The Unconscious Thinks in Braille

It’s unthinkable that a force more powerful than our own will may exist within us. We are convinced, and have proof of our power and autonomy. We build skyscrapers, planes, sculpt glass and create complex organizations, proving that when we have an intention, it most often will materialize. Acknowledging the force, power and influence of the unconscious on the shape of our lives leaves a bad taste in the mouth. How can  a force within my mind – operating mostly outside of my awareness – shape my life? As startling as this is, I am more and more convinced and in awe that the unconscious exists and exerts a seemingly confusing influence upon us toward self-destructive behaviors.

 In the 1900s, Freud asserted the existence of the unconscious (although not coining the term) and brought psychological light to its nature when he began psychoanalysis. He discovered patients consistently suffered from “not knowing” memories, experiences and intentions that he felt were clearly part of the patient’s history but repressed, or otherwise “asked to leave” the stage of conscious awareness. (For the sake of this article, please forgive Freud for asserting things about patients that are now considered questionable in light of the progress and cultural changes in the field since that era.)

 First, unconscious thoughts, feelings, and impulses occur in a wordless state, mostly outside of conscious awareness. Not to say they can’t be known, nor were never known – how else could one repress without distinguishing between which thoughts and feelings are worth repressing and which are not? It’s more accurate to say that the unconscious is “dimly aware,” not completely unaware.

Second, the unconscious behaves as a primitive or archaic structure of the mind, akin to an adolescent development stage, full of feelings, ideas, wishes, and thoughts but without the cohesiveness and structure of the conscious mind. Evolution seems to have programmed us to avoid physical dangers and we have a built-in fear of snakes and spiders to prove it. However, we head toward familiar and yet emotionally dangerous realities without the same built-in warning signals, and we find ourselves making repeated emotional mistakes.

Third, the unconscious thinks with pronoun blindness. It is a reservoir of thoughts, feelings, and structure that constitutes 90% of what you feel, but it is bad with names. When I suggest to patients “your unconscious is confusing mother and lover,” I am clarifying that although the patient intellectually and consciously knows that his mother and lover are different, his unconscious does not and the attachment and feelings toward one have melded into the other. One side effect of this melding is the experience by the spouse that his/her partner is harming him in the same way he felt harmed in his childhood experience by his mother or central caregiver (I think that we are all “harmed” to some degree in childhood insofar as we are powerless to choose differently for ourselves, and we are helpless to the tide of our parents emotional and lived-out realities. One of the essentials of trauma is helplessness, which all children have to contend with daily by way of parental and adult authority).

Remember that the unconscious is a powerful but primitive part of our mind fueling our impressions, beliefs, and attitudes toward the world and others. However, these unconscious impressions do not always distinguish events in the distant past from recent events, particularly if the present pain mirrors central early pain. We continuously experience and re-experience past traumatic memories sometimes referred to as micro-traumas by an unconscious which is wordless, primitive, temporally-confused (time-confused), and pronoun-confused and therefore naturally looking for someone to “assign” the trauma.

For this reason, spouses mistakenly blame one another for emotional harm and are unaware that their unconscious process has contributed to framing their spouse. “Sacred blame” best describes the specific kind of blame that unfolds within marriage as having a structure of justification around it, analogous to the “sacred violence” exchanged between Israel and Palestine. The unconscious’ structure fuels feelings of victimization that each spouse has toward one another because of its blindness despite the conscious mind knowing better.

For example, it’s reasonable to believe a person with a distant and unaffectionate relationship with his mother would seek a loving spouse to fulfill his need for adequate affection and love. If we interviewed him before seeking a mate, he would claim and believe that he set himself on a course of finding someone that met his needs, not one that duplicated his past hurt. In this claim, he would be responding to his conscious intention and would find attracting an unaffectionate spouse absurd. However, he actually does what he intends not to do; seeks out and becomes attracted to a spouse who happens to injure him in the unique way in which he has always felt injured, leaving him re-experiencing the hurt and dejection of his childhood!

His unconscious attraction is pointing him unknowingly toward someone who helps him recreate his early harm and his unconscious has a “blindness” from knowing he is doing so. The unconscious is clumsily compelled to tell its story to the conscious mind by way of recreating early pain in present relationships and in this sense it “thinks in Braille”. The unconscious does not recreate the specific events of our childhood, it points us toward recreating the specific state of mind that follows those early events which is why it is so challenging in therapy to make these kind of connections clearly.

The eureka moment in therapy is the realization that early painful experiences cannot tolerate being left unheard, and if we repress or suppress the pain and grief related to those experiences, our unconscious will point us toward repeating that pain until we surrender ourselves to grieving and naming it.

Most patients feel guilty and ashamed coming to terms with their own hand in the creation of their current life pain. However, it is in the process of taking this responsibility that we indirectly find autonomy and begin to experience life as within our control to shape and define. To the extent that we fight against grief and deny or disavow ourselves from relationship with our inner life, suffering, and woundedness we invite the unconscious to transmit those realties into our daily lives. Healing involves a process of allowing early memories and realities to emerge and be honored, and cannot be willed away.

Freud’s Original Paper on the ‘Repetition Compulsion’

Instead of writing an article, I included an original work by Freud defining the ‘repetition compulsion’ concept referred to in previous articles. The parenthetic comments are my explanations or definitions provided to make the reading more accessible.

Keep in mind this was written in 1914 following Freud’s decision to abandon hypnosis and provides an introduction to psychoanalytic technique as it is practiced today. The major shift in technique involves the patient freely recalling anything that comes to mind, while the analyst attempts to understand what is known as ‘transference.’

