A reporter came to my office a year ago to interview me for an article in the Philadelphia City Paper. This young woman seemed sophisticated and intelligent. She knew I was a psychoanalyst and despite the many pithy New Yorker magazine cartoons, she was amazed and bewildered when she saw my analytic couch. She thought psychoanalysis and the use of the couch were abandoned around 1940.
I wrote my book Nine Lives: A View from Within in an attempt to convey to the layperson some of our therapeutic work as analysts and to underscore the profound value of intensive psychoanalytic treatment. I did not want to write “fairy tales”—that is, that all our patients gain insight and live happily ever after—but to convey some of the experiences, pain, and struggles that unfold in our offices.
Mystification, idealization, and derision have often characterized the view of our efforts. Whereas some of these attitudes represent transferential distortions, our highly touted “splendid isolation” and our obtuse jargon (shorthand codes), have contributed to this perception. These views of what we do therapeutically and who we are as mental health professionals have not been helpful. Nine Lives is an attempt to better understand aspects of the human condition and to shed light on the process and the struggle we confront daily in psychoanalytic treatments.
Below is an excerpt from the Introduction to Nine Lives.
I have worked as a psychiatrist and psychoanalyst for nearly 50 years and I have consulted on and treated hundreds of patients. I have never met an Alien—someone who was beyond the boundaries of human understanding. Every person is unique, every case offers mysteries and surprises, but the common thread reflecting the human condition has always been visible. Some presentations at first appear extreme or even bizarre, but the underlying conflicts and the haunting demons my patients bring, I know “in my bones” because they reflect shared human conundrums. Unfortunately, for some, these challenges lead to emotional dysfunction, great pain, and suffering.
The well-known American psychiatrist, Harry Stack Sullivan, worked with very ill psychotic patients for many years and emerged from the experience observing, “Man is more human than otherwise.” Stated less elegantly and paraphrasing the comic POGO, “We have met them [our patients] and they are us.” If we look deeply into another person's eyes we see ourselves. Sometimes that which we see leads to a sense of kinship. At other times, the reflection can be frightening, promote interpersonal detachment and self-alienation. Introspection, immersion, sensitivity, and a bit of courage will help the reader recognize himself in the clinical material to be presented. Such recognition may be enlightening.
To shed light on the human condition and to underscore how we all share this condition of being human, I will tell you the stories of nine patients (carefully disguised for confidentiality) whom I have treated in intensive insight-oriented psychotherapy. Their stories are dramatic and valuable. Of course, I can only relate fragments of their narratives, but I will tell you about the most vivid moments and hours I spent with these people and the times that were most alive and real for me. Though their past histories and surrounding life events helped me understand the moments we shared, such background was once removed from my immediate experience. It was my contact with these nine people that was intense, rewarding, and unforgettable.
Reflecting the human condition, these individuals struggled in life, largely with painful inner conflicts and battles with childhood fantasies and traumata. However, the resolutions they came to did not work for them. They were left with emotional pain and patterns that were self-defeating and compromised their potential for living a fuller life.
Newell Fischer, M.D., APsaA past president, is clinical professor of psychiatry, University of Pennsylvania School of Medicine; psychoanalyst of adults, children and adolescents; training and supervising psychoanalyst, Philadelphia Psychoanalytic Center; and past president, director of psychiatry, Institute of Pennsylvania Hospital.
Understanding their dysfunction tells us much about being human and about ourselves. Comparable to a finely synchronized and oiled machine, when the apparatus is not functioning well, we are more aware of how it works. Cases of pneumonia force us to learn more about infectious processes and the mechanics of breathing. Listening carefully to a child's nightmares can tell us much about his unspeakable worries.
In telling these stories, I also want to reflect and describe through example an important therapeutic approach that puts a premium on the in-depth understanding of the individual's inner world. The treatment was guided by an effort to unearth and understand those forces and structures within the individuals that were causing them to hurt or to be caught up in self-defeating and destructive life patterns. The in-depth analytic therapy that I will describe is time consuming, requires a certain personal sensitivity and a deep level of immersion. This psychoanalytic approach is based on the conviction that if a person has a greater understanding of himself, and the factors that are causing his dysfunction, this self-knowledge will be crucial in stimulating personal growth and in reducing psychic pain.
…when the apparatus is not functioning well, we are more aware of how it works.
In the present age of seeking immediate gratification, of fast food, takeout dinners, drive-through religious affiliations and e-mail courtships, efforts to do in-depth, intensive, and lengthy psychotherapy may be out of fashion. My students, psychiatrists-in-training, tell me that they are required to interview three patients an hour. Therapy is driven by the pressures from insurance and reimbursement systems. Medications, primarily tranquilizers and anti-depressants, suppress unwelcomed symptoms, and are often the first and the only treatment modality offered. In such 20-minute sessions on alternate weeks, the therapist has to be sure he is looking at the correct clinical chart, check if the medications are causing any untoward side effects, quickly ask how things are going, and then confirm the time of the next scheduled visit. A few patients can be seen for longer sessions and more frequently, but such cases are the exception. Unfortunately this McTherapy also prevails in private psychotherapy practices, again driven by economic forces and social pressures.
These are the two themes in my narrative: (1) an effort to heighten our appreciation of the complexities of the human condition, and (2) an attempt to underscore the importance of therapy that aims to understand the human condition and the deeper dynamics of dysfunction. These themes are inextricably linked.
In intensive insight-oriented psychotherapy, the primary goal is to ameliorate emotional dysfunction and to promote personality growth. In addition, the investigation of the inner world provides a vital avenue to better understand the human condition and better appreciate those inner forces and psychic structures that promote health and the conflictual elements that lead to dysfunction. If the opportunities for pursuing such insight-oriented approaches become greatly diminished by societal pressures, we not only compromise our ability to treat patients in distress but also we lose an avenue to learn about who we are as thinking, feeling human beings.
To expand on these themes, it is best and most direct to first tell you the stories of some of the people who have come to me for treatment, how I understood their struggles and how I worked psychotherapeutically to help them.
The patients described in this volume include, a woman caught in a life endangering pattern of repeated pregnancies with strangers followed by multiple induced abortions; a woman hating her skin color; an executive sleepwalking through life; a sad woman caught up in a delusional marriage; a mother terrified of her infanticidal urges; a self-loathing teenager; a young boy seeking out bullies to beat him up, and a girl starving herself to gain self-control.
It is my hope that Nine Lives will convey some of the complexities of the human condition and underscore the valuable contributions psychoanalytic thinking and therapy provide.