Retrieving a beloved son, Bergdahl

Bowe Bergdahl, a US Army soldier held captive for almost five years by Taliban forces, was the last and only American POW in Afghanistan to bring home. But there were controversies surrounding his return, the two main ones being his exchange for five Taliban detainees from Guantanamo Bay, and claims that our commander in chief Obama did not have the authority to make such an exchange. Additionally, there are those who are angry at Bergdahl for leaving his post, going AWOL, or possibly deserting, and he may face court martial and prison time. Rumors abound about whether other soldiers died as a direct result of their search for Bergdahl.  One former US Army Sergeant, Josh Korder, for example, denounces Bergdahl, “He chose to take off his gear, put down his weapon, and walk away…” and says what Bergdahl did is “just not forgivable.” 

My two older brothers came of age during the Viet Nam war. This was a time when our country did not whole heartedly “support our troops,” calling them, for one, “baby killers” –there is a rumor that Bergdahl saw an American tank run over an Afghani child. Though I am against military action before diplomacy is exhausted, I am happy that our nation does not now disparage these young men and women upon their return home.  I additionally advocate that we not disparage troops who, for whatever reasons, break or break faith.  The older of my two brothers  joined up in the late sixties, his best childhood friend having ‘been the first on our block to come home in a box’  and the other brother made his plans to relocate to Canada should his draft number come up. My parents supported both their sons’ decisions. Looking back, this support of these two antipodal positions now seems remarkable in this political climate where black and white are so rigidly demarcated. Though both my brothers fare well today, we know too well that not all our soldiers come home unscathed.  Can we not find compassion for the horrific pressures troops are placed under?

I am so proud to be a volunteer clinician for TBIPS’ Veterans Family Initiative which provides pro bono and low fee, long term and intensive psychotherapy services without any significant wait time to veterans and their families. I am so proud, too, that training at TBIPS emphasizes negotiation of paradox where seemingly contradictory positions are, with our understanding of multiple self states, welcomed in, each as a necessary part of the whole. We all strive to be whole and wholly connected. No matter what Bowe Bergdahl has done or did not do, he remains the beloved son of Jani and Bob, and I, with them, welcome him home.

The Body, the Self

One of the many courses taught at TBIPS is Repetitive Painful States which addresses the ways experience is encoded implicitly and procedurally, that is, sub-symbolically without language. Painful past experiences of mis-attunement, humiliation, contempt, neglect and other forms of psychological and emotional abuse, as well as physical and sexual abuse, often lead to dissociation as a way of self protection. One way the brain separates or dissociates occurs through the ‘unlinking’ of the amygdala (the emotional brain which stores perceptional, emotional, procedural experience) and the hippocampus (which gives language and context to experience thereby creating explicit memory). The stress hormone cortisol causes increased blood flow to the amygdale while decreasing perfusion to the hippocampus. Many experiences, then, just do not have words!  Alexithymia thus ‘speaks’ to the inability to tolerate certain affect (emotion) states—perhaps because these states were not tolerated by the parent or not regulated as to be made bearable—and so they cannot be known. The therapist who awaits explicit (verbal) narrative in order to make interpretations may feel useless and incompetent, and may blame the patient.

Physical symptoms that are in excess of physical diagnoses or that stump physicians from coming up with diagnoses are often called psychosomatic. It has long been thought that psychosomatic symptoms are a way the body can express what the mind cannot put into words.  Repetitive Painful States then must also introduce candidates and students to concepts about Psychosomatic illnesses (In fact,TBIPS provides an entire course dedicated to ‘psychosoma’—as if there were ever a dichotomy between the two). One paper we read in the Repetitive Painful States course is by Krueger, which notes that somatic experience is the first form of affect.  When parents selectively attend to only the physical needs of the infant, ignoring emotional needs and duress, the infant may learn “to organize experiences around pain and illness in order to obtain attention and affection.”

Krueger reminds us that physical sensations, like proprioception and the skin, allow the infant to differentiate the bounds of the self from the rest of the world. This body cohesion, aided by touch and secure holding, is the first awareness of self.  When the caregiver allows for over or under stimulation, the infant learns experientially an incompetence about the boundaries of the self. Krueger posits that certain disorders—addictions, self cutting, eating disorders, for example—may all be an attempt to discover the boundary of the self and its contiguity to the world, an attempt to delimit the boundedness of selfhood.  Self injury, for example, may help to create body awareness and replace the lost sensation of an underdeveloped or dissociated emotional life.

