Tag Archives: countertransference

The Slide Show

April 6, 2012 By in Living Life, Professional Relationships Tags: , , , , 4 Comments

Truth be told, he and I never should have met in the first place.

Working at a VA associated with a major university has its perks, the most glorious being–residents!  Believe you me:  I am more than thankful to have the opportunity to work with young psychiatrists-in-training, not only because of their energy, their intelligence, their curiosity–but also, yes, I admit it, because of their being on-call in the hospital every night.  We staff psychiatrists have it nice as a result, I do grant you.  Even though we’re on call for a week at a time, four to five times a year, it’s all by beeper.  The men and women slogging it out in the trenches at 2AM are half my age.  They might beep me at 3AM to discuss a case, but, hey:  I fall back asleep easily.  Hallelujah.  For residents and for sleep.

In the latter part of 2010, however, it was not always so.  For reasons too complicated to explain, the staff psychiatrists had to serve as the first-call person on the weekends.  Poor us, I know.  Still, another glorious perk of Med Center VA life?  Having  very competent social workers working through the night in our emergency department, triaging and making life livable for all.  Sweet.  Plus, since we are able to access our VA computer accounts via a secure website, we doctors were able to manage all other matters that fall from the quiet of our homes.  Sweet x 2.

I did, though, cover one particularly memorable weekend:  ten admisions to our inpatient service in the span of two days, with two discharges.  None of the admissions was easy.  None of the discharges was.  By late Sunday evening, both I and the very competent, always-faithful nursing staff had just about had enough, thank you.

It was about 9:30 that evening when the ER social worker called me.

She had interviewed a young man who was struggling with acute drug intoxication issues (among other quite complicated matters, it should be added).  This social worker is quite savvy, yet she was struggling to know what to recommend for the man.  Given his impulsivity, she was quite concerned for his safety.  Still, he had “a way” about him, she told me, that made her wonder whether it might not indeed be OK to release him that night to his family, with outpatient care to be scheduled within a day or so.  I remember her words well, listening to them as I was while sitting in an easy chair in our family’s spare bedroom:  “It’s times like these that I miss having the residents here.  Sometimes that was all it took:  having an MD sit with the patient and convince the guy face-to-face that he’d be better off if he’d just come into the hospital for a while and get himself settled down.”

She was right.  I knew that.  I too was not pleased with the thought of this guy’s just going home in the condition he was in.  I knew I was on solid ground to ask the social worker to contact hospital security and then tell the patient that he was going to have to stay, whether he wanted to or not.  I knew that our VA police, our ER staff, and our inpatient staff were all quite competent enough to make that happen with only the minimal Sturm und Drang.  Nevertheless, I also knew:  Sturm and Drang there would be.  The kid was “strong and wiry,” according to the worker, and “he wouldn’t go down without quite the fight.”   “Code Orange” is what we call such a melee in our neck of the woods.  No good comes from such high drama, for anybody, certainly not at 10PM on a Sunday night and certainly not with an already overworked nursing staff (two admitted patients were already on one-to-one nursing monitoring).  I knew that.

Still, I’ve got the initials behind my name.  All I had to do was to say the word, hang up, and go back to reading my Kindle.  The inpatient doctor would have had to have picked up the pieces in the morning.  Wouldn’t have been the first time.

“OK,” I finally said.  “I’ll be there in a half hour.”

I have colleagues who still roll their eyes on hearing that–and rightly so, I might add.  Their knowing half-smiles say it all:  only you, Rod.  Only you.

After arriving and then enduring the knowing half-smiles of the ER staff, I walked into the young man’s room.  He was lying on his side, facing the wall.  He barely turned his head to look at me.  He wasn’t hostile, but believe me, he wasn’t impressed either.  “I don’t know, man,” was about all he could say.  “I don’t know.”

He eventually did turn to face me.  It had been Afghanistan, I finally learned–that, and a quite, quite complicated life pre-deployment.  Bad, the whole scene, really bad.  He just couldn’t take it any more, the waking up screaming, the never-ending newsreel of blood and body parts in his head, the absolute certainty that it would never end, that it never should end, given what he’d seen, what he’d done, halfway around the world, just the other side of town.  He wasn’t going to kill himself, or at least not really.  He just didn’t care.  About anything.

His family had brought him in.  I sat with them for a good half-hour or so in a secluded corner of the waiting room.  I still can see his father, fighting back the tears that he was too worn out to hide:  “We just don’t know what to do.  I love him more than anything, but . . . we just don’t know what to do.”

When I went back to the patient and told him what his family had said, he looked genuinely shocked.  “You mean they’re still here?” he asked.

“Yes.  They’re worried.  Big time.”

Wiry and strong as he was, he dropped his head and began to cry.  “I’m so terrible to them,” he finally whispered.  “They love me so much.  I don’t deserve it.”  Slowly he raised his head.  “OK.  I’ll stay.”

By the time all the admission dog-and-pony show was over, it was about 1AM.  I was about to head out of our inpatient unit when I saw him sitting by himself in our day room, clad in the standard-issue hospital pj’s, staring at the floor, strong, wiry–and anything but.

