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by Esther Perel
A few years ago, I attended a presentation at a national conference, demonstrating work with a couple who had come to therapy in part because of a sharp decline in their sexual activity. Previously, the couple had engaged in light sado-masochism; now, following the birth of their second child, the wife wanted more conventional sex. But the husband was attached to their old style of lovemaking, so they were stuck.
The presenter took the approach that resolving the couple's sexual difficulty first required working through the emotional dynamics of their marriage and new status as parents. But the discussion afterward indicated that the audience was far less interested in the couple's overall relationship than in the issue of sado-masochistic sex. What pathology, several questioners wanted to know, might underlie the man's need to sexually objectify his wife and her desire for bondage in the first place? Perhaps, some people speculated, motherhood had restored her sense of dignity, so that now she refused to be so demeaned. Some suggested the impasse reflected long-standing gender differences: men tended to pursue separateness, power, and control, while women yearned for loving affiliation and connection. Still others were certain that couples like this needed more empathic connection to counteract their tendency to engage in an implicitly abusive, power-driven relationship.
After two hours of talking about sex, the group had not once mentioned the words pleasure or eroticism, so I finally spoke up. Was I alone in my surprise at this omission? I asked. Their form of sex had been entirely consensual, after all. Maybe the woman no longer wanted to be tied up by her husband because she now had a baby constantly attached to her breasts, binding her more effectively than ropes ever could. Didn't people in the audience have their own sexual preferences, preferences they didn't feel the need to interpret or justify? Why automatically assume that there had to be something degrading and pathological about this couple's sex play?
More to the point, I wondered, was a woman's ready participation in S & M too great a challenge for the politically correct? Was it too threatening to conceive of a strong, secure woman enjoying acting out sexual fantasies of submission? Perhaps conference participants were afraid that if women did reveal such desires, they'd somehow sanction male dominance everywhere--in business, professional life, politics, economics? Maybe, in this era, the very ideas of sexual dominance and submission, conquest and subjugation, aggression and surrender (regardless of which partner plays which part) couldn't be squared with the ideals of fairness, compromise, and equality that undergird American marital therapy today.
As an outsider to American society--I grew up in Europe and have lived and worked in many countries--I wondered if the attitudes I saw in this meeting reflected deep cultural differences. I couldn't help wondering whether the clinicians in the room believed that the couple's sexual preferences--even though consensual and completely nonviolent--were too wild and "kinky," therefore inappropriate and irresponsible, for the ponderously serious business of maintaining a marriage and raising a family. It was as if sexual pleasure and eroticism that strayed onto slightly outreÂ´ paths of fantasy and play--particularly games involving aggression and power--must be stricken from the repertoire of responsible adults in intimate, committed relationships.
After the conference, I engaged in many intense conversations with other European friends and therapists, as well as Brazilian and Israeli colleagues who'd been at the meeting. We realized that we all felt somewhat out of step with the sexual attitudes of our American colleagues. From these conversations, it became clear that putting our finger on what was culturally different wasn't easy. On a subject as laden with taboos as the expression of sexuality,Â each of us is inevitably thrown back on our own experiences.
What struck most of the non-Americans I talked with was that America, in matters of sex as in much else, was a goal-oriented society that preferred explicit meanings, candor, and "plain speech" to ambiguity and allusion. In America, this predilection for clarity and unvarnished directness, often associated with honesty and openness, is encouraged by many therapists in their patients: "If you want to make love to your wife/ husband, why don't you say it clearly? . . . And tell him/her exactly what you want." But I often suggest an alternative with my clients: "There's so much direct talk already in the everyday conversations couples have with each other," I tell them. "If you want to create more passion in your relationship, why don't you play a little more with the natural ambiguity of gesture and words, and the rich nuances inherent in communication."
Growing up in Belgium, a traditionally Roman Catholic society that carries a mixture of Germanic and Latin traditions and influences, I gravitated toward the warmth and spontaneity of the Latin features of the culture. I came here to further my education, and never used my return ticket.
Ironically, some of America's best features--the belief in democracy, equality, consensus-building, compromise, fairness, and mutual tolerance--can, when carried too punctiliously into the bedroom, result in very boring sex. Sexual desire doesn't play by the same rules of good citizenship that maintain peace and contentment in the social relations between partners. Sexual excitement is politically incorrect, often thriving on power plays, role reversals, unfair advantages, imperious demands, seductive manipulations, and subtle cruelties. American couples therapists, shaped by the legacy of egalitarian ideals, often find themselves challenged by these contradictions.
What I'd characterize as a European emphasis on complementarity--the appeal of difference--rather than strict gender equality has, it seems to me, made women on the other side of the Atlantic feel less conflict between being smart and being sexy. In Europe, to sexualize a woman doesn't mean to denigrate her intelligence or competence or authority. Women, therefore, can enjoy expressing their sexuality and being objects of desire, can enjoy their sexual power, even in the workplace, without feeling they're forfeiting their right to be taken seriously as professionals and workers.
Susanna, for example, is a Spanish patient who has a high-level position with an international company in New York. She sees no contradiction between her job and her desire to express her sexual power--even among her colleagues. As she puts it, "I expect to be complimented on my looks and my efforts to look good. If compliments are given graciously, they don't offend, but make clear that we're still men and women who are attracted to one another, and not worker-robots. If a man indicates he likes the way I look, I don't feel he thinks anything less of my professional abilities because of it, any more than I think less of him because I find him handsome."
