingly played by the superb Melissa Leo, of Frozen River and TV’s Homicide, from which she was fired—perhaps because real women cops without make-up and heels don’t exist, in TV land , anyway), and his seven uncouth sisters. [I kept thinking that the seven dwarves had taken up with the wicked stepmother.] Micky fights his way back from repeated losses in the ring, but more importantly, repeated losses to his sense of self vis a vis his family, for Alice repeatedly fails to have a ‘gleam in her eye’ for Micky: “Why can’t you be happy for me?”

Micky’s mom, and his initial manager, Alice demands accommodation from all her children, retaliating with rejection when one of her daughters dares to offer a different perspective. Micky tells Alice, “Can this be my fight, Alice, for once?” and “…I thought you were my mother, too.” Alice and a small coterie of fans see Dicky (because he, also once a boxer and intial trainer for Micky, allegedly knocked down Sugar Ray Leonard in the ring) as “the pride of Lowell” (once a textile manufacturing town that peaked at above 100,000 people) despite that he is now a skinny, skittish crackhead.

Bale’s performance dominates the movie and garnered, rightly so, the Oscar nomination. Dicky, in a parallel process, overshadows Wahlberg off screen as well for the Academy often goes for the performer who, by playing the outlandish or over the top character, stretches the limits of range (e.g. Theron in Monster or Hoffman in Rainman). Dicky, too, fights his way back, from addiction. Micky gains his confidence, and the movie triumphs. Even the cliché about how the love of a good woman (Charlene Flemming, played by Amy Adams, of Doubt, and Miss Pettigrew Lives for a Day) is so seamlessly woven-- after all, this whole film is based on a true story-- that we are pleasingly satisfied. It is a gem of a movie.

Monday, February 14, 2011

Valentine’s Day Thoughts

Having had the good fortune to hear Malcom O. Slavin, PhD speak on Saturday, February, 12, 2011 to the Tampa Bay Psychoanalytic Society, Inc., I came away with some thoughts on love previously relatively unconsidered. In particular, Slavin’s ideas on “adaptive probing” (probing, for example, to access and share an unarticulated fear of annihilation and death consequent to the existential awareness of our finitude and of our human need to make meaning), it occurred to me that the proclivity to probe others comes to the fore in love relations as well. The assertion of self interest through probing to know oneself better by better knowing the other is neither solely selfish nor aggressive. Indeed, it reciprocally requires of the beloved a capacity to allow awareness of the less accessible multiplicity of selves in order for the lover, too, to be able to face (though now, not alone) heretofore inaccessible sides of the self. Patient and therapist, too, cooperatively allow such access, beneficial to both.

In the clinical situation, this intersubjective, mutual probing requires that the therapist not hide behind ritual or role. Can the therapist and patient hold the tension created by emerging multiple selves? Can lover and beloved? Love is both selfish and altruistic. Love is the selfish quest for wholeness, through help from the other, the accessing of parts of one’s self by probing to know the multiple selves of the other. It is altruistic in its very probing, aiding, too, the other to know her/his own multiplicity better. Altruism (putting aside temporarily one’s own agenda or perspective) can deepen our sense of our selves in a way that can be powerfully creative and enlivening. In contemporary psychoanalysis, Relational theorists have, likewise, deepened the meaning of empathy into a two person experience with their recognition that otherness stimulates and nourishes growth of the Self.

Interrelatedness is necessarily reciprocal, and generates a tension between self and other. Just as light and dark require the other to define the one, poles of the dialectic necessitate the other, so each needs otherness and the other to better know the self. In the mutual sharing of both the hope to make meaning and the despair of mortality, what (content) is said is not particularly salient. Rather it is the connection to, and articulation of, the conflictisg needs between therapist and patient, or lover and beloved, that frees both to access a greater diversity in the experience of self. We aid patients in their accessing a more varied experience of themselves by opening our selves to broader and more spontaneous experience. So, too, do lovers mutually struggle to find one’s own subjectivity, and struggle with the subjectivity of the other.

