Take medical doctors, for instance. To get through undergraduate pre-med with high enough grades and class ranking to get into medical school demands a genius level I.Q. — 140 or better. But doctors, as a group, are no healthier, emotionally, than the people who work at the grocery store.
One of my doctor patients (we’ll call him “Tom”) came to see me in a heightened state of anxiety coupled with severe depression. He had been self-medicating, stealing drugs from the hospital and regularly shooting up. His presenting complaint was that his new wife had dumped him for a faith healer who had visited their church. Tom had both an MD and a Ph.D degree and specialized in microbiology at one of the nation’s most respected research institutions. His craft enabled him to be the catalyst for future medical miracles, and losing his wife to a bona fide quack was destroying him.
When a patient is depressed, one of the first things we analysts must know is if there had ever been a suicide attempt, or if suicide was now being considered. Tom readily admitted he was thinking of killing himself. An old wive’s tale states that people who talk about suicide never do it. That is nonsense. Those who talk about it are those who do it. Tom had my undivided attention.
I began seeing Tom twice a day, including Saturdays and Sundays. This is most unusual but Tom was unusually depressed and anxious. After two weeks we were able to back down to once a day, still including the weekends, but after a month we achieved a standard, three times per week schedule.
During our first week together sessions mainly consisted of Tom crying out his words like a blubbering child. I could barely understand him. My only contribution was to let him cry, never interrupting and, when a Kleenex got too wet to be useful, to hand him a fresh one. He always stopped crying long enough to thank me.
In the second week of therapy, Tom was able to start talking without too many tears and was mostly coherent. My immediate interest was in learning about his wife. I knew that she could not be the cause of his emotional meltdown; spouses, alone, don’t have that power. Psychoanalytically they are symbols from the distant past, but she was the obvious, and least threatening, place to start.
I learned that Tom was “Tina’s” third husband. He was 35, she was 25. She had at least two failed suicide attempts that Tom knew of — one in each previous marriage. Her faith healer boyfriend had three other lovers. Tina had to share him with these other women. Tina, obviously, had some serious issues of her own. In layman’s terms, she was nuts. But Tom, the medical doctor with the 160 I.Q., couldn’t see it. He loved her.
When I asked Tom about his childhood he told me his father was a well-known orthopedic surgeon. He specialized in sports medicine and made an enormous amount of money. Prominent athletes sought him out while the NBA, NHL, and NFL picked up the tabs. Tom’s father worked long hours. When he was home he doted on his wife but had no time for his children. He did not abuse them in any way but kept his distance. His passion was his work. “Your father is a saint,” Tom’s mother often said. “He is devoted to helping his patients.” Tom remembered only one family vacation and, in the middle of it, his father had to return to work. A multi-million dollar baseball player had taken a fastball to the elbow, cracking a bone. The best doctor to fix it was Tom’s dad. The story made national news.
Tom was fifth in line out of six children. His mother’s days were spent carpooling them to innumerable functions. Her nights were spent with her husband. They dined together, not with the children. Tom remembered no kisses or hugs from either parent, but he thought of his childhood as close to idyllic. He had everything a kid could want — huge house with swimming pool on the grounds of a country club, with a yacht club five minutes away. His shirts had little alligators on them and he attended the best schools. As Tom and each of his siblings turned 16, they were presented with the keys to a new car. A family tradition.
While talking about his childhood I could feel Tom become defensive. As a formally educated man he knew that we analysts are looking for chinks in the patient’s childhood. When I told him his childhood did not sound so wonderful to me, from an emotional standpoint, he looked hurt and angry. I said there was nothing wrong with country clubs and swimming pools but there was something wrong with emotionally distant parents. “Wouldn’t you have liked some hugs and kisses to go along with the new Corvette? In fact, if you had to choose, wouldn’t you have taken the hugs and kisses instead of the Corvette?” I asked. “How about hugs, kisses and a five-year-old Dodge Dart?”
“I see what you mean,” he smiled as his eyes found the floor. “Did I tell you my older sister tried to kill herself last month?” he asked quietly. We connected. The analysis had begun.
It took over a year before Tom came to the realization that his attraction to Tina was based on his neurotic need to rescue wounded people and heal them. Unconsciously he wanted to be a saint like his father, thereby earning his mother’s devotion. He was finally able to separate his need to rescue, keeping it in the laboratory, and in his personal life find a real woman, not an emotionally insatiable child hidden in a woman’s body. Tom, smart as he was, had been unable to “see” Tina; he could only see who she represented to his unconscious — the aloof mother. On the other hand, a guy who barely made it through high school could have had Tina’s number immediately, silently declared her too flaky, and walked away.
The reality that the intellect and emotions have nothing to do with each other is important to remember for those contemplating therapy. When someone goes to a therapist, at the beginning of the first session she should ask him if he was ever a patient himself. If the answer is “no,” she should get up and leave. That therapist should not be in the business. I could not be more serious. I don’t care if the therapist is an M.D., a Ph.D, or Doctor of Divinity. If he’s never been a patient he should not be in the practice of psychotherapy.
