Time after time.Ā We all know the drill: a new job, relationship, or project starts with such promise, an new scenario of sparkling possibilityā¦.before it eases into the depressingly familiar.
Something unexpected opens the door to change, losing a loved one for instance; surviving members find moments of bonding amidst grief, a silver lining, hey letās not be strangers, before the status quo gradually re-asserts itself and everyone retreats to their silos.Ā
Once again, crickets. Like Charlie Brown missing the football, Sisyphus pushing the rock. Ā Ā Is it them or us?Ā
Maybe they donāt want to hear from me. Did I say something wrong? Eh why should I make the effort?Ā What is with this silence?
Sometimes there is self reproach: Ā This is what s/he always does!Ā Youāre the fool trying to kick the football, again.Ā
Weād like to think we are pretty savvy, and yetā¦
But Iād much rather be the fool (setting aside cases of abuse or manipulation) than the one rushing back to numbing normalcy.Ā
Manageable risk is, on the whole, to the good. There is no surefire way or silver bullet. We fail before we succeed (and other clichĆ©s.) When it comes to changing a habit or way of living, we have to take risks, if only to learn to tolerate the anxiety of doing so. This is why I so often tell patients, āforget the outcome, the trying is the key, keep doing it.āĀ
Usually this is hard because of our vulnerability or craving for certainty.Ā The familiar, after all, is certain, and uncertainty can feel like an old enemy, a bully even, taunting us from the sidelines.
I face this as a therapist, where something feels off, though the problem itself is hard to define.Ā But shouldnāt I know, as the therapist/expert? Whatās up, Doc?
What this means is that I need to take the risk of communicating my confusion to the patient, despite the person saying āReally? What am I paying you for?āĀ
For instance, a person has trouble self-reflecting on their own contribution to the problem (often a fear of risk taking) or they blame themselves entirely: two sides of the same familiar coin, that comforting illusion of control.Ā
Part of my job is to tease things out, find the gray, what the patient can do and what they have no control over.Ā I cannot do this without the patientās help, within our relationship, which mean I too am taking risks in trying to open up therapeutic space to understand.Ā And in reciprocating an even greater vulnerability with me, in whatever way they can manage, the patient begins to practice opening up to others about what they want or what isnāt working for them. This howāa new way of living and relatingāis almost always so much more important than any what or why.
I am starting to think we cling to the familiar as a bulwark against uncertainty and anxious risk-taking, in the name of self-protection.Ā The general anxiety about the political polls, over very real stakes, is one example.Ā We are seduced by the illusion of instantaneous knowing.
Meantime many of us keep busy to avoid thinking the unthinkable.Ā The familiar hustle-bustle anesthetizes us into what Robert Stolorow calls ātranquilizing absolutes.āĀ When we say āsee you laterā or āsee you in the morning,ā those statements are not to be questioned.Ā (Of course he could not win in 2016, until he did.)
Something similar happens with our routines, our way of living and speaking, āstaying busy,ā chattering online, what Ludwig Wittgenstein calls our āforms of life.āĀ Even our familiar speech patterns contribute.Ā Our phrases are repetitions that numb us to thinking in new ways.Ā A very interesting recent online article pointed out how learning new languages might affect our perceptions and lifestyle.Ā
In a way, I am helping the patient develop their own language: an individualized ādialect,ā in talking and thinking about their lives.Ā
Uncertainty can seem opposed to familiarity; often we look past the complexity of our challenges, the knot of several themes or threats intertwining.Ā This in favor of āIāve got thisā or ānothing I can do.ā Sometimes we take action and can do nothing about the outcomeāyet the former is empowering, keeps us moving in the right direction.
Complexityāthose gray areasāis hard to hold onto when emotions are tense or fraught.Ā In an argument with a loved one, we may not want to hear āitās complicated,ā we may simply want to be heard.Ā The intensity of anxiety can cloud our thinking, as the great psychoanalyst Wilfrid Bion often noted, blocking our way to reflection and thinking things through, tapping into the intuition that often bring perspective and possibility.
One clinical example from years past involved a patient (āJohnā) who needed help getting sessions going.Ā At the start I might gently inquire about his state of mind, whatever occurred to him, and so on.Ā For the longest time, the answer was the same: nothing.
