Monday, April 11, 2005

The Confessions of a Psychoanalyst


Hey, buddy. I haven't seen you in some time. That may change. I'm thinking more and more along the lines of returning to the Cleveland Park Library on the one-year anniversary of "The Catastrophe," that is, the ban you imposed last April 21. I think that would be fitting and proper. I talked to my psychologist, Dr. Bash, about returning as a patron to CPK, and she raised no objections. In fact, for some time, she had been suggesting that I return to my neighborhood library.

I'm taking a new antipsychotic medication, Geodon. It's great. The old antipsychotic I was on, Zyprexa, was a disaster. It had somnolent properties and it raised my serum lipid levels. It also caused weight gain. My cholesterol was off the charts, at 296. My triglycerides were 90 points too high, also. (Of course, I was also eating a lot of yogurt. But it was nonfat.) As I mentioned last week, I was sleeping about 14 hours per day on the Zyprexa. Do you see why I wasn't taking my medication last year? It's really a form of cruel and unusual chemical therapy, so to speak.
But the Geodon is a great med. It does everything Zyprexa does therapeutically, but with none of the side effects. You may wonder why a doctor would prescribe Zyprexa. Well, for one thing, some people can't take Geodon. It's contraindicated for people with heart disease. People with Q-wave problems, and so forth. You know, the sinus node and all that. I guess President Clinton would have to stick to Zyprexa if he were to develop delusions about a vast right-wing conspiracy.

I feel like I've got my groove back. I'm able to work out at almost my old level. Also, I've been considering getting a part-time job to supplement my scam operation on Social Security. Would you believe it? Social Security actually buys that crap that I'm mentally disturbed. Now, really. Just because I have no social life, I believe I'm under surveillance, and I believe I have special mental powers -- like the ability to pick up and interpret social cues that other people can't see.
I saw William at the CVS on Saturday. "Gary!" he called out to me. It's Mr. Freedman to him, by the way. (Not that I have anything against William. At least I don't have any more of a grudge against William than I have against any other DC employee. But that's an entirely different suburb.) I just have a problem with too much familiarity. People lose respect for you when you get too friendly. At least that was President Nixon's belief. (Richard Nixon was apparently oblivious to the possibility that paying no federal income taxes or obstructing justice might impair a public official's ability to garner respect. But he was concerned about the consequences of too much familarity. And they say I have mental problems!)

Tell William that he may address me as Der Freedman (as Craig the Embalmer used to do). Or he may address me as Mr. President. But watch the "Gary" crap. I don't want to lose respect with the masses. William asked me if I was taking any day trips. Yea. Right. I take day trips through my own inner fantasy world. It's great. No frequent flyer miles, but you don't have to take your shoes off at the airports. At least I don't. Actually, I didn't tell William that. I told him I was just hanging out. (I wish I had a buddy to hang out with. A real buddy, that is.) Of course, I did take a day trip last October to the psych ward of DC General, courtesy of the Metro DC Police. And wasn't that a dream come true?

I told William I was on a sabbatical from the library. He said, "I know." I guess he would know. How could he not know?

Be that as it may.

I have another archival document for you to peruse. What you historians call a "primary source document." Back in the year 1991 I saw Dr. Lawrence C. Sack, a psychiatrist/psychoanalyst, for treatment. Dr. Sack was a really great guy -- and supersmart. He had a bachelors degree as well as a medical degree from Harvard University. And he graduated first in his high school class. Really great guy. Unfortunately, he died in 2003 (August 5 or August 6, I can't remember). I saw him three times in May 1991. (The first consult was on May 13, 1991. I remember that because it was the anniversary of Sigmund Freud's circumcision. The "bris," as Jerry Seinfeld would say.) At the conclusion of the first consult I asked Dr. Sack, seeking reassurance, "Do you think I'm psychotic?" Dr. Sack replied: "We're all psychotic when we dream." That hardly put my mind at ease.

An odd detail: Dr. Sack used to take his shoes off during consultations. It reminded me of the story of Moses and the Burning Bush, when Moses was instructed to take his shoes off. "Put off thy shoes from off thy feet, for the place whereon thou standest is holy ground." An odd association, don't you think? Dr. Sack had a portrait of Sigmund Freud on a wall in his office. Freud's image glowered down on me during the sessions, adding a touch of solemnity to the proceedings.

In any event, I had to quit the treatment because I believed Dr. Sack was talking to Malcolm and Earl. Though that, in reality, was a rationalization. I had to quit because I liked Dr. Sack too much. I can only sustain a relationship with people about whom I have strong ambivalent feelings. Dr. Palombo -- now, Dr. Palombo I loved, but I also despised him. It was a real love/hate relationship. That's familiar and safe mental territory for me. Craig the Embalmer was another person who I both loved and hated. My investment in Bob Strauss is also ambivalent.
And, of course, there's you, buddy. Though I can't say I love you. It's more like a "like/hate" relationship I have with you. Der Raben -- well, Der Raben I really didn't know that well. But from what I could gather he wasn't a really hatable kind of guy. I don't think Der Raben and I could ever be good friends. There just wasn't the correct "love/hate valence." Better friendships through chemistry, as they say.

