Annie G. Rogers, Ph.D., is assistant professor of Human Development and Psychology at the Harvard Graduate School of Education. A Shining Affliction is her account of her own breakdown and healing during her doctoral clinical internship. We meet Rogers when she is beginning her clinical internship at a children's residential and day treatment center outside Chicago. With great difficulty and extraordinary perseverance, she succeeds in forming a therapeutic relationship with Ben, a very disturbed five-year old with a history of autism and head-banging, parental abandonment and foster care. But Rogers' success with Ben triggers a psychological crisis within herself, for her own history is one of severe childhood abuse, and she is currently in a destructive psychoanalytic psychotherapy. Her therapist, Melanie, once held out the promise of personal closeness to Rogers, but then rejected her, and now is subtly blaming Rogers both for her own problems and for the obstacles in their relationship. Straining to connect with Ben and Melanie, Rogers' mind snaps. She falls into a psychotic dissociation, not her first, threatens Melanie with a fake gun and a real knife, and is hospitalized. Rogers' description of her states of dissociation are highly visual and nearly bursting with everything going on within her. After several months of hospitalization, with her insurance about to run out and transfer to a state hospital immanent, Rogers takes charge enough to change her fate. "I slam myself into my body so hard it hurts and my skull rings with the impact. 'No,' I say, 'you are not sending me to the State Hospital.'" Discharged on medication, and with the support of her sister and close friend (with whom she lives), Rogers is still going in and out of states of dissociation. Then she begins therapy with Sam Blumenfeld, "someone my friends have unearthed for me after a careful search." Rogers' treatment with Blumenfeld is the turning point of her life. As portrayed by Rogers, Blumenfeld is the realization of the deeply competent psychoanalytic psychotherapist. His comments address both what she says and feels, and acknowledge her present state while helping her to discover the path of her recovery. "I took a gun and a knife to my therapist and I threatened to kill her," Rogers tells Blumenfeld. "You must have had a very good reason for wanting to do that," he responds. And they are off. The stories of Rogers' childhood abuse, and of her damaging treatment by Melanie, unfold in parallel with the story of her healing treatment relationship with Blumenfeld. Chapters describing her conversations with Blumenfeld and her treatment of Ben, which she resumes, alternate with descriptions of childhood abuse, traumatic manipulation by Melanie, and dreamlike dissociative sequences featuring a cast of internal characters including an artist (whose technical knowledge of painting is lost in Rogers' recovery, and which she has to relearn) and an angel named Telesporus. Eventually, there is a meeting involving Rogers, Blumenfeld, and Melanie, from which Rogers emerges with a clearer understanding of how her own weaknesses, together with Melanie's, combined to dump her into psychosis, and how her own strengths, together with Blumenfeld's, combine to make a relationship that lays the foundation for her emerging sanity. Dr. Neruda's Cure for Evil is the only book of these three by a writer who isn't a psychotherapist. However Rafael Yglesias, the author of Fearless and a string of other novels and screenplays, has told a story that is so suffused with the texture of psychoanalytic psychotherapy that it could easily have been written by an insider. It is presented as a case history in three parts: First, Dr. Neruda's own psychological history; second, the history of his treatment of a patient, Gene Kenny. The third section is described as "a record of my investigation into the cause of the catastrophic failure of (Kenny's) therapy...and my radical alternative treatment." Rafael (the author's namesake) Neruda is the son of a Jewish mother, Ruth, and Cuban father, Fernando, both of whom are children of immigrants; bright, talented, self-absorbed, leftist. From Tampa, where Fernando's parents live, he supports Castro on the radio. In savage reprisal, he and Ruth are attacked by terrorists, who beat him and rape Ruth in young Rafael's presence. Fernando flees to Havana, leaving Ruth and Rafael to fend for themselves in New York. They are poor, life is hard, and Ruth has no way of healing the wounds of terror. She is unwilling to accept help from her brother Bernie, a hugely successful capitalist, the ersatz patriarch and financial mainstay of the family. Ruth becomes increasingly isolated and paranoid, deteriorating into