Krueger, D. (2001). Body self: development, psychopathologies and psychoanalytic significance. Psa Study of the Child, 56:238-259.

American author and poet Maya Angelou died today.

She was 86 years old. She has been an inspiration to America in its struggle to transcend racism and sexism. As a teen I read her moving autobiography and coming of age story  I Know Why the Caged Bird Sings (1969) whose title was taken from Paul Laurence Dunbar’s poem. It was my first understanding of the trepidation that awaits female children for it portrays Angelou’s own rape at the age of eight.  Today in our electronically connected world we have plenty evidence of female children’s precariousness, a world where Nigerian girls are kidnapped from school, and in Pakistan Yusuf Malala is shot in the head for advocating for girls attending school. I did not know then, at fifteen, that I would one day become a psychoanalyst and work so predominately with survivors of childhood sexual abuse, but Angelou’s book must have been an impetus for me just as it has been an inspiration to countless others.

 Perhaps there is no better epitaph for her than her poem Still, I rise:

You may write me down in history
With your bitter, twisted lies,
You may tread me in the very dirt
But still, like dust, I'll rise.

Does my sassiness upset you? 
Why are you beset with gloom? 
'Cause I walk like I've got oil wells
Pumping in my living room.

Just like moons and like suns,
With the certainty of tides,
Just like hopes springing high,
Still I'll rise.

Did you want to see me broken? 
Bowed head and lowered eyes? 
Shoulders falling down like teardrops.
Weakened by my soulful cries.

Does my haughtiness offend you? 
Don't you take it awful hard
'Cause I laugh like I've got gold mines
Diggin' in my own back yard.

You may shoot me with your words,
You may cut me with your eyes,
You may kill me with your hatefulness,
But still, like air, I'll rise.

Does my sexiness upset you? 
Does it come as a surprise
That I dance like I've got diamonds
At the meeting of my thighs? 

Out of the huts of history's shame
I rise
Up from a past that's rooted in pain
I rise
I'm a black ocean, leaping and wide,
Welling and swelling I bear in the tide.
Leaving behind nights of terror and fear
I rise
Into a daybreak that's wondrously clear
I rise
Bringing the gifts that my ancestors gave,
I am the dream and the hope of the slave.
I rise
I rise
I rise. 

Maya Angelou

Film Series: Children and Trauma: Pan’s (the Faun’s) Labyrinth (2006)

Director Guillermo Del Toro commented on Ofelia (Ivana Baquero) as “a girl who needs to disobey anything except her soul.”  Our discussant Adriana Novoa, PhD (Dept. History, USF) elaborated the theme of disobedience: Not simply the anti-Franco fighters against the fascists; Ofelia repeatedly disobeying her stepfather Captain Vidal (Sergi Lopez) and ultimately the faun (Doug Jones) –which leads to redemption and the restoration of her family. At the end of the film we see clearly through the fantasy when the stepfather finds Ofelia talking to the faun but sees her talking to no one, and Novoa notes here that the audience is posed with the question of whether to obey reality or to choose fantasy which allows the narrative creation to resurrect Ofelia. If the audience chooses reality, Ofelia is dead; Disobey reality and Ofelia is restored to her kingly family and lives on in the underworld.

Novoa also speaks to the question of authority: is it from the control of others, or an understanding (partly through narrative) of knowing oneself? She noted how the sadistic Vidal did not know his own father, and worse, was unknown by his father.  Vidal knew of his father’s famous military bravery, particularly through legend of the father having stopped his watch at the time of his death in battle. Novoa saw this as symbolically cutting off time (and connection) to the future (his son), and Vidal is assiduous about keeping the watch running. When Vidal knows he is about to be killed, he hands his infant son over and instructs the rebels to tell his son of the time of his death. Mercedes (Maribel Verdu) tells Vidal that the baby will never know of his father. And so the transgenerational transmission of trauma is illustrated for each father in turn will not know his son, nor the son the father.

