Robert Winer, M.D.

September 6, 2009

It Was Just a Dream...

Most of my night dreams are prosaic, nothing to get especially stirred up about, plausible extensions of scenarios from my daily life, no more compelling than a typical daydream. But then there are the occasional vivid dreams, which may have a nightmarish quality or a feeling of joyous transcendence. I awake, and for better or worse they evaporate. It’s these latter dreams I want to talk about.

I don’t have this thought – it was just a dream -- when I wake up from a bad dream. I just feel relief then, glad that it’s over and that I’m awake now. And so relieved that the horrible tidings weren’t true. That fluorescent orange junk wasn’t really spewing from the center of my chest, I haven’t been sawed in half and hollowed out, I don’t have just months to live. And I don’t think: it was just a dream.

“It was just a dream” is what I’m thinking when I wake up from a great dream, and that thought signals disappointment, probably bitterness. Why can’t I stage that fabulous show in my real life? Why can’t I fly? Why can’t I be sixteen? Why can’t I have her? That’s the crux of it of course, it was just a dream. But hold on for a second. It was real in the dream. Isn’t that the point of dreams – that they feel entirely true? So why do I discount the experience? Some of the most intensely pleasurable moments of my life have occurred in dreams (along with some of the scariest). Broadly speaking, I have two forms of consciousness, waking and sleeping, and both are phenomenologically totally compelling when I’m in them. The reality I experience when I’m dreaming doesn’t feel less real than the reality I live in when I’m awake. So why do I give short shrift to my experience in dreams?

The most obvious reason is that I can’t make them happen and I can’t control them. I’m not in the driver’s seat when I get on roller coasters either, but I do know roughly what the ride will be like, and I’ve chosen to hop on board. Not so with dreams. This is ironic, of course, because the dream is entirely of my own manufacture, even though I don’t have access to its construction. I think the catch is that when I wake up, I can’t choose to fall back asleep and pick up where I left off. (Occasionally that does happen, but certainly not at my bidding.) And in that moment I feel the loss.

The exquisite cruelty of the situation is that, as Freud reminds us, a dream is the realization of a wish. My good dreams aren’t just happy scenarios, movies I’ve stumbled into; they’re expressions of specific longings that are very important to me. That’s the rub. And so, when I awake, I have to bear that the realization of my desire has been deleted: it was just a dream. Moving through my days, I feel the ache of the dreams I can’t realize, the losses that can’t be undone. We try to make the best of what we have. Our lives are narratives of loss and incomplete mourning (it is in the nature of things that mourning will always be incomplete). Contending with our losses, we push forward. We try to reach the clearing of acceptance, the recognition that what has happened cannot be undone, the knowledge that we will always be living in the consequences. We mourn our murdered alternative selves, the roads that could not be taken; we weren’t there.

Memory is both a blessing and a curse, both the warehouse for storing my experiences and the graveyard that never lets me escape my deceased. Dreams are where we revive our memories and longings, breathe life back into them, but just briefly, for they deflate as we awake, leaving us empty-handed, it was just a dream, a cruel tease. And so the thought “it’s just a dream” becomes a marker for my recognition that there’s no escaping the realities of my life, the choices made, the accidents befallen, the injuries suffered and inflicted. This is my lot. In a recent interview, Woody Allen said that at 73 he can no longer sustain the fantasy that young women would find him desirable. Age brings us that too, the cancellation not only of prospects, but even of imaginings. But we still have our dreams at night, where life is timeless and anything is possible.

August 31, 2008

Advice For Therapists: A Lifetime of Experience in Nine Easy Lessons

First, accept that you will be at the mercy of the clock. Your patients may feel that the meter is running, but you don’t run the meter. You’re as much in debt to chronos as they are. You will start the sessions on time. And you will end them on time, even when you have more to say, or something that just now occurs to you to say, or when you feel guilty about having had nothing useful to say and are afraid that your patient will never come back because you’re too dense and you want to at least apologize by going five minutes over. The discipline takes no prisoners.

Second, accept that there will be long stretches in which you will have no truly useful ideas. Try not to fill those stretches with busyness. Try not to feel too stupid and inadequate. Bear the thought that you may never get to a clarifying insight about this person. Try not to think about a rival who would have been smarter. Well, you can’t not think about her, but at least try not to let it get to you.

