Here comes the flood: Why new patients' questions are futile yet seductive

But crucial to understanding - via their seduction of the therapist

I remember when my book came out last year, about treating addiction psychoanalytically, a few therapists adhering to the 12-step model insisted that when it comes to this problem, analytic therapy is a waste of time.  (Thanks for sharing.)

Meanwhile many psychoanalysts express bewilderment, say they simply don’t “do” addiction.  If even clinicians are confused, what are patients to do? 

Photo by nikko macaspac on Unsplash

Some begin treatment by asking, “what is an addiction versus a habit?  My partner says I’m an addict and maybe s/he’s right though it’s bullshit.  So, am I?”  Here we see the divisive confusion of a dysfunctional relational system.

Such symptoms—or ways of life, I should say—are often keenly divisive; a partner feels sorry for the sufferer but wishes they’d get better already.  So does the struggling person beating themselves up for dragging everyone down.  This is why the slogans of AA or well-intentioned internet memes can be reassuring but a means of avoidance, when it comes to dealing with others. 

We tend to oversimplify in the face of angst.

Consider that many behavioral compulsions, to unknowingly avoid the pain of underlying problems, resemble early toxic relationships; here a patient, beat up and bruised, is compelled to maintain the relationship or behavior that injures them. 

Baffling to those who wonder “why can’t they stop?”…unless we place it in a context of an early scenario where giving up the hope that one day it will be better is more frightening or overwhelming than saying goodbye. 

This terror of the resulting void—often perceived as a cosmic abandonment—can fuel the binary questions of early treatment: Can I get my partner to get help?  Can depression be rewired in the brain?  Is the internet truly addictive?  (Yes.)  

Such either/or questions are in fact red herrings, shiny objects.  I have not yet learned the patient’s personalized idiom, cannot yet speak to what is really bothering them, keeping them up at 3 a.m., cannot yet help them translate prosaic worries into the existential pain or terror that grips them.  

Such questions often pull on me with bewitching magnetism; I want to answer, be helpful, reassuring, sound smart.  Except my responses often sound like psychobabble. “Well, patient, we will engage in a process where certain feelings arise, and we sift for themes and personal meanings and what happened in childhood and this sounds like clichéd crap even to me…”

We cannot see our own nose, as Orwell said; here I am drawn into the overly-familiar, namely the Thanksgiving game I described in my first post, where then like now there is terror of sounding stupid, like a know-nothing, leaving us both lost. 

Where are we now? The great drama of therapy. In this case futility and confusion is shared, and now I know more accurately what the patient experiences. I am with them, in a sense, at 3 a.m.

The language of the familiar, the everyday, tends to bypass these more soulful, whispered worries.  Our authentic idiom, the language of the real we might say (with a nod to Lacan), is soothed by the tranquilizing comfort of the useful language games we play in our everyday life. 

Perhaps as children, we had to memorize the rules of caregivers’ games for the sake of survival, with a ban on improvisation. But now relief is not only elusive, but we also cannot even speak to what might be relieving. 

In a way, addictions or OCD behaviors are more extreme versions of our everyday activities, normalized distractions from what is bothering us and how to speak to it.

We might push aside or intellectualize such problems to carry on, but then life becomes nothing but carrying on.

The flood of the everyday is the thief of personal narrative.  

Our conscious intellect is not a bad thing; “intellect” is itself a concept, as is “thinking,” both indirectly observed yet commonly understood.  The language of tender intimacy is less common, frightfully foreign if never encouraged or lived—like the child hiding behind the couch, catastrophically ignored (per Winnicott.) Sometimes therapy really is like hide and seek, with higher stakes.

In the extreme reaches of compulsivity (including work), life becomes arid, calling out for the redeeming precipitation of alcohol, sex, sugar, or “figuring it out”—the most tempting of all.  

Behind a patient’s smart-sounding questions—intelligible, compelling—are the camouflaged expressions of I’m hurt, frightened, drowning, can you help?  Sometimes the simplest things are the hardest to say.

What makes it so hard to say them?

How in other words do I help someone speak sparely of woundedness if they were raised in an intellectualized system?  I often enter a hall of mirrors with parentified, abused, or neglected children, who precociously intuited the rules of games or lines of a script they mustn’t forget.  Soon our scripts are synchronous, both of us spinning and talking around rather than about more visceral concerns.

How does one “access feelings” if they elude awareness?

I want to say, well you just know a feeling when you see it.  But some genuinely do not.

What then, Doc? Eh, Mr. Expert?

The key, I think, lies in embracing the stupid.  

More on that next time.