Wednesday, March 15, 2023

The Squares Won't Line Up

A while back I read an interesting article once about our collective, Western treatment of emotional pain.  The article made the case that emotional pain has become its own treatable syndrome, wrong in its experience and to be treated away. I think this is true, and not necessarily a bad thing.

I think of this as an issue of, as one brilliant friend put it, the "order of things". Yes, from a meta perspective, one might assume that emotional pain results from outdated and useless paradigms of identity and experience. The pain is "wrong" and the thinking paradigms are "wrong". Seems simple enough: straighten out the thinking paradigms and the pain should disappear, right?

After years, sometimes decades, of effort to repress, understand, therapize, cathart, share, metabolize, and medicate the "wrong pain" away, clients are sometimes ready to face states that have taken on the shape of not just sadness, or loneliness, or anxiety. The states have taken on the shape of more primitive experiences: blackness, existential aloneness, death. How conscious these states become is a matter of adding mental structures to protect the psyche, or just plain running.

The "wrong pain" is perceived as obliterating and dissolving in its direct encounter, or perhaps just potentially crippling to the personality and its functioning. This region of pain can feel like the ominous location in the psyche that drives the personality in its entirety. One believes for a while that s/he might find temporary relief via vaguely addictive processes, but temporary relief is really the only respite imaginable. 

Another process emerges when the ego, exhausted and devoid of hopeful faith in one's own system, surrenders. The technical, step-wise approach to this process should be guided by someone with a mechanical understanding of how the pain developed, along with correct capacity and motivation for helping another face it. The work can feel dangerous because it is: to the ego, its erected and existential reinforcements, to the most vulnerable part of the personality who sits in the dark reworking a kind of rubics cube system of logic with squares that never line up, to the therapist him/herself, who must undergo training and more training, allowing for a technical and creative process to guide the encounter.

Some dimensions of experience may never be "mentalized" in a traditional sense: that is, understood at an emotional level, to be thought about and worked through via thought structures. Rather, some states must be encountered and survived. The memory/personality structure is relieved of its duty to survive the very mind erected to protect it. Until then, one is forced to constantly twist and turn the thinking structures in an effort to find relief. It never comes, because the squares don't line up.

Emotional pain is a symptom. Without hope to face the deepest pain, it becomes its own syndrome to be treated away. After facing the pain, the thinking structures that perpetuate it are relieved of their duty, and straighten out on their own. As a secondary effect of the primary process, the straightened out thinking structures were an important part of the system to address. But without comprehending their function as essential to primary feelings of safety, the thinking structures are destined for being reworked to seem different, but never really be different; their function is too essential.

We let go of what we believe is essential to realize - a bit at a time - that we save ourselves only by surrendering to a bigger love than we knew how to perceive when we first needed it. Letting go of the pain, itself, is sometimes the scariest part of the work. 

Thursday, December 29, 2022

Return To The Organic: An Invitation

In my work I am often struck by how creatively psychic reality is expressed physically. Awareness of this phenomenon can lead to realization; emotions long stifled can be recognized and recovered, then processed and shared. This is no perfect formula: we must attend to the body's challenges, acknowledging the concrete realities of environmental stressors and injuries. But a delicate and attentive relationship can develop between the mind and the body when the link that separates the two, feelings, can be tolerated and symbolized.

When one stifles emotional expression, as so many of us have been raised and socialized to do, emotion can be capped and forced down into the body, where that force can limit the easy, organic movement of the soft tissue that helps waste move through the body and be let go of. This "body-ifying" of emotions does seem to work in the short term; but though the mind can feel immediately relieved of painful emotion, if severe enough, one can be left with a physical difficulty swallowing, eliminating, or both. 

Without a place to put painful emotions, and without a way to digest and eliminate them, one can turn to a partner. This partner, who may be empathic and have difficulty with boundaries, can find herself unwittingly functioning as a receptacle for her partner's unacknowledged pain. When, inevitably, this pain overflows, she may appear to have had a "meltdown", a kind of PTSD attack that relieves the system of psychic waste that cannot be processed, partially because it does not belong to her. This empathic partner might, alternatively, "tighten up" to avoid this kind of overflow or explosion; in this case the pain might be again forced into the body, leading to idiopathic physical pain, or even autoimmune disease.

This interpersonal system of waste management is developed unconsciously as a matter of necessity, and it works for a while. Its breakdown can feel catastrophic for the person who has not developed a method for digesting internal pain; the threat of years of repressed pain flooding the system can feel like an impending tidal wave, the landing of a tornado of chaos, or even a complete "lights out" end to conscious life. However, its breakdown may also be a turning point, a kind of necessary defeat in preparation for an entirely new way of functioning. Picasso's "Every act of creation is first an act of destruction" comes to mind. 

As an individual who has struggled with metabolising his own sense of internal chaos encounters its inevitability, through a breakdown either internally or interpersonally, resistance and rage may dominate the process. One might feel that, after a lifetime of hyperfunctioning and control, the unavoidable reality of chaos is a kind of cruel destiny. One might find the loss of a partner who has functioned as a metaboliser to be an abandonment of almost metaphysical impact. And yet the slow development of the capacity to internally experience and tolerate, then think about and respond to, emotions serves as a new platform for psychic life.

The end of one system of pain management is often the beginning of the development of a new one. When we outsource primary psychic functions to other minds, the day of reckoning does, eventually, come. Yet one usually knows, deep down, that he has had to design a mechanical workaround for a system that should have been functioning organically. He may feel he has cheated the system, though he is not sure how; or that punishment is coming, though he is not sure why. A return to the organic may seem like the end of the world, but it often just marks the end of the reign of the mind. As this ending becomes unavoidable, an invitation to the reign of the psyche, of which the grounded mind is an important functioning part, emerges. This invitation must be accepted for the new beginning to unfurl.

Wednesday, February 10, 2021

Glass Straw

 The Engine and the Glass Straw

When I work with people I often am struck by the power of their minds. Here are people so good at thinking, so good at analyzing, and so sure of their correctness (maybe desperately so) that involving myself in a cognitive wrestling match proves often….well, futile.

This leaves me in a bit of a conundrum. As a therapist, I’ve been trained to work in lots of ways using lots of techniques, most of which are aimed towards one goal: changing thinking.

Changing thinking is a noble and sometimes effective aim. Identifying cognitive distortions and working to correct thinking to reflect reality more accurately can help an individual limit the anxiety and sadness distortions cause. This work can help organize sane responses to stressors. Who would argue with that?

I would. But not because there’s a fundamental problem with cognitive approaches. I would argue that, ultimately, they prove mostly ineffective with people I work with.

Working with a mind both powerful and certain can prove exhausting and frustrating. Early in my work with patients I often thought to myself, “Can’t you see the way you’re thinking is the problem? Can’t you take a different perspective that might work better?”

The answer was….no. Despite my best efforts, and dare I say, the best efforts of my clients, the thinking persisted, unmoved by any force of logic or persuasion.
I liken it now to interacting with a mind that operates as a powerful car engine, roaring towards some undesired destination, yet absolutely committed to its direction. It took me a long time to realize that this engine was designed to drive the car away. 

Away from what? Away from the place remembered, but not known.  The mind here is a machine, designed to race towards forgetting. No mental effort of mine was going to change that. No mental effort of the patient’s was, either.

And so, with no way to change the map, our work became a kind of daring journey towards the place escaped from. This psychic destination was often so filled with pain and panic that any movement towards it appeared slow and difficult, often accompanied by a sense of terror and futility.

After a bit of time clients often become aware of a thin glass straw up around the corner of the engine. Its fragility in the face of a bumpy road and a hot, exhaust spewing machine seems the essence of absurdity; in fact, encountering it seems to lead only to the intermittent detection of a slight breeze across the top of this straw, a breeze gentle enough to carry a white feather by. 

Learning to pay attention to that breeze is like learning to receive a wisp of a breath in the midst of a raging storm or like straining to discern a whisper offered from a far corner of a hall filled with a cacophony of voices. 

The attention narrows, the whisper is heard, the cacophony silences. 

The glass straw is, after all, no silly remnant, no appendix of the psyche. It serves as a vertical tunnel of sorts, to another way of being, unmapped. 
The mind roars its objection.

But the call home has not been silenced. Only repeated, infinitely to ones own ear, until, finally heard.

Wednesday, October 11, 2017

Treatment, Love and Limits

I have treated so many adults on the spectrum. A few successfully.

And what I learned in school has proven barely relevant to the process.

Clients who come in trapped in the prison of their mind are in a fight for their lives. No clinician, no person, can ever win a battle to break into the fortress.

It's what the fortress is guarding against that needs addressing. Most clients I've met are dying of loneliness.

Most are guarding, full time, against a pervasive and nameless panic, or, in Sylvia Plath's words, the "o-gape of complete despair".

To imagine I might outsmart a client's mind, as it builds and rebuilds its walls of protection, is to have no understanding of my own limits.

I hope that, as we develop more and more complicated ways to name and talk about symptoms, we will eventually come to the simple understanding that to learn to give and receive love, after one has learned to live without it, is the bravest, most heroic journey.

It is the only journey. The rest is walking in circles.

Thursday, January 29, 2015

Adults, Autism and Snipping

We’ve probably all heard about (or felt) imposter syndrome. In my work with adults on the spectrum, I notice that many of my clients struggle with some version of it. Even those who have achieved success in academic, professional, financial, and even social contexts struggle privately with the sense that none of it is real.

In contexts they’ve mastered they can appear socially adept (or so good at their jobs that social deficits are pardoned). But outside of a mastered context (whether the context is reddit or academia seems of little relevance), many struggle with something beyond social anxiety. I call it social panic.

How then are these adults able to function so well in these mastered contexts? It baffles both my clients and their loved ones. There are probably a number of ways to understand the discrepancy, and one way I describe it is via the idea of snipping.

Snipping is my way of describing how people with certain default styles cope with emotions that are beyond his or her capacity to handle. Under extreme stress, some of us snip the connections that bind us to parts of our own experience. It might be a foreign concept to someone who has never experienced it, but many of my clients recognize the phenomenon, though they’ve been unaware of it or unable to describe it.  

For instance, many of my clients are intellectually gifted. Their methods for processing reality may already differ a bit from those with less specialized brains. If the emotional load involved in processing reality in this way is too large to handle (as can be the case with those who perceive patterns and detail that remain out of awareness for most of us), adults on the spectrum have the option of snipping their awareness of the emotions. 

This is not necessarily a neurological reality (though I wouldn’t be surprised if it gets backed up by imagery sometime soon), but it is a way to describe the emotional shutdown so many clients experience, an experience they always describe as involuntary. I’m guessing if I had the option to do some snipping to avoid painful emotions I might rely heavily on that technique for managing everything from boredom to stress to grief.

Some clients snip not just their awareness of their emotions, but their awareness of their bodies, of time, of events taking place around them, of identity itself. Because of this snipping, they may be (in ways that seems almost genius – and maybe are) able to transcend typical limitations associated with the body (think of the busy programmer who forgets to eat or go to the bathroom), time (think of the musician who has been trying to master a piece for 12 hours straight), events around them (think of the cool mindedness of the non-reactive stance you’ve seen in the midst of conflict) and even identity (think of the adult who transcends typical limitations of gender, and even ego).

The snipping phenomenon can be a great tool, obviously, but like most coping styles, it appears to come with both benefits and costs. The benefits seem obvious: untethered from ego and emotion, my clients can often think in ways others can’t. Awareness of ego and emotion, especially, compete for attention and energy; divorced from these sources of internal resource depletion, clients on the spectrum can immerse themselves in music, programming, philosophy, etc. in ways that a more diversified brain might find out of reach. Clients often dazzle me with their perspectives and intellect.

The costs involved in snipping are sometimes immediate (such being unable to participate in a charged emotional situation that demands emotional engagement) and more often long-term (a life that runs like a machine but lacks vitality). Clients sometimes store negative emotions, such as fear and grief, in their bodies – digestive problems, sleep disturbances, jaw clenching, etc. – and even more often suffer symptoms such as difficulty harnessing attention and swings in motivation, as well as compulsive productivity alternating with periods of disassociation. Snipping can allow a bright person to block out fear so s/he can develop and express intelligence and think in ways that are exciting, but the fear has not truly been dealt with and transcended. It has been avoided, and - out of sight - it may even have grown.

The adult who has built not just coping mechanisms, but a life and a career (or even an identity) on a foundation of snipping maybe very wary of changing the system. I think this wariness is wise! When changing how one processes and interacts with reality, things tend to get shaken up. Who is to say it will be worth it in the end? A therapist who promises that it will be “worth it” is promising something she cannot know, and certainly cannot ensure. The client who ventures forth to change the snipping system must want something that s/he might not even be able to name. And s/he must have, to some extent, faced the reality that the system is breaking down, or is limited in ways that have come to be unacceptable.

When working with clients on the spectrum who have a snipped connection, I don’t make promises and I try to remain cognizant of the reality that I can’t sell the worth of knitting together that snipped connection. Realizing that a beautiful system of rationality and logic is limited or inadequate can be both painful and frightening. I have compassion for the pain of the realization, a respect for the difficulty of the path, and a willingness to walk with the client who dares to embark on the journey.