Paulina Robalina, LCSW discussed the dissociation engendered by trauma where a child creates a fantasy world to cope with the untenable reality of (in this film, a mis-attuned mother and a sadistic and murderous stepfather). The ‘Pale Man’ ravenously eats children and fairies alike just like the stepfather tortures and murders rebels and any disobedient sympathizers. The toad is killing the flowering tree just like the stepfather is responsible for the mother’s death (impregnating her, killing the doctor, burning the healing mandrake). Ofelia must make choices not only that obey her soul, but be willing— like any hero or Christ figure— to sacrifice herself to save the innocent.

Nominated for Best Foreign Language Film and Best Original Screenplay (del Toro), Pan’s Labyrinth won three Academy Awards: Best Achievement in Cinematography (Guillermo Navarro), and Best Achievement in Make-up (David Marti, Montse Ribe)and Best Art Direction (Eugenio Caballero-art and Pilar Revuelta-set).

Continuing with the “Children and Trauma” Film Series, next month is The Virgin Suicides on April 13, 2014 at 200pm at 13919 Carrollwood Village Run.

Poem

Paper dolls

Paper dolls linked hand in hand, stretched out in a row

Me standing between me, looking to and fro

Hard to see all of me when stretched from here to there

if I try to bend and flex, I easily rip and tear

And when the wind blows

The doll follows like a waif

Some almost letting go, not feeling safe

Better pull together, better pull in close and tight

Now we hold together,

what a lovely site

Fold one over the other,

like an accordion to play

Now there’s strength in numbers,

all here to stay

Each doll important, each make the other strong

All of me’s are different, but none of me’s are wrong

Hugging each other close, now we all belong

Not so easily ripped now, not so easily torn

And when the wind blows, now we flex and bend

Now there’s strength in numbers, now we don’t pretend

Holding tight together it’s much easier to be,

Now I see all of you standing in between me

by Stacie Lauro, MD

Psychiatrist, Psychoanalytic Candidate at TBIPS

co-created with and with much gratitude to:

Heather Pyle, PhD; Bruce Reis, PhD; Alice Bartlett, PhD; Lycia Alexander-Guerra, MD:

Bruce Gilberg, PhD; and, of course, Phillip Bromberg, PhD;  and to patients to whom I am very privileged, honored and grateful to be a part of ... and many others 

The Worst of Human Nature from one of the Best Filmmakers

Nominated for Best PictureThe Wolf of Wall Street, based on the autobiography of Jordan Belfort, a stockbroker who capitalized on money laundering and fraud, stars Leonardo DiCaprio in a manic performance as Belfort, and is directed by Martin Scorsese (Goodfellas, The Departed for which this oft nominated director won the Oscar).  The scene where DiCaprio, almost decerebrate from excess quaaludes, is hysterical (Jerry Lewis couldn’t have done it better), and at the same time we are sickened by Belfort’s relentlessly heinous debauchery.

Were it not so hilariously farcical, the film would be too painful to watch. It is like a car wreck from which one cannot avert one’s eyes. What is mangled here is the better angels of our nature. This wolf is ravenous, rapacious. Additionally, there is the sickening awareness behind the humor of what is going on outside the movie theatre: the growing gap between haves and have nots widening, ever widening. This country’s new robber barons are on Wall Street and Belfort narrates for you how they do it. This movie is not about transformation. There is no real redemption, for Belfort or for the country. Deregulation and SEC’s failure to enforce allows human avarice to run amuck, and this true story disheartens. Likewise, the commodities traded here include women and I think ‘woe to the republic.’

The lure of drugs and sex and the power of money all too easily make us lose our bearings. I would like to imagine that  perhaps people who fall off the edge into the abyss of avarice and gluttony never had any (bearings) to begin with, never knew fulfillment of any magnitude inside themselves and so sought it outside themselves, the bigger the inner hole, the bigger the need for external highs. But who among us would not be seduced?

I have this theory about drug addictions: In infancy and toddlerhood the brain is developing rapidly. Experiences of recognition and effectiveness and mutuality develop the parts of our brain that produce feel good chemicals like dopamine, serotonin, endorphins, and endogenous opioids. Lack of such experiences leaves our brain deficient in the capacity to produce such chemicals. Then one day we stumble across alcohol or cocaine or marijuana and suddenly we feel something we’ve missed, normal, good. Who wouldn’t want to feel that way as often as possible?

