Neuroscience and Psychoanalytic therapy

In his talk How Understanding Some Neuroscience Can Increase Empathic Attunement on April 13, 2013, Max Harris, PhD presented to the Tampa Bay Psychoanalytic Society on ways neuroscience informs our clinical work. We now understand that mother’s right brains develop their babies’ right brains, in regulation of emotions and coordination of intentions. It is hopeful to know that psychotherapy, too, confirmed by neuroimaging, also can modify neuronal networks. This is due to the plasticity of the brain, and brought about partly through modification of dendritic branching (growth of new connections or pruning of older ones). New experiences rearrange neural networks!

Relational Trauma can come about from abuse, neglect, or chronic misattunement. Trauma, through the HPA (hypothalamic-pituitary-adrenal) axis, can decrease blood flow to the hippocampus and increase it to the amygdala, such that language and context are decoupled from  sensory and procedural memory, and dissociation can ensue. (Trauma can also turn genes on and off via methylization.)  Dissociated experience, often a result of dysregulation of affect, of the patient or the analyst may be communicated through a co-created enactment. This dyadic dissociative process can vitiate reflective function.   The therapist , using self regulation, can serve as ‘container’ (Bion) in helping to regulate patient affect.

Because there are cortical (cognition) connections to the subcortical limbic system (emotions) and limbic connections to the gut (with its chemical messengers the same as some neurotransmitters) and body via vagal nerve, Harris reminded therapists to attend to facial and bodily expressions and right brain, nonverbal  communications, including one’s own.  Mirror neurons may also be a mechanism by which we can feel our way into others’ experience. Harris enumerated three aspects of empathy:  Reflective, Affective, and Intersubjective: the thinking about experience through reflective function, mentalization and theory of mind; vicarious affective matching where one feels oneself into the experience of another; and the intersubjective, where therapist and patient negotiate experience through shared dialogue. Empathic attunement, then, relies on the social right brain, mirror neurons, the parasympathetic and enteric systems’ emotional experience, as well as on the left prefrontal cortex’s reflective function. 

Survival, then gratitude in a Thank you Poem

WInnicott wrote of survival in his 1969 The Use of an Object paper. Survival for the mother or the analyst attacked by the baby or the analysand, respectively, means neither withdrawing nor retaliating. One analysand put it this way.

Thank you for allowing to express disdain for you without taking offense, without crumbling or acting childish.

Thank you for allowing me to express contempt without making me feel wrong. 

Thank you for allowing me to express disgust without retaliating.

Thank you for allowing me to hate you without making me feel ashamed, bad. 

Thank you for allowing me to be me and not throwing a guilt trip on me for doing so.

Thank you for allowing me to grow.

Thank you for allowing me to express my feelings.

Thank you for being you.

Thank you for showing me it's ok to be imperfect.

Thank you for teaching me how to withstand forces that want to rip me apart.

I want you as a friend, not an analyst.

I want you as an analyst, not a friend.

I didn't know you could be both.

Thank you for accepting me as I am, and all the hell that comes with that.

Thank you for letting me hate you.

Thank you for no strings attached.

Thank you for no conditions. 

Thank you for no retaliation.

Thank you for love.

Thank you for your patience as I try to share my pain, find who I really am.

Uncertainty and Poetry

Contemporary psychoanalysis has sought to deconstruct the authority of the analyst as ‘the one who knows’ and, instead, struggles to open itself to uncertainty, spontaneity, and surprise in the analytic situation. In struggling to become more open to uncertainty, I was pleased to see on PBS Newshour an interview by Jeffrey Brown on March 4, 2013 of poet and renowned translator David Ferry. Now 88 years of age, David Ferry was given the Ruth Lilly Lifetime Achievement Award in 2011 and recently won the 2012 National Book Award for Poetry for his most recent collection of poems, titled Bewilderment.  When asked by what he was bewildered, Ferry answered,

Everything…just as everything we say to one another is an attempt to try to get something clear to the other person or to ourselves and.... that's always a partial success and a partial failure. … [T]he title [Bewilderment] acknowledges that.

I thought how like the attempt between analyst and analysand that is, or between any two people really, in any relationship, striving to approximate ever closer, and accepting that inevitably it fails, as it must fail, for we retain our otherness.