Third. Remember that however your patient is negotiating his life, however abysmally self-destructive his choices may be, for him every alternative to this life is more horrific. Being alone is worse than being hated, for him. Try to get your mind around that, it’s the single most important thing about doing therapy. So it’s not going to be helpful to chasten him, in the encouraging and supportive and clarifying and interpretive ways that we do that. The first thing to understand, to really understand, is just this, that from his point of view he is doing the very best he can. Unless he knows that you get that, he may listen to what you have to say, and make apparently appreciative, even brilliant, contributions, but he’ll privately think you’re clueless, and that his plight is hopeless.

Fourth. Be grateful for small moments. One extraordinarily difficult young woman, who I was temporarily seeing for free after she was fired from her job, surprised me by saying that the smallest changes are priceless. I thought she wasn’t deliberately being ironic. Doing therapy is like fishing, waiting patiently, sleepy and alert, not too eager to jump but ready for the unexpected tug, while accepting that it may never come. Jesus said to the two mariners he took as apostles: Come with me and be fishers of men. Take delight in being caught off-guard. And when the moment comes, don’t commandeer it. Less is more.

Fifth. Never assume that you know what your patient means. The one thing you can never say too often is: Tell me more about that. You know less than you think.

Sixth. Harold Boris said that being your patient’s therapist is not an invitation to tromp around untrammeled in your patient’s mind. Knock before entering. Don’t try to be clever.

Seventh. Our therapies are strewn with compliance. We all figured out how to rescue our mothers. If we need to have our patients need us, they will do just that, in the guise of helplessness. Never take anything for granted.

Eighth. Don’t hold on. Our patients usually know when it’s time to leave, by their lights. Only hams are cured. Bear the fact that their departures are usually tougher on us than they are on them. Don’t be like the mother who yelled after her kindergartener heading off for his first day of school, “Some day you’ll miss me when I’m gone!” Let them exit graciously.

Ninth. Love your patients.

August 1, 2008
Stowe, Vermont

How I Learned to Write

The first time I wrote a paper was for an Adolescent Psychiatry meeting in Chicago. I’d been asked to do it by a man who was like a father to me in those days, although later we would let each other down. The paper was obsessively thick, and I was going second. As I read it to the group, I became preoccupied with somebody in the tenth row who looked enormously bored. I couldn’t wait for it to be over. Afterwards, the first speaker told me that the case I’d described was unbelievable; initially flattered, I quickly realized that he was accusing me of having made it up. I thought he was trying to curry favor with our shared mentor. Thirty years later, at the memorial service for this patriarch, this fellow spoke of how close the two of them had been over the years, but how in the last three years they had only hurt each other every time they spoke. So it came full circle, and my rival and I had this bond after all.

My improvement as a speaker came with the recognition that the trick was to zone in on someone in the audience who looked interested in what I was talking about. There has to be at least one in every crowd. Keeping that person entertained was easy and the other people stopped existing. This was my turning point as a public speaker. I also discovered that beginning with a funny story was tricky business because if no one else thought it was humorous I’d be demoralized from the start. Better to begin with an aphorism, something wise and slightly impenetrable.

Another mentor pushed me to write; over the years he invited me to contribute chapters to volumes he was editing. On one of those occasions he told me that I’d written the best essay in his book. I never thought he was impartial! Some time later I was moaning about how bad my writing was and he reminded me of what he’d said. I thought he was complaining that I wasn’t taking his praise seriously, and I believe he was right. I don’t think I’d been fishing for a compliment, it was more that I’d been uncomfortable with his praise, and I hadn’t let it mean as much to me as he’d wished I had.

On my fiftieth birthday I got a call from the human sciences (or whatever) editor at Basic Books. She said that one of her authors had spoken highly of some book chapters I’d written; would I consider writing a book for them? I picked myself up off the floor and met her in New York for lunch at some fancy place where I told her that Roy Schafer was one of my favorite psychoanalytic writers (he’d published with them) and she told me I was so much better than Roy Schafer. It took me a couple years to write the book, and then it took her three months to do whatever she did with it before she rejected it. I decided that she’d sent it to Roy Schafer to read and that he’d hated it. I haven’t been able to make eye contact with Roy since. Panicked, I sent the manuscript to Jason Aronson and he read a chapter, liked it, and sent me a contract all in the space of a week. Redemption! Months later, my best friend held a book signing party for me. The only thing he said about the book was: wasn’t it funny that the printer mistyped “Rodin” as “robin”. Painfully, I still remember that. What bothered me wasn’t that he was making fun of the book, but that my getting published had hurt our friendship.

