Tuesday, August 10, 2010

My Life in Therapy

I got an email from one of our readers asking for the Shrink Rappers' opinion of an article in the New York Times by Daphne Merkin entitled "My Life in Therapy". My first thought was: "I am sooo not the person to be blogging about this." My clinical practice consists entirely of medication management, occasionally with additional crisis intervention and brief supportive therapy. I know that Dinah will have more to say about this story when she gets back and will probably say it better than I can. Nevertheless, I'll give it a shot.

In keeping with the Dinah tradition, I'll summarize the story and post a couple excerpts, then give my thoughts on it and ask for comments.

Merkin writes about her forty-plus years of experience as a psychoanalytic patient in New York City. Her first therapeutic contact took place when she was ten years old; she writes about her initial ambivalence and resentment of her therapists, what therapy has taught her over the years and also what therapy has cost her in both financial and personal terms. In spite of her professional and successful outward appearance, she suffered from repeated episodes of depression. Therapy helped keep her alive, but also occasionally provoked the symptoms she was struggling to contain:

"In therapy that was more psychoanalytically oriented...I tended to get trapped in long-ago traumas, identifying with myself as a terrified little girl at the mercy of cruel adult forces. This imaginative position would eventually destabilize me, kicking off feelings of rage and despair that would in turn spiral down into a debilitating depression, in which I couldn’t seem to retrieve the pieces of my contemporary life."

Although she knew that therapy would not provide her with a "cure" per se, she travelled from one analyst to the next in the hope of converting her “hysterical misery” into “common unhappiness”. Finally, while looking for her last doctor, she came to a conclusion:

"Now, however, in my 50s, I only felt persuaded that the last thing I wanted was to put myself into Dr. F.’s hands. I realized that I had been carrying a “Wizard of Oz”-like fantasy with me all these years, hoping to find someone who would not turn out to be just another little man behind a velvet curtain. It was not that I found all my shrinks to be impostors, exactly, but it dawned on me that I no longer had the requi site belief in the process — perhaps had never had it in sufficient quantity."

For the first time, she decides to try living a life without therapy: "All those years, I thought, all that money, all that unrequited love. Where had the experience taken me and was it worth the long, expensive ride? I couldn’t help wondering whether it kept me too cocooned in the past to the detriment of the present, too fixated on an unhappy childhood to make use of the opportunities of adulthood."

There are obviously limitations to what Merkin can write about: the only type of therapy she experienced was psychoanalysis, and it was unclear to me whether or not her clinical depression was ever adequately addressed pharmacologically in spite of the fact that all of her analysts were psychiatrists. Setting aside these issues, I was disappointed in the story. Her chronological list of therapist descriptions eventually took on a vacuous, droning tone of endless disappointments. She admitted that in spite of years of experience with treatment she lacked the ability to recognize a good therapist; she judged each new potential doctor based upon their wardrobe, or the office decor. The article appeared to be mainly a depiction of the New York analysand zeitgeist rather than a progressive story of one individual patient.

Frankly, I've heard better descriptions of the therapy experience, descriptions that were deeply personal and more heartfelt, from our readers. Merkin's article lacked poignancy, intensity and warmth and for me it had the feel of an intellectual exercise rather than a personal revelation.

She made one point successfully: that although the unexamined life may not be worth living, sometimes the examination of life takes the place of living.