Jeffrey Brown noted, “ This is a man clearly obsessed with connections and links,” when referring to how Ferry integrates with his original poetry lines from famous classical works [Ferry is  an acclaimed translator of the Babylonian epic "Gilgamesh" and of Latin texts by Horace and Virgil, and is presently working on an English version of Virgil's epic, "The Aeneid"]. Ferry explains. “One reason for doing that is what it says in my own poem [See below], its usefulness for that poem. It also, I think, does mean that there's a kind of motive to connect what you're saying to the past of writing, that you want your own poem to be part of that kind of enterprise.”

Talk about the intersubjectivity of poetry: Ferry is influenced by Virgil and then he changes Virgil when he includes the classic work in his modern poems.  Ferry says it like this:  “When you read something, and especially when you're reading compellingly great [poetry],  that becomes part of your identity, at least while you're reading it. You become changed by reading it.” Though Ferry adds, “And then you're finished with it. Then you're lost again. Then you're back to just who you are.” I know that a number of analytic patients feel that way between sessions as if the change within us is too imperceptible to be held.  I think who we are now includes how the poem had changed us then. Our impact on our patients, and theirs on us, remains, however imperceptible. [You can never stand in the same river twice.]

I will close with an excerpt from Ferry’s "Ancestral Lines" which talks about our connection to the past:

It’s as when following the others’ lines,

Which are the tracks of somebody gone before,

Leaving me mischievous clues, telling me who

They were and who it was they weren’t,

And who it is I am because of them,

Or, just for the moment, reading them, I am,

Neil Altman, PhD visits Tampa to discuss Race and Class

Neil Altman, PhD spent the day on February 16, 2013 with the Tampa Bay Psychoanalytic Society with a presentation on “Race, Class, and Culture from a Psychoanalytic Perspective.” Altman noted that arrogance, to think we know something we don’t know about the unconscious,  is an occupational hazard for therapists, and that the analytic attitude is about being surprised. We have to have enough humility to be confronted by our patients about our blind spots. Like colonial mentality, if we hold on perniciously to the idea that there is a mainstream, then there are deviations, deviants, from that mainstream, and we locate ourselves in a place of exclusionary normalcy.

When psychoanalysis evolved to a where the relationship, too, is included in the focus of study, the analyst is removed from the ‘objective’ perch and becomes, as Sullivan noted, a participant-observer, implicating the analyst in the inquiry. Once we acknowledge our participation then we can find a way of looking at it. An analytic perspective focuses on the process (“the landscape we live in”) rather than the end point. One attendee put it aptly: once sacred aspects of the frame were let go, what remained sacred was the relationship; two factors are of utmost concern: emotional availability and self-reflection. Another attendee noted that emotions are central to relationship, and we have struggled since Descartes, who was wary of emotions as unreliable and the cause physical illnesses, to reestablish their rightful place in our decision making.

Altman says that race, class, money, all have an interplay of emotions in the haves and have nots, and in contempt and shame. While each of us is organized toward shame proneness, the social system aggravates this when it is organized in ways that activate shame. In shame based cultures, the defense is saturated with what it defended against. Race is organized by relation of polarities: good and bad, dominant and submissive, privileged and un-privileged. When we move from the paranoid-schizoid position (in Kleinian terms) of splitting, projection, and polarities to the depressive position which integrates good and bad into wholeness, we transcend polarities. The depressive position, seeing the other as a subject also capable of being hurt and harmed, allows for guilt, and calls into action reparation.  

Some aspects of working in community mental health agencies were discussed: the dilemma of objectifying patients while encouraging autonomy; how analysts can represent Fairbairn’s exciting and rejecting objects: the bad object first excites then rejects, first seduces, then abandons [see 2008 paper by Altman et al On Being Bad While Doing Good].  Aron and Starr have published a new book A Psychotherapy for the People where they note that Freud envisioned that one day psychoanalysis would be available  to everyone just as surgery is available to everyone.

A number of attendees resonated very personally with Altman’s talk, sharing they had parents who crossed race or class divides to marry. One observed “I was born into multiplicity … I was different yet the same.” Another added, “Race is one way we separate ourselves.” 

Because in the discussion of otherness by race and class, we need to include gender, I will close with some comments made by Gloria Steinem in a recently aired (2-27-13) PBS Newshour in which she said that Society moved, for economic reasons, to hierarchialize human beings in terms of sex, race and class, where power and control included women’s bodies and reproduction, and we must return to humans being “linked, not ranked” where the “paradigm of culture is the circle, not the pyramid.”