The Ethical, Compassion, and Complexity in Psychoanalysis

With a sense of social responsibility members of the Tampa area psychoanalytic community have developed and maintain initiatives that respond to the need of the other, supporting veterans’ families, for example. These colleagues serve without fanfare and invite us all to contribute. They may not experience it this way, but I believe their work in this regard belongs to the ethical, and suggest also that this personal inclination to the good informs and supports their psychoanalytic work.

In the larger psychoanalytic community as well, the turn to the ethical seems increasingly well established. Psychoanalysts and others, many inspired by Neil Altman’ pioneering work, are involving themselves and their writing with Palestinian-Israeli troubles, with transgender, with the undocumented, with whiteness and gross inequality, with class differences understood from below. Important voices in American relational psychoanalysis (Adrienne Harris, Eyal Rozmarin, Melanie Suchet) are now seriously engaging with the work of Emmanuel Lévinas. Likewise, in 2011 Donna Orange formally incorporated into psychoanalysis an “ethics beyond ethics”as an inherent dimension of her Hermeneutics of Trust. And the discourse of asymmetrical responsibility has appeared also in the psychoanalytic literature in the work of Adrienne Harris and Warren Poland. Also in 2011 two interdisciplinary conferences, including many psychoanalysts, took place: Psychology for the Other in Cambridge, MA, and Bystanders No More in New York City.

I have always understood Jessica Benjamin’s work, psychoanalytic and otherwise, as belonging to the ethical with her efforts to help liberate us from domination-submission forms of relatedness so we can flourish. Extending Benjamin’s and Judith Butler’s work, relational psychoanalyst, philosopher, and feminist theoretician Lisa Baraitser in London suggests that in Lévinas’ ethics, responsibility redefines recognition. After the birth of her first child, Baraitser began to ask “How do we take responsibility for the other (the infant) prior to the possibility of recognition by that other?”, and to point out that in maternal encounters (the
title of her book) the maternal subject tends to collapse in the face of the need of the fragile and developing child. As therapists we may experience something similar in the face of the need of the devastated child in our adult traumatized patients, like the ones Lauren Levine presented.

Respect for the asymmetrical responsibility to respond to the need of the other is, in part, what places our psychoanalytic work in the realm of the ethical. The clinical accounts Levine shared with us brilliantly illustrate what this looks like in practical terms.

I have suggested already that in these cases, she conducted a minimally theoretical psychoanalysis, a therapy by understanding, especially emotional understanding, that seeks to promote comprehension and to heal by participation in the emotional life of her patients. Levine is able and willing to enter the patient’s suffering and share the painful history, willing and able to “undergo the situation”with the other.

In so doing Levine’s work highlights another dimension of what makes psychoanalysis an ethical undertaking: compassion. Not pity, condescension, or mindless or inauthentic “making nice,” compassion may be experienced by the analyst as a relentless desire to accompany and to understand.

An emergent property of well-attuned relational systems just as hostility and contempt seem as if naturally to characterize others, compassion is both process and attitude. Etymologically compassion means ‘to suffer with.’ Our traumatized patients often feel crushed by a sense of futility. When we suffer with them, and struggle together to make sense of it, their suffering can begin to acquire meaning. Lévinas argues, moreover, that responding to the need of the other is precisely what brings us into subjectivity, into being.

Attention to complexity and its attendant fallibilistic attitude are other components of what one might term Levine’s compassionate psychoanalysis. “I don’t care what you think ...it is only my opinion that counts...!”, or words to that effect roared the patient in response Levine’s spontaneous joy about the painting the patient had selected to buy. Knowing that patient and analyst are so intricately, so complexly related, even though stunned and hurt by her patient’s rebuff, in a fallibilistic spirit Levine reached out to her patient for contact. These matters are usually more complex than we have ever realized and there was more work to be
done to find out what happened.

Respectful of her patient’s suffering, Levine accompanied her patiently and without too much knowing, managing to stay engaged in dialogue with her, to good ends: in the process of transacting this rupture in the following session, perhaps in dawning recognition of Levine’s hurt, the patient said something like– “I don’t know why I feel like crying”!

A compassionate attitude may enable hitherto unknown and impossible ways of experiencing. As process, psychoanalytic compassion perhaps can be understood as a form of emotional understanding.