Transference refers to the observation that patients unconsciously transfer feelings toward the therapist and unconsciously treat the therapist as the parent (or central caregiver) in an attempt to resolve early pain, trauma, etc. With this new technique, Freud’s aim was to help the patient understand the way in which they were unconsciously recreating their central pain within the context of the therapy. Freud believed making this phenomenon known to the patient helped cure symptoms.

According to The Source published in June 2001, “During transference, people turn into a ‘biological time machine.’” A nerve is struck when someone says or does something that reminds you of your past. This creates an “emotional time warp” that transfers your emotional past and your psychological needs into the present.

Freud came to the understanding of ‘transference’ when he realized that each patient projected their old pain onto him and experienced him as the source of their original pain. One patient may have described him as “warm and open” and the next as “critical and harsh.” This realization informed his style of analysis toward taking a neutral, somewhat blank stance toward the patient allowing ample room for the patient to ‘transfer’ and make him whatever they needed to in order to resolve feelings and understand transference as a projection.

The article also refers to ‘resistance,’ another challenging analytic term. The simplest way of thinking about resistance is the refusal of the patient to accept the course of treatment and the analyst’s interpretations. The reasons  are complex; however, I think about it as the patient’s unconscious expectation that the analyst will hurt them in the very way that the repetition predicts. This leads to the client’s refusal to allow in what the analyst says and until pointed out, a ‘resistance’ to treatment interferes with progress.

XXXII

FURTHER RECOMMENDATIONS IN THE TECHNIQUE OF PSCHO-ANALYSIS

Recollection, Repetition, and Working Through

It seems to me not unnecessary constantly to remind students of the far-reaching changes which psychoanalytic technique has undergone since its first beginnings. Its first phase was that of Breuer’s catharsis, direct concentration upon events exciting symptom formation and persistent efforts on this principle to obtain reproduction of the mental processes involved in that situation, in order to bring about a release of them through conscious operations. The aims pursued at that time, by the help of the hypnotic condition, were ‘recollection’ and ‘abreaction’ (abreaction is an analytic term meant to describe the release of emotion achieved through the recall of past trauma, analogous to ‘lancing the boil’). Next, after hypnosis had been abandoned, the main task became that of diving from the patient’s free associations what he failed to remember. Resistances were to be circumvented by the work of interpretation and by making its results known to the patient; concentration on the situations giving rise to symptom-formation and on those which lay behind the outbreak of illness was retained, while abreaction receded and seemed to be replaced by the work the patient had to do in overcoming his critical objections to his associations, in accordance with the fundamental psychoanalytic rule. Finally, the present-day technique evolved itself, whereby the analyst abandons concentration on any particular element or problem, contents himself with studying whatever is occupying the patient’s mind at the moment, and employs the art of interpretation mainly for the purpose of recognizing the resistances which come up in regard to this material and making the patient aware of them. A rearrangement of the division of labor results from this; the physician discovers the resistances which are unknown to the patient; when these are removed the patient often relates the forgotten situations and connections without any difficulty. The aim of these different procedures has of course remained the same throughout: descriptively, to recover the lost memories; dynamically, to conquer the resistances caused by repression.

One is bound to be grateful still to the old hypnotic technique for the way in which it unrolled before us certain of the mental processes of analysis in an isolated and schematic form. Only this could have given us the courage to create complicated situations ourselves in the analytic process and to keep them perspicuous (transparent and clear).

Now in those days of hypnotic treatment recollection took a very simple form. The patient put himself back in an earlier situation, which he seemed never to confound with the present, gave an account of the mental processes belonging to it, in so far as they were normal, and appended to this whatever conclusions arose from making conscious what had before been unconscious.

I will here interpolate (add on) a few observations which every analyst has found confirmed in his experience. The forgetting of impressions, scenes, events, nearly always reduces itself to ‘dissociation’ of them. When the patient talks about these ‘forgotten’ matters he seldom fails to add: ‘In a way I have always known that, only I never thought of it’. He often expresses himself as disappointed that not enough things come into his mind which he can hail as ‘forgotten’, which he has never thought of since they happened. Even this desire on his part is fulfilled, however, particularly in cases of conversion-hysteria (this refers to when psychological symptoms are expressed as bodily ailments). The ‘forgotten’ material is still further circumscribed (to enclose or define within boundaries) when we estimate at their true value the screen-memories (screen-memories are memories that patient’s recall about childhood that symbolize the psychological reality of the past without necessarily being an actual account of something that happened in the past). which are so generally present. In many cases I have had the impression that the familiar childhood-amnesia, which is theoretically so important to us, is entirely outweighed by the screen-memories. Not merely is much that is essential in childhood preserved in them, but actually all that is essential. Only one must understand how to extract it from them by analysis. They represent the forgotten years of childhood just as adequately as the manifest content represents the dream-thoughts.

The other group of mental processes, the purely internal mental activities, such as fantasies, relations between ideas, impulses, feelings, connections, may be contrasted with impressions and events experienced, and must be considered apart from them in its relation to forgetting and remembering. With these processes it particularly often happens that something is ‘remembered’ which never could have been ‘forgotten’, because it was never at any time noticed, never was conscious; as regards the fate of any such ‘connection’ in the mind, moreover, it seems to make no difference whatever whether it was conscious and then was forgotten or whether it never reached consciousness at all. The conviction which a patient obtains in the course of analysis is quite independent of remembering it in that way.