Winnicott, though, reminds us that there is also always a private self that remains incommunicado. A lover, then, must tolerate the unknowableness of the other’s core self while simultaneously reaching towards knowing. Slavin, in his deeply philosophical probing of human experience, posits the evolutionarily adaptive function that this core self guarantees: a safe guarding of ourselves and our own interests when we simultaneously seek, sometimes through accommodation, surrender, or altruism and love, the enriched experience of self and other. Without this ever present tension between self and other, Slavin noted, human evolution would not have been possible, as we would, instead, be like ants, bees, or wasps, in a totalitarian utopian vision where individual needs and separateness disappear. Humans, in loving, find ways of negotiating each other’s differing realities and seek to accommodate without over accommodating. It is not a bad trade off.

Lycia Alexander-Guerra, MD

Thursday, February 10, 2011

Oscar Countdown: Black Swan

Khan (1973) writes that “the unique achievement of Freud is that he invented and established a therapeutic space and distance for the patient and the analyst. In this space and distance the relating becomes feasible only through the capacity in each to sustain illusion and to work with it.” For moviegoers, the screen becomes the transitional space as we struggle, in Darren Aronofsky’s Black Swan, to sustain contact with the fragmenting world of ingénue prima ballerina Nina Sayers (Natalie Portman) whose tenuous hold on reality simultaneously confuses and enthralls the audience. Khan states “The vehicle of this working with illusion is symbolic discourse,” but the symbolism moviegoers embrace is the visual image. Just as the ‘good enough’ therapist (or mom) opens and sustains the transitional space by never asking ‘what is created and what exists in external reality’ (Winnicott), likewise, when watching Black Swan, we do not ask what is real and what is hallucination.

Aronofksy uses Tchaikovsky’s ballet Swan Lake, a fairy tale of transformation in which the princess Odette is turned into a bird by an evil magician who tries to marry his daughter Odile, in Odette’s stead, to the prince Siegfried. Odette is released from her bird form only by love or by death. In the film Black Swan, it is the choreographer Thomas Leroy (Vincent Cassel) who wants Nina (who is perfect to dance the virtuous White Swan) to transform herself so that she can likewise become a perfect Black Swan.

More than just a battle of good and evil, this film of the doppelganger White/Black Swan speaks to the multiple selves that make up each of us. In his review of Black Swan Roger Ebert writes “It is one thing to lose yourself in your art. Portman’s ballerina loses her mind.”

Our inability to “stand in the spaces” between multiple self states, to balance each and privilege rigidly none, is, according to Bromberg, what leads to pathology. If one dissociates parts of one’s self such that these parts become unrecognizable to the self, then these disavowed parts of the self become ‘not-me,’ and are unusable to enrich and create experience. When Nina looks in the mirror, whose reflection appears is sometimes foreign to Nina as she seeks to dance both the white and black swans perfectly. Aronofsky and, especially, Portman dedicate themselves to the grueling and unnatural demands of ballet, which transcends the normal human body into twisted perfection.

In this performance, Portman outpaces all the competition for Best Actress. Like a trembling rabbit with hawks circling overhead, Portman’s exquisite and unrelenting expressions of confusion and fear draw us in to her fragmenting sense of self. For Nina there are many dangers, from her ominously impinging mother (well played by Barbara Hershey), from her sexy, alternate rival (Mila Kunis), and from within.

While I would not choose Black Swan for Best Picture, it is, in my view, a close contender, and I was glad for Aronofsky, particularly since The Wrestler (2008) was, I think, wrongly overlooked in the nominations for Best Picture.

Khan, M.M. (1973). The Role of Illusion in the Analytic Space and Process. Ann. Psychoanal., 1:231-246.