After I discussed the film “The Pawnbroker” at the Lincoln Center and the New York Times wrote an article about this and about our group, The Forum for the Psychoanalytic Study of Film, a book agent approached me about putting together a volume of film essays. I gave him a batch of the papers that I’d already written and he told me they had too many fifty-cent words in them. He wanted me to make change? He wasn’t talking about the pieces being jargony, just too literate for what he saw as the intended audience. I think he didn’t buy me lunch. When I’ve run into him from time to time over the years he chums me up with, “Hey, how about that film book?” He doesn’t give up easily. He’s a friend of one of my close friends. Watch out for the friends of your friends.

Much of the writing I do these days is on-demand: I agree to discuss a paper, or to respond to a film. Over the years I’ve found something that I think of as my voice. A little showy; a little ironic; a little bit full of myself, but not too much. Even so, every time I sit down to face the blank screen I have this moment of dread that this time I’m going to come up empty. And then, voila, I find something to say. It’s like pulling rabbits out of a hat, except I wasn’t sure they were there! But it’s also like making it across the high-wire, defying death once again. I live to write another day. But isn’t that what writing is all about?

DREAMS: Julia's dream


My late teenage sister sat next to me at my middle school lunch table; we were across from some of my socializing friends. I was acutely aware that she was sick and bald as she had been, and that she and I weren’t talking. I felt isolated somehow, until she suddenly looked at the girls across from us with an expression that managed to remain serene; it said, “don’t mess with my little sister.” We drew closer together and that constant void which I bear was crushed in the dream. She was my sister, and I was hers. And I didn’t need friends. (I’ve been depressed off and on since my sister’s death by cancer 3.5 years ago.)


I’ll tell you what comes to my mind as I reflect on this dream, to illustrate how an analyst might think.

The dream appears to occur in the context of a young woman’s continuing struggle with feelings raised by her older sister’s death a few years ago. The chronology suggests that Julia might now be a teenager, perhaps in high school. It would appear that she might have experienced her sister as an important protective figure and that she feels lonely and vulnerable without her. There is a suggestion that Julia feels socially isolated, perhaps actively excluded by her peers, and that she misses her sister’s support at times like these. (Which doesn’t exclude the possibility that her sister might have ignored her, and that the dream represents a wished-for relationship.) Her phantasy in the dream is that her sister is present to watch over her, and so she doesn’t need friends (who can let you down, or hurt you) and she’s fine.

Usually dreams are prompted by some event of the prior day that stirred conflicted feelings. I could imagine, for example, that Julia might have felt rejected by a peer (or peers) the day before; the person might have been a friend, but also might not have been one. Hearing this dream in a session, if Julia didn’t volunteer a context for the dream, I would likely ask about the previous day.

I imagine that Julia is past middle school now. (For one thing, the dream is much too well written for a middle schooler.) We all know that negotiating the social networks of middle school is often a harrowing experience. Peer cruelty seems worst at this age, especially for girls. So I am imagining that yesterday’s experience might have been a reprise of some painful experiences from that time, and I would ask about that. It might lead us to a useful discussion of what she went through during those years.

Some details: Julia speaks of “socializing friends,” not “friends who were socializing.” This suggests that her world might be divided into people who easily socialize (others) and people who are more isolated (imaginably, her). I was struck by the statement that she and her sister weren’t talking. This raises the possibility that her relationship with her sister might have become problematic toward the end (and that the dream imagines overcoming that). I would listen for that, and if that seemed plausible, and if she seemed ready to open that subject, I’d ask about it. I’m next caught by the phrase “managed to remain serene,” wondering about “managed.” Remaining serene seems to require effort – is she alluding to her own efforts to contain her feelings and not lash out? The idea of a void being “crushed” seems an odd metaphor (you can’t crush nothingness) – the word suggests aggressive feelings, perhaps the consequence of feeling socially isolated or rejected. Her phantasy at the end is that if her sister were with her she could feel completed, protected from the threat of loneliness.