In the manifold (various) forms of obsessional neurosis particularly, ‘forgetting’ consists mostly of a falling away of the links between various ideas, a failure to draw conclusions, an isolating of certain memories.

No memory of one special kind of highly important experience can usually be recovered; these are experiences which took place in very early childhood, before they could be comprehended, but which were subsequently interpreted and understood. One gains a knowledge of them from dreams, and is compelled to believe in them on irresistible evidence in the structure of the neurosis; moreover, on can convince oneself that after his resistances have been overcome the patient no longer invokes the absence of any memory of them (sensation of familiarity) as a ground for refusing to accept them. This matter, however is one demanding so much critical caution and introducing so much that is novel and startling that I will reserve it for special discussion in connection with suitable material.

To return to the comparison between the old and the new techniques; in the latter there remains very little, often nothing, of this smooth and pleasing course of events belonging to the former. There are cases which, under the new technique, conduct themselves up to a point like those under the hypnotic technique and only later abandon this behavior; but others behave differently from the beginning. If we examine the latter class in order to define this difference, we may say that here the patient remembers nothing of what is forgotten and repressed, but that he expresses it in action. He reproduces it not in his memory but in his behavior; he repeats it without of course knowing that he is repeating it.

For instance, the patient does not say that he remembers how defiant and critical he used to be in regard to the authority of his parents, but he behaves in that way towards the physician. He does not remember how he came to a helpless and hopeless deadlock in his infantile searchings after the truth of sexual matters, but he produces a mass of confused dreams and associations, complains that he never succeeds at anything, and describes it as his fate never to be able to carry anything through. He does not remember that he was intensely ashamed of certain sexual activities, but he makes it clear that he is ashamed of the treatment to which he ahs submitted himself, and does this utmost to keep it a secret; and so on.

Above all, the beginning of the treatment sets in with a repetition of this kind. When one announces that fundamental psycho-analytical rule to a patient with an eventful life-history and a long illness behind him, and then waits for him to pour forth a flood of information, the fist thing that happens often is that he has nothing to say. He is silent and declares that nothing comes into his mind. That is of course nothing but the repetition of a homosexual attitude (this was an attitude that prevailed with Freud and had more to do with the Victorian culture within which he was working, not a current view among most analysts), which comes up as a resistance against remembering anything. As long as he is under treatment he never escapes from this compulsion to repeat; at last one understands that it is his way of remembering.

The relation between this compulsion to repeat and the transference and resistance is naturally what will interest us most of all. We soon perceive that the transference is itself only a bit of repetition, and that the repetition is the transference of the forgotten past not only on to the physician, but also on to all the other aspects of the current situation. We must be prepared to find, therefore, that the patient abandons himself to the compulsion to repeat, which is now replacing the impulse to remember, not only in his relation with the analyst but also in all other matters occupying and interesting him at the time, for instance, when he falls in love or sets about any project during the treatment. Moreover, the part played by resistance is easily recognized. The greater the resistance the more extensively will expressing in action (repetition) be substituted for recollecting. The ideal kind of recollection of the past which belongs to hypnosis is indeed a condition in which resistance is completely abrogated (let go, released). If the treatment begins under the auspices of a mild and unpronounced positive transference, it makes an unearthing of memories like that in hypnosis possible to begin with, while the symptoms themselves are for the time quiescent; if then, as the analysis proceeds, this transference becomes hostile or unduly intense, consequently necessitating repression, remembering immediately gives way to expression in action. From then onward the resistances determine the succession of the various repetitions. The past is the patient’s armory out of which he fetches his weapons for defending himself against the progress of the analysis, weapons which we must wrest from him one by one.

The patient reproduces instead of remembering, and he reproduces according to the conditions of the resistance; we may now ask what it is exactly that he reproduces or expresses in action. The answer is that he reproduces everything in the reservoirs of repressed material that has already permeated his general character – his inhibitions and disadvantageous attitudes of mind, his pathological traits of character. He also repeats during the treatment all his symptoms. And now we can see that our special insistence upon the compulsion to repeat has not yielded any new fact, but is only a more comprehensive point of view. We are only making it clear to ourselves that the patient’s condition of illness does not cease when his analysis begins, that we have to treat his illness as an actual force, active at the moment, and not as an event in his past life. This condition of present illness is shifted bit by bit within the range and field of operation of the treatment, and while the patient lives it through as something real and actual, we have to accomplish the therapeutic task, which consists chiefly in translating it back again into terms of the past.

Causing memories to be revived under hypnosis gives the impression of an experiment in the laboratory. Allowing ‘repetition’ during analytic treatment, which is the last form of technique, constitutes a conjuring into existence of a piece of real life, and can therefore not always be harmless and indifferent in its effects on all cases. The whole question of ‘exacerbation of symptoms during treatment’, so often unavoidable, is linked up with this.

The very beginning of the treatment above all brings about a change in the patient’s conscious attitude towards his illness. He has contented himself usually with complaining of it, with regarding it as nonsense, and with underestimating its importance; for the rest, he has extended the ostrich-like conduct of repression which he adopted towards the sources of his illness on to its manifestations. Thus it happens that he does not rightly know what are the conditions under which his phobia breaks out, has not properly heard the actual words of his obsessive idea or not really grasped exactly what it is his obsessive impulse is impelling him to do. The treatment of course cannot allow this. He must find the courage to pay attention to the details of his illness. His illness itself must no longer seem to him contemptible, but must become an enemy worthy of his mettle, a part of his personality, kept up by good motives, out of which things of value for his future life have to be derived. The way to reconciliation with the repressed part of himself which is coming to expression in his symptoms is thus prepared from the beginning; yet a certain tolerance towards the illness itself is induced. Now if this new attitude towards the illness intensifies the conflicts and brings to the fore symptoms which till then had been indistinct, one can easily console the patient for this by pointing out that these are only necessary and temporary aggravations, and that one cannot overcome an enemy who is absent or not within range. The resistance, however, may try to exploit the situation to its own ends, and abuse the permission to be ill. It seems to say: ‘See what happens when I really let myself go in these things! Haven’t I been right to relegate them all to repression?’ Young and childish persons in particular are inclined to make the necessity for paying attention to their illness a welcome excuse for luxuriating in their symptoms.

