Brooklyn Zoo (2 page)

I’d been lucky enough to stumble into therapy, and so slowly—how lucky I was—I began to see that the things that were most distressing as I moved through my young adulthood
barely existed outside my head
. It cannot be underrated, that ability to distinguish between outside and in. Left and right I was distorting external realities to make them match my earliest internal ones, or involving myself with people who confirmed old and sorry expectations, or unconsciously cajoling others into buttressing my most unpleasant fears. Neurotic misery, Freud called it. Condemning the future to death so it can match the past, the singer-songwriter Aimee Mann called it. Dr. Aronoff, influenced primarily by the Freud protégée Melanie Klein, called it clinging to the bad breast. Over and over together we found evidence of this insistent grasp. With time I understood that the way I had come to see the world, my place in it, was more about perspective than any absolute reality, and if that was true, at least many more things were possible. I had never been religious, but for the first time in those years I knew what it felt like to believe absolutely in something
intangible, to have faith, though Dr. Aronoff made no claims of divinely sanctioned insight. It was simply an education, allied to a temperament more patient than my own, that had allowed her to bestow her gifts. To be able to offer others what she had given me, some freedom from old bad feeling, I just had to go to school, nothing I hadn’t done before.

In terms of formal education, several options were available to me on the road to becoming a psychotherapist. The simplest, because of its relative brevity, would have been social work school, but having spent many years listening to my mother lament that social workers got no respect (another masochist’s mantra), I was not about to sign up for that. The most lucrative was likely to be medical school, which would set me up to become a psychiatrist, but psychiatrists were no longer necessarily trained in talk therapy: instead, they prescribed pills. I had nothing against medication, but I did not find it interesting in any but the most cursory way. A doctoral program in psychology—comprising four years of theoretical course work and concurrent talk therapy with actual patients, followed by a yearlong clinical internship—seemed like the obvious choice. Dr. Aronoff was neutral but supportive. I half wished for her to tell me she thought I would be good at what she did, but I was well schooled enough by then in the ways of therapy to know we would only examine this desire. For her to explicitly say so would have felt superficial in the context of our relationship anyway, and also less powerful than the fact that in my heart I believed she felt it, as she had for many years been my stalwart teacher.

The first patient I ever saw in therapy had a problem with a kitten. A nineteen-year-old undergraduate at the same university
where I was by then in the second year of my doctoral training, she had recently adopted this kitten and had found herself faced with the terrifying realization that she was not responsible enough to care for the animal. She was distraught, really in a panic. Could she simply return it, she wondered, or was it destined to become a victim of her reprehensible immaturity? “He would be so much better off with somebody else,” my patient told me with fierce passion as tears stained her translucent skin.

I don’t remember how the issue was resolved, if the kitten stayed or went. What I do recall vividly is that my patient and the young cat had some striking autobiographical similarities. Like her pet, my patient had been stuck with a nineteen-year-old single mother, one too irresponsible to parent her to boot. My patient had silently endured her mother’s unpreparedness, waiting for what had felt like lifetimes in front of schools or friends’ houses for a woman who’d promised earlier that day to pick her up, or in bed for her mother, who she always feared dead, to relieve yet another late-night babysitter. To cope, my patient, like every child before her, honed psychological defenses: ways one protects oneself from anxiety and grief and injuries to self-esteem. She spent many hours lining up her dolls—not playing, just arranging.

While I listened to my patient lament for her poor cat, I knew for certain that she was re-creating an earlier emotional experience of her own, trying the whole scenario out on the kitten to see what would happen. Psychologists call this particularly creative defense “acting out”—replaying once terrifying situations to transform old feelings of vulnerability into experiences of power. Acting out is driven by the unconscious need to master anxiety associated with old and powerfully upsetting fears. We act out what we cannot allow ourselves to
remember, and usually even once we’ve remembered, we forget again and do the whole thing over. Psychologists call this forgetting “repression,” the doing over “working through.” When viewed from a therapist’s chair, it’s rather like watching a play in which the star is also writer and director for an unsuspecting supporting cast. By the time I’d met my first patient and heard about her cat, I had read papers on “the repetition compulsion” and “core conflictual relationship themes” and so on and so forth, but I also knew firsthand what it was like to feel so unconsciously compelled to repeat. My own mother’s explosiveness had early on left me with two rotten choices: either she was very crazy, or I was very bad. A fair portion of my early adulthood was spent trying to work out which it was, and to that end I befriended more than a couple of high-strung girls, each of whom I grew close to and then finally cut off abruptly, exclaiming “She’s crazy!” to anyone who had patience enough to listen. Dr. Aronoff finally asked whom I actually thought I was trying to get rid of.

“When you listen to yourself talk about this cat,
does it remind you of anything
?” I asked my patient cryptically in our early days together. Of course it did not. It was too soon. She was not yet ready to know. Later, as invariably happens, she would re-create an aspect of her childhood dilemma with me, regularly missing sessions as I waited bereft in my office, longing for her to appear just as she’d once ached for her mom. A good therapist uses her own emotional reactions to help the patient put her early experience into words, but I wasn’t there yet.