All right.  I’ll confess it to the entire world.  Here it goes, ready?

Sometimes the Dad in me takes a gut punch whenever I look at these guys, see that far-off look in their eyes, watch their slow breathing, their mouths slightly opened, with just enough shortness of breath to remind both of us that it can all be so tiring, life.  Death.  These are the sons and daughters of my peers.  Each one of them could have been mine.

There.  I said it.

It’s called “countertransference” in the lingo of my trade, the all-too-human feelings that arise in us all-too-human treaters in our all-too-human work.  It can be a problem.  It’s not always, not by a long shot.  It just happens.  I’m no neophyte to this.

Still, it had been a long night.  For him.  Strong, wiry, lost–him.

I went over and sat across from him at the table.  He looked up, a bit confused, even.

“You don’t have to stay, you know,” he said.

“I know.”  We just looked at each other.

I launched into my spiel, the one about feeling so intensely, so deeply that a group of men can almost think the same thoughts simultaneously, not quite knowing where one of them ends and the other one picks up.  About love.  About having a part of your soul ripped out of you when you realize your brother of brother’s not there any more, not even in one piece any more, never again to laugh, cuss, get drunk, stare at a computer screen, reading an e-mail.

“Were you in the military?” he finally asked.

“No.”

Once again, he looked genuinely shocked.  “So how do you know all this?”

“You guys tell me.”

It was his first smile of the evening, skeptical though it was.  “You actually listen?”

I wasn’t quite sure what to say.  I suspect I smiled as well.  “Yeah, that’s sort of the point, you know,” is what I think I finally said, something like that.

The smile disappeared, yet replaced not with a frown, but rather with this look of puzzlement that had a sort of “well, who’d-a thought . . .” quality to it.

“Thanks, man,” he finally whispered.  We shook hands.  I went home.

It’s been a long road since then.  Really long.  Good stuff.  Not-so-good stuff.  He’s told me more than once:  “I think about that night a lot, you sitting there with me at that table.  I really do, man.  I really do.”

It had been a while since I’d seen him.  Stuff.  Not-so-good kind, at least recently.  He looked good, though, better than I’d seen him in a while.  He was so proud of himself, of all the work he’d been doing trying to get his life together, of his dreams to help other veterans.  He was wearing a well-worn Indiana University soccer outfit, still strong, still wiry.  He has one of those “Yeah, I know, I’ve been bad, but you still like me, don’t you?” smiles.

He’s right.  And he knows it.

He handed me a CD.  “Here, man.  I want you to have this.  It’s pictures, from Afghanistan, different stuff.  Just us mainly messing around, you know.  Not really any combat.  I just want you to have it.”

“Thanks.”  I took it.

After he was gone, after I’d written my encounter note, I opened up the D: drive of my laptop and pressed the CD down into it.  My photo program opened up the first picture.  He  was lying on a cot, shirtless, clearly just waking up, clearly not that impressed with the photographer.  I hit the slide show button.

My photo program eases one picture into another, like moseying along through the family album, giving you a few seconds to prepare yourself for the ridiculous look on whoever’s face is about the grace the screen, a sort of retrospective, “This Is Your Life” quality, know what I mean?

It was his smile.  Over and over.  He’s quite photogenic, actually.  Combat fatigues, physical training outfits, swimming trunks, goofy T-shirts, posing with local troops, robed men at fancy hotels, cute kids, even with President Bush, no lie.  There was this family wedding picture.  He was in a tux, holding what looked to be the ring-bearer, his hair slightly longer than Army-issue, sun-bleached just enough.  Went well with the smile.  The whole look.

I didn’t cry.  Yet there was something inside me, that Dad something again.  It’s a sincere smile, his is, one of those “you gotta love me” types, one of those that says–not shouts, mind you, just says–”Here I am, world.”  Here I am.

God, I wish he didn’t know what he knows.

Please, dear God.  Let him find peace.

Will Do, Sir

January 28, 2012 By in Professional Relationships Tags: , , , , , , Leave a comment

The last of the series of posts on gender (at least for now).

As I said earlier, I have found that male veterans very frequently tend to respond differently to me as a male  therapist and “authority figure” than do men who are not veterans.  Given some of the factors I’ve pondered–veterans’ more willing acceptance of male authority, their gut awareness of the possibilities within non-sexual male relationships, and the complex relationships men often have with their fathers–I have been considering the pros and cons of my relationships with these men.  I present these thoughts not as universal examples to be followed,  but rather as ideas some male professionals may wish to consider.

(Usual caveats apply, i.e., the ideas are all mine, as is therefore the blame; lots of very smart people will disagree vehemently with at least every word, so take it all with a pound of salt; and, yes, I fear that the only data I have to support these conclusions is that most accursed, most out-out-damn-spot-able of all data, the most dreaded two words of the social sciences lexicon, the destroyers of many an academic career:  merely anecdotal.)

1.  Male veterans often respond quite quickly–and quite effectively–to male authority figures who show both sincere interest in them and sincere respect for them.

As I noted earlier, I have been quite taken aback by how readily many tense situations with very distraught male veterans diffuse themselves simply by my saying to them something to the effect of “Look, I’m just here to help, really.  What’s been going on?”

