MADMAN - John R. Suler, Ph.D. - copyright 1995
Chapter 4 - Respite
Good follows bad.This unexpected free time greeted me like an oasis.
I picked up my knapsack in my office and headed straight for the elevator. With rounds curbed I had exactly 25 minutes free until my next appointment. Images of lounging in the cafeteria, a cup of coffee warming my hand, flashed between my thoughts of revenge against Ron. During case conference I could undermine his comments with fancy theoretical objections. In the staff meeting I could toss out an innuendo about his incompetence. But verbal challenges are mere sublimations of much more primitive urges. On the elevator I could spit in his face and knee him in the groin.
As I turned the corner I sighed with relief. Ron was not standing by the elevator. Surprisingly, the doors opened without my rapping the button. Manna. I stepped in, avoiding eye contact with the other passengers, and pressed G. As the doors closed I realized I had forgotten to check the up/down arrows. Which way was the elevator headed? Several of the floor indicators glowed with the desires of the pilgrims standing behind me, so it could go either way. My stomach, floating towards my ribs, informed me that it was down. Perfect!
To be an elevator, wandering aimlessly in the vertical, dispassionately carrying harried passengers who for a few short moments in their travels must confront one another. Everyone always stares straight ahead, silent, trying their best not to see, hear, or smell the others, or be seen, heard, or smelled. It's like a bad existential play.
Standing there, immobilized, a pressure slowly mounted in my chest. Still pissed off at Ron? No, it was more than that. I never did like being in an elevator. Being enclosed in that tight box, with people's eyes on my back, made me ill at ease. It was a violation of personal space - the invisible zone surrounding our bodies that we do not allow strangers to enter. It's a zone reserved for intimate relationships. When anyone else penetrates it, we feel anxious and violated. Compressed personal space is like a pressure cooker. When the elevator doors finally opened, we'd all ricochet out of this container like bursting popcorn.
First in, first out. As soon as the doors widen enough for me, I squirted through like a watermelon pit. A wave of cool air greeted me as I popped out. Without looking back to see if the others made it, I hurried down the hallway to the cafeteria. It was nearly empty. I walked directly to the coffee dispenser and pondered the choice of a large or small cup, a decision that somehow soothed me.
"May I help you?" A stumpy kitchen aide, wearing a poorly fitted uniform stained by forgotten mishaps, stared at me with a void but content expression. Her servile grin exposed her gray, chipped teeth. She reminded me of those ambulatory schizophrenics you sometimes see in fast-food restaurants, usually sitting alone in the corner, dressed in old mismatched clothes, talking to themselves between sips of coffee and tokes on their cigarettes. If this woman was indeed a psychiatric patient, she was more fortunate than most. Chronic schizophrenics may spend many years in rehabilitation programs designed to rebuild basic living skills, such as how to wash clothes, cook, keep a checkbook, or carry on a coherent conversation. Yet very few ever succeed at the ultimate goal of living independently and securing employment. Even holding down what most people consider a menial job would be a tremendous accomplishment for these poor souls. In the hospital's psychiatric day treatment program, the inspiration for all its members was the legend of one former patient who graduated and got a job as a kitchen helper in one of the fancier restaurants in town. Fear, anger, and a profound feeling of futility swept through the program when they learned a few months later that she had been admitted to the hospital. During an acute psychotic relapse she had tried to slice her wrists in a food processor.
"Just getting some coffee," I said as I handed her some money and prepared my cup.
She looked puzzled. "This's a nickel, sir. A small coffee's 25 cents."
Embarrassed, I quickly dug some change out of my pocket and fumbled with it in my hand. Some of the coins jammed into my keyring, a few dropped to the floor. Now look at who needs rehabilitation! I finally managed to retrieve a quarter from the confusion and passed it across the counter. As I turned to leave, she called out after me, "Sir, you forgot your nickel!"
"Keep it," I mumbled and continued my escape. I sat down at a table on the periphery of the semi-circular cafeteria, next to a window. Before taking my long awaited sip of coffee, I noticed that I had forgotten to stir in the cream. Of course there was no useful implement nearby, except a chewed up plastic straw on the seat across from me. I left my pen upstairs and I sure didn't want to return to the serving counter. When there are no other options, be primitive. I deftly jabbed my finger into the solution, giving it a quick spin. It was much hotter than I expected. With a mind of its own the finger leaped out of the cup and into my mouth for relief. As I sucked out the pain I quickly surveyed the cafeteria: No one was watching. Now more determined than ever to overcome any obstacle, I wrapped my tingling finger and its companion digits around the styrofoam container, fully prepared to enjoy this drink, even if it killed me.