As emotional availability, psychoanalytic compassion may be what empowers our willingness to accompany patients to the deepest circles of their experiential hell. Not moral masochism on the part of the analyst, nor to be contrasted properly with psychoanalytic work, psychoanalytic compassion is the implicit interpretive gesture of reaching out to embrace our patient in a sustained, even relentless, struggle to find an understanding.

To state it briefly: a compassionate response to the suffering of others is an ethical imperative, and, as it brings us into subjectivity, it adds meaning to our lives; a humble life in the service of the other is our ethical vocation; psychoanalysis becomes an ethical pursuit when we learn to notice and to care for psychological fragility; the primary and fundamental task of psychoanalysis is relief of suffering; commitment to relief of suffering is our fundamental therapeutic vocation; we are called, summoned, addressed, and responsible even
when we are unsure what this address means; our work belongs to the ethical, to the vocational. For me all this is implied in the work Levine shared with us.

In her post of February 9th appended, Lycia Alexander-Guerra cogently writes: “I have read a few papers in my time, but none quite like Levine’s. Her voice is unique; it transcends theory. In a feat of lived, not
theorized, relationality and intersubjectivity, Levine’s papers are as much about her experience as about her patient’s.” Indeed. I believe Lauren Levine was as emotionally available to us, her audience, and will be to her readers later on, as she is to her patients. Such emotional availability may be what makes it possible for her to so powerfully convey her work. It may also be the reason why we established indeed a shared humanness enriching one another!

Ernesto Vasquez, M.D.

See other comments posted to the blog of the Tampa Bay Institute for Psychoanalytic Studies, Inc by this author under the February 9, 2014 post titled ‘Mutual Vulnerability’

MUTUAL VULNERABILITY

In April 2008 at the American Psychological Association, Division 39 (psychoanalytic division) meeting I first heard Lauren Levine, PhD, who was a candidate at the time, present a paper weaving her experience as a mom with that of her analysand’s. There was something so moving and so singular about her presentation that I immediately invited her to Tampa to speak to our local psychoanalytic society. And in 2010 she presented two papers in Tampa, both papers subsequently published. She is guest faculty at the Tampa Bay Institute for Psychoanalytic Studies, Inc and when I found out she had written another paper, I asked her to share it with us. On February 8, 2014 she presented her latest works to the Tampa Bay Psychoanalytic Society, Inc.

I have read a few papers in my time, but none quite like Levine’s. Her voice is unique; it transcends theory.  In a feat of lived, not theorized, relationality and intersubjectivity, Levine’s papers are as much about her experience as about her patient’s.  In her mindful disclosures to her patients, she reflects to them, in her eyes, themselves, deepening connection and expanding the space for creativity, for herself and her patient, and opens the possibility for desire and greater aliveness. There is reparation and resilience, and transformation ensues. In "A mutual survival of destructiveness and its creative potential for agency and desire," Levine demonstrates how destruction became an agent of change.

I have often stated to supervisees that I feel myself with certain patients holding on to the rim of the abyss, dangling there by one hand, holding the patient, whose weight threatens to pull me down, with the other. I am torn to breaking. I know I must join the patient in the abyss and I know to do so will be the end of us both. Levine, too, describes standing on the edge, trying to pull the patient out of the abyss, feeling too frightened to join him there. There is great shame for us, the therapist, to have doubts about our competency so triggered. It collides with our past vulnerabilities of childhood helplessness and ineffectualness. But, as Levine notes, no matter how difficult it is to find a shared humanity we reach out nonetheless to the disparaging other, knowing that it is in the fidelity to the shared process that hope lies.  

Humor and Affiliation: Nebraska

Nebraska, directed by Alexander Payne (Sideways, The Descendents) is a refreshing surprise. It is my favorite pick. Unassuming, shot in black and white (cinematographer Phedon Papamichael), with luscious views of the plains states, or plain states to some: cows, rolled hay bales, small towns and lonesome barns, it made me laugh! even more than the absurdity of American Hustle or the eerie quirkiness of Her. But its unexpected humor, like Garrison Keiller’s Lake Wobegon, grabs us at our most human, and we nod with the knowingness of lost tenderness.