Sometimes there was a āhot topicā to discuss, some recent wrinkle or problem. But when there wasnātā¦crickets. I was starting to feel like Charlie Brown.
This was confusing, as our sessions were usually productive once we got rolling; we often ended on a note of, āletās pick this up next time,ā as if we had too much to talk about.Ā But at the start of next session, zip.
As if we were starting from scratch, much like Sisyphus, stung by amnesiac blanknessāin which I have developed a keen interest, prompting this very column. This is due to working with anxiously guarded or dissociated patients, where that ānothingessā represents the void of their own psychic developmentā¦where all roads detour to the same silence. They need the protectiveness of the numbing silence that imprisons.
Usually John would blame himself for thisā¦Iām such a difficult patient, Iām sorry, I wish I could remember, I donāt know whatās going onā¦. Ā He forgot to write it down and didnāt know why. I myself might remind him of several of the themes we were working on. It began to feel like a passive āscrew you, Docā but he adamantly insisted the failing was his alone.
It belatedly dawned on me: the blankness, the etch-a-sketch of these moments, served a purpose, speaking microcosmically of his larger dilemma: he tended to start projects (regarding job hunting, dating, photography, and now therapy) which soon stalled out into nothingness.Ā
Change was neededā¦and prohibited by unseen yet powerful forces.
TheĀ nothingness also served him, was familiarā¦like his original family scenario with a highly controlling, volatile mother and indifferent and absent workaholic dad.Ā This left John as the de facto man of the house, in looking after his little brother (who was on the spectrum, with behavioral challenges) and mother bedridden much of the time, with advancing diabetes and neurological ailments.
To differentiate, to pursue his own lifeā¦his own mind, evenā¦including here in therapy, prevented a most frightful risk for John.Ā I think he was highly anxious, even terrified to talk about all this, as he had needed to squash his feelings (and etch-a-sketch his needs) to get through the day.Ā All his father cared about was straight Aās, so that was another burden he carried alone. There was also his emergent bisexuality, which he found liberating at first, though it now left him at the same crossroads.Ā
Even mild dependence had always led to rigid obligation, in other words, leaving him in limbo with me. To take more initiative was to surrender a precious illusion he was not even aware of yet. He focused on a magical freedom versus the hard-won actual liberation I offered, at first: the latter is always so much harder.
But there is another element of numbing familiarity here: namely, my own.Ā This etch-a-sketch syndrome was deeply provocative to me, because it is so often the hallmark of an alcoholic family.Ā It hamstrung my own therapeutic mobility. In such a family, promises are made (then implicitly abandoned), change is afoot, hope in the air like gunpowder after fireworksā¦all of it leading nowhere, the childās heart breaking (silently, off anyoneās radar) as things again return to the numbingly chaotic status quo. The childās voice is silenced (out of fear of angering caregivers), and later the patient sits in silence waiting for āpermissionā to more fully exist.Ā
And from whence does that permission come from?Ā A complicated question for another day.Ā Ā
In the meantime, if you are wrestling with a familiar problem and arenāt sure what to do, take a cue from Al-anon:Ā Donāt just do something, sit there.Ā Learn to listen to the whispers within, ask what acceptable risks are before you.Ā Life is trial and error, we are all Charlie Brown sooner or later, flat on our back, breathless and confused, especially at the end when the final clock runs out.Ā Why not try getting quiet?Ā
Noise from our podcasts and phones and streaming services, the digital fracas and busy-busy-busyness can protect us only so much.Ā In a strange, even ironic way, it is that tilt toward nothingness we need, to clear the space for our own thoughts (versus the noise of everyone elseās), that can be facilitated by an empathic other, the seed of the potential space Winnicott discusses, that amounts to so much yet little or nothing at all, at first.
Do you find patients keeping secrets from you? Not revealing all to you ā so you canāt offer them all the help they requ if you know their whole story?
Yes for sureāusually because they expect theyāll be shamed, criticized or judged, as has happened historically. This sets up the delicate balance of leaning in and out on my part, the negotiated relational dance. Not too intrusive, nor too distant. Thx for your readership as always.