incest with Rafael. Eventually, she has a breakdown after viewing footage of the Bay of Pigs invasion on television. Ruth is hospitalized and Rafael, at nine years of age, goes to live with uncle Bernie. He becomes the ersatz genius son to the ersatz family father, Bernie's shining star. But, except for cousin Julie, everyone relates to him from a position of manipulation. Deeply affected by his family's trauma, abandoned now by both his parents, Rafael learns that manipulation is the key to survival. "I lived in terror of losing my new crown as Prince Rafael...No feeling was revealed or given a voice without first undergoing a meticulous examination by the Stalinist censor and Jewish coach in residence in my head. I was undercover." Ruth is transferred from Bellvue to Hillside Psychiatric Hospital, a private facility, paid for by Uncle Bernie. There, she receives psychoanalytic treatment from Dr. Halston, who interprets her emotional pain, not as the inevitable result of what has happened to her, but as a twisted expression of her own inner drives. Ruth retreats into catatonic withdrawal, her paranoia confirmed by Halston's misdiagnosis. She is given shock therapy, "recovers" sufficiently to be released, and is discharged under long-term analysis with Halston to "bring her to normality." Under Halston's orders not to see Rafael after her discharge, Ruth is put up in an apartment with a "companion" and five sessions a week with Halston, all paid for by Bernie. Halston reports that Ruth is doing well--until she commits a spectacular suicide. Fernando, absent and incommunicado for years, now abruptly reenters Rafael's life and whisks him away to Spain, where he is living with another wife and angling for a writing deal. Rafael believes that his father has come for him out of love, but Fernando has his own purposes for claiming Rafael--another adult manipulating him. Uncle Bernie travels to Spain behind the private investigator he's paid to track Rafael down, and brings the disillusioned and broken boy back with him. Physically and emotionally exhausted, Rafael's defenses finally collapse, and he tells the truth, for a change. "'I'm sick,'" he tells a teacher, "with perfect accuracy, for once." Uncle Bernie brings him for treatment to--Dr. Halston. Halston makes a deal with Rafael: Rafael will tell him his secrets and Dr. Halston will help him get well. But Halston's brand of treatment includes interpreting Rafael's reports of incest with Ruth as fantasies expressing his own unconscious wishes, not as realities he experienced and must somehow come to terms with. Eventually, Rafael tries to kill himself, for real; he is discovered and saved by coincidence. Luckily, this time he is hospitalized at another facility, where he is treated by Susan Bracken, a psychiatric resident. Bracken takes a decidedly different approach to Halston's. "Very quickly," Rafael says, "we were having a fight whose tone was an intimate argument between equals." Equipped with Rafael's extensive suicide note and Halston's clinical notes, convinced that Rafael was truly determined to kill himself, Bracken goes on the offensive: "What crap. Look. Did you get those Cubans to attack your mother?" "No." "Did you make your mother go crazy?" "No--" "What did you do , actually do, that was wrong?" "I told you. I lied about my father." "Oh yeah, right." "Isn't our time up?" But Bracken isn't put off, either by Rafael's initial rejection of her or by her own misgivings that his treatment would require a different approach than the one she was being trained to give. She trusts her instincts, and eventually Rafael is healed enough to resume his life. He becomes a child psychiatrist, dedicated to working with children who have been badly abused. The next section describes Rafael's treatment of an adult, Gene Kenny. Rafael had treated Kenny as a child and resumed treatment years later at Kenny's request. Kenny has become a brilliant but timid and easily manipulated computer scientist, and treatment helps him to value and assert himself. But after ending treatment, Kenny self-destructs in a violent episode that is completely at odds with his personality. Rafael concludes that his treatment of Kenny was somehow at fault. Rafael decides to investigate, to find out what went wrong. He discovers that Kenny had been chewed up and spit out by the father-daughter team in charge of the computer company he worked at. How Rafael uncovered the story of Kenny's undoing, and what he did about it, is the very unlikely but hugely entertaining story of the third section, in which Dr. Neruda leaps out of the consulting room and into the world to treat the father/daughter team from hell. Irvin Yalom, M.D., is the author of one of the most widely