I would like to stress that these thoughts are simply my associations to the dream, as it was presented to me, with no other knowledge of the dreamer (beyond some evidence that she writes well and is internet savvy!). If I were sitting with her I would treat these thoughts as hypotheses, possibilities to be further pursued, reexamined, or contradicted. As a therapist I don’t try to work toward certain knowledge, I look for plausibility. A good idea, for me, is one that seems plausible, given the evidence, an idea that can be pursued in the course of our dialogue.

September 16, 2007

Marriage at Midlife


(The following text is excerpted and modified from a marriage ceremony I wrote in 2006; the occasion was the marriage of two friends.)

Marriage at midlife is rather a different proposition than marriage of the young. Our sense of time becomes more acute, we may have had more past than we will have future. And thus our choices become more critical, more urgent – we don’t have time for mistakes. By midlife we are more formed as people, more organized around our own needs and preferences, more clear about who we are and who we are not. And so marriage at midlife raises the threat of unwanted surrender. It poses the question: can I both be whom I have made of myself, and yet yield myself to this new partner. In a letter to a friend, the great German poet, Rainer Maria Rilke, addressed these concerns:

“The point of marriage is not to create a quick commonality by tearing down all boundaries; on the contrary, a good marriage is one in which each partner appoints the other to be the guardian of their solitude, and thus they show each other the greatest possible trust. A merging of two people is an impossibility, and where it seems to exist, it is a hemming-in, a mutual consent that robs one party or both parties of their fullest freedom and development. But once the realization is accepted that even between the closest people infinite distances exist, a marvelous living side by side can grow up for them, if they succeed in loving the expanse between them, which gives them the possibility of always seeing each other as a whole and before an immense sky.

“That is why this too must be the criterion for rejection or choice: whether you are willing to stand guard over someone else's solitude, and whether you are able to set this same person at the gate of your own depths, which he learns of only through what steps forth, in holiday clothing, out of the great darkness.”

And yet, at the same time that we have these concerns about our continuity, about protecting the shape we’ve taken, we are only alive in the now, the present moment. The ancient Greeks made a distinction between “chronos,” chronological time, the time of our days, the time that passes, and “kairos,” the right time, the propitious moment. Kairos is the eternal time present in every moment. Love captures the present moment. In the moment of love we believe in each other, that is love’s truth. As Hamlet told Ophelia: “Doubt thou the stars are fire; Doubt that the sun doth move; Doubt truth to be a liar; But never doubt I love.” Marriage at midlife is the triumph of kairos over chronos.

And wedding at midlife is distinctive in yet another way. When young couples marry, they are often planning to start a family. For those couples who are already living together, the decision to marry may express a wish to legitimate their children’s births. Having children may then become an expression of a long-term vouchsafing. And in that sense, the choice to marry at midlife represents a freer and more focused commitment, a commitment that is more fully about the other: I simply want to spend the rest of my life with you.

By the same token, at midlife we have a fuller experience of life’s limitations, and we are less inclined to expect miracles. Knowing something more of our own frailties, we don’t expect partnership to be uncomplicated. We aren’t blindly idealizing of each other in the way we could be when we were younger; both for better and for worse, we are no longer capable of such headstrong naïveté. Hopefully, we have a better sense of ourselves, including our own difficult ways, and we grant that also to our partners, we don’t expect more from them than we expect from ourselves. It’s not so much that we’ve changed, or that we’ve chosen so much more wisely. That’s a fool’s paradise. It’s more that we’re willing to live within the frame of what life can offer, what two complicated people can offer each other.

There is so much more to be said about this.

August 7, 2007

Michael Moore's "Sicko"

“Sicko” is a missed opportunity. I can’t understand why it has been lionized by the critics (the San Francisco Chronicle critical consensus rating has had it at or near the top of the pile for weeks). I thought it was glib, painfully cutesy, arguing by anecdote, riddled with editorializing music that was telling us what to feel. Moore is treating us like four-year-olds. Among the critics, the Washington Post’s Stephen Hunter was one of the very few who complained.

It’s not that Moore is wrong about the problem. Our health care system is hugely inadequate. The current issue of Consumer Reports details the state of our HMO’s and PPO’s and it’s a discouraging story. Corporate America could make a companion piece to this film filled with anecdotes of people who received life-saving health care in a timely way, interspersed with highlights of the weaknesses in the delivery systems in England, France, Canada, and Cuba, and we would feel moved by that too.