There is another danger, that in the course of the analysis, other, deeper-lying instinctual trends which had not yet become part of the personality may come to be ‘reproduced’. Finally, it is possible that the patient’s behavior outside the transference may involve him in temporary disasters in life, or even be so designed as permanently to rob the health he is seeking of all its value.

The tactics adopted by the physician are easily justified. For him recollection in the old style, reproduction in the mind, remains the goal of his endeavors, even when he knows that it is not to be obtained by the newer method. He sets about a perpetual struggle with the patient to keep all the impulses which he would like to carry into action within the boundaries of his mind, and when it is possible to divert into the work of recollection any impulse which the patient wants to discharge in action, he celebrates it as a special triumph for the analysis. When the transference has developed to a sufficiently strong attachment, the treatment is in a position to prevent all the more important of the patient’s repetition-actions and to make use of his intentions alone, in statu nascendi, as material for the therapeutic work. One best protects the patient from disasters brought about by carrying his impulses into action by making him promise to form no important decisions affecting his life during the course of the treatment, for instance, choice of a profession or of a permanent love-object, but to postpone all such projects until after recovery.

At the same time one willingly accords the patient all the freedom that is compatible with these, restrictions, nor does one hinder him from carrying out projects which, though foolish, are not of special significance; one remembers that it is only by dire experience that mankind ever learns sense. There are no doubt persons whom one cannot prevent from plunging into some quite undesirable project during the treatment and who become amenable and wiling to submit the impulse to analysis only afterwards.  Occasionally, too, it is bound to happen that the untamed instincts assert themselves before there is time for the curbing-rein of the transference to be placed on them, or that an act of reproduction causes the patient to break the bond that holds him to the treatment.  As an extreme example of this, I might take the case of an elderly lady who had repeatedly fled from her house and her husband in a twilight state, and gone no one knew where, without having any ides of a motive for this ‘elopement.’  Her treatment with me began with a marked positive transference of affectionate feeling, which intensified itself with uncanny rapidity in the first few days, and by the end of a week she had ‘eloped’ again from me, before I had time to say anything to her which might have prevented this repetition.

The main instrument, however, for curbing the patient’s compulsion to repeat and for turning it into a motive for remembering consists in the handling of the transference.  We render it harmless, and even make use of it, by according it the right to assert itself within certain limits.  We admit it into the transference as to a playground, in which it is allowed to let itself go in almost complete freedom and is required to display before us all the pathogenic impulses hidden in the depths of the patients mind.  If the patient does but show compliance enough to respect the necessary conditions of the analysis we can regularly succeed in giving all the symptoms of the neurosis a new transference-colouring, and in replacing his whole ordinary neurosis by a ‘transference-neurosis’ of which he can be cured by the therapeutic work.  The transference thus forms a kind of intermediary realm between illness and real life, through which the journey from the one to the other must be made.  The new state of mind has absorbed all the features of the illness; it represents, however, an artificial illness which is at every point accessible to our interventions.  It is at the same time a piece of real life, but adapted to our purposes by specially favourable conditions, and it is of a provisional character.  From the repetition-reactions which are exhibited in the transference the familiar paths lead back to the awakening of the memories, which yield themselves without difficulty after the resistances have been overcome.

I might break at this point but for the title of this paper, which requires me to discuss a further point in analytic technique.  The first step in overcoming the resistance is made, as we know, by the analyst’s discovering the resistance which is never recognized by the patient, and acquainting him with it.  Now it seems that beginners in analytic practice are inclined to look upon this as the end of the work.  I have often been asked to advise upon cases in which the physician complained that he had pointed out his resistance to the patient and that all the same no change had set in; in fact, the resistance had only then become really pronounced and the whole situation had become more obscure than ever.  The treatment seemed to make no progress.  This gloomy foreboding always proved mistaken.  The treatment was as a rule progressing quite satisfactorily; only the analyst had forgotten that naming the resistance could not result in its immediate suspension.  One must allow the patient time to get to know this resistance of which he is ignorant to, to ‘work through’ it, to overcome it, by continuing the work according to the analytic rule in defiance of it.  Only when it has come to its height can one, with the patient’s co-operation, discover the repressed instinctual trends which are feeding the resistance; and only by living then through in the way will the patient be convinced of their existence and their power.  The physician has nothing more to do than to wait and let things take their course, a course which cannot be avoided nor always be hastened.  If he holds fast to this principle, he will often be spared the disappointment of failure in cases where all the time he had conducted the treatment quite correctly.

This ‘working through’ of the resistances may in practice amount to an arduous task for the patient and a trial of patience for the analyst.  Nevertheless, it is the part of the work that effects the greatest changes in the patient and that distinguishes analytic treatment from every kind of suggestive treatment.  Theoretically one may correlate it with the ‘abreaction’ (abreaction is an analytic term meant to describe the release of emotion achieved through the recall of past trauma, analogous to ‘lancing the boil’) of quantities of affect pent-up by repression, without which the hypnotic treatment remained ineffective.

