Friday, July 24, 2009

Room 101 - Pt 3

People with bipolar disorder almost invariably have a psychiatrist, who prescribes their medications. Frequently they also have a therapist -- in my case a clinical psychologist whom I'll call Laura. Laura's office is typical of most. It is comfortably furnished. It is uncluttered. Its walls are light in color and the few prints and photographs on those walls are light in tone. Sunlight pours in through large picture windows. All in all, the room seems cheerful, reassuring, and safe.

In many ways that impression is accurate enough. Laura is good at her job and I have always felt as if I were in safe hands.

In one key respect that impression is wrong. Decidedly wrong.

The worst thing in the world is in that room.

As in Nineteen Eighty-four, the worst thing varies from individual to individual. And as in Ninety Eighty-four, the interlocutor often knows what it is, if not in the early sessions then usually after a few months. That's because although each person is ultimately unique, the symptomology falls into broad patterns that offer an experienced therapist -- O'Brien, to pursue the analogy -- solid clues as to the likely underlying problem. Certain patterns, for instance, are common to adult children of alcoholics. Others are common to persons with borderline personality disorder, still others to persons who have been sexually abused.

The worst thing, however, is seldom evident to the client, because they have spent most of their lives excluding it from their awareness. The techniques of exclusion have usually taken the form of the very attitudes and behaviors that eventually bring them to the therapist's office in the first place. As Carl Jung once explained, "People will do anything, no matter how absurd, in order to avoid facing their own soul." Or more famously: "Neurosis is always a substitute for legitimate suffering."

And yet, when finally confronted with the worst thing in the world, the client is seldom surprised. Because in order to avoid a thing they must, at a a semi- or subconscious level, have an idea of what that something is. They know that they have been, all along, on a journey to discovering what specifically is in Room 101. But unlike Winston Smith, they have usually entered Room 101 by choice.

They have done so notwithstanding the stigma attached to psychotherapy. It is common to hear people pour scorn upon psychotherapy or uncritically accept the crudest caricatures of it. Upon encountering someone like myself, who no longer minds saying that he sees a therapist, their attitude is at best one of incuriosity.

In their disdain the scoffers are powerfully abetted by ubiquitous media images of therapy. In the culture wars it is common to hear of a "therapeutic society" that promotes victimhood and diminishes individual responsibility -- it is no accident that blaming one's parents is thought to be the alpha and omega of therapy. In commercials the therapist is usually portrayed as an eccentric disciple of Freud, distant and detached, scribbling on a pad of paper while the client, recumbent on the proverbial couch, says all sorts of wacky things. On television the therapist character is often brought in to deal with someone accused of a serious crime or whose behavior, at the very least, is utterly bizarre. (Favorable depictions of therapy, by the way, are almost equally unrealistic.)

If the suggestion is made that therapy might be helpful to them, the scoffers rule it out of bounds, even when the presenting problem -- a marriage that is failing, an uncontrolled temper that is wreaking havoc on their personal or professional lives -- is screamingly obvious.

These are people who have not made an informed or reasoned decision about therapy. Their choice comes from their gut. They understand instinctively that the worst thing in the world is in the therapist's office, and no way in hell are they going there.

Part 1 - Part 2 - Part 3

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