Moore is arguing for a single-payer system, like those in the aforementioned countries. While this may well be the direction in which we need to move, I’m aware that France and England have private care practitioners also (and that there are brokers in Canada who facilitate traveling to the States for medical care). If the system works so well, why do those doctors get used? What gaps in coverage are they closing? I’d like to hear a balanced account that argues why a state financed system, despite its limitations, is the way for us to go.

The problem, as I see it, is that the free market system doesn’t work well when it comes to health care. If you’re buying a home, you can be clear about what you’re getting and what you should be paying for it – you can have an inspector check out the structure and you can look at the pricing of comparable houses. If you’re purchasing a car, you can read Consumer Reports and learn about the vehicle’s repair track record and get their impartial take on the road worthiness of the options you’re considering.

But health care plans are much harder to appraise. As the Consumer Reports article points out, the people who are reasonably happy with their plans are those who haven’t been seriously ill. Consumer dissatisfaction rises sharply for those who’ve been sick and have had to use their plans in consequential ways. It is very hard to know in advance how good your coverage will be if you’re in trouble, and this makes it difficult to choose a health plan in an informed way. And so we respond to the sales pitch, the pricing, the convenience. Our employers may only have a single choice to offer us, and that choice will likely have been influenced by cost considerations that are not in the workers’ best interests.

As Moore effectively points out in “Sicko,” the incentives in for-profit health care are on the wrong side: the company, and its doctors, are rewarded for denial of care. In contrast, in some of the state-run systems, doctors get bonuses for effective care. If car manufacturers tried to increase profits by cutting corners, we’d see the consequences clearly in rate of repair data, and that would immediately have consequences for the manufacturer. But it’s not possible, and it will never be possible, to get this sort of information when it comes to health care. The inability of the free market to respond effectively to the quality of care may be the single best reason for us to have a single-payer system (with or without a private care alternative).

For a different Michael Moore, check out his very engaging confrontation with Wolf Blitzer on CNN.

Cheney, Clinton, and the Revenge of the Nerds

Dick Cheney and Hillary Clinton have this in common: fanatically obsessive nerdiness. Both meticulous craftsmen, they pursue their agendas with rigor and discipline. For now, their objectives differ, and not along the lines you might imagine. Cheney seems propelled by a patriot’s desire to keep America safe – a desire whose implementation has taken on astonishingly perverse proportions – while Hillary is driven by the imperative of being elected, to justify to herself how she’s spent the last dozen years of her life.

Cheney is purposive. Not interested in being in the spotlight, he’d rather be invisible, a faded grey eminence. He’s determined to chart the course of our nation according to his own perspication, and he’s interested in others only to the extent that they can serve his ends. The Washington Post reports that on 9/11, when the first tower pancaked, everyone in the room gasped, except for Cheney, who stayed focused, eyes locked on. At this junction Aspergers wanders through one’s mind.

I believe that Cheney has as his first priority keeping this homeland secure, and that he is entirely prepared to make us a police state if that’s what’s required. To that end he’s ready to sacrifice the entire Bill of Rights, the Geneva Conventions, international regard, the rights of the Congress, and, of course, public opinion. America has Vox Cheney. He might have been disposed to think of the Executive Branch as a monarchy in any event, but 9/11 sealed the deal. I don’t think that he is pro-business out of self-interest for I think he would be fully capable of protecting his own corporate investments without abetting the interests of others, if it came to that. Rather, I suspect that it has to do with aiding business to satisfy the entitlements of Republican constituencies, so that he can get the electoral support to continue his crusade. Dick Cheney is Jack Bauer without a conscience. And he’s remarkably competent, tactically and strategically, at every level, adeptly delegating or micromanaging as the situation calls for, in pursuit of his agenda. This is a brilliant methodical man.

Hillary, in one regard, is the precise opposite: at this point she seems to have no policy objectives at all. With all her energy channeled into a single goal – getting elected – she behaves with the flexibility of a rug salesman: do whatever it takes to seal the deal. Every step she takes, every move she makes, seems calculated, tested in her focus groups, calibrated by her people, plotted on her matrix. Nerdy? This is a woman who, Michael Tomasky reports, spent a chunk of her time at Wellesley College devising a better system to ensure the return of library books. When I heard that there’d been a small brouhaha about her cleavage on the Senate floor, I pictured her prep team measuring out the quarter-inches in advance. It’s unkind of me, but seeing a wry expression on her face in a Times front page photo a week ago, I found myself wondering how much time it had taken to train those facial muscles to contract that way. Hillarious rigor. She has me at the point that I can’t believe that anything could be spontaneous, certainly not a smile. And this is probably all smart strategy – she’s way ahead in the polls and she’s effectively neutralized Obama.

