Given that many of the blog’s readers are not mental health professionals, I must explain what many modern mental health professionals imagine when I say that I just spent a week at the national meeting for the American Psychoanalytic Association.
I would say that, roughly, you might consider that the idea conjured in their minds would be something akin to my having spent a week in a joint conference of the Whig Party and The Flintstones’ Loyal Order of Water Buffaloes (Grand Poobah and all).
I will not bore you, dear Reader, with the history of this phenomenon. Suffice it to say, blame is justifiably placeable upon all parties involved.
On the one hand, for example, we have the “Freud is Dead” folks, riding their moral high horses up and down Park Avenue, dancing with timbrels that the cocaine-crazed, misogynistic, pseudoscientific-witchcraft reactionary has finally been cast into the sea (or at least the East River), as generation after generation of “modern” therapists quote with disgust all that they know about the evils of psychoanalysis, basing that knowledge, of course, on the three pages on the topic they read about in their personality theory text in grad school, the source of such text having been the textbook author’s brief perusal of Peter Gay’s The Freud Reader. But if you’re modern, brilliant, scientific and/or progressive, what more would you need to read, after all, correct? Life’s short enough as it is.
On the other hand, nothing–and I mean nothing–is more ludicrous and irritating than sitting in a crammed hotel room, with nothing but a measly plastic cup of water to soothe the nerves, listening to and watching a bunch of psychoanalysts cat-fight with each other (in public, no less) about whether some particular turn of phrase is real psychoanalysis or not. Think of it as Woody Allen with attitude, over and over and over . . .
Yet I’m happy to report–very happy to report, in fact–that modern psychoanalysis ain’t your granddaddy’s psychoanalysis. We may have decided in our get-it-done, metric-obsessed, treatment-planned, cost-contained culture that psychoanalysis and psychoanalytically-informed psychotherapy are dead, unproven, elitist, worthless, yadda-yadda, but believe you me: just because those who manage the purse strings, the graduate programs, and the DSM-V say something is so, that don’t necessarily make it so.
This past Saturday, for example, I was, for lack of a more snazzy term, blown-away by a presentation by Dr. Mark Solms, a psychoanalyst and neuropsychologist (try that one on for size) from Capetown in South Africa. His presentation, “Psychoanalysis by Surprise,” a joint discussion with Dr. Kimberlyn Leary, Program Chair for the meeting, concerned Dr. Solms’ quite honest, quite ruggedly nuanced, current understanding of his return to his South African home. It was stunning: two leading psychologists (psychologists were once banned from the American Psychoanalytic), a Caucasian male and an African-American female, talking at the Association’s quintessential get-together about race, privilege, shame, and living by the seat of one’s pants.
Solms is the sixth generation of a wealthy, European, land-owning family in South Africa who himself had left the country in the 1980′s to avoid conscription into the Afrikaner military, who then returned to his family’s vineyard/farm after the dismantling of apartheid. There he found several multi-generational Black families who had “come with the land,” i.e., essentially having lived there as serfs. He described the painful, yet mutual process that they all underwent as together they worked to make the farm a cooperatively-owned venture as a successful wine producer.
Leary was a supportive, yet deeply-incisive interviewer who probed into all the psychological and political complexities of the situation, and Solms met every question with an honesty that was exemplary. He made no claims to “heroism,” no claims to “getting it right” or assuming that “it will all work out.” He only made claims to wanting to do the right thing, using the most full understanding possible at any particular point, stating simply that as an analyst he had to “face all the truth I could, especially about myself” and then live and act in accordance with that truth, whether in the past, today, or tomorrow.
As the day went on, I thought about how Solms had described his doing his best to be himself in the face of political and personal realities that simply “were.” Being in the city where the Twin Towers had once stood, I could not help but think about similar realities that continue to “be” for me, including an ongoing war, the consequences of which will surround me for the remainder of my professional and personal life. I woke up Sunday to a fresh, New York morning, so I decided to walk down to the 9/11 Memorial from the Waldorf-Astoria, where I had been staying.
I knew it would be a hike.
Boy, was it. I’m getting old.
It was great, though, walking down Park Avenue, past Union Square, down Broadway to the Financial District. I don’t know what I was expecting, truthfully, Manhattan at 7AM on a Sunday, but I have to be honest: a lot of times I felt like Will Smith in that crazy zombie movie, just without the dog. I mean, there weren’t no one nowhere.
Sure, there was the de rigeur Starbucks every fifteen feet, and I grabbed a poppyseed muffin at a bakery run by a Japanese family, along with a croissant further down the road at a coffee shop named Gregory’s, replete with two twenty-something baristas arguing over how to open the cash register, dressed in the all-black, slim-cut, open-collared shirt/flat-fronted trousers that appear to be pro forma among all males in Midtown even remotely close to that age demographic. But other than that, basically nada (or should I say, nadie), just Yellow Cab after Yellow Cab after Yellow Cab, looking for whom to pick up, I haven’t a clue.