“The unconscious doesn’t know who is abandoning whom,” one supervisor said to me, explaining that my patient was likely feeling left by me, even though she was the one who was not showing up.

“If she had come regularly and had experienced you as a consistent part of her life, she would have had to grieve all that she didn’t have as a child,” one of my professors commented in my final weeks of school when I presented the case—which had by that time spanned three years.

I saw many clinic patients during my four years in graduate school. They arrived with their problems and their stories, and because I was being educated in the psychoanalytic tradition, I learned to begin by asking myself two questions. First, what was their developmental level? At what point in their emotional development had things begun to go awry—the earlier it had been, the worse off they were. Second, what was their character organization? In what ways did they tend to distort reality in an attempt to feel less pain? Together these answers provided an important if gross starting point for every treatment. A patient’s developmental level was psychotic, borderline, or neurotic; his character organization within that level masochistic or obsessive or narcissistic or depressive—the list goes on some—depending on the constellation of defenses he tended to favor. (Myself, I was neurotic, and my own character style a tinge masochistic with stronger undercurrents of depressive: having felt from quite a young age that painful experiences with my parents were my fault, I believed I was so bad. I was not unlike other psychotherapists in that regard. What better way to alleviate a constant and nebulous sense of guilt than to devote one’s life to helping others?)

These two dimensions shed light on the patient’s internal experience, on how he organized and perceived his life. What had become more popular in the world at large, under the rubric of cognitive-behavioral therapy, or CBT, was an emphasis on discrete symptoms, say social phobia or panic attacks, that could supposedly be alleviated in short, rote bursts
of ten sessions or fewer. At my school patients came to us for long-term work and character change, to alleviate troubling thoughts and behaviors and then some, as true well-being is more than just the absence of symptoms.

In class, semester after semester, we worked our way through a hundred years of psychoanalytic theory in the order it was written. Outside class I sat with patients and supervisors and tried to figure out how to apply my book learning to my clinical work—the most difficult part of becoming a therapist. As I relaxed through those years into the reassurance of my teachers’ formulations about the people who arrived to see me weekly, I came to grasp why I had finally chosen to study psychology. Having early on found myself in a world where the attitudes of others confused and pained me, I needed badly to make sense of people, to order them, like my patient with her dolls.

But it was not an auspicious moment for nuanced thought, and while I did not fully realize it yet in those first years of graduate school, neither was it a good time for psychology as a field. As if the pernicious hostility toward the psychoanalytic way of working were not enough to threaten the best chance people had for richer lives, the confluence of cultural forces, the advent of pharmaceutical commercials, and a general human aversion to deep consideration of complication had over the course of many decades swayed the conventional wisdom: psychological problems were nothing more than chemical occurrences in the brain, something one caught, like a cold, or was born with, like color blindness. If Descartes’s four-hundred-year-old error had been the separation of mind and body, of rationality and emotion, the modern equivalent, at least in the popular consciousness, seemed to be a separation between brain and mind, in some cases leading to the disappearance
of the mind altogether. The medical establishment did not dismiss talk therapy completely, but it seemed to have come to believe that its primary utility was not to make meaning but rather to convince people to take their pills. (“You do the hard work of getting people to be medication compliant,” a psychiatry resident said to me once, in the patronizing tone I would become accustomed to hearing from young psychiatrists, as if this were a skill that one might reasonably spend many years in school acquiring.) The sensible idea that the sum total of one’s biology
and
life experiences contributed to emotional strengths and vulnerabilities seemed to vanish into air, and along with it esteem for the actual hard work done by psychologists. And so it came to pass that my discipline was slowly being phased out of medical centers—the treatment site of choice for the most disturbed and outcast patients. By the time I completed my four years of doctoral course work and accepted the internship offered me at Kings County Hospital, there were fourteen psychiatrists running and medicating the seven adult inpatient units. There were four psychologists in total covering those wards. Even in the place where I had been invited to complete my training, there was this suggestion of how little what I had to offer might be valued. For my own part, I couldn’t quite get that message out of my mind.

On the first morning of my internship at Kings County Hospital my stomach felt raw. My new professional clothes, so chic in Macy’s dressing room just one month before, looked now only dowdy and overly beige. I met my friend Jen on the corner of Joralemon and Court Streets, halfway between our Brooklyn apartments—mine in tree-lined Brooklyn Heights, where I was renting a small fifth-floor walk-up with
my classmate turned fiancé, George; Jen’s in a grittier, hipper neighborhood just the other side of the Brooklyn-Queens Expressway. We met near the Court Street station to ride the Number 2 train out to the far end of our borough, to East Flatbush, where our Jewish immigrant relatives might have settled just two or three generations prior, but which was now home to other, darker-skinned newcomers: Haitians, Jamaicans, Trinidadians, Guyanese. It was less than five miles from where I’d lived for years, but until I interviewed at the hospital, I’d never as much as passed through the neighborhood. In a city of destinations, East Flatbush was not one at all.