Though I wasn’t there at the time, I now feel nostalgia for the Hillary who had the passion to pursue her ideas about health care during her husband’s first term, even though her plan wasn’t popular and it didn’t help Bill’s prospects. That Hillary is missing for me, and I have no confidence we’ll ever see it again. I imagine she’ll spend her first four years mainly trying to position herself for winning a second term (Bill’s tenure besting hers would be really insufferable).

I have a theory about why winning has become such a super-ordinate goal for her, trumping all other concerns or motives. I imagine that the Monica Lewinsky business must have been really humiliating, and that she could easily have felt that the only self-respecting thing to do would have been to dump him, even during his second term. The only way that she could have justified bending over for Bill would have been by rationalizing that this sacrifice would be required for her to acquire the Presidency. It isn’t really relevant to my point that it also happens that this would be true. Despite many women’s contempt for her for staying, the fallout of her departure would have probably made a presidential run impossible. And if not impossible, way less effective without Bill. But I can imagine that for her, now, not getting the throne would mean to her that she’d been a fool for making this deal, and that would be completely unbearable in terms of being able to feel OK about herself. So she needs to win, at any cost, to justify how she’s spent the last twelve years. That’s the only thing that matters now. Her electorate is the Hillary Support Group.

A friend asked me if I’d vote for her if she gets the nomination. On the plus side, it would be nice to have Bill back in the White House; she might, like JFK, choose a great support staff; I’d rather have the Executive Branch leaning left than solidly right; and maybe I’m just too cynical about her current loss of her soul. On the other side, if she disappoints me, I’ll feel I only have myself to blame. That shouldn’t be a reason to stay home on Election Day: though I’d feel tempted, I’d just be protecting my self-esteem like she’s doing now.

The candidates who are taking stands are doing badly: McCain, Edwards, Kucinich, Paul. Those who essentially stand for nothing, in a policy sense, or whose predilections are totally fungible, are doing well: Giuliani, Clinton, Thompson, and Romney. Obama falls in between. He’s primarily arguing for a form of reasoned and collaborative leadership, rather than for a specific agenda, and this is going poorly now because it’s precisely not his temperament to stand up for himself and fight back. In the political arena it’s becoming increasingly apparent that his style is self-defeating, a 21st century reprise of Adlai Stevenson. The race will not go to the passionate or the thoughtfully reflective, it will go to the nerd, the technocrat best able to engineer this electoral season, and that, for better and worse, will be Hillary.

April 20, 2007

On Time - Chapters 3 & 4


Roy Schafer linked the cyclic and linear psychoanalytic visions of reality to two of Northrop Frye’s mythic forms, the comic and the tragic. The comic vision, Schafer points out, is founded on unqualified hopefulness, the fantasy of rebirth, the prospect of another chance. He writes:

The view of cyclic return implies that the past can be redone, if not undone. Thereby it implicitly denies the passage of time. It cancels out pastness. Its perspective is timeless. There can be and there is, again and again, what Balint (1952) has termed a new beginning. (1976, p. 29)

By contrast, the tragic view is linear, expressing the idea that a choice once made is made forever, that the past can not be unmade, that “a truly cold mother, a savage or seductive father, a dead sibling… years of stunted growth and withdrawal, and so forth, cannot be wiped out by analysis (p. 38).” Psychoanalysis positions itself between these two perspectives. Without a comic vision, it would be pointless; without a tragic vision, interminable.
We can reframe this from a clinical viewpoint. In mania we obliterate the past: everything that matters is present in the moment, imminent. When mania dissolves we are left with its underside, reflected in Macbeth’s defeated observation:

Tomorrow, and tomorrow, and tomorrow
Creeps in this petty pace from day to day,
To the last syllable of recorded time;
And all our yesterdays have lighted fools
The way to dusty death.

In depression we are chained to the past, prisoners of that which has befallen us. In the depressive position, in mourning, we try to transcend these polarities – try to be guided by the past and not controlled by it, try to live in the present, try to imagine a future that is not only determined by that which has gone before. We try to use life’s cyclicity for our ongoing benefit.