Now I will say that the man with the two neatly-manicured, black Scottie dogs on long leashes did make his entrance on cue as I walked past his Park Avenue apartment building just north of Union Square, and even though this Midwestern boy was shocked to see a huge–and I mean, huge–Babies ‘R Us across the street, with a PetSmart, no less, down Broadway, I guess that nannies and dog sitters have to have a place to drop by in a pinch as well, don’t they.
So, anyway, I finally made it down to the 9/11 Memorial, no small thanks due to Steven Jobs and my iPhone 4S. Problem: there’s so much construction around the area, they’ve cordoned off the memorial “for safety.” Bigger problem: the cordoned off area was closed. And wouldn’t open for another two hours. And I had a meeting I was already late for.
Well, all right, we’ll make it work. I’ve lived in Boston and spent quite a bit of time in DC and Chicago, after all, so the NYC subway was going to be no big deal, I had to assume, plus it also seemed relatively straightforward from all the maps I’d seen, plus there was still hardly anyone walking around that part of Downtown except for cops huddled everywhere, in search of doughnuts, perhaps, I don’t know, and the occasional Japanese tourist. So, easy Plan B: just zip down the nearest station, buy the pass, and then get on back to the hotel. I checked out the map at the bottom of the station stairs: it seemed that I could probably hit the next station and transfer to the line I needed, but I thought I’d better check with the attendant in the tiny closet we were all calling the station entrance.
“Good morning. I need to get to the 51st and Lexington station,” I said, “so I go down to such-and-such station, correct, to get on the Green Line?”
Sorry, New Yorkers who are now guffawing your heads off: that’s what we called it in Boston.
“What?” came the guy’s answer. “You need the 6 Uptown?”
“Uh, well . . .”
“You need to get over to Broadway and take the 4. I think you can change by the Brooklyn Bridge, maybe, and then get where you need to go.”
“Uh, Broadway? I . . .”
“Yeah, just go up the stairs, hang a left. You can’t miss it.”
Now, granted, I should have asked for clarification, but, look, I’m a guy, I’m proud, and I wasn’t quite sure it would be worth the few seconds of either of our lives to ask one more thing and then have each of us endure the answer he most likely would have given, so . . .
I walked up the stairs and hung a left. Well, then there was a right, but not that much of one, but fortunately I had the 4S, so I got to Google Maps and then . . .
Finally I made it to the requisite station. Uptown, OK, that’s it. 4 to 6, 4 to 6.
I get down into the station to find a handsome young man, maybe around twenty-five, dressed casually in jeans and a sweatshirt, standing arms akimbo before the station attendant behind the (I can only assume) bullet-proof glass, announcing “Are you sh**tin’ me?” in a relatively calm voice, all things considered, really. By the time I’d made it to the bottom of the stairs, though, he’d progressed to a more animated “F*** the MTA!” but then he turned toward me and quite calmly began walking toward the stairs (vigorously shaking his head all the while, granted).
The clueless, Westside Indianapolis in me must have been radiating forth, for as he reached me, he merely rolled his eyes and quietly stated, “There’s some train stuck down the track and they don’t know when it’s going to be fixed. You probably should head over to such-and-such station, that might work better.” Then he lunged up the steps and, poof, he was gone.
Well, OK . . .
So I got up to the top of the steps and said a thank-you prayer one more time for Steven J, as I ended up downloading this app that showed me which station I needed to find to get to “The 6″ directly. Consequently, proudly emboldened, I then lunged forward myself, only to hear to my far left, “F*** you, you f***in’ f***!!”, as some quite large woman was shouting down into a dumpster located along the street at God-knows-whom and as a motley crew of multi-coated individuals were kibbutzing about the whole spectacle from the 24-hour McDonald’s only feet away, small and medium coffees in hand, as I recall.
“All right,” I thought to myself, “now I feel like I’m in New York.”
So what does all this have to do with combat veterans and combat trauma/PTSD?
Solms had essentially talked about the art of “playing the cards one is dealt,” recognizing that we indeed get to deal sometimes, sometimes not. We take responsibility for our deals. We make everything else work as we can, but hopefully in light of not the truths we hope to know, but of the truths we need to know and can know, if we will only be brave enough to ask for them and then to listen to the answers we get.
Sometimes the answers are dramatic, leading to lives changed on massive, bucolic farms at the feet of breathtaking mountains. Sometimes they are far less so: walks longer than expected, plans for deep reflection that become wild goose chases in which rich and poor come and go on a Sunday morning.
Earlier in the week I had had the chance to have dinner with Mike Piro, a West Point graduate who writes the blog ptsdsurvivordaily. We spent a great evening together, and I had the pleasure of spending a few hours with a man who’s bravely faced his demons, come out on the other end, and is trying to make life better for his brothers and sisters-in-arms. He spoke of his experiences at the VA, both positive and not-so-positive. He spoke of his West-Point-grad wife, their sons, his family, his co-workers, the support he feels, the debt to others that he believes he owes.
Later that week, I also had a chance to speak at length to another combat veteran who is trying to make his life work. He too feels that he needs to do whatever is possible to make other veterans’ lives better.
Both men want to learn what they can and do what they can to accomplish their missions.
