A (Brief) Summary: My Journey From Psychoanalysis and Beyond

 

Throughout my career, I've been privileged to explore the intricate tapestry of the human mind, encountering many concepts that have not only shaped my professional outlook but have also offered profound insights into the essence of human nature. 

Psychiatry has always been a field of endless discovery. Each patient brings a unique story, each case a unique challenge, and each I've learned has unlocked new dimensions of understanding. Here, I share some of the key concepts and developments that have been pivotal in my work, critical in unlocking human potential - and even revolutionary in my practice. 

Nature vs. Nurture

From the outset, the realm of psychological treatment has, to a greater or lesser degree, acknowledged the inter-relationship of nature and nurture. Nature refers to inborn traits stemming from our genetic constitution - the structure and functioning of the brain. While nurture refers to the environmental factors that operate and change us throughout our lives. 

Nothing is static. Nothing stays the same, Even the hardest rock changes in the continuous process of wearing away as in erosion and the accumulation of detritus in the process of aggregation. Such is the case with our nature as it is shaped by the different experiences we encounter throughout our lives. 

Freudian Psychoanalysis 

Psychoanalysis was the predominant approach to the psyche/psychological treatment from the 1940s to the1960s. 

This method focused on the individual and their past with a study of dreams, memories and defense mechanisms (defenses are like ship stabilizers that maintain our equilibrium, to help us function in the real world and prevent us from reeling off course).

Anna Freud, a prominent psychoanalyst and daughter of Sigmund, worked in the early to mid-20th century and identified the common defense mechanisms. 

*DEFENSE MECHANISMS include: 

1. Denial, the refusal to acknowledge or accept a concept of reality that causes distress. (For example, an older person may deny the loss of intellectual and/ or physical faculties that occur in the aging process.)

2. Repression operates to keep painful or distressing memories out of our consciousness or awareness.

3. Projection operates when an individual attributes their unacceptable thoughts or feelings or impulses to another person.

4. Displacement describes what happens when an individual re-directs their emotions or impulses from their original source to a less threatening target. 

5. Rationalization is a thought process that operates to find a logical or socially acceptable explanation for unacceptable behaviors, feelings or thoughts.

(Becoming a psychotherapist to work out one’s persnal conflicts.)

6. Sublimation channels negative or unacceptable impulses into socially acceptable activities or behaviors. (Becoming a nutritionist to combat one’s 

impulsive eating habits).

7.Regression: reverting to earlier, less mature behaviors in response to stress or conflict. (E.g. a depressed person who withdraws from social interactions.)

8.Reaction formation: expressing the opposite of one’s true feelings or impulses to cope with anxiety.

9.Intellectualization: Avoiding emotional distress by focusing on a logical or intellectual explanation for a situation. 

(For example, to regard one’s abnormal EKG as an interesting study of heart functioning). 

10. Undoing: Engaging in behaviors to try to “undo” or make up for unacceptable thoughts, feelings, or actions.

Shakespeare’s Lady Macbeth is a classic literary example. She repeatedly washes her hands after engineering a murder.

Recognizing defense mechanisms can remove obstacles to progress.  

The process of analyzing the unconscious and the mechanism of defense could last for years.

Following the Freudians, the Neo-Freudians broadened the array of psychological techniques available. Austrian psychoanalyst Heinz Kohut (1913-1981) contributed significantly to this expansion with his introduction of concepts such as empathy, mirroring, and confrontation. These ideas enhanced our comprehension psychology. Kohut's theoretical frameworks provided psychotherapists with new tools to address the needs of individuals with personality disorders, particularly those who had suffered psychological or physical trauma in their early lives. 

Stigma

In the past, personality disorders were often viewed with significant stigma and posed challenges in treatment. Nowadays, some clients actively inquire if their issues are related to such disorders. Unlike several decades ago, when being diagnosed with a personality disorder was a shameful label, many young people today find comfort in knowing that their symptoms are part of a recognized diagnostic category and can be treated effectively. 

Diagnosis

A diagnosis is crucial for providing the right treatment, yet it should be approached with flexibility and openness to change. It's wise to remain prepared for unforeseen developments, as diagnoses can sometimes shift unexpectedly. 

For instance, some years ago I was surprised to learn that Mr. C, whom I had treated for depression for decades, overnight developed manic symptoms. This rapid shift of mood suggested that his depression was one aspect of a bipolar disorder with the potential for moods to fluctuate rapidly from a depressed state to a state of pathological euphoria.