It’s in the nature of psychoanalytic treatment that time is both inescapably present and elusively sempiternal. Sessions begin punctually at an appointed time and end on the dot. We actually call these meetings “hours,” although customarily they don’t last that long. This locution may reflect our sense that we need to hold back a bit of the hour, take a pause between patients to reclaim ourselves, so that we do not live entirely at the mercy of their time. It is our own ten or fifteen minute hour. Nonetheless, perhaps out of greed, or obsession, or restlessness, the discomfort of time-on-our-hands, we may skip this intermission. Firmly ensconced in time, the session will take on a rhythm of its own, and yet often both parties can intuit, without looking at the clock, when the meeting’s end is drawing near.

At both edges we protest the clock’s control, time’s arrogant claim on us. A patient’s habitually late arrival may express a variety of meanings. I can’t come early because longing for you is too painful. I can’t come early because it gives you too much power (See? I stopped at Starbucks on the way!). I can’t stand your having other patients – I am late and I do not see them, I’ve make them disappear. But buried in all of this: the session begins at a time of my choosing, not yours, and not the time of chronos. I am my own clock (and perhaps, ultimately, I take exception to death). On the other end, as a supervisor I have encountered clinicians who routinely do not stop their sessions on time. Not licensed to analyze my supervisees, I’ve made do with my own speculations about their motives. Perhaps it’s not being able to bear being the patient’s bad object, the mother who turns her back. Perhaps it’s her fear of her own aggressiveness: every ending is a petit homicide. But, indeed, for both therapist and patient, the session’s ending is a little death, a moment of mortality, and prolonging the hour can be an attempt to deny that. We are so ambivalent about the need to maintain boundaries in treatment that we have had to install a host of safeguards for ourselves and our patients. We make our professions mandate loyalty oaths. Surely part of the problem is forbidden desire and incestuous longing. But buried in all this is the pain of limit, of the inevitability of the march of time, the unbearable nature of loss. Refusing to let the stroke of time end the hour is our form of protest. Apropos, I read from the libretto of a theatre piece, “Lost Objects:”

It’s not our darkness that we fear
not our darkness that we fear
but our light

our darkness that we fear
our light

our darkness we fear

darkness fear


And yet (or, perhaps, and so) the chronos of the hour is offset by an aura of timelessness. The end of each session isn’t “good-bye,” it’s more like “auf Wiedersehen” – “until we see each other again.” We have breaks in our schedules – weekends, professional meetings, holidays, vacations – but even these are generally predictable, and cyclical, and our return after the absence reminds both of us that the treatment is indestructible. And we’re extremely reliable about keeping our appointments. It takes an encounter with general anesthesia to get an analyst to cancel a session. The difficulty so many of us have canceling when we’re ill probably has a lot to do with our unease with being vulnerable. The nuance is that we can’t bear having our patients see us that way. Our sense of wellbeing attunes to their idealization of us: we are unbreakable, eternal. The press to reschedule the missed session, coming from either side, may mainly be about denying the loss.

April 8, 2007

On Time - Chapters 1 & 2



Time’s arrow peeks out at me from behind my awareness. At moments it faces me full-frontal; it is aimed at my heart.


There is much in my daily life that distracts me from time’s inexorable march. Nature is cyclical. Each dawn is a new beginning -- and each evening an ending, but only temporarily so, for I know that another daybreak will follow. If today’s sessions didn’t go well, I remember that I’ll have another chance tomorrow. I watch from my office window as one season yields to the next, and the seasons come full circle. Culture is shaped by repetition, whether commemorative, like Thanksgiving, or functional, like Election Day. Once again we gather here. There are, to be sure, individual differences. Some of us are more likely to seek out novelty, others familiarity – consider how you choose (or don’t choose) vacations, how you select the television you watch. But for all of us, in an overarching sense, so much of daily life is reiterative, obscuring time’s passage. Today’s newspaper will be followed by tomorrow’s. As soon as this paragraph ends, another paragraph will begin.

In its nature, all thought is recapitulation. This goes well beyond Freud’s observation that the finding of an object is always a re-finding of it. Of course we can only recognize that which we have thought about before. A truly novel experience would be entirely mystifying, awakening to a nightmare. But it is also true that, as Heraclitus said, we don’t step in the same stream twice. The object re-borne is shaped by the act of rebirthing, changed by all the other things that are going on in the state of consciousness in which it is remembered. In that sense, all thought is original. And yet a common preoccupation of struggling authors, thus most authors, is that they will have nothing new to say, and all too often this stops the writing effort dead in its tracks – or, more hopelessly, before it ever gets on the tracks. The writer imagines himself an ink-spiller, a hack recycler.