If at all possible, don’t say anything like that from a “power-above” position, certainly not figuratively and, if at all possible, not literally as well.  Think of yourself as looking at the veteran eye-to-eye, although not necessarily directly eye-to-eye.  (That can be chancy, as some men see this as a power move–which it can become, if you’re not careful.)  You’re not there to stand the guy down.  You’re there to listen, whatever your job (education, law, medicine, business, law enforcement).   Think of yourself as planting yourself (not fastening yourself) firmly to the ground, certainly figuratively, perhaps literally.  You have to have the mindset that you’re not there to push anybody around, but neither are you there to be pushed around yourself.

My experience has been that if you do this as a male professional, you will go far.  In more tense situations, I have found that this strategy can greatly reduce the chances of any physical or emotional violence ensuing from the veteran’s distress.  But again, it’s not just about showing sincerity. The key–bar none–is showing respect.  I cannot overemphasize this.

I’m going to shift into guy-talk here:  Walk into the room, man-to-man, without your having anything to prove, but also without apologizing for what you know, what you do, and what in the real world might limit you from getting done what you’d like to get done for this veteran before you.  I use “man-to-man” quite specifically:  you’ve got to have an attitude that  shows the veteran from the get-go that you’re just another guy trying to make it in this world, thank you, and yet you might even be able to help him out with a thing or two, who knows, give it a shot.

If you do, the whole game will shift in seconds.  Trust me on this one.  Seconds.

2.  When two men are interacting, it’s always, always, always, always about hierarchy and shame.  Always, always, always, always.

Obviously this is a corollary (or maybe a prerequisite) for idea number one.  For those of us men who have embodied the traditional male values of our culture (whether we’ve wanted to or not), we implicitly understand this fact once it’s brought to our attention.  Traditional men always–always–filter the world into who’s- one/who’s-two.  It is what drives many women and many men of a non-traditional bent absolutely batty.   Don’t fight this fact.  Instead, use it to your–and the veteran’s–advantage by never forgetting the following:

a.  Your relationship with the veteran will never–never–not be about hierarchy; you will always be the one with the power, no matter what you think or try; so use that power wisely and humanely.

I said above that you should enter the room with a plan to meet the veteran “eye-to-eye.”  I’m not backing off that suggestion.  However, never forget what you know implicitly:  the “level-playing-field” or “eye-to-eye” position is never a stable one for those of us who embody the traditional male.  We spend our lives trying to develop that capacity with our lovers, and even then we can usually only stay there for relatively short periods of time (famously much to our lovers’ chagrin).  And with other men, we sustain that position only i). when drunk, or ii). when in the most dire of circumstances (e.g., combat).  As soon as those external factors subside, we’re back to number-one/number-two.  Always.

The secret for a male professional working with a male veteran (again, if you both embody the traditional) is this:  know in your heart that you’ll always be number-one, but never smash it into the veteran’s face.  Your job is always to keep his future at the forefront of your mind:  you want to show him what it means for a man in the number-one position to nurture, not control the man in the number-two position, so that the veteran, when his time comes, will be able to pass on that skill to the number-two-position men who will come after him.  The good father nudges his son into the future–and then lets him run with it.  The good professional does the same with the veteran he’s working with.

b.    You always have to keep the veteran’s self-esteem at the forefront of your work, always.  Given that he will always feel “less than” to you (no matter how he’s acting), he is always at risk for intense shame reactions.  You won’t be able to stop the shame, but you darn well can make sure it doesn’t spiral out of control.  Shame out of control can lead to immediate emotional withdrawal–or immediate emotional (and sadly, sometimes physical) attack.

I impose two rules on myself whenever I work with men, and I especially apply these rules to my work with male veterans:

i.)  Use the phrase we guys a lot.  Help the veteran understand that self-esteem regulation is at the heart of the emotional life of most men, including us traditional-male professionals.  You don’t tell the veteran your problems.  You don’t give him a blow-by-blow about your own sordid tale of how you finally (let’s hope) pulled yourself together.  But you do acknowledge that, as traditional men, we struggle throughout the life cycle with finding mutuality in our relationships and with keeping our shame from overwhelming us.  You try to help the veteran understand how his own personal history plays itself out against the backdrop of the emotional struggles that most of us traditional men still have to face every day (even after decades of therapy).  In other words, we’ve got to get the guy to feel that he’s not alone–that even the big-shot professional can, at a meaningful level, “get it.”

ii).  Whenever you have to deliver a potential critique–even a very potential one–always preface your remark with something like, “Look, I’m not trying to be critical (or a jerk) about this, but I think we both know there’s something we have to face here.”  I owe the “we both know” part to my absolutely-all-wise clinical supervisor, Dr. Martha Stark of Boston.  The rest I take responsibility for.

Now, yes, you and I–and at one level, the veteran–both know that in fact I am about to be critical when I say that.  Yet saying it does two things simultaneously:  a).  it reminds me before I say something that, indeed, I’ve got to be careful not to be too critical, and b). it tells the veteran that I understand that critique is hard and that I only do it because I want the best for him.