Since the 1960s, various approaches have been developed to expedite the journey towards better mental health. These approaches focus on elements such as interpersonal relationships, the integration of mind, body and emotions as well as Eastern meditation practices.

The range of techniques introduced included behavioral, cognitive, humanistic and integrative-holistic therapies. Additionally, therapies specifically aimed at treating trauma, such as EDMR (Eye Movement Desensitization and Reprocessing), have been designed to target symptoms of Post Traumatic Stress Disorder directly. 

The object relationships school addresses the problem of "splitting", in which a person or a situation is viewed as "all good" or "all bad", a relatively common problem with far-reaching consequences in the realm of personal, interpersonal and world events. 

If you perceive the world as toxic, you end up shaping a hostile environment. In truth, the world both nurtures and deprives, and it is the individual's task to discern reality in the present moment and manage to integrate both aspects. Typically, the ability to see objects (people, places and things) as neither wholly good nor wholly bad develops in the brain around the age of twelve. However, some individuals, particularly those who have experienced trauma - be it psychological or physical - struggle to perceive and reconcile these dual aspects of reality. 

Any form of psychotherapy can address this dichotomy, which can cause discord with and individual, (intrapersonal or within oneself), in interpersonal relationships (our connections with others) and in the broader world. 

Curiosity

While scientists have yet to pinpoint the exact area of the brain responsible for curiosity, it remains a crucial trait for adapting to our constantly changing world and for a deeper understanding of ourselves. 

Summary

Attempting to categorize humans into strictly defined boxes - without acknowledging the fluidity and openness needed in ongoing dialogues - is not only limiting but potentially harmful. 

The field neuropsychology has become increasingly complex, enhancing our understanding of the brain and mind. As a species, we continue to evolve in a dynamic world. Keeping this in mind reinforces the value of maintaining an openness to change. 

Paradoxically, while we often crave stability, a rarity in its true form, real life presents us with turbulence, akin to ocean currents or the shifting of tectonic plates at the Earth's core

Shaping Life into a Work of Art (or Psychotherapy and Dialectics)

Dialectically speaking, I’m ok and I’m not ok. 

You could say I first discovered dialectics at age ten when my mother’s fifth child, my brother, was born. Confused by my intense and contradictory feelings of love and hate, I wrote them in a little notebook. Committing my feelings to paper allowed the distance to make sense of my dilemma. I loved my brother, an adorable, helpless little being who needed constant care and attention. And I hated him because he further deprived me of the attention of my already overwhelmed mother. Awareness of contradictory yet appropriate feelings made good sense, and I accepted myself (instead of remaining confused and potentially hating myself). And (unconsciously) I probably consoled myself by feelings of powerfulness when I cared for him and imagined I was his second mother. 

Recognized as early as the Greek civilization and expressed in the writings of Plato and Socrates as well as the Chinese philosophy of yin and yang, dialectics views the world in a continuous state of metamorphosis. Thesis and its opposite, antithesis combine to form a synthesis. Over time, the synthesis breaks down into a new thesis followed by its opposite, antithesis, and the process continues ad infinitum. 

Another way of perceiving the process is in the oft-quoted paradoxical aphorism by the Greek Heraclites: one can’t step into the same river twice. The river changes continuously so that it is the same river but not the same. The Biblical story of Creation can also be viewed from a dialectical perspective: Adam (thesis) and Eve (antithesis) unite to create an infant (synthesis). The cycle also plays out in human development. At first the infant is one (or symbiotic) with their mother. Gradually the baby begins to recognize a self (thesis), a person independent and separate. Next, the baby learns to integrate self in the world (antithesis). As an individual interacts with the world, they gradually learn to negotiate with other people; this in turn introduces the need to integrate the opposites of gratification and frustration. 

We usually don’t think how our personal world as well as the world outside us are in a continuous state of flux. Creative and destructive forces dapple our day. This blog addresses the role of dialectics in our daily lives. Understanding the abstract process dialectics can help to ground us and normalize our human condition. The (abstract, philosophical) concept of dialectics (thesis) applied to real life (antithesis) grounds us in awareness (synthesis) and lies at the roots of the psychotherapeutic process. The vast arena of psychoanalysis, psychotherapy and pharmacotherapy helps to resolve stumbling blocks and curve balls that life tosses us. 