The feeling that living is repetitive can thus be both paralyzing and reassuring, even in the same moment. Even so, time’s linearity can’t be entirely avoided. The passage of time brings us up short. We have birthdays, cake and ice cream, another reunion, but with a quiet reminder that time’s arrow has another notch. The August after the oldest child graduated college, he was setting out to find his fortune in sustainable community development in Oregon while the rest of the family was packing the van for summer vacation. He noticed that they’d loaded up more luggage for their trip than he was taking for the rest of his life. Over the next few months, with this awareness that his son was now an adult, the father felt drastically older. It wasn’t a physical feeling, rather a shift of identity. More precisely, the father sensed that he was his own age, something he’d been hedging all his adult life. Time’s arrow can catch us by surprise.

March 6, 2007

G.W. & Hillary: America Agonistes

Reading an article by Patrick Lang in Foreign Policy, “What Iraq tells Us About Ourselves”, I reflected on concerns I have about America.

While friends of mine were upset by the thought that the Republicans have stolen the last two presidential elections from the Democrats, I was troubled that half my fellow countrymen (more or less) wanted to elect George Bush, even in 2004, even after all that had happened. His current approval rating has fallen to 29% -- but from another point of view, it is compelling to think that almost a third of America approves of the job he’s doing. The argument can be made that this third is simply the “religious right,” who believe that he is committed to their values, and that trumps every other consideration for them.

But I think something more is involved. At this point Hillary Clinton is substantially leading in the polls over her rival contenders. She and Bush are strikingly similar in style. Both have a Master of the Universe persona: seeming total self-confidence, arrogance, a take-no-prisoners bullying approach. Neither is inclined to seriously consider the points of view of people outside his or her immediate circle (legislators, citizens, etc.), except insofar as they can use such information to advance their own agendas (e.g., Hillary uses her focus groups for election tactics). So what is it about us that we find this appealing?

Certainly since 9/11 we have been willing to sacrifice a great deal for the sake of strong, decisive leadership; the current administration has counted on our anxiety and exploited it. The most effective complaint they made about John Kerry was that he “flip-flopped,” and that struck enough of a responsive chord in America that Bush was narrowly reelected, despite his failure in Iraq and the unmitigated terrorist threat. Jimmy Carter seemed too undefined in his presidency, too preoccupied with parsing shades of gray. After the Iran hostage crisis, we wanted a reassuringly forceful president and we elected Reagan, a patriarch, and we haven’t turned back since. On the contrary, we’ve been so desperate for authority that we’ve chosen style over substance.

Faced with the reality that globalization and the evolving power of the excluded now make us more vulnerable than ever, no longer protected by our geographical isolation (two buffering oceans), we try to push these realities aside and we respond with a thoroughly defensive grandiosity. We decide that everyone should want to be like us, and we set out on the mission of converting the nations of the world to American-style democracy. Patrick Lang sees this development as “brewed from such [American cultural] elements as enlightenment, optimism, Puritan utopianism, a Calvinist tendency to forgive sinners, and the settler’s lack of respect for the weak and ‘native’ peoples of the world.”

I would go beyond that, and add that all these qualities have been dramatically heightened, in a defensive way, as a response precisely to our current sense of being endangered. That might be why we decided to take on Iraq, rather than terrorism, in the years after 9/11. That war seemed more winnable – in fact, we had Bush’s triumphal moment on the carrier – although it has turned out that we were wrong about that. (Since Vietnam we’ve been looking for winnable wars.)

Europe seems more familiar with sorrow. While there are various strains of national pride there, we don’t sense the kind of triumphal spirit we find in America. 9/11 was remarkably humiliating for us, and we haven’t recovered. On the contrary, we’re responding by trying to sustain a fantasy of indestructibility. I think this is why the Bushes and Clintons, and their circles of friends, appeal to us. Much as we might dislike Dick Cheney, his overt denial of difficulty resonates with our deep wish to be reassured.

And now, Hillary. We’re in trouble.

January 3, 2007

Science of Sleep

I recently discussed dream analysis in an interview about the film Science of Sleep, directed by Michel Gondry. You can read Vicky Hallet's review at Read Express