OSCAR NOMINATIONS for BEST PICTURE: Argo

Argo received seven Oscar nominations. In addition to Best pic, for which it won the Golden Globe, is Best editing,  and Best supporting actor in Alan Arkin as film producer Lester Siegel.  [Ben Affleck won the Golden Globe for Best Director, not nominated for an Oscar, and stars in the film as Antonio Mendez, CIA extractor]. Lincoln was nominated for twelve, Life of Pi, eleven.  A big fan of Anne Hathaway, but not musicals, I did not see Les Mis, and, living in the hinterlands, I did not yet get the opportunity to see Amour, but this year Argo is my favorite nominated movie among many really good films.. Like Zero Dark Thirty and Lincoln it depicts a story based on actual events (so the ending, as it was in Titanic, is known) but due to exquisite editing (William Goldenberg deserves the Oscar) and playing a bit fast and loose with some facts (exciting screenplay by Chris Terrio), Argo is surprisingly suspenseful ( much more, to me, than Zero Dark Thirty), unexpectedly humorous (thanks to Arkin and John Goodman as make-up artist John Chambers) and more engrossing than the other two, true stories.

The daring plot to rescue six Americans who escaped the overtaking of the US Embassy in Iran on November 4, 1979, where 52 hostages were held for 444 days until their release was successfully negotiated by Jimmy Carter without loss of life, is thrilling, and unbelievable. Only in Hollywood could such a plot to pretend to make a movie (Argo) succeed in extracting from a hostile land six Americans hiding out in the Canadian ambassador’s residence. Except it did. The “Canadian caper” remained classified for 18 years. These six foreign service workers  were skeptical about Mendez’s escape plan, till one recognizes that Mendez has put his own life on the line as well.

Argo has everything we could desire in entertainment: suspense, valor, triumph, humor, and, if we forget the USA’s involvement in the coup d’etat that usurped authority from the Parliamentarily elected Iranian Prime Minister and gave it to the Shah for its own gain, we are proud to be Americans on the day Cora and Mark Lijek, Kathy and Joe Stafford, Lee Schatz, and Robert Anders made it home.

I found this film moving, but I was most moved by the final scene in which Mendez, one of the true heroes of this true story -- who is separated from his wife at the time of the Canadian caper-- reads a goodnight story to his son in bed, and the camera alights on the shelf where sits the story board Mendez kept for his son from the script Argo which would never be made. The story board of the fake film depicts the hero, in a space age hover craft escaping across the desert with a small boy beneath his arm.

OSCAR NOMINATIONS for BEST PICTURE: Beasts of the Southern Wild

Directed by Benh Zeitlin, Beasts of the Southern Wild won the Camera d'Or at the 2012 Cannes Film Festival, and the Grand Jury Prize at the 2012 Sundance Film Festival, among other awards. It is a remarkable culture captured by a young filmmaker on a remarkable budget.This sometimes grainy, sometimes sepia tinged film about the people who live in the area of the Mississippi delta called “the Bathtub” is difficult to watch, but I could not look away. To see five year old Hushpuppy (Quvenzhane Wallis, youngest ever nominated for Best Actress) be so neglected is heart breaking. We see crumbling glaciers as Miss Bathsheba teaches about the melting ice caps, much as we see Hushpuppy’s world crumbling. The glaciers unleash imaginary, giant boars called Aurochs into Hushpuppy’s world, and she stands them down. This, I suppose, is to indicate to the audience that she can triumph over the real life adversities that face her: the abandonment by her mother at a much younger age, the illness (cirrhosis?) that is ravaging her father Wink (Dwight Henry), and the ongoing neglect and intermittent continued abandonment that her father inadvertently repeats. That she survives the hunger and filth of her makeshift home, much less survives Hurricane Katrina, is unimaginable to this middle class, white woman who put baby proof hinges on all the kitchen and bathroom cabinets.

No matter how inadequate the caregiver, a child attaches to the one on whom it is dependent for survival. If a caregiver is reliably responsive with care and comfort, the child feels a safe haven from which to explore the world, and can turn back to that caregiver when hurt, frightened, or lonesome. When a child turns to a caregiver who is rejecting or dismissive, the child learns to avoid turning to the caregiver, and instead, learns to soothe itself by focusing on some more reliable thing, such as Hushpuppy found in the red sports jersey her biological mother purportedly wore.