First published in Zeitschrift, Bd. II., 1914: reprinted in Sammlung, Vierte Folge. (Translated by Joan Riviere).

Toxic Blame in Marriage

We are consciously aware of the positive attributes that attracted us to our spouse or partner. We thought they were attractive, funny, charming etc. and we for the most part do not consciously consider the negative attributes of the partner during courtship. However, there was something else compelling about the potential partner that was drawing you toward the relationship. This article explores the unconscious process of our negative attraction to our spouse, and the way in which the negative attraction creates an interlocking pathology that often leaves both feeling disillusioned. Understanding negative attraction ultimately sheds light on why marriage is designed for disillusionment, and that the purpose of the disillusionment is to re-tell the untold childhood story of each spouse within the safety of the marriage. Most marriages stall at the fork in road created from these feelings of disillusionment, and never understand the lessons and opportunity built in to this experience.

Interlocking pathology means I hurt you in a specific way that complements the way in which you hurt me so that our hurting has an “aggressor and victim” cycle leading to an endless series of hurtful feelings with no end. I’ve written previously on Freud’s concept of the “repetition compulsion” which he used to describe the way in which undigested pain in our lives resides within us on an unconscious plane. The pain attempts to express itself (as if of its own mind) by provoking us to re-create central pain in our lives where we previously aborted or disallowed a complete grieving process.

(The following case is for illustrative purposes only, and does not reflect an actual case or patient)

For example, imagine a typical case consultation of a couple seeking therapy. Mrs. Smith complains that her husband is neglectful, uncaring, distant and lacks intimacy. Mr. Smith complains his wife is overbearing, critical, hostile, nagging, and that she does not truly love him.

Upon interviewing the couple, a story emerges about each spouses’ childhood that bears an eerie parallel to the specifics of the complaints about each other. Mr. Smith describes at two years of age, his father leaving the home and how embattled he and his mother became. His mother was suffocating and over- involved in his life in a hostile, invading manner. As a teenager he left home for long periods simply to avoid his mother’s intrusiveness and criticism.

Mrs. Smith reports while her parents remained married, her father was an alcoholic, extremely withdrawn and dismissive and her mother played the classic enabler role. She remembers awaking to intense screaming and fighting coming through her parents’ bedroom walls. The marriage motto seemed to be “stay together at all costs,” no matter how bad the marriage or how severe the father’s alcoholism. She reported feeling her father was emotionally unavailable and feeling unwanted by him.

If you listen to each story with regard to the relationship with the parents, some striking parallels emerge. Mr. Smith reports his wife is ‘always on his case,’ feeling criticized by her and fundamentally unwanted and unloved. Mr. Smith is so angry at Mrs. Smith that he refuses intimacy with her, despite desperately wanting connection, because of how unsafe and overbearing it feels for him to be in relationship. Mrs. Smith feels that Mr. Smith does not want her, refuses intimacy, and has numbed to her very existence. Mrs. Smith feels trapped in the marriage and resigned herself to a life of unfulfilled needs.

We frequently change pronouns in the stories we tell ourselves about who has hurt us. In other words, Mr. Smith to some extent replaced “his mother” with “my wife” in how she “intrudes upon me, criticizes me and does not love me safely.”  Mrs. Smith also amplifies her experience of her husband insofar as her lingering pain and feelings of rejection from her father color and shape the way she interprets the meaning of her husband’s aloofness.

Freud argued that central (unconscious) pain was unwittingly repeated in our adult lives in an effort to master early pain we experienced during the profound helplessness of childhood. Since resolving our painful feelings and unwanted realities is impossible during childhood, the grief becomes latent and “lies in wait” until there is enough safety and control in our adult lives for a replay of the earlier pain to be enacted in the hope of gaining mastery of these early experiences.

The uncanny ability of each spouse to detect in the other the personality characteristics and patterns that make re-injury by a loved one most likely to occur is striking! This explains the unspoken aspects of attraction, the so-called negative attraction that draws us to pick a mate so suited to hurt us in the unique way that helps erupt old pain.

Marriage in this sense becomes an emotional vehicle in our unending attempts as humans to master old pain. I refer to it as the “Myth of Mastery” in the sense that we cannot resolve early pain by holding our spouse accountable for pain that they have not caused. Each spouse is asking the other to apologize for pain for which they are not responsible – the pain with a capital P. I notice by way of observing divorced friends and relatives that remarry the shocking resemblance of the new spouse to the old. A person’s ability to recreate old pain with a new spouse is eerie.

While there are exceptions, in most cases divorce is the ultimate unconscious attempt to master old pain and to mistakenly attribute old pain to the rejected spouse. Divorce is tempting because it is fed by an illusion of mastery over experiences that cannot be resolved by action. Resolution of pain comes by embracing the helpless reality that we experienced in childhood (and beyond); that feeling pain and allowing ourselves room to grieve fundamentally is an act of letting go of control, and grieving over experiences that cannot be changed.

The process of couples’ therapy primarily involves helping make the connection between old pain and the current state of disillusionment within the marriage. Bearing the disillusionment while making these connections helps couples realize that the intensity and conviction of their feelings of victimization requires some skepticism and perspective. Each can take responsibility for having unknowingly picked a partner so closely resembling the parental figures of the past, and both can be absolved from the fuel of conflict – early, incomplete pain that intertwined itself with the real-world conflict inherent in marriage. If both listen to the other’s childhood stories and appreciate the unique way in which their current behavior mimics each other’s earlier pain, this naturally leads to empathy between the couple. It also makes room for the couple to release each other from having to apologize for the Pain, which removes toxic blame. When toxic blame is transcended, love and intimacy spontaneously arise in a safe, holding environment without direction from the therapist.