3.  Expect the veteran to be wary of you for a while, but always be on the lookout for a shift to vulnerability.  When you see it, do not “psychically approach” him any more than you already have.  Instead, still keep yourself firmly planted–but, if you will, soften your “stance” a bit.

Don’t worry:  if you’re looking for the “shift” from hierarchical jockeying to a more willing acquiescence to the “superior rank” of the professional, you’ll see the point of change, no problem.  It tends to be in the eyes, in my experience.  Especially if the veteran is distressed, he’ll move from defiance in those eyes to uncertainty.

REMEMBER THE SHAME RULE.  This is the most vulnerable point in the whole contact.   You can blow the whole kit-and-kaboodle in a heartbeat if you’re not careful–and the onus is always on you!   Give him his dignity.  Let him ease into the subordinate role.  You’re in the superior role, as I said earlier: that ain’t changing, so just keep your cool and don’t rush in to save him.  Trying to save is a power move on your part, always, no discussion, no debate.  He doesn’t need your salvation.  Period.  He needs your strength and your assurance that you both will get through this.

4.  If you follow these rules, you’ll be shocked–really, I mean it–at how quickly you can get to very difficult subjects.  I find myself being able to talk frankly about self-esteem regulation (yes, for those in the know, that dreaded word narcissism) quite quickly and quite directly.  They’ll start trusting you with their fears, their anxieties, their guilt, their hopes, their you-name-its.  If you both know it’s about hierarchy, both know it’s about shame; and if you can get him to feel in his gut that you’re wanting to encourage him, not control him–honestly, professional guys?

They’ll follow you into battle.  Will do, sir.  Will do.

This leads me to my final thought:

5.  Consequently, you should expect your relationships with these men to become quite intense.  There’s no need to avoid this.  There’s no need to be ashamed of this.  Remember the basic rules:  it’s about him, not you; forget any fantasies of rescuing him from diddley-squat; and realize that you can’t change the past, no matter how much you (and he) might want you to be able to.

I will even go farther:  enjoy this intensity with him.  Traditionally the worry about enjoying in these intense situations is that you could cause more trouble for the veteran by doing so.  It is true:  you run the risk that men who actually do fall on the borderline spectrum–men who struggle with intense emotional lability within personal relationships–will start playing out those struggles with you if you show “enjoyment”  too much (i.e., be too chummy, too self-revealing), leading to chaos and overinvolvement (or underinvolvement) with the veteran on your part as a professional.

But again:  these are male veterans who were honorably discharged.  For at least two years they had to be ready to experience strong emotions in the presence of men in superior positions.  They knew the rules, specifically:  they had to write into their genetic make-up the rules against fraternization, the rules that forbid superiors and inferiors from having personal relationships (even relatively innocent ones), lest the men so moved to fraternize find themselves court-martialed in a heartbeat.  Believe me:  the military takes that stuff quite seriously.  The military is founded on one principle:  order.  So far, even the most pained borderline male that I have met at the VA has been far less willing even to dare to pull for more “special” relationships with a male professional superior than you would expect from borderline individuals, male or female, in the general population.

But . . .

Just as long as the male, professional superior doesn’t encourage, either implicity or explicitly, the fraternization process!!!!  It’s all up to you, in other words, my fellow, professional friends.  And believe me:  that’s the military’s take on the whole deal as well.  Woe to the officer who gets too entangled with an enlisted man (and, yes, that could be sexually, but I’m more talking about getting too buddy-buddy).  It won’t be pretty.

But again, it’s really surprisingly easy to avoid this:  simply keep a paternal/big brother stance.  Enjoy the guy.  Stick with him through what he has to go through.  And nudge him–all right, sometimes push him a bit–into his future.  Encourage him to love.  Let him know, through your own assurance, that true love is possible.  Encourage him to make out of life what he can.  For some of these veterans, that will mean some mourning, on both your parts, of what-could-have-been.  Don’t back away from that.  Believe in his future notwithstanding, even when neither of you has a clue what that future will be.

Then once he starts to move into that future, don’t run after him.  Just sit back and watch him move into love and work the best way he can.  Perhaps because of what war has done to him, he may always need your support in some important way–i.e., he’ll have to come back frequently for assurance, guidance.  Don’t get discouraged.  Just because the brilliant-ones say that all should be fine after twelve sessions or so, don’t let that stop you.  Believe in yourself.  Believe in whatever he can do.  Keep going.  No Plan B.

And enjoy.  Enjoyment per se  is not “boundary crossing,” i.e., getting too involved.  Enjoyment is just enjoyment.  No more.  No less.

It helps you get up in the morning and face another day.

And that’s a good thing.

Dream and Weep

January 27, 2012 By in Living Life, Professional Relationships Tags: , , , , , Leave a comment

About a year ago, Dr. Ghislaine Boulanger came to the University of Indianapolis to give a presentation on adult-onset trauma.  Dr. Boulanger is a psychoanalyst who has endeavored to broaden the psychoanalytic understanding of PTSD beyond the traditional focus on childhood trauma.  As a result of her work with Viet Nam veterans, witnesses to the 9/11 attacks in New York City, and survivors of the Hurricane Katrina disaster in New Orleans and the Gulf Coast, she has written eloquently of the complicated psychological meanings of the tragedies and/or horrors that can completely alter adults’ lives.