Hushpuppy may have been able to befriend the Aurochs, but I imagine that the demons inside herself, not the least of which might be a belief that she drove away her mother and that she killed her father, will be much harder to face. Children like Hushpuppy need not only food and shelter and safety from the storm that rages outside, but require also sufficiently skilled mental health services if they are to stand down the wild beasts within.  

OSCAR NOMINATIONS for BEST PICTURE: Zero Dark Thirty

Zero Dark Thirty is a necessary film, and a rare one because it portrays a female protagonist that is not in a romcom. Like Lincoln and Argo, it is based on a true story, and while keeping to real events and to firsthand accounts of the May 1-2 raid [zero dark thirty is military speak for half past midnight] and killing of bin Laden, there has been some controversy—as if Zero Dark Thirty were supposed to be a documentary, or as if it glorifies torture -- about director Kathryn Bigelow’s choice to open the film with scenes of “enhanced interrogation.”  While no torture by the CIA yielded info about bin Laden’s whereabouts, director Kathryn Bigelow thought it important to include it as part of the fabric of the ‘war on terror,’ a war which included torture by both the CIA and the military, the latter which may have yielded  info from detainees in Guantanamo.  As if we needed reminding why the U.S.A. so relentlessly pursued bin Laden, scenes are preceded by a dark screen where we hear the voices of phone calls from the World Trade Center and hijacked planes of 9/11.

Much like Lincoln, Zero Dark Thirty is a long and plodding, explicative film for which the outcome is already known. One might have to enjoy history to love either film. Unlike Argo, which rearranged facts to be more cinemagraphically appealing, there were few moments of tension or suspense for me in Zero Dark Thirty. [Even in Django Unchained, foretold of the legend of Broomhilda rescued by Siegfried, the tension is not ‘Will she be rescued?’ but rather by how much injury and to whom.]  I love film, yet find that sometimes a picture is not worth a thousand words. Never was this more true for me then after reading in the New Yorker (August 8, 2011, Getting Bin Laden by Nicholas Schmidle, Reporter at Large) the account of the raid on bin Laden’s Abbottabad compound. There Schmidle apprises us of the rush to the third floor of the compound in which the first SEAL to arrive on the third floor, seeing two women shielding bin Laden, throws his own body over these two wives-- lest they are wired with bombs-- so as to minimize the potential damage, protecting the SEALS coming behind him. I found this account in the New Yorker very moving. But Zero Dark Thirty is not a film about the raid, its climax, nor about the Seals who kill him once found. Instead, it is about one CIA agent’s (Jessica Chastain’s Maya) dogged mission to find bin Laden.

I applaud Bigelow-- one of the rarely acclaimed female, great filmmakers, and a great filmmaker of any gender—who paired up again with writer Mark Boal (also together on The Hurt Locker, Best pic, Best director, 2010).  Unlike the Hurt Locker, this film builds little character. [We get to see James Gandolfini (the Sopranos) cast as Leon Panetta, then CIA Director.] I also am proud of the CIA agent, a heretofore unsung hero, who used intelligence and determination to have her theory triumph in a man’s world.  Perhaps this dedication to single mindedness leaves no room for expansive character portrayal. Perhaps Zero Dark Thirty had to tediously plod along as it did so that the audience might get a taste for how  the seemingly interminable decade long hunt, the grueling beurocratic slog, might have sometimes felt to the team of CIA agents dedicated to this task. We don’t get discouraged; but they could not have been certain of the outcome.

Almost ten years and billions of dollars later, Maya leaves Pakistan, alone, on a cargo plane, mission accomplished, and is asked “Where do you want to go [from here]?”  Are her tears of exhaustion, loss, or relief?

OSCAR NOMINATIONS for BEST PICTURE: Life of Pi

Life of Pi, based on the same-titled 2001 novel (Booker Prize for Fiction in 2002) by Yann Martel, screenplay by David Magee (nominated for best adapted screenplay) is a lush and fanciful tale of a spiritual journal of survival. It is nominated for eleven academy awards, including Best Picture and Best Director (Ang Lee, Broke Back Mountain). Piscine Molitor Patel “Pi” (Suraj Sharma) is a young man whose fight to survive after having lost everything, including his parents and brother, is a kind of love story about the love of life, his own life, as exemplified in Richard Parker, the tiger with whom he is stranded on a life boat in the middle of the ocean.  