Depression, Suffering, Grief and the Power of Language

If I began this paragraph with a racial epitaph, you would experience an immediate, intense, visceral and cognitive reaction that automatically restructured your thinking in ways that you could not defend. Only those with extensive training could alter the cognitive and emotional impact of hearing that kind of word. In other words, the language and the specific words we choose have an important and powerful impact on the listener or reader that is often underestimated. Some words have more power and meaning than others; an error in describing a car part is less important than an error a neurosurgeon makes during an operation.

Words used by the public and mental health practitioners have a power and danger akin to the neurosurgeon’s language. There is not a more worn-out, overused, misused, and misguided word thrown around the mental health field than the “d” word (depression). Imprecise phrases such as “I am so depressed about that grade,” or the commercials describing the standard symptoms of depression (irritability, loss of appetite, feelings of sadness, sleep disruption, etc.) create a cognitive and emotional reality that leads us to sometimes inaccurately attribute all bad feelings to depression. When we assign all of our bad feelings to a concept such as depression, we are susceptible to search for strictly biological remedies such as the latest pill for depression. I chuckle when I see these ads because I wonder who wouldn’t qualify for a list like that? All people feel at least some of those things everyday, and all of those things over a lifetime.

Depression, suffering, and grief are relatives but not the same. It is extremely important to split hairs when it comes to their definition. Suffering is unavoidable pain that we feel moment to moment that is part of being a human being. We live in a world that is not necessarily working against us, but it is at best benignly defying us and requiring effort and persistence that often involves suffering. We also suffer because of the many things in life that are out of our control; death, loss, the complexity of relationships, and our feelings. Suffering is similar to depression but our society makes room for the low-lying, persistent, and ordinary feelings of suffering; it’s normalized.

Grief is very commonly confused with depression and often the symptoms present as similar, if not identical to depression, except when someone is grieving they typically are not feeling the shame and self-loathing of depression (a point made by Freud in Mourning and Melancholia). Grief is refreshing because it is not clouded or mysterious in origin. If we lose a loved one, we grieve and we know why. Grief feels temporary, whereas depression feels permanent and suffering is a permanent reality. When grieving begins, I feel deeply affected and altered, however, each day I sense I am progressing and in time healing will occur without outside intervention. Our minds are self-healers when grief is felt, acknowledged and allowed to run its course.

Depression is an experience of intense feelings identical to grief other than two major differences. First, we don’t know exactly “why” we are depressed. We are mostly puzzled and suffering from an unidentified antagonist and the cause is internal, not from an external event (or at least not a clear one). Second, self-loathing is keen and incisive, and involves the magical thinking of a child in that when a depressed person is trying to explain his feelings, he is looking to blame himself first for a crime he did not commit. Listening to a depressed person speak is similar to listening to dream-language; the meaning of the feelings are unclear and symbolic.

Psychotherapy will only become unnecessary when there is pill for grief. What we often mistakenly refer to as depression is really recurring and unmetabolized grief or suffering that needs to be brought to consciousness so the mind can heal itself. To my patient’s suprise, when I treat the pain of “depression” I rarely eliminate the pain. I change their relationship with depression from a vague, meaningless, incomprehensible pain into meaning-making relationship. I accomplish this mostly through “trianglular listening” as described in an earlier essay in which the significance of their grief is felt and understood as connected to meaningful experiences in their lives in which a grieving process was previously skipped over, incomplete, or not allowed.

Understanding Triangular Listening in Therapy

When a therapist is listening to a patient tell a story, he is listening uniquely in order to identify the story’s theme and wondering what traumatic story is being re-told that echoes an earlier traumatic circumstance.  The therapist is also wondering when he will become the pronoun in the story, and knowing when he does, it will allow for a deepening conversation which utilizes the concept of “triangular listening”.

For example, a patient told me a story about how his boss was untrustworthy and unfairly treating him. He felt his boss was “only interested in profit” and was disregarding his unique needs and was leaving him feeling unrecognized and unappreciated. Upon listening to this story I was thinking two things: first, if you change the pronoun in the story and replace “the boss” with “the therapist” that the patient in all likelihood has hidden feelings of being taken advantage of by me, and he feels I am under-appreciating him and somehow at risk for taking advantage of him. Second, I am wondering about how “the boss” pronoun could be substituted with “my father” (for example) and he may be telling me a story about an original traumatic wound in which he felt marginalized and underappreciated by his father whom he felt was untrustworthy and self-interested.

In making this connection between the current story of the patient, his hidden feelings toward the therapist, and his father I am making a therapeutic triangle in my mind between the present experience (the boss), the past original trauma (the father), and the patient’s experience of me (the transference).

What I often do in this circumstance is I attempt to understand the connection between the three so that the patient decreases his conviction about the significance of the boss, and broadens his perspective to understand that he may be experiencing me in that same way and having a hard time saying that directly. If the patient accepts this premise, then we can begin to search and become curious together about what the significance of the story is in terms of his early experience. The patient often makes the connection at that point to his early experience so that he can identify the connection between latent feeling about his relationship with his father and the way that those unresolved feeling mirror themselves and color the way in which he experiences other significant relationships in his life.