Dr. Boulanger is brilliant, engaging, warm, and deeply committed to helping professionals learn to work more effectively with adult sufferers of PTSD.  Very graciously she agreed to serve as a consultant to me last spring as I began to consider moving into full-time work with the younger veteran population.  The conversations we shared together were to me very rewarding, challenging–and sometimes just downright painful.  She is no stranger to the profound emotions we professionals can feel whenever we take seriously the lives of those who have had their innocence ripped from them.  She warned me: this was not going to be easy.

I thought of Ghislaine today.

I have worked with a young veteran who repeatedly experienced horrific encounters while serving on deployment in the Middle East.  He has struggled to make his life work since his return.  He has met only limited success.

He comes in regularly to see me, even though (by his request) we do not delve deeply into his past experiences or into the current thoughts that those experiences trigger within him.  Yet he appears to enjoy our spending brief periods of time together, chatting about his family and his hopes for their better future.  I enjoy spending time with him as well.

As soon as he sat down this last time, though, he told me, “I brought something.”

“What?”

He pulled out his phone.  “A song.”

Never having been good at the poker face, I clearly amused him with my perplexed surprise.

“I listen to it a lot,” he continued. “Try not to be around anybody when I do.  Freaks people out.  But sometimes it just comes up in my playlist.  Can’t help it.  It’s about what goes on inside my head.  You want to know what PTSD is?  Right here.  This song.”

I hesitated.

“Glad to listen,” I told him.

I’m still not quite sure I meant that.

So he turned on the mp3 player in his phone.  Immediately he smiled sheepishly.  ”Better turn this down.”

Good thing he did.

Of course I had never heard the song before, never even heard of the group who played it, given how pop-culture clueless I am (ask my kids).  After it was over, he told me that it was entitled Dreaming, by the Armenian-American hard rock group System of a Down.  He had discovered their 2005 album Hypnotize in a book of random CDs he’d found somewhere in his basement.  He can’t remember where all the CDs had come from or from whom he’d received them.  But it was this album, this song that finally–finally–enabled it all to make sense for him.

The following are the words, as presented in AZLyrics:

For today we will take the body parts and put them on the wall

For treated indigenously, digenously
Human right is private blue chip, pry
For treated indigenously, digenously (We’re the prophetic generation of bottled water, bottled water)
Human right is private blue chip, pry (Causing poor populations to die, to die, to die)

You, you went beyond
And you lost it all
Why did you go there?
From beyond You saw it all
Why did you go there?

For treated indigenously, digenously (We lost consumer confidence in casual karma, casual karma)
Human right is private blue chip, pry (Confetti, camouflage, camouflage, the flage, the flage)
For treated indigenously, digenously (We’re the prophetic generation of bottled water, bottled water)
Human right is private blue chip, pry (Causing poor populations to die, to die, to die)

You, you went beyond
And you lost it all
Why did you go there?
From beyond You saw it all
Why did you go there?

She lost her mind
Someone kicked her into the back of the line
She lost her head
When they called and said that they thought he was dead

Dreaming of screaming
Someone kick me out of my mind
I hate these thoughts
I can’t deny

Dreaming of screaming
Someone kick me out of my mind
I hate these thoughts
I can’t de-

For treated indigenously, digenously (We lost consumer confidence in casual karma, casual karma)
Human right is private blue chip, pry (Confetti, camouflage, camouflage, the flage, the flage)
For treated indigenously, digenously (We’re the prophetic generation of bottled water, bottled water)
Human right is private blue chip, pry (Causing poor populations to die, to die, to die)

You, you went beyond
And you lost it all
Why did you go there?
From beyond You saw it all
Why did you go there?
Na, na-na-na

Dreaming of screaming
Someone kick me out of my mind
I hate these thoughts I can’t deny

Dreaming of screaming
Someone kick me out of my mind
I hate these thoughts I can’t deny

You will take the body parts and put them on the wall

And bring the dark disaster

I could say that the lyrics in italics were pure cacaphony, for I had no clue what they were as I listened.  Yet cacaphony is not exactly the right word, honestly:  that implies a disorder that aggravates, making you wonder why you’re wasting your time listening to this junk.  No way was I wasting time on this.  No way.  The sounds slashed me, creating a column of bleeding x’s right about where my soul should have been, almost goading me to come back for more–if I dared.

The words not in italics, though?  Crystal clear, shattered-ly–no, ground-to-a-powder-ly crystal clear.   Why did you go there.  Dreaming of screaming.  Someone kick me out of my mind.

Dreaming of screaming.

I’m not quite sure when it happened.  Given that I was struggling at times to understand the words, I had bowed my head and closed my eyes to concentrate.  Maybe it was the first dreaming of screaming.  I don’t know.  But I felt it.  I felt the tear inching its way toward the surface.  It was giving me a choice.

You can stop me now, it seemed to be saying to me.  Or you can let me go.  You pick.