So here is the point, the result of an eye-opening, mind-opening week for me at a convention that should, so they tell me, have been irrelevant to the lives of combat veterans everywhere, a point even more especially meaningful to me in light of my thoughts in yesterday’s post, Military Suicide, Resilience, and The Song That Never Ends:
My current employer, the Veterans Health Administration, is doing all it can to provide the best care for combat veterans who suffer the effects of combat trauma/PTSD. By spearheading work in treatments such as prolonged exposure therapy (PE) and cognitive processing therapy (CPT), they are providing more and more veterans the opportunity to develop skills to manage their emotional lives more effectively. In addition, they are offering medication options that can also help accomplish those same treatment goals.
But we have to face reality: the VA is the largest single-payor healthcare system in the United States. It takes a lot of administration to keep that going. In addition, the VA is under the direction of the Secretary of Veterans Affairs, a member of the President’s Cabinet, a political organization first and foremost, dedicated to veterans, yet mired in the constant danse à trois among the Executive Branch, the Congress, and the media. Administrative bodies, even ones whose purpose is human in application, must maintain order, spend money wisely, constantly evaluate what is “wise” and what is not, record, report, analyze, report again, revise, start over, making Microsoft’s Excel, PowerPoint, and SharePoint, the sine qua nons of a stable global existence for us all.
Here’s the deal. Treatment for emotional dysregulation is evidence-based. It can be measured. It is good, therefore, in the “proper” way, one that can literally be carried by a lackey up to Capitol Hill to waive in the face of legislators (or administrators, depending on who’s doing the outraged J’accuse bit for the day).
“Treatment” for coherence is, however, at least for the foreseeable future, not evidence-based, or at least not so in the “proper” ways that play well for accountants and Senators. Therefore it may be good, but those who must report to those who control the purse string will always have to ask, “What use is it in the administrative-political context?”
Therefore, I suggest that we let the VA do what the VA can do, hold it accountable for what it should be held accountable for, and not ask it to do what it cannot. It can be held accountable for promoting emotional regulation. It cannot, however, in my opinion (which, usual caveats, is mine and mine alone), be held accountable for promoting coherence.
That’s where veterans like Mike and others are going to have to come in.
You see, psychoanalysis, i.e., real, modern psychoanalysis that is lively, controversial, and ever-changing, does have a thing or two to say about coherence. Now, granted, like any discipline, it tends to say those things in a jargon-y way that can be off-putting at times. But all stories can become more coherent the more we are willing to look at all facets of the truth, objective and subjective, and then live with the consequences.
Combat veterans usually do not have a lot to say about the technicalities of emotional dysregulation. Thus, they usually need to depend on experts to help out.
They, however, do have a lot to say about coherence. Many have found it (or at least a satisfying-enough facsimile), and those who have are wanting to learn as much as they can so that they can share that coherence with their brothers and sisters.
I would like to do what I can to help them in the goal.
Therefore, I will be setting up a Tumblr and a YouTube account, and I am going to start posting five to six minute videos that will discuss and explain about ways to think about making life more “coherent” post-deployment. I will not be talking about treatment issues. My goal is not to turn combat veterans into amateur therapists.
It is my goal, however, to help veterans understand, in as non-technical way as I can, how to think more systematically about what can make life more coherent and what can make it less so. I want to give them a vocabulary that they can use to express what is working in their lives and what is not, not a jargon/psychobabble vocabulary, but rather a human vocabulary that has been, in my opinion, well-tested over time to help make more sense out of life for a lot of people.
As a result, I hope to do what I can to help veterans not only to share more effectively with their VA (or private) therapists what is going on, but even more to serve as “first-response encouragers” to help fellow veterans who may not yet be ready to seek formal treatment. By being able to express more clearly how life has become or can become better, these veterans can, in the well-worn phrase, “play it forward” again and again.
Folks, we need to face facts: the VA will never have enough money. Even if “evidence” comes forward of the effectiveness of ways to improve emotional coherence in veterans, that “evidence” is not going to be available for a long time, years maybe. No evidence, no money, no programs, period. One can cry foul about this until the cows come home. All it will get one is hoarse–and still cow-less.
The real future of American (and I would say also Canadian, British, Australian, and other) combat veterans will be in the hands of those veterans who have learned the techniques of emotional regulation in therapy and who will then be able to take whatever time is necessary to help other veterans regain meaning.
Like Dr. Solms in his endeavor, I have no clue whether what I will try to do in mine will make one whit of difference. I can only share ideas, not promises. I do trust, though, that veterans will let me know one way or another whether I’m being helpful or not. If I fail in one task, I will be glad to do what I can to change course and try another. This is a two-way street. I am hopeful that persons such as Mike and others will keep me on track–or, if necessary, politely (or not so) tell me to stick to highfalutin’ blog essays and otherwise shut the, well, up.
If I can be helpful, in other words, great. If I can’t, well . . .
I can at least find the 6 now. Next stop, the other Boroughs, and then,who knows, maybe one day Long Island? Connecticut?
Ah, the dreams that keep us going.