It doesn’t mean that his boss is or is not self-interested, etc. and I make no attempt to challenge the reality of the way in which he experiences him. I simply ask the question (without directly asking) “why is this story significant?” and “why is this particular experience so meaningful that it has come to mind again and again in therapy?” When this triangular connection is shaped by the therapist, the patient is more likely to heal from the original wound, and less prone to shape his current experiences in ways that repeat old pain.

If it only were as simple as ADHD

The probability that your child will be diagnosed with a particular mental illness has as much to do with trends in the mental health field and the “lens” of the doctor than it does with the symptoms that you may be describing to the doctor or therapist.

When I worked on an inpatient psychiatric unit that worked with severely mentally ill children, we had a running joke with regard to the diagnoses that the children received because it varied so much depending upon which of our psychiatrists saw the child. We had the psychiatrist who diagnosed almost every child with ADHD, and another who saw almost every child as having latent Bipolar Disorder. Needless to say, my confidence in the accuracy of the diagnoses I saw with these children lowered each day that I encountered yet another diagnostic flip-flop between each doctor.

It was also unfortunate for the kids who may have benefitted from  either diagnosis if it were possible to know definitively it was accurate. But how were we to know? The standard response from the psychiatrists was to try the medication and see if it helps. The theory was that if the medication helped, we could deduce through reverse engineering that they must have had the diagnosis for which the medication is commonly prescribed.

I’d hardly call that a scientific approach. A majority of the population would positively respond to Ritalin. We’d focus better, complete more tasks, complete tasks that we had been delaying for years, and our concentration would make it appear to an outside observer that we were calmer. Does this mean that we all have ADHD and don’t know it? Of course not.

Understanding the mind and the complexity of human experience requires an organic, whole process. When the mental field divided diagnoses into five hundred different parts in an attempt to mirror the structure of the medical field it advanced itself in the sense that certain diagnoses could be teased out and understood in more powerful ways. This helps the patient’s medication management in particular so that the right class of medication is attempted with regard to the particular diagnosis.

However, when the field fractured into five hundred little pieces it also set itself back a hundred years. A child who has attentional issues is having these symptoms potentially for several reasons, some of which would benefit from understanding and psychotherapy. Many, many children who are struggling with family issues (parental discord, e.g.) express that in the form of symptoms commonly referred to as ADHD. Many children that are depressed begin acting out in ways also confused with ADHD, and the problem is that if we only medicate this child, and never inquire deeper, how will the origin of this child’s symptoms ever be fully understood and resolved?

Freud’s Masterpiece: The Repetition Compulsion

It is confusing to contemplate what motivates someone like Halle Berry to repeatedly select an abusive, philandering husband despite her conscious intention to select someone trustworthy. It raises one of the most important questions that can be asked about human nature — why do we hurt ourselves? And why do we do so repeatedly as if on automatic pilot? Furthermore, why are relationships (particularly marriage) simultaneously damaging and an opportunity to heal. Something negative about our spouse attracted us to them in ways that we were not consciously processing during courtship, and it is within our negative experiences of them that we have the opportunity to heal from our original (unmetabolized) wounds.

Freud defined the repetition compulsion as the repeated pattern of self-harm that is motivated by an unconscious force (something he termed “the death instinct”). He apparently conceived of the notion during sessions with a female child he was treating who had been abandoned by her mother. He was fascinated to witness the child re-enact the “scene” of her mother’s abandonment by repeatedly throwing a doll over the couch and saying goodbye to it. She enacted this scene over and over again in front of him without conscious awareness that she represented the abandoned child.

Freud recognized at the time that he was witnessing an aspect of human nature fundamental to who we are. Namely, that when we are traumatized (which we are all to varying degrees) and we are unable to grieve our suffering, that our disconnected awareness of the original trauma leads to an impulse to recreate the feelings and mind state of the original trauma. The way that we “remember” lies within understanding who we attract into our lives, and in particular the way we shape our perceptions of how others treat us. From an unconscious point of view, we recreate our original pain as if we are the amnesic director of a play about our early lives. The oddity is that we are the only ones participating in the play who have lost the script!

Therapy offers the patient the opportunity to examine the gap between the early pain of life that was too unbearable to process or understand and the stories we tell ourselves as adults about the repeated ways in which we are harmed by others. Most patients realize through this process that the theme of the stories they tell have an eerie mirroring quality, as if they have simply switched pronouns in each retelling of painful experiences from the past and present.

Does this mean that Halle Berry “caused” her own pain? Yes and no. Yes in the sense that she very deliberately picked men in her life (unconsciously) who were most likely to act-out in her marriage in ways that repeated early childhood abuse that she suffered from her father.  And yes in the sense that she may have even provoked rage and anger in these men. However, mostly no in the sense that since her early abuse was unthinkable and unbearable, she didn’t know that she was the doll being thrown! She picked them without knowing why she was drawn to a personality style that was likely to recreate such painful feelings for her.

This brings us to the most important question: Why do we behave in self-destructive ways? Why don’t we simply say to ourselves “I will pick someone unlike my father, etc. who will treat me with respect, and kindness”.  Freud was puzzled by this question. He termed the phrase “the death instinct” to describe our self-destructive tendencies and he thought that there was a force in human nature as strong as the life instinct working in opposition to those things that are good for us. This concept still exists in analytic circles (in particular with therapists from the object/relations camp) as a viable explanation. However,  it falls a bit short in understanding why we engage in such irrational behavior. In my opinion, the death instinct explanation is the equivalent to saying that “evil” exists without explaining why it exists.