respected texts on group psychotherapy (now in its fourth edition), as well as other professional texts and research, and two earlier novels. In Lying on the Couch , Yalom has written a story about the gap between training and personal authenticity in psychoanalytic psychotherapy, in which a treatise on the subtleties of betrayal and redemption is woven into a seriocomic story of psychotherapy gone wrong and right. We meet Earnest Lash in a prologue. A biologically oriented psychiatrist with a medication practice, Lash is the junior member of the hospital medical ethics committee who is assigned the case that no one else will touch. Dr. Seymour Trotter, "patriarch of the psychiatric community and the former president of the American Psychiatric Association," has been accused by the husband of a client of sexual involvement with his wife. Now, Lash has to interview Trotter about this charge. Trotter admits the charge but stands by his decision as therapeutic ("sometimes the right thing is the wrong thing"), describing a case that makes the ultimate therapeutic betrayal seem plausible. Trotter himself certainly believes it: "I never betrayed my field, or a patient." Lash does the right thing and testifies against Trotter, but he is so moved by Trotter's sincerity, originality, and belief in him--Trotter encourages Earnest to give up his medication practice and become a psychotherapist--that he does just that. Several years later Earnest has a full therapeutic practice and aspirations to become a psychoanalyst, and is in supervision with Marshall Streider, a honcho in the local San Francisco analytic establishment. Streider is precise, correct, and in control, and Earnest sees him as the epitome of psychotherapeutic accomplishment. As the story unfolds, however, Streider emerges as cold, calculating, and egocentric. Then Earnest begins treating Carol, who presents as very lonely and extremely seductive. In fact, "Carol" is the jilted wife of a former patient of Earnest's. Domineering, contemptuous, and scornful of her husband, Carol is nevertheless furious when he leaves her for another woman. She cuts the crotches out of the underwear he left behind, then vows revenge on Earnest, whom she blames for her despised husband's betrayal. Carol is an attorney who hates therapy and therapists because she was seduced and then abruptly abandoned by her therapist in college. She enters treatment with Earnest under an false name, determined to seduce and destroy him. Earnest is lonely, horny, and deeply affected by Carol's seductiveness. Meanwhile, he is trying to become a more authentic person as a psychotherapist. Carol is therapeutically affected by Earnest despite herself, as he repeatedly finds his way around her defenses. Then Streider, whom Earnest has stopped seeing for supervision, gets conned by a more masterful manipulator than he himself is. Furious, he goes to Carol for a legal remedy, but stays to talk with her about his life and problems. Carol ends up becoming more therapist than attorney to Streider, and the novel unfolds, often with humor verging on slapstick, as Carol, deceiving Earnest, who is trying to be more authentic than ever with her, nevertheless consults with him about Streider, so that Earnest ends up essentially supervising Carol in the treatment of his own former supervisor. Although each of these books tells a different story with different characters, the power of psychoanalytic psychotherapy both to exacerbate previous emotional damage and to heal emotional injuries and discover a way to health, is central to each one. The difference between the damaging and healing therapists is not a matter of training or method, but rather of something deeper and more essential. How these therapists relate to their clients emerges from who they are as persons. Lash, Bracken, and Blumenfeld are quite different as individuals, yet they share qualities of authenticity, common sense, and a deeply respectful empathy, that somehow make it possible for their profoundly injured clients to enter into healing relationships with them. These qualities, which are at the very heart of the best psychotherapy, have eluded formalization in training systems. Melanie, Halston and Streider are all "well trained," but, for them, training has become mere technique in the hands of therapists whose personal orientation is toward control, not healing. Perhaps in recognition of this, Rogers includes an afterword calling for more openness in the training and supervision of psychotherapists. But it seems unlikely that calls for, or even attempts at, openness, will be enough to turn the Melanies, Halstons, and Streiders among the psychotherapeutic training faculties into Lashes, Brackens, and Blumenfelds. |