Here’s a concise picture of how psychological theories manifest the dialectical process and expand the therapeutic approaches. Freud’s work unified the opposites of unconscious and conscious thinking to resolve inner conflicts. Conscious (thesis) plus unconscious (antithesis) leads to greater awareness (synthesis). The American philosopher and psychologist William James (1842–1910) defined the experiencing self (thesis) and the observing self (antithesis) that work together in a synthesis to enhance awareness. The Austrian American psychoanalyst Heinz Kohut (1913–1981) expanded Freudian theory by introducing the supportive techniques of mirroring and empathy (thesis). Working together with confrontation (antithesis), these tools enable a therapist to treat problems and/or traumas that stem from early development. American psychologist Marsha Linehan (b. 1943) created Dialectical Behavioral Therapy that incorporates the tools of group therapy and journaling. Group therapy helps the individual consider other points of view. Journaling offers the chance to jot down contradictory thoughts. 

How we cope with loss also relates to dialectics. While on a trip to India, my tour group stayed with a woman whose story exemplified the power of transforming loss to gain a larger view of the world. She prepared a delicious smorgasbord of Indian treats for us and entertained questions. A member of our group asked our hostess what had inspired her to entertain tourists. She became animated as she described the most painful event of her life. She had lived a quiet existence with her family until her son was killed in a highway accident. Her husband withdrew from her and the world as he continued to grieve. After two years, she realized she wanted to go on with life and decided to fill the void by opening her home to tourists, to prepare Indian meals and to listen to others’ stories. 

Innovation, too, follows a dialectical pattern. Advances in any field occur when a ground-breaking thinker incorporates diverse influences (thesis) from the past and synthesizes them into something novel. Pablo Picasso (1881–1973) combined the theme of African masks with Cezanne’s concept of perceiving objects from various vantage points. From these influences, he, along with Georges Braque, created Cubism. The American painter Basquiat (1960–88) combined elements of neo-expressionism with themes of racism and colonialism. 

Conclusion: Dialectics expands our understanding of patterns of existence and helps us process the opposite forces that confront us throughout our lives. 

Dear Readers, I welcome your comments. 

Jsimon145@gmail.com

To Discover Your Belief System, Analyze Your Behavior: How A Psychiatrist Changed her Belief System from Impatience to Acceptance

 

William James, the psychologist often referred to as the father of psychotherapy, was the first to appreciate the concept of our two selves—one that acts and the other that analyzes those actions. By developing the second self that (critically, realistically) observes their own behavior, we psychotherapists teach clients how to become their own psychotherapist. 

 

Here’s an example from my own life. Even a tiny observation of how I behave informs me of an aspect of my character revealed through a brief dialogue between my observing self and my experiencing self.

 

One Saturday at the health club, I was riding on the shabbat elevator that is regulated to stop on every floor. Although I know that pressing the buttons will not affect the elevator’s functioning, I persisted in button-pressing! “You are an Impatient person,” 

my observing self informed my experiencing self!

Observing self: "Your behavior says a lot about you. You are an impatient soul."

Experiencing self: "Yes, I agree. Let me explain the feeling behind my (ridiculous) action. I feel that I will never have enough time in my lifetime to fit in everything I want to do, everything I want to learn. But here’ my justification. On my death bed, I will be able to say, I tried to cram as much as I could into my life!"

 

To accept Dr. James’ concept, to perceive our one self as actually two selves, the experiencing and the observing, gives us the possibility to become our a self-healer. During dynamic psychotherapeutic sessions, we develop our observer self to comment (accurately), lift us out of the moment, and examine our behavior.

 

The division of selves allows us to become a more complete, aware person. We may not always like what we see about ourselves. Next, we arrive at another fork in the road: to accept (resign ourselves) to who we are in the moment or to change our behavior and our belief system. For example, I could choose to work on myself, on my impatience, to decide to become more patient and accepting of whatever time I have. I just remembered a line from the play Tally’s Folly by the playwright Terrance McNally: “However much time there is in a lifetime, is a lifetime.” 

 

To me, the evolving self is an exciting, creative one. Except for the objects on our shelves, in reality, very little is static in the world. And each of us is in a perpetual state of becoming. In each of us we can find/discover our most important creative project, our self, evolving.