Original screenplay by Bob Nelson, Nebraska is a road trip rich in characters, compassion and raw humor. An aging Woody Grant (Bruce Dern), with declining cognitive function who is no longer allowed to drive, so fervently believes himself to be the million dollar winner of a magazine marketing sweepstakes that he is willing to walk to Lincoln, Nebraska to claim his winnings even as his harridan wife Kate (June Squibb) and his two sons try to convince him the letter is a scam. On their journey there is a stop in Woody’s hometown of Hawthorne, Nebraska, where avaricious family and former friends, a felon nephew, and  the truth according to Kate-- whose forthright and funny commentary is Oscar worthy— do not dissuade but initially embolden Woody on his quixotic quest.

We like Woody’s younger son David (Will Forte) right off. It is not just his nuanced ‘porcelain prince’ face, or that his former live-in girlfriend does not look like a Barbie, or even that, like Judge Reinhold’s character in Ruthless People (no one had more ruth), he sells stereo equipment. David carries within him a compassion for his flawed father, and his earnest search for answers from a father who has none, his unflagging willingness to forgive his father’s previous failings and bring Woody a little happiness in his last years cinch for us David’s understated heroism. We wonder from where did David receive his bounty of compassion.

Even this graceless age of economic hard times and ruthless every-man-for-himself mentality cannot obscure the understanding of kinship by a son for his undeserving father. It is not from Woody that David receives any answers. David nonetheless learns things about Woody from those who knew him back when – there is a glance between Woody and his former girlfriend (Angela McEwan), and what might have been, that is hauntingly wistful. The film score by the reunited Tin Hat adds well to the mood of the film. David protecting the dignity of his father is a peerless grace in an age devoid of it. If all the other Best Pic nominations echo contemporary alienation, selfishness, and indifference, Nebraska reminds us of our communal and filial bonds.

Nebraska is nominated for six Oscars, including Best Picture, Director, Actor, Supporting Actress, Cinematography and Original Screenplay.

12 Years a Slave, Best picture of the Year

12 Years a Slave deserves best pic (and the Golden Globes thought so, too) if only to hold a mirror to the USA so we never forget (like the Germans teaching the Holocaust). It is a British director, Steve McQueen (who won New York Film Critics Circle’s Best director for this film) who must tell us Solomon Northrup/Platt’s (Chiwetel Ejiofor, of Kinky Boots, Children of Men) story. The film depicts Northrup’s autobiographical account, published in 1853, of his kidnapping, in 1841, and what he survived after being sold into Southern slavery.

Friends told me this movie was hard to watch. With the exception of the flogging of Patsey (Lupita Nyong’o), I did not find it so. The triumph of Northrup’s determination to “live” not just survive in order to return to his wife and children is strongly woven throughout the film. While we are not privy to whatever survival guilt or PTSD Northrup subsequently suffered, we know that a strong family and community connection had immunized him enough to allow him to move the Abolitionist movement forward for a nation oblivious to its shame. In addition to seeing  people treated like property, raped, beaten,  and eerily forced to dance for the merriment of their slaveowners, also horrifying to me was slave owner Ford (Benedict Cumberbatch) reading scripture to family and slaves alike while the film narrative juxtaposes slaves being beaten and murdered.  

For those who avoided this film to save themselves from the painful truth of this nation’s shame, I urge you to see it for it is a beautiful film about the human spirit and the power of love for family and freedom. I often tear up watching films, but this film brought me to frank crying (with joy). There are also  excellent performances from Sarah Paulson and Michael Fassbinder, and cameos from Brad Pitt and Paul Giamatti.

Like 12 Years a Slave (see 1-28-14 post) American Hustle turns a mirror on the USA, but American Hustle is a mere needle biopsy whereas 12 Years a Slave is the full body MRI showing a pernicious and widespread cancer in American history. David Denby of The New Yorker called American Hustle the best movie of the year but asks if it is an important movie.  While American Hustle depicts the real life Abscam affair it is so farcical that we forget this is a slice from history. Director David O. Russell (The Fighter; Silver Linings Playbook) and the superb acting of Jennifer Lawrence, Amy Adams, Christian Bale,  Bradley Cooper and Jeremy Renner make this film highly entertaining even while it is difficult to empathize or identify with such a group of con artists and self serving sociopaths (politicians and FBI agents) , including those who think they work for the common good.