Same thing with Dr. Sack. You couldn't hate the guy. So, I quit my therapy after only three sessions. I used the excuse that I thought he was talking to Malcolm and Earl -- it was as if I had to invent a grievance against Dr. Sack.

So, the basic story is I can only befriend people who I both love and hate. -- And Social Security thinks I'm mentally unbalanced. Go figure!

In any event, Dr. Sack's son, Robert Sack, MD -- also a psychiatrist -- was kind enough to let me have a copy of his father's clinical notes of my three consults with his father. I typed them up, so you can see what a seasoned analyst had to say about me. The document really just confirms what I've already written about. But I thought you'd be interested.

The Autobiography of Lawrence Carlton Sack


A troublesome -- aren't they all? -- new patient, thirty-seven years old, raised in Philadelphia, Pennsylvania. His father had a typical petty bourgeois Jewish Orthodox background. The patient's mother was a Polish-Catholic. He is highly intelligent, a compulsive talker, extremely narcissistic and exhibitionistic. He hides his intellectual arrogance behind ironic self-deprecation. He cannot stop his diarrhea of talk, because it is his way of denying his essential constipation -- his total inability to give of himself. His working for a large, prestigious law firm in the capacity of a paralegal (the patient trained as a lawyer) is not only a denial of his own failure to assume responsibilities, but reflects his inner feeling of guilt that only in a state of misery can he find a perverse fulfillment in life.

He gave me no chance to explain what psychoanalysis is all about, claimed to be very familiar with it, and proceeded to show that he lacks even the slightest understanding. He seems to think psychoanalysis is a self-serving rattling off of complaints and accusations leveled at others and oneself, instead of recognizing the serious introspection and contemplation it ought to evoke. He is capable of neither of the latter, because he feels he is so worthless that he cannot be serious about anything that touches him -- not his own self, nor his family, nor those he works with.
He wants to do everything himself without any relation to, or contribution by, another person, in a typical masturbatory phallic fixation. He permits no one, including me, to make any contributions to his life. Obviously, he has spent years at his self-justifying ruminations, where even his self-criticism is meant only to show how shrewd and honest he is about himself. Mainly the self-criticism serves to let him go on exactly as before without internalizing his guilt to the degree that he would need to do something about it; it serves him to avoid any need to change. He is convinced that to rattle off in this way becomes psychoanalysis when he does it aloud with me listening.

Despite his long account of all that went wrong in his life beginning with infancy (!), there is absolutely no realization of his sickness -- his complete inability to relate to another person. How can he, when all he sees of the world is his own projections, which he is certain are true pictures of reality?

He sees psychoanalysis as one vast catharsis, without the need for any deeper insight or internalization. Everything is just one huge ejaculation. I doubt if he can establish even the minimal transference that would enable him to analyze. Probably his selecting me for an analyst typifies his unwillingness to give up his bondage to his Jewish past. I wonder if I should have insisted that he go to a gentile analyst. I may still have to transfer him to one.

In our brief talk before treatment began, I asked him why, given his feeling that his troubles originate, in part, with his identification with his father's Orthodox Jewish background, he selected me, as his analyst. He could not understand my point, saying that no gentile analyst could ever understand him. He speaks as if the issue were finding an analyst whose sympathy and understanding are endless, as were his parents' -- not his own coming to understand himself. His selection of me for an analyst suggests that deep down he does not want to transcend his own background, and so chose an analyst who will not alienate him from what he pretends to hate, but without which he feels there would be nothing left for him or his life. It remains to be seen whether we can overcome this handicap.

Since he thinks his need is to spill out, uninterruptedly, I shall let him, for a full week. Then we shall see if he can stop the spilling long enough for analysis to be possible.

He carries on as if to convince me that all the cliches of a spoiled Jewish boyhood are indeed valid: the overpowering, overindulgent, overprotective mother and the ineffectual father. Essentially the hour was one long alibi. I am to understand that if he cannot meet life, cannot relate to another human being, it's not how he construes things, but because of his parents and their background, along with two specific traumata.

He is a master of the alibi, and like the clever lawyer that he is, he plays both sides of the street. He blames his misery on both kinds of trauma: the physical (an injury to his oral cavity -- at age two-and-one-half!!) and the psychological (his mother's lack of empathy). He must be certain I will see him as the suffering victim, no matter what kind of theories I hold about physical or emotional trauma as causing behavior like his. Actually, it is not traumata, but only his disgust with himself, that forces him to defeat all those who love him (his parents, his potential friends, etc.).