He could have read every book on the topic of mental health. He could hold the chair in psychiatry or psychology at a major university. He could be published extensively, even be on the bestseller list. He could be more famous than Amos, but if he has not had the experience of being a patient, with the feelings and insights the process generates, he cannot possibly understand the psychic dynamics of the unconscious mind. Without that understanding the dynamics of psychotherapy will not be available to him. His knowledge will be intellectual. That therapist, with all his degrees, will be inept. Psychotherapy is about re-experiencing feelings. Understanding the theories is an important part of a therapist’s training, but it is secondary to his personal analysis.
It goes like this. All of us find commonality on the emotional level. It is a matter of degrees. Within us we carry goodness, evil, fear, joy, frustration, hope, love, hate and guilt. We are Mother Theresa on the one hand and ax murderers on the other. We are the soldier who jumps on the grenade to save his buddies, just as we are child abusers. We are the fireman who charges through the flames to save the old folks, as well as the woman who secretly wishes for her parents’ deaths so she can get the big inheritance.
Human beings are saints and sinners — on the emotional level. To understand how true this is, and how deeply this yin and yang of goodness and evil are embedded in us, we must, for a time, be a patient. If a therapist has not had that experience he will not be aware of, and therefore will feel immune from, the forces of his unconscious mind. This makes him especially naive and quite possibly dangerous. No book, high academic degree, or series of lectures can take the place of being a patient in order to understand and recognize the depth, power, and conflicting forces present in the unconscious mind of Everyone.
It is only in the regressed, dependent, vulnerable state of psychotherapy, where total trust, faith, and sometimes incredibly embarrassing honesty pour forth, that we become aware of the workings of our emotional system. The unconscious must be heard and, most importantly, felt if it is to be grasped. A psychotherapist must have a solid grasp of his own unconscious before he starts messing around with someone else’s. Textbooks are essential in the field of mental health, just as they are in all professions, but alone they are worthless in the making of a psychoanalyst. Emotions must be felt and shared with another person to be understood.
Popular books concerning emotional health can be misleading and should not be expected to “make someone better.” Their value, rather, are as vehicles to get a person to a shrink if, after reading them, he thinks that’s a good idea. If anyone recommends a book to improve an emotional state, that person is psychologically unaware. (It is frightening to me how many therapists recommend books to their patients.) No book will make someone emotionally better although they may initially appear to do so. But the result will be short-lived and soon the person will be right back where he started, maybe even worse. “That book didn’t help me at all. I must really be screwed up!” Books concerning the emotional mind can be dangerous, especially if the reader has unrealistic expectations of them.
Naturally I include this book in that assessment. From it you’ll pick up jargon so you can talk like a shrink; you’ll read about some interesting people and concepts, and you’ll gain a heightened awareness of how the mind works on the emotional level — yours and everyone else’s. You’ll also know more about me than you’ll want to know, but none of that will improve your emotional state.
Mental health is about how we feel on a day-to-day basis. It’s about what we do, and what we don’t allow ourselves to do; what we think, and what we don’t allow ourselves to think; what we say, and what we don’t allow ourselves to say. It’s about how decently we treat other people, and how decently we treat ourselves. And if any of the above are out of sync, reading a book will not help. Nor will getting a Ph.D in psychology. Books, lectures, and academic schooling are food for the intellect, but the intellect and the emotions are separated by oceans. Only an emotional experience will permanently correct an emotional problem.
It used to be that psychiatric residencies included at least some psychotherapy training in their curriculums but, sadly, that is rarely the case today. The training is exclusively pharmaceutical-based. One reason for this is that the medical profession relies heavily on insurance companies; in other words, keep the costs down. Therefore “talk therapy” is often discouraged in favor of medications which, it is assumed, cost less.
However, an article in The Economist (April 16, 2006) entitled “Talk is cheap” states differently.
“Robert De Rubeis of the University of Pennsylvania ... conducted the largest clinical trial ever designed to compare talk therapy with chemical anti-depressants. The result ... is that talking works as well as pills do. Indeed, it works better if you take into account the lower relapse rate.”
For some mental conditions, such as schizophrenia and bi-polar disorder, drugs are essential to begin treatment. They can also have much value in cases of severe depression. But drugs should always be used in conjunction with person-to-person, intimate talk therapy. The emotional mind is people oriented.
“Newsweek” magazine (February 6, 2006) published an article by Jay Neugeboren entitled “Meds Alone Couldn’t Bring Robert Back.” Neugeboren is writing a book and interviewed hundreds of former mental patients, many who’d been hospitalized for more than 10 years, and were now recovered and leading full lives: doctors, lawyers, teachers, custodians, social workers. Jay asked them what made the difference:
“Some pointed to new medications, some to old; some said they had found God; some attributed their transformation to a particular program, but no matter what else they named, they all — every last one — said that a key element was a relationship with a human being ... most of the time this human being was a professional ... who said, in effect, ‘I believe in your ability to recover and I’m going to stay with you until you do.’ That’s what brought them back.”
Over the next several months The Smoky Mountain News will publish Waynesville author Jim Joyce’s memoir about the years he spent as a psychoanalyst. Each week we’ll begin a chapter in our Books section, and the chapter wil be finished on our Web site. You’ll also be able to find the previous chapters in their entirety on the Web site. The book is now available for purchase at rockpublishing.com/eagleshtm.