Concentrating, I looked down into the cup. Streaks of cream swirled in circles through the dark liquid, slowly breaking off into disconnected chains that curved back on themselves as they continued their revolution. Attracted by some unseen force, they began to weave through each other, exchanging parts, dancing intricate and rhythmic patterns. Independent worlds colliding, fusing, separating as they traveled in unison around an invisible center. Clouds that wandered thoughtlessly through a mocha sky.
My trance was broken by the wind whistling through a small gap in the window. The trees outside swayed in response to the breeze, their nearly bare branches rippling in series of waves, beckoning the change of seasons. Hopefully, the approaching winter would not be as harsh as the last. I remembered Jon's story of a schizophrenic patient who had been delivered to the inpatient unit by the police. They had found him at the shore trying to vacuum the beach with his mother's electrolux. On the third day of his stay on the unit, he wandered out of the hospital and into the surrounding woods during the peak of a blizzard. Hospital security searched for him for several hours, but to no avail. Eventually, despite their wounded pride, they called on the state police for help. When the rescue party finally found him, he was deep in the woods, lying on his back in the snow, without shoes or socks, muttering something about symphonies in the sky. He was saved, but not his frostbitten feet. They had to be amputated. I felt queasy as I imagined a life of teetering on fleshy stilts.
My journal! By instinct I reached inside my knapsack for that familiar spiral notebook. It was one of those super-thick, college-lined versions, now completely filled with writing, with the exception of a few more blank pages. It was like an old friend, my mother, my shrink, my guru - all in one. I always kept it with me. As I weighed it in my hand, I noticed its cardboard cover was cracked, worn at the edges. Nearly a third of the tiny holes fastening the cover to the spiral binding were pulled loose. If the cover pulled off entirely, the delicate inner pages would be exposed directly to the harsh world outside. If I didn't take steps to protect it, over time, page by page, the whole journal would disintegrate. Scotch tape might do the trick, or at least a safe place on my bookshelf once I had moved on to a new notebook.
For how many volumes, linking past and present, would my stream of thoughts persist? Sometimes, when I reread my old entries, I sound rather silly and naive. One day in the future, when I look back on my current state of mind, will I again be embarrassed by what read? If only now I could grasp that intangible, potential me of years hence.
Besides using my journal to vent my emotional and intellectual ruminations, I also tried to improve my writing through it. We psychologists can be notoriously stale writers. For instance, we allow ponderous aggregates of adjectives and nouns to strangle their companion verbs. We stand by idly and watch active conjugations being usurped by the passive tense or reified by "-ations" that grow at the end of words like tumors. Psychoanalysts, who supposedly herald the dynamic quality of the mind, often use such semantically concretized gems as "hypercathected libidinal impulses" rather than "sexy"; while behaviorists, in knee-jerk fashion, make such statements as "they were engaged in eating behavior" rather than simply "they ate." But the real culprit behind the devitalization of psychological language is the contemporary emphasis on objectivity and the scientific method. Experiments are conducted, statistics are analyzed, results are obtained. God forbid there should be an "I," a real flesh and blood person with feelings and biases who is the subject of these actions! No! The impression is that all these scientific feats emanate from some unseen force, from a disembodied, ethereal knowledge that lies beyond human foible.
The wind again drew my attention outside. The sky, mottled with shades of dark and light, seemed like a giant reflective canopy that paralleled the textures of the wooded landscape. For an almost imperceptible moment, my mind flashed on the image of wandering barefoot through a snow-drifted forest.
I quickly opened my notebook and thumbed through the pages. Hoping to lose myself in that odyssey of ideas, I reviewed the last entry:
What is the psychotherapist? A mirror, a shadow, a barometer, a good parent? Like a mirror, he reflects back to the patient what he sees occurring before him - how the patient is thinking, feeling, and acting in the present moment - a mirror that magnifies the subtle clues to the unconscious, boosts self-awareness, and solidifies the patient's identity by confirming the feelings that others ignored and the patient himself may have denied. Like a shadow, the therapist deliberately may remain ambiguous. He does not discuss his personal life, his religious or political beliefs, or his true opinions of the patient. He becomes an elusive, mysterious figure whom the patient, out of a natural human need to identify people, shapes according to his expectations, fears, and desires. The therapist draws out and intensifies the patient's tendency to recreate and relive relationships from the past, usually with parents. But the therapist at times may also need to be a real person, in fact, a substitute parent who offers what the patient needed, but never got, as a child - encouragement, recognition, acceptance, nuturance, even love. Almost always, the therapist is a barometer that senses the interpersonal impact of the patient. By measuring her own thoughts and feelings in reaction to the patient, she gains insight into the patient's world. Angry when manipulated, bored when flooded with idle talk, anxious when invaded by psychotic ravings, she attempts to master these emotional reverberations as a pathway to understanding the patient. A thin line divides disaster from success, for these feelings can easily sabotage her work.