Oddest thing, it was, not at all something I’m accustomed to, this–how should I put it–challenge my emotions were offering me.  What was worse:  the front part of my brain, that part that is charged with keeping a lid on these emotions?  It almost seemed to be delighting in my being forced to make a decision, as if it were saying to me, “So, what is it:  gonna do it or what?”

I really did contemplate sending the tear back to its pool of origin.  I really did.  For the briefest of seconds, that seemed not only easiest course of action to take, but (oh, even better) the most therapeutic.

Yet it was as if my frontal lobe with its logic and my limbic system with its emotion were together bolting right straight toward me, sputtering  in one voice, “Don’t you even dare, pal.  Don’t.  You.  Even.  Dare. ”

What makes you so special, hot-shot, they seemed to be sneering to me, that you don’t have to suffer this kid’s life.  Seriously?

In the end, I had to agree with them.  Didn’t want to, at least in a way, but you know, so what, really.

So I fished, rather than cut bait.

From that moment on, I really didn’t contemplate the actual tears much.  Mind you, there was no sobbing or drama, so it’s not as if major intervention would have been in order.  My eyes just trickled.  One trickle after the other.  After the other.  She lost her head, when they called and said that they thought he was dead.  One after the other.

My God, I could only think.  This is his mind.  He told me straight way.  This is it.

My God.

The song over, I looked up.  He too was looking down, he at his phone, turning it off, staring at it for those few seconds.  Then he looked up at me.

He clearly hadn’t been prepared for what he saw.

I knew I had to act fast.

First, I smiled, not broadly, just–smiled.  He seemed so young to me all of a sudden, as if he’d just stepped off a skateboard rolling down Tenth Street, flipping it up into his hands with his right foot as he had begun walking up the front steps of the hospital.  He’s slender, not a big man.  He was wearing a stocking cap pulled down over his ears, just edging over the top of his Shaggy-Rogers-scraggly beard.

I turned to get a Kleenex, biding for some time.  As I did, I simply said, “You seem surprised that it affected me so.”

Kleenex in hand, I quickly dabbed the couple of tears in the corners of the eyes, brushed over the one trickle-track still left on the right cheek.  I looked back at him.   I was still smiling, as I recall.

I imagined wanting to take him by the shoulder, assure him that all was going to be OK, somehow, OK enough, at least.

“I am,”  he replied.  Then he paused.

“I’m sorry,” he then said.  His voice betrayed a shame that was about ready to vortex out of control.

“Sorry?”  I quickly answered back.  “What you mean?”

He swallowed.  “I’m sorry I upset you.  I didn’t mean to.”

It was the opening I needed–didn’t have a clue what actually to do or say, mind you, but it was my time, I knew it.  I just shot from the hip.

“Please don’t feel sorry,” I told him.  “I’m not upset at all, not in the least.  It’s just what I do, you know:  feel.”  Another pause.

And then something else just popped out.

“You  need that from me, you know, feeling.  You doubt that you can touch anybody, really matter to anybody.  I guess we both need the tears.  Like, to prove you wrong.”

For a few seconds, nothing.  Then he smiled the saddest smile I’ve seen in a long time.  “Why would anybody want to take anything I say seriously,”  he whispered, almost rhetorically, as if he were commenting to a group of bystanders on the strange utterances of this man seated  before him.  His voice caught.  “I mean, I’m a nobody.  Everybody knows that.”

For a few more seconds, nothing as well.  I of course knew, at least at some level, that he’d thought that way of himself long before he’d climbed into that plane headed for Kuwait.   This was an old, old story.  Still, it did take me aback for an instant, hearing him say that so plainly, matter-of-factly.

“Tears say differently,” I whispered back.

He smiled a little less sadly, as if he’d decided that he just didn’t have it in him to go another round and prove me the numbskull that I am.

“Maybe,” he replied.  “Maybe.”

Then he looked back down at his phone.  “Let me show you something.”

With a few clicks, he smiled at his handiwork, and then pointed the phone back toward me.  In its middle was this picture of a boy, probably around four, five tops, smiling the Cheshire-cat grin of Cheshire-cat grins.  It was almost a Precious-Moment kind of picture–if it weren’t for the fact that the kid had the orneriest look on his face that you could imagine.

I looked back up at him.  His fatherly smile was not broad, but it was no longer sad.

“That’s why I’m alive,” he said to me.  “That’s why.”

I sit in a quiet corner of my house, typing away.  My son is not far off, checking out some DSi-computer link with all his might and all his soul.  My younger daughter is asleep upstairs.  My wife is in the room next to my daughter’s, half-devouring, half-perusing the latest mystery downloaded onto her Kindle, still not quite yet ready to give up and head to bed so early.  My elder daughter is living the high life as a freshman up at Goshen College, probably right about now watching some Netflix golden-oldie with her boyfriend and the rest of her cronies, who knows.  So normal.

We have no clue, I, my family, you, your family.  None of us over here does.

Dreaming of screaming.  Someone kick me out of my mind.

The tears were real.  As is he.  We keep going.

No Plan B.

Oedipus, Revisited. Sort of.