 

Dear Reader, I welcome your responses. Jsimon145@gmail.com

 

 

 

 

Collaborative Approach to Psycho-pharmaceutical Treatment

As we know, there is a wealth of material about everything readily available to us at our fingertips on the Great Wide Web. (While I appreciate the inherent dangers, I embrace the convenience, having spent hours of research in library stacks decades ago.) Recently, I’ve discovered that the internet can also be an avenue for collaboration with patients who want to be involved in choosing their medication. I suggest that they research the pros and cons of the medications for us to consider as a treatment team. Of course, the final decision is mine. I will not prescribe any medication that I do not think is an appropriate choice. 

 

A recent example is a person who has experienced treatment failures with a few psychiatrists in the past. To me, this history suggests a particular diagnosis. I have suggested that they research medications that have been effective for this diagnosis. They have appreciated the suggestion and done their research. We look forward to our collaboration as we discuss and try some psychopharmacological options. 

 

Dear Reader, I look forward to your comments.

Jsimon145@gmail.com

Some Thoughts on "A Beautiful Noise," the musical, based on the life of the Singer-Songwriter Neil Diamond

The morning after I saw the scintillating musical on Broadway, A Beautiful Noise, I found myself asking the question: what is the relationship of the artist’s work to understanding himself? This query has occupied thousands of writers’ minds and resulted in almost as many books that explore the intriguing question. 

I applaud this production, an interpretation of the life of a star, in which the therapist’s office serves as a backdrop for Diamond’s music. Admirable too is the depiction of Diamond as less than an ideal client. He is resistant: He doesn’t want to be in this space undergoing an exploration of his deeper self. He is here because his wife Katie sent him. He reluctantly reveals that she finds him “difficult to live with.” After the failure of his past two marriages, he is receptive to heeding her advice.

 

We psychotherapists prefer a client who is open, willing, and eager to undergo the therapeutic journey. But in this production, the clever therapist hooks Mr. Diamond as he’s about to walk out the office door. She opens a thick volume of his lyrics and asks about a specific song. She has captured his interest. Now he can’t escape the task ahead of recognizing the aspects of himself that he has buried and that now create some inner conflict and express themselves in his relationship with his wife.

 

Although Diamond’s songs are an expression of himself and document his journey, they do not accomplish the task of psychoanalysis. The relationship of the artist to his work embodies a deep and personal connection that emanates from his experiences. It is a form of self-expression and communication with the world but doesn’t substitute for a psychotherapeutic exploration. 

 

The therapist accomplishes the task to help the client discover his inner conflict, the thoughts and feelings that veer in opposite directions. She accepts her client and mirrors or reflects to him what she hears in his words and adds an occasional comment of interpretation. As he participates in the therapeutic relationship, the client comes to recognize and accept aspects of himself that he hadn’t recognized, avoided or denied. In Diamond’s case, it is the failure to acknowledge a part of his identity: his early years as the lonely little boy, a nobody from Brooklyn. Through the psychotherapeutic experience, he recognizes and accepts this aspect of himself. The joyous, uplifting song I Am…I Said expresses the delight in acknowledging his full identity. The lonely boy from Brooklyn joins hands with the world-traveled singing star. He doesn’t have to perform on stage for the rest of his life to be Ok. 

 

Conclusion: The goal for a celebrity and for each one of us is the same: coming to terms with who we are, our deepest self in the past and present that helps to guide us on an authentic path. 

 

Dear Readers, I welcome your comments. Jsimon145@gmail.com

My Psychotherapeutic Journey: Deprivation and Motivation

Whether we realize it or not, in some ways, we are all deprived children. This statement may jar and even antagonize some of you readers. Nevertheless, I persist in my exploration of this topic that I find intriguing. 

Deprivation can occur in the physical, mental or emotional realm. For this essay, I’ll focus on the psychological realm in which the deprived state causes a deviation from the (theoretical) optimum. Most often, a deprived child finds one way or another to compensate for the unmet need. 

Taking myself as an example of a deprived child, when I was ten years old, my third brother was born. I experienced the feelings of happiness and sadness. Confused, I began to write down my feelings to try to understand these contradictory feelings. Committing my thoughts and feelings to paper helped me define them. I discovered they made good sense. I was happy to have a baby brother. (I pretended that he was my baby.) But I was sad because my mother now devoted her time and attention to him and had little left for me. Journal writing helped to give me a sense of mastery over my environment and lifted my spirits. 

In retrospect I see my adjustment of journal-writing as (a kind of) deviation from normal. Most ten-year-old children would be playing with their peers or taking a dance class or a piano lesson both of which I craved but weren’t available to me. 