Monday, February 7, 2011

The Psychotherapeutic Relationship

The therapeutic process is not only about what is intrapsychic (the content of the mind, and the unconscious); it is also an interactive, bidirectional, and co-created engagement between therapist and patient. Regardless of any particular theories one utilizes, fostering from the very outset a mutually respectful relationship with the patient is paramount. Understanding diagnoses will not be helpful if the patient does not come back. To that end, the patient must, from the beginning, implicitly understand that you are trustworthy, respectful, and caring. Sometimes it is helpful to acknowledge with open inquiry the interpersonal experience. Collusion with patients’ illusions, without inquiry, may serve to increase the patient’s anxiety, hopelessness, and self-alienation.

Hoffman (1983) and Aron (1991) recognize that, while the relationship is mutual (both make contributions and affect one another), it is also asymmetrical. Relationships, including those between therapist and patient, are constituted by mutual regulation. We affect and are affected by each other, and, when this is not the case, one or both can feel ineffectual, unrecognized, even helpless. We aspire to mutual recognition. While we want the patient to journey her or his own path, we do not aspire to foster an autonomy that threatens the patient with isolation. When we do not demand pathological accommodation, or when we offer being alone in the presence of the other, it may be the patient’s first, or a rare, experience of autonomy without risk of loss of connection.

In seeking to connect with us, patients may probe beneath our professional façade. Do not mistake striving to know the therapist as [only] hostile or as [only] resistance. Consider the wish for connection and a longing to have an authentic effect on others. Sometimes patient silence is hostile as when the patient is too furious to speak or is withholding. Sometimes an experience or memory has no words. But sometimes it reflects a wish to be accepted as one is, without having to perform or produce. It is okay to admit that you do not know what the silence is about but would like to know, and likewise, it is okay to sit in silence, intimating your willingness to wait. I remember Hermann Hesse’s Siddhartha: I can think, I can wait, I can fast. Sometimes the therapist must be so willing, too.

Aron, L. (1991). The Patient's Experience of the Analyst's Subjectivity. Psychoanal. Dial., 1:29-51
Hoffman, I.Z. (1983). The Patient as Interpreter of the Analyst's Experience. Contemp. Psychoanal., 19:389-422.

Thursday, February 3, 2011

Oscar Countdown: Winter’s Bone

Sometimes when I think back on certain movies, I see them in my mind’s eye as shot in monochrome, much like I imagine the grey ash of nuclear winter. It is how The Road, I think, should have been shot. Of Enemy at the Gate I remember muddy grays. Bleakly monochromatic is also how I remember Debra Granik’s Winter’s Bone. But the bleakness of Winter’s Bone cannot mask its beauty. The mythical quest and unwavering performance of Jennifer Lawrence as Ree Dolly is anything but bleak or monochromatic. At the heart of Winter’s Bone (adapted for screen by Anne Rosellini and director Debra Granik from Daniel Woodrell’s novel of the same name, and which won the Grand Jury Prize at the 2010 Sundown Film Festival)is a heroic seventeen year old girl who must find her bail-jumping father, or his body, to save her younger siblings, her mentally ill mother, and herself from eviction.

Mythical heroes exhibit unusual courage or strength [of character] or devotion. In her journey to achieve the difficult task set before her, Ree Dolly exhibits all of these. Like Antigone seeking her brother’s corpse, she is unflinchingly determined; she, like Hercules, endures many trials; and like Orpheus, she enters the Underworld, here of both methamphetamine cooking, Ozarks’ poverty and of death. She uses her wits and she is, with grace, aided from unexpected quarters. Ebert and others ask incredulously how could this courageous and determined girl spring from a mentally disabled mother and a meth-cooking father? To that I answer that mystery of origin is the very origin of heroes.

Just like a movie-goer suspends disbelief in order to immerse one’s self in the world of the film [I like to sit close and have the screen fill my peripheral vision], so, too, does the psychotherapist immerse herself in the patient’s world, accepting the psychic reality of what is presented. Worlds as foreign to us as the isolated culture of the back country Ozarks must become, for the therapist, our familiar, if only intermittant, home. The patient’s quest, and ours, just like the hero’s, is a journey of self discovery, which entails overcoming mythical monsters [many, internal], to achieve, as Joseph Campbell noted about heroes, knowledge or new abilities. Sometimes the most salient new ability is the way one is with others.