January 27, 2012 By in Professional Relationships Tags: , , , , Leave a comment

A few days’ hiatus (would that it would have been vacation, but at least my son and I did survive exponents in Algebra I, with polynomials now on the way, yee-hah.)

Before I continue, a reminder:  once again, I’m not saying that male professionals are in any way better situated to work with male veterans simply by reason of gender.  Certainly the veterans whom I’ve met have previously worked with both men and women professionals, and most of their experiences with those professionals have been positive.  Neither am I saying that I have anything “special” to offer the guys.  Instead, I am only saying that I have noticed that my experiences as a male professional with almost all these male veterans have differed in kind from my previous experiences with men in similar settings.  This has caused me to ponder.

1.  Since the draft ended in the 1970′s, military men have been volunteering to enter into–and for at least some time, stay with–a very intensely traditional-male culture, especially one that is intensely hierarchical.

If you stay in the military (at least long enough and successfully enough to qualify as eligible for VA health benefits), you are consequently no stranger to having to respond to men who hold sway over you.  And note that parenthetical qualifier in the previous sentence:  you were able to stomach those higher-up men’s “sway” long enough and successfully enough to a). keep yourself out of jail and b). earn an honorable discharge (or one close thereto).  Many men find it nigh onto impossible to spend much more than fifteen microseconds in any type of submissive role to another man (and I’m definitely including in this group men who should easily have the wealth and/or the smarts to know how to cut their losses, play the good-little-boy role, and do so, pal).  This is not, in other words, merely a a phenomenon of “the masses.”

2.  Military men know that nonsexual, yet quite intimate relationships with other men are possible well beyond the sphere of the “chums” you’ve hung around with since you first heard the word “Nintendo.”

Never underestimate this fact.  True, for example, in college you can make some intense relationships, especially if you are heavily involved in something akin to the traditional Greek system.  But it’s not so much the quantity of the relationships of military men, but more the quality of the relationships within that quantity.  At a gut level, military men know that even strangers can become so deeply dependent on one another (male strangers, that is), their worlds (and mindsets) can be forever changed.  I haven’t been impressed that being the social chairman for Sigma Chi has qualified the average non-military guy for such a visceral, unconscious, if you will, expectation.

3.  For many, many military men, their fathers have loomed largely in their lives, whether for ill or for good.

Truthfully, I’ve yet to meet a military man who is ho-hum at the mention of the father figures of his life.  Some men feel intensely close and loyal to their fathers (or their fathers’ memory), having entered the military as a way to honor their father’s (or grandfather’s) similar service, or at least to “make Dad proud.”  Making Dad proud can translate quite readily into making any man proud who has achieved a place of respected meaning in a male veteran’s life.

Yet many more, sadly, have anything but such positive feelings toward the men who have influenced them.  To a man, though, these men seem therefore to be yearning for contact with some type of male authority in their lives who will indeed engender pride and loyalty–yearning  for that contact far more, one might say, than their more-fortunate, paternally-blessed compatriots.

Granted, all military men have learned the hard way that the military, like Life, can bring less-than-ideal male leaders into their lives.  Many, in fact, came to expect just that to happen with every new assignment, every new station.  That didn’t stop them, though,  from hoping against hope–or better, being poised–to respond within a heartbeat’s space of time to authority that is decent and, within that hearbeat’s period and beyond, heartfelt.

So again, it seems to me that many military men enter their relationships with male professionals with a certain “readiness” that can, for many male professionals, be quite rewarding and quite productive.  But quite fraught as well, if one is not on one’s toes.  More on that next post.

Sitting with Pain, Sitting with Life

January 21, 2012 By in Professional Relationships Tags: , , , , , , Leave a comment

Before we continue with male professionals and male combat veterans, some concepts to get on the table:

Remember:  do not assume that all veterans who return from combat are suffering from post traumatic stress disorder (PTSD).  Many who have served in Iraq and Afghanistan are managing fine, thank you.  However, the more a veteran saw combat engagements, physical destruction, etc., the more likely the veteran will be suffering from some form of PTSD.

Also, do not assume that even if the veteran is suffering from PTSD, the veteran will be emotionally charged in all contacts with you.  For professionals such as attorneys, educators, salespersons, for example, you might see veterans only briefly, perhaps in settings that are not at all that stressful or important.  You’ll be working with men and women who are just trying to live their lives.  Aren’t we all.

The more you are interacting with a stressed veteran with PTSD, however, the more likely that you are going to be experiencing yourself a variety of strong emotions as you sit with the veteran, even if you are discussing (what should be) relatively  unemotional material.  As I stated in a post several days ago, just sitting in the presence of a distressed combat veterans–even a mildly distressed one–can be an experience unto itself.  Most of these veterans are already quite intense in their emotional responses; if you add anxiety to that intensity, you can have a quite a combo on your hands.

And it will be a combo that you yourself are going to feel inside you.  The way our brains are built, most of us quite naturally experience the emotional states of others because of the capacities of parts of the frontal lobe of the brain (the part of the brain behind the forehead and, to some extent, the eyes).  These areas of the brain sense the nuanced physical expressions of people with whom we’re talking–how they’re looking, sounding, acting– allowing us to form quick, working assessments of their overall emotional state at the time.  This is nothing more than one biological explanation for the phenomenon of empathy.