When I got to college, I did not know what a feeling was. The girls on campus regularly asked each other, how are you feeling today? I knew there was something wrong because I could not answer the obvious question. To explain: I was the oldest of five children, reared by an intelligent, conscientious mother, who worked full time to support us. She had no time or energy to pay attention to the feelings of each of her five, demanding offspring. (She considered herself successful in providing each of us with a quart of milk on hot, summer days.) 

Uncovering feelings of deprivation in our childhood can help to explain some of the choices we’ve made as well as our life course. Somewhere along the way, I decided that if I became a physician, I’d have some control over my life and enough money to do what I wanted. As a psychiatrist I could justify my own psychotherapeutic journey and help others on their own. 

My first psychoanalyst, Dr. A did not understand my feelings of childhood deprivation. In his eyes, I’d been raised by “loving” parents; they had provided me with a good education and supported my journey through medical school. Dr. A’s lack of understanding caused my depression, stemming from a failed marriage, to deepen. Perhaps Dr. A hadn’t known the depth of deprivation in his own childhood, or at least had adjusted well enough in life, not to have probe deeper into his own psyche. Was he fortunate or not? (Hint: There is no right or wrong answer.) 

Then, through social connections, I met a gestalt therapist who recommended his brand of therapy. As an eager patient in a gestalt therapy group, I experienced support and learned an approach with tools that were able to reach my deprived psyche. 

Then I was assigned a new psychoanalyst, Dr. B, to continue my psychoanalytic training. Fortunately, she understood deprivation and I had a healing experience. I learned too that more important than a therapist’s training, is their ability to recognize the psychological needs of their client. 

Dr. B knew how to use the techniques of the neo-Freudians like Karen Horney. whose down-to-earth books were helpful but not entirely healing. She understood self-psychology advanced in the writings of Heinz Kohut who expanded the psychoanalytic toolbox to include mirroring and empathy, tools that reflect a client’s state of being. 

Perfect empathy in our imperfect world is impossible even in near-ideal circumstances with good-enough parenting. Parents are burdened. They too have baggage, and with their busy lives, rarely have the chance to unpack it. Without necessarily meaning to they may transfer a portion of their less-than-optimal adjustment onto their offspring. 

In conclusion, many of us have experienced some degree of emotional, physical and/or spiritual deprivation in our past that points us on a journey to repair or compensate. Most often the details lie deeply buried in our unconscious mind. If we are fortunate, we get by without recognizing the specifics. When we encounter some major obstacle in our personal and/or professional lives, we may turn to psychotherapy (and at times psychopharmacology too) to unravel what stumps us in our journey. 

I continue to work on myself, writing a daily journal and an occasional poem, fascinated by the unending conundrums of living. I find writing nurturing, reinforcing the creative journeys I travel with my clients. 

Dear Reader, I welcome your comments: jsimon145@gmail.com

Poems from The Ravens Perch

 

Dear Reader, 

I would like to share my poems that were published in an online international literary and visual arts magazine on October 4, 2023. 

Fish Out Water 

Dad showed his interest
in us kids by clipping
articles from the New York Times

Clipping was safer
than kissing, or brushing
flesh on flesh

The coelacanth, a fish thought
to be extinct was rediscovered
trapped in a fisherman’s net

We envision his lunge
eons ago from sea to land,
unwieldy body, sprouting
lungs and appendages

Like Dad, unmoored,
an outsider, searching
for his spot on earth

Dad, an odd fish. We
five kids agree, days
after the newsprint fades

Today we ask: what drove
the coelacanth from the sea?
What spurred Dad
to leave us, his family?

Perhaps it was curiosity
that led him to risk an
unraveling, the long,
arduous journey
to end in a curious,
dubious finale.

Muse 

I train my muse daily.

Her wings light as a fairy’s
so I coax and treat her gingerly
to earn her visits frequently.
How mightily with unpredictability,
she alights and ever too soon
flits away: turns lights out like
a June bug taking off July.

The Entertainer 

He is always proving to someone that he exists.
On the ship’s deck,
at the 6am breakfast
he aims to entertain the entire round table
of six, blurry-eyed passengers
with his whiskered joke.
Suddenly their eyelids lift
because the punch line is coming,
racing around the corner
outruns the first cup of coffee
to win the race and fill
the passengers and the entertainer
to the brim.

Please send your comments or questions to jsimon145@gmail.com.