The preferred explanation described by Existential Psychotherapists is that the motivatation to re-enact early painful experiences is simply the fact that we are built to complete our original grieving. In other words, we cause ourselves new (mirroring) pain so that we can bring our early pain out of an unconscious state into conscious grieving that ultimately completes the arrested healing process, increasing our wholeness and our authenticity.

The Power of Psychotherapy is Lost in a Culture of Biological Determinism

We’re fortunate on the one hand to live in a culture with such an advanced medical system, however, the medical establishment’s territorial claims over many mental health issues as well as other conditions such as addiction have DECREASED the likelihood of the general public receiving the appropriate treatment and help for those conditions.

I’m unsure how the territorial infringements first began. I think it began because the mental health field was younger and beginning development in the early part of the century and it desperately wanted recognition from the medical establishment. One of the ways it received recognition from the medical establishment was to mirror the medical establishments structure of diagnosis and treatment. In other words if you have a skin condition, the diagnosis that you receive means everything in terms of the proper treatment being delivered. However, the mental health field is a trickier matter. I may treat several patients with the same “disorder” from different points of view and each of them demand that I do so insofar as they each have a unique life history, personality, and resiliency.  Therefore, diagnosis points in a certain direction with treatment and is important and sometimes crucial in working with mental health patients, but the link between the diagnosis and treatment is vague, and there will never be a pill for every possible variety of neurosis.

I’ve met with several families who have been victimized by the biological determinism overpowering the mental health field currently. Most of them have received a diagnosis from a primary care physician when the child is young and the parents and doctor together have from that point on approached that child’s condition as if it is a simple matter of cause (a broken brain) and effect (misbehavior or other mental health symptoms). Most of these parents are disillusioned to realize that after years of dispensing psychotropic medication to their child, they have not come any closer to treating the underlying structure of the condition. If they return to the doctor or psychiatrist to complain, they are often prescribed additional medication and/or diagnoses without deepening their understanding of the nature of their child’s condition.

Don’t get me wrong, I am not one who disbelieves in the efficacy of all psychotropic medication. It is especially beneficial to those with Bipolar disorder and Schizophrenia and not particularly helpful for the other 498 mental health conditions listed in the diagnostic and statistical manual for mental health disorders. And even for those with psychotic disorders such as Bipolar and Schizophrenia medication alone is not enough to treat the condition nor enough to adequately understand the etiology of the symptoms.

What you are not going to hear on Oprah is that the brain and environment are a two-way street. The mental health field is in an era that currently distorts the complexity and interactivity of nature versus nurture when it comes to understanding a variety of mental health conditions and addictions. Understanding mental health symptoms cannot be reduced to thinking that “a broken brain is causing broken behavior” in a linear one-directional manner. Certainly the brain is affected by and sometimes structurally changed by mental health conditions, however, the environment is a powerful, powerful force in having shaped those changes and is also a powerful force in offering hope to change the so-called “broken brain”.

Psychotherapy and specifically psychoanalysis are major agents of change with mental health conditions that are underappreciated in their power and effectiveness to promote healing. They are not in vogue right now because these methods are expensive, time-consuming, slow, confusing, and sometimes provoke immense pain in the healing process. However, our field and the patient are losing out on something immensely helpful to their suffering, and ultimately something that will re-wire the brain — from the inside out.

The Intention of Grief

I’m puzzled and fascinated by the form and place that unresolved grief takes in our lives. Grief has a life of its own. If you don’t make space to know it and feel it, it has an uncanny ability to find you.  Grief has to be expressed and understood, and if it isn’t it will hold onto you until you know it and surrender to what it has to say.

For example, I was startled and shocked to witness intense shaming and criticism from my niece’s coach at her last soccer game. He’s always had a tendency toward the negative as compared with the other coach, but he was emphasizing the negative uniquely on Saturday. The intensity of his criticism toward my niece and others was hard to communicate without being there, however, I hope that it is clear that I am not talking about benign coaching feedback to players. He actually yelled at my niece after she shot on goal “Good shot, next time pass the ball!” which was absurd because it was her and the goalie with no one else in sight to pass it to. My niece picked up on his tone as well and was in tears after the game. She said that the coach was yelling at her all game and we agreed that we would intervene and find a resolution or find another team for her.

This example of unresolved grief is classical in its presentation in the sense that grief adheres to us in hidden ways. When the coach was confronted with his misbehavior he was genuinely shocked by the feedback. It was as if he was considering for the first time the possibility that he may have been negative and harmful to the girls.

In his defense, I do believe that he didn’t “know” how he was impacting the team. But we have to allow Freud into the conversation at this time in the sense of saying that he was unconsciously acting-out a central experience in his upbringing (either familial or sport-related from his childhood) that had been dissociated from his consciousness awareness.  In other words, when grief isn’t felt and known by us and honored as a natural process of being human, our conscious memory may forget the original hurt, but our unconsciousness will not allow us to forget. We “remember” by acting out those original hurts in the form of our adult relationships and in a sense we recreate the very pain that we have suppressed from consciousness to begin with.

Freud termed the phenomenon the “repetition compulsion” in order to describe the way in which he noticed that his patients repeated complaints in relationship after relationship, at work, school and home, repetitively until they understood the way in which they were manifesting a central pain in their childhood in the style or shape of relationships that they formed as adults.

I’ll guarantee you that if we had this coach in therapy what would be revealed is a very painful experience with a hypercritical coach, father, etc. that he has not fully felt, accepted and allowed himself to grieve. If and when he makes that happen, his “blindness” to his abrasive style will disappear as if magically transformed from something he doesn’t “know” to something that he feels and mourns over, and therefore he refuses to repeat with other children.