Sunday, June 06, 2010

The Pent Umbrage of the Tempy, Part V

You’ve had a simultaneously obscure and vivid experience—it felt like a breakthrough of some sort. Something which you could never quite put your finger on had been bothering you, annoying you, agitating you—and then somehow, without knowing what you were doing, you had put your finger on it, you had scratched at the annoyance, put an end to it, and unmistakably knew you now felt better.

That’s the only thing you do know—that some vague irritant in the shadows of your field of consciousness had been, without ever becoming fully conscious, removed, AND, not only was the irritant removed, (and thus the field of consciousness cleansed), but also there’s a feeling of renewal, strengthening, change and conviction in the tonus of your entire being.

There’s nothing uncertain to you about what you have claimed—that you felt an irritation “in your mind” AND that now you don’t and feel much, much better. But there is uncertainty about what precisely has happened…What was causing the irritation? What happened to make the irritation go away? What if the irritation was imaginary? What if the feeling it went away was imaginary? What if you had imaginarily cleaned away an imaginary irritant? What if the feeling of relief now is imaginary? In the mind, the imaginary can be felt, but you know to believe that in reality these feelings are more than imaginary could have serious and dangerous consequences. How do you know you are not making this blunder?

You’ve made it before…You were carried away in a most serious and destructive enthusiasm fourteen years ago….You’ve never forgotten that…In comparison to the horrible consequences of this burst of enthusiasm, your blasé fourteen following years had not seemed half bad. There had been a sense of refuge and sanctuary in these years…A respite….From life and from madness? You've recovered a feeling of life--have you also revived your dangerous madness?

Thursday, June 03, 2010

The Pent Umbrage of the Tempy, Part IV

1. Your patient, a garden-variety neurotic, has had the audacity to unilaterally announce termination of twelve and a half years of therapy. Though you had recently learned of your patient’s job loss, and thus had speculated you would soon be, due to your patient’s lack of funds, diagnosing your patient as cured, at least for the time being, the abruptness and arbitrariness of your patient’s announcement has disturbed you. Your patient speaks of a “desire to end this” and refused even in theory to acknowledge the extreme danger of acting on such a whim. The crucial decision of when to terminate must be treated as the highly technical matter it is.
2. When contacted, (as required by due diligence and the high standards of professionalism and ethics of this hallowed field of scientific psychotherapy), your patient’s friend and employer evinced a touching concern for the change which had come over your patient. The friend, though hoping to see further treatment made compulsory, quickly noted couldn’t personally be responsible for paying for it because of the anxiety and guilt this would induce in the patient. Similarly for the employer, who suggested an appeal for funding from an appropriate government agency. This would, however, be outside of your purview, as you have long observed a correlation between motivation in therapy and personal payments. A consensus is developing that something must be done—there is a feeling of both warmth and pleasantly exciting urgency in these communications.
3. Your office gives some discrete notice about the situation to the proper authorities.
4. In all of the recent interactions, your patient has questioned your authority. Of course you have always encouraged your patients to do so. What remains troubling, however, is when your patients fail to take up an authoritative questioning of authority which it is your solemn duty to impart to them. Questioning of authority must obey the guidelines you learned during your eight years of post-med school residency. Such distress this causes you when their uninformed “critical” thinking leads them to criticize you. Or disobey you. Or disregard your treatment recommendations. The potential hazard this presents to their mental health requires all expedient and drastic measures be taken to prevent any further motion in these aberrant directions. Until the patient can be compelled to learn the proper techniques for thought and questioning, it is preferable they be compelled to desist. This isn’t easy of course. If their ability to learn and think and feel properly was fully functioning, you would not have been seeing them in the first place.