Pi’s family departs its homeland of India --accompanied by their formerly owned zoo’s animals—on a ship bound for North America where they will sell the beasts and start a new life.  When their ship goes down in a storm, only a few make it to the life boat. In addition to Pi and the Bengal tiger Richard Parker, there are the mama orangutan, a broken legged zebra, and a ravenous hyena. Each perishes until only Pi and Richard Parker remain. The hyena eats the zebra and orangutan; the tiger eats the hyena. To avoid becoming its next meal, Pi must catch enough fish and fresh water for the both of them. As the two move toward a mutual understanding, Pi, all the while evading the jaws of the tiger, discovers that caring for Richard Parker becomes Pi’s reason to live, just as Martel says the writing of this novel became the direction and purpose for his life.

Perhaps in some other year I would have voted it the best film of the year, but not this year with so many excellent films. Still certainly I found Life of Pi the most beautiful, and think that cinematographer Claudio Miranda deserves the Oscar. Any adjective of praise (magical, beautiful, miraculous, gorgeous) all apply here. Ocean becomes sky, sky, ocean, both firmament for glowing stars and phosphorous, fish and clouds, as the universe is gloriously united as one whole, a whole which includes Pi, and which he treats with reverence.  

To dedicate one’s life to some purpose, or to belong to some greater whole than oneself, confers meaning to life where all, for each of us, is eventually lost. Disappointment, tragedy, death come to us all. In the interim, we strive for connection and meaning making, sometimes rewriting the facts to make bearable the tale. It turns out that Pi’s story may have been reworked, that the hyena is the ship’s cruel and culturally insensitive cook, who kills the zebra sailor and the orangutan, Pi’s mother, and eats them both and uses them for bait. That leaves Pi as the tiger, looking to find reason to save himself amidst his enormous survival guilt.  

OSCAR NOMINATIONS for BEST PICTURE: Django Unchained

Django Unchained is a fun movie Quentin Tarantino style,-- that is, with excessive blood and violence—treating irreverently, as he did in Inglorious Basterds, a serious subject, this time, slavery. I haven’t seen this much blood, comedic, since Kill Bill anime scenes.  Only Tarantino can make me smile at his copious use of it.  On NPR’s Fresh Air, Tarantino tells Terry Gross that there are two kinds of violence in Django Unchained: “There's the brutal reality that slaves lived under for ... 245 years, and then there's the violence of Django's retribution. And that's movie violence, and that's fun…” The villains are so heinous that their exsanguination is almost sanguine. [Still, I saw, in horror, a ten year old in the theatre with his parents; Also I can see why its release was delayed after the Sandy Hook Elementary School massacre in Newton, CT.]

Christoph Waltz (Inglorious Basterds, and Saturday Night Live, Feb 16th), nominated for Best Supporting Actor for his portrayal of the German bounty hunter Dr. King Shultz, has impeccable timing and delivery, surprising us again and again. But the greatest cognitive dissonance for me was seeing the distinguished, inimitable Samuel L. Jackson playing at an Uncle Tom. It is such an unexpected casting as to be laugh out loud funny. The love dance of words and expression between him and Leonardo di Caprio in their first scene together is exaltingly funny. Were it not for Schultz’s exquisitely timed and gentlemanly offered cheekish lines, it would be Jackson who steals the show. Just as in Silver Lining Playbook, humor here is fueled by disbelief about what the characters do next. Tarantino directs the exaggerated facial expressions as if a silent film (as in the disbelief on black and white faces alike to see a free black man in the pre-Civil War south enjoying the privileges of a white man).

I found Django Unchained one of the funniest of the Tarantino films, a spaghetti western, a bloody Blazing Saddles, with the sweetness of Silverado, dealing humorously, much like Silver Lining Playbook, with a very unfunny subject.  America’s history of slavery is almost absent from the psychoanalytic literature, despite its vast lexicon of trauma and trauma’s intergenerational transmission. Tarantino brings slavery dead center to the discourse. His trade mark, over the top bloody exhibition of human suffering raises to the level of absurdity, allowing the unspoken, much like Bion’s alpha functioning does, to enter the conversation.

Benjamin writes of the difficulty in maintaining the tension necessary to see the other as a subject like ourselves (subject-subject interaction) and the inevitability of continually falling to a subject-object relating. Racism obliterates the subjectivity of the Other and, in so doing, diminishes the self as well. Slavery’s absence from the psychoanalytic dialogue, as if hidden from awareness, creates a void in meaning and intimates our own sense of shame.  Tarantino unabashedly brings slavery center stage and nudges me out of my comfort zone, holding my hand as I laugh irreverently, and for this I applaud him.