A bit melodramatic, but not bad for a day's work. I felt inside my knapsack, searching for a pen, but couldn't find one. That's odd - I always have a pen somewhere. Sitting with perfect posture at the table behind me, a man sporting wire-rimmed glasses and a cleanly pressed lab coat was reading the New York Times. He looked so intent on his digest that I felt uneasy about interrupting him.
"Excuse me, can I borrow a pen?"
Without looking up, he glided his hand to the plastic holder inside his breast pocket, selected a black Bic from the array of pens and pencils, and extended it to me. Incredibly accurate manual dexterity! A surgeon, no doubt.
"Thanks!"
I turned to a fresh page. It stared back at me, blank and indifferent - a tabula rasa waiting to be molded by my thoughts and desires. It's not easy converting nothing into something. I marked down three asterisks. Never did like using dates to begin my entries. After twirling the pen for a few thoughtful revolutions, I dove into the page:
Why do people become psychologists, psychiatrists, or for that matter any kind of psychotherapist? What attracts them to such a complex, ambiguous task as insight therapy? With the exception of some psychiatrists and psychologists in high-fee private practice, most people are not going to get rich in this profession. Most psychotherapists are grossly underpaid - which says something about how our culture views mental health. Some might say they enjoy helping people. This may indeed be true - but it can be an oversimplification. Some therapists may find it easier trying to overcome the suffering or emptiness of their patients than to confront their own. Some may have grown up as the "helper" in their family, cast into that precarious role of advisor and mediator among siblings and parents, expected to soothe emotional turmoil while holding their own feelings at bay. For them, psychotherapy comes second nature; it is simply an extension of their interpersonal style, only now they call it "work" and get paid for it. Others become therapists because they thrive on the status and power. If people come to you for advice, you must be wise. If they are sick, you must be healthy. If they expect to be cured, you must possess some healing magic. It's a kind of omnipotence, perhaps a compensation for deeper feelings of helplessness. Psychotherapy also lets them peek into the most intimate areas of a person's life, which can satisfy the voyeur in almost anyone.
The feeling that someone was watching broke my concentration. Sure enough, the physician next to me was peering over the top edge of his paper, his eyes focused intently on my mouth. I quickly realized I had been chewing on his pen. I pulled it out from my teeth and smiled self-consciously. He lowered his eyes into his paper and continued reading. As I grabbed my coffee cup I noticed that it was almost empty. I wasn't aware of how fast I was drinking. A little oral today, aren't we Dr. Holden?
I reread what I had just written. No wonder the oral tension! What was I really trying to get at here? Behind the intellectualizing I was wrestling with a personal question: Why did I, Thomas Holden, become a psychotherapist - and a psychoanalytic one at that?
All during elementary and secondary school I loved science, or maybe I just thought so because I excelled in those courses, which everyone considered very important in those days. I frequently imagined myself as a biologist, or physicist, or in my more romantic moods, an Antarctic geologist. In my first year at college - which was one of those large, dehumanizing universities - I was quickly swept up by pre-med fever. Every day, with a calculator strapped to my belt and a lump in my throat, I scurried from calculus to biochemistry to physics, all the way scholastically pushing and shoving other students for my chance to bask in the fleeting light of the almighty "A". Most of the time I succeeded, but gradually the grades lost their power to satisfy me. I grew bored and frustrated with the so-called hard sciences. Despite the impressive scientistic jargon, they really provided no definitive answers. Like Tantalus, I felt that I was being teased by the promise of a complete explanation, an illusion that slipped away from my fingers each time I reached out for it. Take physics, for example. What is the essence of matter? Physicists don't know for sure. They keep slicing up the atomic pie into smaller and smaller parts. They aren't even sure if matter is fundamentally discrete or continuous, an entity or a quality, which is not much of an improvement over the ancient Greeks who debated the same issue.
