25 July 2013
This needs to ripen, but no too much.
The thought is well enough formed now to describe, if not
yet to name. To be sure, this is living inside my own head again. Only this
time not the dark internal cacophany that grew hidden and briefly overtook the
last decade. Time, and the decisions made have well and truly made me. Whether
on the marae, upon the streets of Unreal Cities or in this now-familiar
corner . . . discovery is replaced
by scope, the vision of middle age.
Is all growing growing apart? The black and white and red
threads hold tightly together as they pass through the eye of the needle, so
that they may pass at all. But once past, what remains is letting go. The
experience of her sitting beside me, regressed enough by the drink to let me
know that she could not really see me, and that any self-making I had
undertaken was what I would take away from the relationship, not bring to it.
Welcome back, indeed.
And today, in of all places, a kitchen remodeling
discussion. I felt the familiar pang of the value proposition dying, as I have
seen it countless times in medicine. I suspect if I proceed I will be getting
Abilify countertops and Pristiq appliances, when a MAOI would have done better.
I suppose beginning that conversation with a vision and no great concern about
cost is like coming into the ED with anxiety, fully insured when there’s an
open bed. In other words, my own fault. A better student of one’s illness would
not be carried forward by the perverse incentives in the system.
Then, after a convivial evening, to watch the cross-purposes
unfold in real time. I mean, really, who goes to a cocktail party, dinner and
downs half a dozen drinks before mentioning at 2130 that “we” have homework due
tomorrow. If you are lucky enough not to be in the “we’, the only real move is
to step aside. Wierdly, Kristen took sides, and even odder, the side of
cross-purposes.
26 August 2013
Therapy is exposure in quiet chambers, a cut that does not
kill and so a gift, if we can but experience it this way. It is not easy, and
it is not a zazen. Simulacra such as catharsis, confession or endless thought
experiments are easier, but of little value. For some, even the dim lights are
too hot.
Process: change you will notice
To think, speak and act more adaptively in a world that is
oftentimes, but not always, sane. (Game theory?)
what shall I think?
“whatever you are thinking” is the easy answer. Free association is easy once
learned, and deceptively difficult to cultivate. Mindfulness is a good place to
start. Unlike CBT or DBT, however, it is important not to consciously do
anything with the observations for some time, such as look for upstream
“triggers” or downstream behaviours. Notice also that I do not say “feel”, as
we need to reserve this term and keep it as close to a meaning of “body
sensations” to work analytically. The assumptions going in are (1) bodily
drives are limited aggression and libido (full stop) and so (2) the primary suite of feelings are very
limited--pleasure, anger, disgust, fear--depending on how these urges match
with subconscious calculation of their achievability. Finally, because drives and primary emotions are
fundamentally pre-linguistic, we damage them (but also provide “grist for the
mill”) when we dress them up intellectually as ambivalence, jealousy,
dissonance or guilt. In practice, this requires a discipline (learned or
enforced) of expressing thoughts declaratively through a “scene”, vignette or
sequence that should be described as narratively (show, don’t tell) as
possible:
For example,
“That morning at the office, when I saw Tina enter and I
noticed myself focusing on her breasts. This was followed by a fleeting vision
of myself sucking on them, like a child, but at the same time very sexual. I
felt very warm at first, but then more of a prickly-heat or flushing sensation,
very embarrassed.”
“Think a moment and try and say more about what you mean
when you say embarrassed.”
“Let’s see. I suppose ashamed that I was thinking such a
thing.”
“But you said embarrassed, and that word tends to be used
for situations where one is caught by an observer. Was someone else around, or
did she seem to react as though she were aware of your thoughts?’
“No, I was alone, and she was rummaging through her purse
and couldn’t see me through the glass, anyway.”
“okay”[silence]
Note the therapist does not make an interpretation. Some
might be tempted to see the “offer” of shame as an invitation to expose a
superego-id conflict and to go fishing for similar experiences (“can you tell me
a time when you have felt this before?”). However, such a response invites
association that is not free, or the patient’s, for that matter. This therapist
keeps the follow up as literal as possible, asking for clarification then
retreating back into silence, thus allowing the patient’s association to
continue, which it does:
“You know, now that I think of it, the afternoon before I
overheard one of the secretaries telling another that Tina was still breast
feeding her 4 year old. I chuckled to myself at the time; I guess at the
disapproving and gossipy tone of it. But I also remember being very distracted
and irritable on the ride home. I masturbated as soon as I go home, which is
unusual for me as it makes me quite sleepy after. But you know what, I felt
much better [laughs]
what shall I say?
Effective free-association usually results in less talking,
rather than more. A comfort with silence, a willingness to let thoughts pass
or to tolerate a bit of anxiety
while seeing how they play out internally.
what shall I do?
30 August 2013
The last payment . . .
I think you understood better than I did during our divorce
proceedings that monthly payments were not a “punishment”, but quite literally
a form of accountability. Over time I came to see this, and it served as a
reminder that I must own my actions, my words and my choices. Sometimes the
money was difficult to come up with, other times I hardly noticed. But each and
every month for a time equal to our marriage I was confronted with the fact that
not acknowledging my shortcomings had carried a price, and that I could either
change or pay forever.
The misery that is divorce is only compounded if afterwards
one chooses to heap blame on “the ex.” Moreover, it is a perverse kind of
refusal to let go, and an unflattering exercise in vanity. The fact is, one can
only ever know and change what he got wrong, and there was plenty in my case.
From the very beginning of our relationship, I behaved as if love somehow
excused my words or actions. I was thoughtless, narcissistic and glib. Worse
still, I hurt you. Not once, but time and time again. I know it wasn’t all
awfulness, and I have many fond memories of our time together, but I was a
failure at our marriage and that has humbled me.
I do not owe you any more money, Sandy, but feel that the
“payment” would be somehow incomplete without a genuine apology and an
acknowledgement of the positive feelings that have survived all these years.
And so . . . I am truly sorry for the pain I caused you. I love you, and will
always.
3 September 2013
3AM. Reflections upon doubt. It seems to me that there are
two categories of self-doubt: doubt in one’s character (“Am I a good person?”)
and doubt in one’s ability (“Am I able to do this?”). The two intersect in the question, “Am I strong enough?”,
which is a question of will, but
also of faith in one’s “better” self.
The meds and the alcohol were a shield of sorts, but from
what? Perhaps nothing more than the daily grind of low-grade conflict,
negativity and frustration that we all must find some way through. In this
case, they served an adaptive purpose . . . until they didn’t anymore.
I can see how both confidence and practical self-regulating
skills can atrophy after a period of reliance on meds and alcohol, but of
course they do not disappear altogether. In the end, perhaps it’s a “locus of
control” exercise: learning how to reach inward to self-contained regulatory
mechanisms, then reaching out to others (matee, sponsor, friends) before
reaching for the Rx or bottle. A good cry, a good chat and fight the good
fight. Repeat.
One thing you need never doubt is my love for you.