Therefore, you the professional, must be prepared to have a physical-emotional response to a distressed combat veteran.  Furthermore, if it is likely that you will be interacting with veterans regularly under such circumstances (making tough legal decisions, talking about how a class is going, negotiations for the purchase of a home), you need to have a “game plan” in mind for managing your own responses as effectively as possible.

The best metaphor I have found to help you formulate a game plan is the metaphor of place and distance.  Imagine yourself in front of the distressed veteran.  Your goal is to keep an “ideal distance” between you and the veteran, certainly figuratively, and perhaps even literally.  You don’t want to be drawing “too close” to the veteran (for now, let’s focus on emotionally), but neither do you want to be “puling back” from the veteran.  You want to keep yourself firmly planted where you are, smile, and do what you know to be helpful.

Remember:  if the veteran is experiencing strong, distressing emotion–it’s not about you!  Even if in a way it is (e.g., you’re a teacher giving a grade), the intensity of the emotion is always about their war experiences, never about the current situation.  Granted, you will be the one in the room with the intense veteran, so it is about you in that you’re going to have to deal with the situation.  You will absorb the emotion, whether you want to know or not.

Absorbing, however, does not imply a responsibility for figuring out what to do with the emotion.  For some of you (mental health clinicians), yes, it will.  More for you below.  For most professionals, though, you have the following mantra available to you at all times:

1).  I don’t like this emotion.  The veteran doesn’t like this emotion.  It’s about the war, not about me.

2).  If I focus on the task at hand–while recognizing to myself that this situation is a little hot–I can keep both of us focused on that task.

Think of it this way:  you want to be aware of the “elephant in the room” (i.e., the distress), while not focusing on the elephant.  You can certainly acknowledge the distress in a straightforward, humane way (“I know, this stuff’s hard to get through, but really, working together, we’ll get the job done”).    But you stay firmly planted in the (relatively) neutral psychic middle ground between you.  (I’m reluctant to call it a “demilitarized zone”:  too many ways the connotations could go.)

No need, in other words, to withdraw emotionally and become too cool and analytic, on the one hand, or too timid and indecisive on the other.  But also no need to get more emotionally involved, i.e., get too close.  If you’re not the veteran’s therapist, then, think of it this way:  congratulations!  Since you can’t heal the war’s wounds in the veteran’s life (neither can the mental health clinician, but that’ll be for another day), you don’t have to get too caught up being “helpful.”   Such “help” rarely turns out to be so.  Trust me.

Be nice.  Do your job.  Stay put.  Acknowledge the pain, but work with the life.

Briefly, though, for those who will have to address that emotions directly, let me say this.  Without doubt, the best way to be able to sit with someone else’s strong emotion over time is for you to have a solid, workable sense of the following–and not just intellectually, but down to your bones:

1.)  There can be a good-enough coherence to a life–never perfect, but good-enough.  And I’ve got that.

2).  Just being with a person in pain makes a difference–a real one, not just a this-is-the-best-we-can-do, compromised one.   I know that.  People have made a difference for me by being with me at crucial times.  I can do the same for this veteran.

3).  The more coherent you feel, the more comfortable you will feel in your middle-ground place and therefore the more you wil be able to offer yourself emotionally to the veteran, for from the beginning you will be confident that the middle ground is not only precisely where you need to stay, but also where you can indeed stay, even while opening up, in a truly vulnerable way, your heart.

Back in the day (I hate to say it, but I’m old enough, I can), all mental health clinicians were taught that the best way to achieve this confidence in your position was to undergo your own therapy–why?  So that, simply put, you will know in your own gut that it can happen and it can stick.  You don’t have to rely on textbooks or what others have told you, for someone stood warmly and comfortably in your own middle ground, managed well whatever came her or his way, and voilà, consequently your own life eventually felt much more manageable.

Today, my sense is that many younger clinicians are, at best, encouraged only to get “pieces of work” done to manage specific “challenges” that arise in the clinician’s professional or personal life.  Long-term, intense sitting with one’s pain in the presence of another is now, apparently for some, considered to be 1).  too expensive, 2). too time-consuming, and 3). not all it’s hyped up to be anyway.

Well, maybe.  But warning:  if you’re sitting for any length of time with a distressed veteran, with a goal of helping that veteran in that distress, you are heading right into “Danger, Danger, Will Robinson” territory (check out Lost in Space in Wikipedia).  I certainly know that I would never have been able to manage myself well with combat veterans had I not had the insights and experiences of my own therapy.

“Catching pain” is real.  Sitting with pain–and with a life trying to go forward in the midst of pain–is hard.  Really hard.  As mental health clinicians, our hearts (and sometimes our bodies) often want to bolt smack dab upright from the sitting position and get moving, darn it, this is war!  Fight or flight, right?

No, not right.  Sit.  Absorb.  Teach and demonstrate what you can.  But then “metabolize” that emotion, as the psychoanalyst Wilfred Bion once said.  Over and over.  It won’t be fun, trust me.  But it will be worth it, for the veteran–and for you.

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