Before and after class, during office hours, and in chance meetings on campus, I bombarded my professors with questions. At first they were delighted that an intelligent student took such an interest in their field. But soon they felt cornered. They tried to ward me off with deliberately abstruse explanations. They tried to placate me with facile solutions like "More research is needed" or "It's just a theory." Eventually, they wouldn't answer their door when they heard my knock.
At the end of my freshman year my father died. My mother found him in the backyard lying next to the lawn mower, its blades still spinning as the motor hummed away, indifferent to the fateful situation. His death was quite unexpected, even though heart attacks are not uncommon for a Holden. A torrent of emotions overwhelmed my family. Except for me. Not that I wasn't aware of having these emotions, but they seemed faded, distant, as if part of me was standing back and observing them in someone else. No matter how hard I tried, I was unable to attach myself to what was happening.
That summer, not knowing what to do with myself, I decided to take a course in psychology. In retrospect I see that it was also an act of quiet, bridled desperation - an attempt to understand my problems, to make sense out of my life. Little did I know that seeking personal help from an introductory psychology course is as productive as consulting Reader's Digest to find a cure for Alzheimer's.
But I did enjoy the course and in my sophomore year switched majors. I was enticed by psychology's paradox. Although it strives to be an objective science it ultimately becomes entangled in the webs of subjective experience. Not exactly a science and not exactly an art, it teeters between the objective and the experiential, between the rational and irrational. The word "psychology" itself fascinates me. Break it down into its component parts: It's the study of the "psyche" - which translates from Greek into "mind," "soul," or "spirit." Ironically, psychologists would shudder at the thought that they study the soul or spirit. Souls are not very scientific. Many psychologists - mostly the hardcore behaviorists - would even reject the idea that they study the "mind." You can't see the mind; it can't be examined objectively - so why bother studying it at all. Maybe it doesn't even exist. All that exists, all that is observable, is behavior. Mind is just some kind of ghostly epiphenomenon. Psychology, they claim with pride, is the study of BEHAVIOR. Of course, some psychologists still want to study things that happen inside the head, and they still want to say that their work is objective and scientific, so they stretch the definition by claiming that mental processes are a type of behavior. Which, to me, seems silly. You can't have your cake and eat it too.
I remember reading somewhere - though I can't remember where - that another Greek translation of "psyche" is "butterfly."
In the back of my head an alarm sounded. Ticking silently, my internal clock had been marking the passage of time. My watch confirmed the warning: Two minutes until my next appointment. I stuffed the journal into my knapsack and sucked down the remaining cool drops of coffee. As I stood up I heard the surgeon politely clearing his throat. Hidden behind the financial section, he extended his hand towards me, palm up. Suddenly realizing the meaning of this gesture, I placed the pen in his hand. "Thanks!" I said.
"A writer without a pen is like a surgeon without a scalpel," he casually commented as he slipped the pen back into its appointed home in his pocket.
"Although I would be more careful about chewing on a scalpel," I added playfully. He sighed. "Neither a borrower nor a lender be," he muttered to himself as he turned the page of his paper.
Alone in the elevator, I drifted back to thinking about my journal. If it survived the onslaughts of time, what fate awaited it once I, its creator, sloughed off this mortal cocoon. Perhaps one day a weary antique dealer will discover it hidden behind a secret panel in an old rickety desk. The faded scribbling will be meaningless to him, but by an odd twist of fate the notebook will fall into the hands of an historian. Fascinated by this unique find, he delves obsessively into the writings to fully comprehend this mind that reaches out to him from the past. He spends weeks in the library sifting through old journals, searching for clues to the identity of this obscure writer. A reference here, a footnote there, piece by piece he reconstructs the puzzle. In a dream the vision comes to him. The message is clear, the insight profound. Retrieved from limbo, a new psychology is born. He becomes My Biographer who writes a book that catapults me, his ancestral mentor, and himself to fame.
I'm not holding my breath. Nevertheless, it's interesting to speculate about how future generations will review my life and work, should I attain a status worthy of review. I pictured the entry on Thomas D. Holden in a yet to be published version of Who's Who in Psychology. I tried to imagine what it would say:
major contribution in the area of... of..."
I drew a blank. As I stood there, perplexed by my temporary inability to anticipate my life, the elevator doors opened. The demands of the present were calling me.