Thursday, September 25, 2008

An Analytic Hour

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.


Evydense said...

Please don't read this comment as "harsh" or "judgemental", but rather as "insightful" ...yeah, I'm reading this as one of the most intuitively insightful (and, I think, painful at a level you don't want to feel yet) entries you've written since I've known you.

I picture the frail little six year old girl, holding her favorite dolly, telling the good doctor where Uncle Johnny used to touch her, or a sixteen-year-old drug user who denies that the pot found in his boot isn't his, but he's just holding for a friend.

And in both cases the good doc has it wrong. Uncle Johnny used to always tell her great stories, but she hated how he used to pat her on the head like she was a little kid or something, and the sixteen-year-old was just holding a bit of weed for a friend.

Are you the doctor or the patient or the victim or the rescuer? Or all of the above.

Gary Freedman said...

Are you the doctor or the patient or the victim or the rescuer? Or all of the above.

I am all of the above. As I've pointed out before "I" am a collection of personalities.

Gary Freedman said...

This is a parody of a creative piece by the psychoanalyst, Bruno Bettelheim.

Anonymous said...

still doing parodies of original works, i see, gary!