OSCAR NOMINATIONS for BEST PICTURE: Silver Lining Playbook

Called a dramedy, or a quirky romcom,  Silver Lining Playbook  (nominated for Best Picture; Best Director (David O. Russell, The Fighter); Best Actor (Bradley Cooper, The Hangover); Best Actress (Jennifer Lawrence, The Hunger Games); Best Supporting Actor (Robert De Niro); Best Supporting Actress (Jacki Weaver, Animal Kingdom) is based on a book of the same name by Matthew Quick, and it is very, very funny-- in a hmmm, more than ha ha, kind of way. Still, I laughed out loud, not the least when Patrizio Solitano, Jr’s (Bradley Cooper) psychiatrist Dr. Patel (Anupam Kher) tells him he needs “a strategy,” as if that, in and of itself, would help this man’s terribly chaotic life. (As a psychiatrist and psychoanalyst I have a bias for exploratory therapy and for relationship. Sure, discipline and will are components of success, but so is good enough parenting.) Pat needed not only advice and medication, but psychotherapy. (My psychiatrist- psychoanalyst friend with whom I saw the film also roared here with laughter. We both know that patients who seek mental  health treatment for advice don’t need advice as much as they need to figure out why they can’t take the advice they have already been given.)

But Dr. Patel’s advice turns out to be the heart of Silver Lining Playbook, the playbook (in sports’ circles) being the strategy.  Who’da thunk the strategy would be preparing for a dance competition and falling in love. What I like about this film is that the strategy, to survive this crazy curve ball life throws us, is that it takes a village, a team, family and friends, pulling for you, rooting for you, and strategizing, then, implementing with you, a plan. 

I was especially taken with Jacki Weaver’s performance as Dolores Solitano, the perpetually worried-looking mother. Perhaps having a son who has bipolar disorder who was recently hospitalized for a violent loss of temper would make any mother walk on eggshells (as would the unpredictable violence of any loved one).  I wondered to myself if Dolores herself had not always been anxious, from childhood unpredictability of her own, and how this anxiety might be communicated, day in and day out, to her sons from their infancy via affect mirroring (where infants, in imitating the facial expressions of their mothers, signal their brains to feel what the facial musculature indicates) or via a disorganized attachment of her own.  Small children, too, need a strategy for coping with stress, and in the absence of a strategy -- because the parent as a safe haven is also the stressor, children do not know whether to approach for comfort or flee/freeze in alarm—a child becomes disorganized and disoriented, including moments of dissociation from the double bind. (Cooper, for example, in his confusion, pursues the very wife who betrayed him.)

There are many theories about the etiology of bipolar disorder, including the genetic. But should we muse psychoanalytic, I think Pat, perhaps having learned sadness and anxiousness from his mother’s style, coped with these unpleasant affects by their very opposite, manic grandiosity. (In my experience, bipolar adults have usually been the designated ‘savior’ of their distressed family, with grand expectations thrust upon their shoulders.This was not the case in the Solitano family, where the older brother was preferred, by the father, to be the achiever.) Bipolar Disorder or not, I wonder if Pat did not suffer with affective dysregulation. No matter.  His taking his medications relieved his parents’ anxieties about him. Some in the mental health profession have accused Silver Lining Playbook of spouting love, in lieu of medications, as treatment of mental illness. Bipolar disorder definitely requires medication, but affect dysregulation (sometimes treated with meds until self regulation, through long term intensive psychotherapy dealing with attachment, relationship and improving a sense of self, is achieved) may find sufficiently reliable, accepting, soothing, and negotiated love lends itself to self regulation (I recall Tender Mercies). Besides, people, even with, maybe especially with, psychiatric illness do better with love.

Cooper is redeemed not only by chance, I mean dance, but by the love and support of family and friends. As ill-conceived as the help of his parents may be, their love and concern, dawning much like it does on the adult emerging fresh from adolescence, eventually shines through. Jacki Weaver is brilliant as the worried mother who indefatigably walks on eggshells trying not to set her son off into a manic episode. Jennifer Lawrence is as talented here as everywhere I’ve seen her, meeting, out of a desire for connectedness, Cooper’s craziness where she finds it. In this regard, she may have been the better therapist.   

Like Django Unchained, Silver Lining Playbook, riffing on an unfunny subject (here, mental illness),  is a black comedy of sorts, and most of the humor is fueled by disbelief about what the characters do next.