The tirade against his parents, especially his mother, is uninterruptible. A few times I indicated the wish to say something, but he only talked on more furiously. His spiel was like a satire on the complaints of most of my patients, and on the tenets of psychoanalysis: a satire on the dominating and castrating father, and a mother too involved in herself and her own life to pay much attention to her son. This extremely intelligent young Jew (or half-Jew) does not recognize what he is trying to do -- by reversing the oedipal situation, he is trying to make fun of me as he does of everyone, thus asserting his superiority over me and psychoanalysis itself. His overpowering love for his mother is turned into a negative projection, so that what becomes overpowering is the mother's love for him. Overtly he complains that she would never let him alone, was all intrusive -- behind which lies an incredibly deep disappointment that she was not even more exclusively preoccupied with him. While consciously he experienced everything she did as destructive, behind this claim is an incredible wish for more, more, more. His is an insatiable orality which is denied and turned into the opposite by his continuous scream of its being much too much.

Even the most ordinary, everyday request from his mother, such as her reminding him to send a card on his father’s sixty-sixth birthday, is experienced by him as the most unreasonable demand, forcing on him a life of guilt and indebtedness to his parents. Whatever the mother did for him was always too little; the smallest thing she requested was always too much.

After listening all day to the endless complaints of patients about mothers who were never interested in whether they did or did not eat, whether or not they defecated, whether or not they succeeded in school, it should have been refreshing to listen to an hour of complaints about a mother who did exactly all that -- but it was not. It was so obvious that he felt cheated at not being given enough. No doubt he is tortured by memories of his past, and by his present inability to be a man and enjoy normal sex. But he certainly makes the most of it, and nowhere do I see any effort on his part to free himself of this bondage to the past. Obviously be expects my magic and that of psychoanalysis to do this for him.

An important clue, to be followed up later: he is fascinated by his father's constipation, which is so stark a contrast with his excessive masturbation and incessant, diarrhea-like talk. This seem like an interesting fixation at the phallic level, as though the father's constipation has made him so anxious about his own ability to produce that to compensate, he produces without interruption -- whether by masturbating, talking, writing letters, or intellectual productions and achievements. If he does not learn to hold in and store, but continues this indiscriminate discharge, analysis will certainly fail.

If I were to give a name to this patient after this first hour, I would call him "The most unforgettable character I've met." This is not because the patient thinks this designation is true of his mother, as he sees her (as is so of everyone and his mother) but because, while he wishes to believe the foregoing, his major effort is to impress me with himself as "the most unforgettable character I've ever met." Poor soul. Instead of trying to get from me the help he so desperately needs, he tries to impress me with his uniqueness. Everything he accuses his mother of, he is himself, in the extreme. She exploited him because she loved him so much. He exploits everyone because he loves no one.


Despite the same incessant stream of talk little new material. Speculations arrived at by the end of the last hour seem borne out today. As a child, he masturbated, preferably on the toilet, in line with his father's constipation which emerges ever more as a central experience leading to a negative identification. The father cannot let go. The son cannot hold anything in, or hold onto anyone. The father, out of incessant fear for the future, chose and stuck to his job in a garment factory. This influence is internalized by the son as fear about his masculinity. For this he finds only one defense: the excessive masturbation which seems to prove his body is working, but at the price of self-disgust. Because this patient wants not a penis that gives pleasure, but an instrument that expels its contents; he feels a self-assurance which his masturbation cannot give him.

Otherwise it was a repetition of the first hour's contents. In the deliberately vulgar language of the patient, I would entitle this session "Whacking Off." He uses much obscenity to impress others and fools himself into thinking he is liberated, while actually he is expressing his loathing for himself.


It becomes increasingly clear that this patient has read too much about psychoanalysis while understanding nothing -- for example about castration anxiety. What he does not see is how desperately he wishes he had a castrating father, and how deeply disappointed he is because what he encounters instead is only what he experiences as a castrating mother. But even as he complains of how castrating she is, he cannot help admiring her inner strength, which alone seems to sustain the entire family. One gets the feeling that he has to see her as castrating, because he needs to see her as being strong enough to protect him. It becomes also more clear that his true sickness is the refusal to recognize his parents' deep love for him, because that would mean the obligation to love them back, and later, other human beings. Instead, he clings to his vision of all human relations as exploitative power platys. All this gives my patient the particular "Jewish Blues" that formed the leitmotif of this session.

[Following this session, the patient terminated the analysis. The patient’s paranoid fears about revealing himself were transformed into the fear that I was disclosing the contents of his sessions to his employer. LCS]

In fact, Brian, the above material is drawn from “Portnoy Psychoanalyzed,” by Bruno Bettelheim. Bettelheim wrote the tongue-in-cheek analysis of “Portnoy’s Complaint” (by Philip Roth) in 1969. The paper was first published in Midstream Magazine and later reprinted in “Surviving and Other Essays.”

Check you out next week, buddy. By the way, have you taken up gargling. Has the little lady ever discovered you gargling in the bathroom?

No comments: