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A Psychologist's Thoughts on Clinical Practice, Behavior, and Life

When the Mind Ignores What the Body Knows

Thirty-years ago I was asked to treat an eight-year-old child who, stricken with leukemia, had been discharged from the hospital to die at home. Though fearing the emotional turmoil, I felt unable to refuse the request, feeling that he needed someone.

 

The boy looked terrible at our first meeting, holding a white enamel tray lest he vomit. I introduced him to "our friends," the stuffed animals in my office (Bertram Bear and Darrell Dog and Barry Bird and Gregory Gorilla) while we played a board game. He looked healthy at the following sessions, not bringing a tray, and playing and interacting with our friends comparably to my other young patients. He seemed so normal that I embraced the frequent delusion that his doctors were wrong and he wasn't dying. Then one day, when he became too ill to travel, I went to his home and spoke with his parents in the kitchen while he lay in bed.

 

Despite my heavy work schedule and preoccupation with him since we met, I felt nothing when he died but my body reacted differently. Though continually healthy, I immediately developed an unpredictable explosive diarrhea which made me unable to perform my duty as expert witness in court. Medical tests found nothing wrong and when the diarrhea ended two months later, I sensed it was gone forever and it never returned. Had my body tried to expel the poisoning stress through diarrhea? I wondered. A primitive reaction explained by psychosomatic medicine which holds that what cannot be spoken will be expressed through the body.

 

Twenty-six-years later I was referred for treatment an adult who, after extensive surgery, was being heavily medicated by his doctor for pain and self-medicating himself with forbidden alcohol and cigarettes. Having become a troublesome hanger-out in her office, she referred him to me "for therapy." A first glance told me he was dying. He had no interest in therapy, I didn't see him for long, and my increased blood pressure lasted as briefly. A week later, without conscious intent, I spontaneously spoke of the boy who departed life too soon, leaving his parents and me and our friends to grieve. Then I did cry.

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The (Confused) Rooster That Crowed - A True Story

In a semi-rural Community Mental Health Center where I once worked, a social worker, without telling anyone, brought in a caged rooster to give to another worker at the end of the working day, parking it in a closet in the women's bathroom. When one entered the bathroom and turned on the light, the rooster crowed, mistakenly believing that it was dawn. Women leaving the bathroom and reporting having heard a rooster crow were considered crazy by the staff ("probably their time of the month").

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Murder, Mayhem, and Evil

During my first job as a psychologist at a psychiatric hospital, I told my psychoanalyst/supervisor my adolescent patient's statement. "That's psychotic," the doctor replied. Though able to define "psychotic," until that moment I hadn't grasped the power of this condition.

Similarly, when mass murder horrors become public, the perpetrators are often viewed with surprise for these men had seemed so normal. They lacked the twisted features of horror film characters and spoke coherently though of bogus beliefs. Columnists asked the usual question of "why," and provide their usual answer that "no one knows." But this is not true!

 

While predicting violence cannot be certain, it correlates highly with several factors: failure in life; substance abuse; the ego capacities governing thinking and behavior being inadequately developed; and having a fragmented "sense of self," sense of who they are. The killer's frequent decision, to suicide in "glory," is considered preferable to their continued painful existence.

 

Though their act was horrendous, these individuals are not often considered "insane." The legal definition of insanity is determined by state statute, most usually whether a person can distinguish "right" from "wrong," and rarely succeeds as a defense. But to describe them as sane does not imply that they possessed "normal" control over their behavior though, except for those with extreme limitations, this should not influence their punishment. There is evil in the world and some succumb to its temptation. Yet even for the rest of us, the unconscious is very powerful and one must respect its power.

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Swamped by the Worried Well in the Emergency Room

Emergency Room workers are being swamped by medically healthy people who are frantically seeking testing for coronavirus. Though the present national period time is exceptional, their behavior is no different from anytime when anxiety escalates and panic overwhelms.


Anxiety is the normal, healthy experience when the mind senses danger. It can produce symptoms that mimic virtually any medical disorder: pain in the head or back; nausea or dry mouth; scarily heightened blood pressure; skin eruption; lack of appetite. All instantly vanishing when the fear that aroused them disappears. During normal times, forty to sixty percent of the people arriving at an Emergency Room who fear that they're having a heart attack are really suffering a Panic Disorder. This is the condition when the normal symptoms of anxiety are misinterpreted as a deadly medical event.


More public education about the human mind is sorely needed.

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Overcoming an Agitated Depression

There are few more painful experiences than an agitated depression: the combination of pervading anxiety and deep depression. Which can result following such common trauma as divorce or unemployment. Or even apparently nothing since, as I never tire of saying, the unconscious is very powerful and one must respect its power.


Because feelings reflect both mind and body, they cannot be separated. Thus does remaining in bed make depression worse and incoherent flight increase panic. So when altering the body through constructive activity, as by involving oneself in a work or household chore, the agitated depression lifts and, sometime later, its unconscious cause (if one exists) may surface.

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The Anxiety of Physical Illness

Physical illness involves feeling different, disconnected from the usual experience of possessing control over oneself, having the ability to reason, and considering oneself omnipotent in the world. While unrealistic, feeling all-powerful is needed for it enables one to function in the world, to engage in needed routines without anxiety. Yet this critical sense can be disrupted by physical change, even one so insignificant as suffering a conventional cold or stomach upset for these deny the person the feeling of intactness and affect reasoning.

 

Suffering a severe illness can be far worse as thinking processes change and helplessness ensue, the latter being the scariest of all feelings: when the ill person becomes passive, and his body no longer respects his commands.

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The Normal Psychological Pain of Serious Illness

A TV celebrity recently spoke of the anxiety and depression he felt upon learning his diagnosis of pancreatic cancer. These normally occur when serious illness threatens. And also, for that matter, following a cognitive or physical disability for either can reduce a person's normal functioning ability.

The diagnosis of cancer may well have a unique anxiety-bearing capacity for it possesses similarities to those of the unconscious mind, which are widely feared: its occurrence is unexpected and arising from nowhere; seemingly irrational; and experienced as all-powerful. But this is false since every unconsciously-derived act has a valid reason, even those which appear senseless. In one published case a surgeon felt compelled to repeatedly, publicly expose himself despite the legal and reputation risk until psychotherapy revealed that, by doing so, he was boasting to his mother how powerful he was, as he had wished to do when a toddler.

One member of the clergy, a three-time survivor of cancer, advised the following: that, when afflicted by serious illness, pray, but also get the best medical advice possible.

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Suggested Doctoral Dissertation Topic: Why Do Some Good-Reader Children Hate To Read

I've long been puzzled why some children in therapy who have no problem reading won't spontaneously read or profess to dislike it. Having tentatively concluded that, since reading involves the active use of the self, this creates anxiety for these disturbed children and motivates this resistance. But I've also encountered seriously disturbed children who read many books a week.

 

Certainly, there may be other contributing factors besides psychopathology: whether early-life parent encouragement of reading existed; the child never having grasped the escapist, soothing possibilities of reading fiction; or their over-involvement in another activity such as video games whose obsessive-compulsive elements reduce anxiety and is one reason for their popularity.

 

In any case, this would seem a worthwhile topic for study. And now the idea is yours!

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When the Fantasy of Having Had a Loving Mother Must End

After telling me his nightmare, a patient rejected my interpretation of it as reflecting anger toward his mother. "No, my mother always loved me," he said. Which may have been true for her relinquishing of parental rights enabled the patient's life to dramatically improve after his adoption and psychotherapy.


It is hard to accept being unloved at birth. Though the helpless infant can survive without physical care, psychological neglect can equally damage their future. And the most important person in their earliest years is their mother or mothering figure. Viewing the world with an immature mind, every child considers their parents to be omniscient. Thus if the child is unloved, it must be their fault.

 

Only with maturity, and possibly psychotherapy, can one accept a basic psychological truth: that while all children are lovable at birth, some mothers ore incapable of providing it. For this realization to occur, two things must happen: an acceptance of their parent's limitations, and their own.

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On Anthony Weiner and Unconscious Motivation

Though knowing only published reports, Weiner’s self-defeating behavior has one positive element: it reminds people of the power of unconscious motivation. A gifted psychoanalyst once wrote of his patient, a surgeon, who repeatedly exposed himself publicly. This risky behavior ended after the doctor’s interpretation: the surgeon’s behavior lay rooted in early  Read More 
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