Of course, American feminists achieved momentous improvements in all aspects of women's lives. Yet without denigrating those historically significant achievements, I do believe that the emphasis on egalitarian and respectful sex--purged of any expressions of power, aggression, and transgression--is antithetical to erotic desire, for men and women alike. I'm well aware of the widespread sexual abuse of women and children. I don't mean to offer the faintest sanction to any coercive behavior. Everything I suggest here depends on receiving clear consent and respecting the other's humanity.
The writer Daphne Merkin writes: "No bill of sexual rights can hold its own against the lawless, untamable landscape of the erotic imagination." Or as Luis Bunuel put it more bluntly: "Sex without sin is like an egg without salt."
The Lure of Fantasy
Many in our field assume that the intense fantasy life that shapes the early stages of erotically charged romantic love is a form of temporary insanity, destined to fade under the rigors of marriage. Might not fantasy, though, and particularly sexual fantasy, actually enhance and animate the reality of married life? Clinicians often interpret the lust for sexual adventure and the desire to cross traditional sexual boundaries--ranging from simple flirting to infatuation, from maintaining contact with previous lovers to cross-dressing, threesomes, and fetishes--as fears of commitment and infantile fantasies. Sexual fantasies about one's partner, particularly if they involve intense role-playing or scenarios of dominance and submission, are often regarded as symptoms of neuroses or immaturity, erotically tinged romantic idealization that blinds one to a partner's true identity. Our therapeutic culture "solves" the conflict between the drabness of the familiar and the excitement of the unknown by advising patients to renounce their fantasies in favor of more rational and "adult" sexual agendas. Therapists typically encourage patients to "really get to know'' their partners. But I often tell my patients that "knowing isn't everything." Eroticism can draw its powerful pleasure from fascination with the hidden, the mysterious, the suggestive.
Terry had been in therapy for a year, trying to come to terms with the shock he'd experienced in the transition from a two- to a four-person household, from being one half of a couple involved erotically to being one quarter of a family with two children and no eroticism at all. He began one session by announcing: "All right, you want to hear a real midlife story? You're going to get one. My wife and I recently hired this young German au pair to work for us during vacation. It's ended up that every morning, she and I take care of my daughters together. She's lovely--so natural, full of vitality and youth--and I've developed this amazing crush on her. You know how I've been talking about this feeling of deadness, my energy dropping, my body getting heavier? Well, her energy has wakened me up. I want to sleep with her and I wonder why I don't. I'm scared to do it and scared not to. I feel foolish, guilty, and I can't stop thinking about her."
As I listened to him, I thought that what was happening to him was an awakening of his dormant senses. The question was how could he relish this experience without allowing the momentary and exhilarating intoxication to endanger his marriage?
I didn't discourage Terry from his "immature" wishes or lecture him. I didn't try to talk reason into him. I didn't try to "explore" the emotional dynamics beneath this presumably "adolescent" desire. I simply valued his experience. He was looking at something beautiful; he was fantasizing. I marveled with him at the allure and beauty of the fantasy, while also calling it by its true name: a fantasy.
"How beautiful and how pathetic," I said. "It's great to know you still can come to life like that. And you know that you can never compare this state of inebriation with life at home, because home is about something else. Home is safe. Here, you're trembling, you're on shaky ground. You like it, but you're also afraid that it can take you too far away from home. I think that you probably don't let your wife evoke such tremors in you." As he left, I told him to keep that thought in mind over the next week.
A few days later, he was having lunch in a restaurant with his wife and she was telling him of her previous boyfriend. "I'd been thinking hard about what we talked about," he told me. "And, while we were sitting at the table, I had this switch. Normally, I don't like hearing these stories of hers--they make me jealous and irritated. But this time, I just let myself listen and found myself getting very turned on. So did she. In fact, we were so excited we had to look for a bathroom where we could be alone."
I suggested that perhaps the experience of listening to a fresh young woman was what enabled him now to listen to his wife differently--as a sexual woman in possession of her desirability. He was viewing his familiar wife from a new distance. I invited Terry to permit himself the erotic intensity of the illicit with his wife: "This could be a beginning of bringing lust home," I said. "These small transgressions are acceptable; they offer you the latitude to experience new desire without having to throw everything away."
Reviving Sexual Imagination
It always amazes me how much people are willing to experiment sexually outside their relationships, yet how tame and puritanical they are at home with their partners. Many of my patients have, by their own account, domestic sex lives devoid of excitement and eroticism, yet are consumed and aroused by a richly imaginative sexual life beyond domesticity--affairs, pornography, prostitutes, cybersex, or feverish daydreams. Having denied themselves freedom and freedom of imagination in their relationships, they go outside, to reimagine themselves with dangerous strangers.
Yet the commodification of sex--the enormous sex industry--actually hinders our potentially infinite capacity for fantasy, restraining and contaminating our sexual imagination. The explicitness of sexual products undermines the power of mystery, the voyeuristic pleasures of the hidden. Where nothing is forbidden, nothing is erotic. Furthermore, pornography and cybersex are ultimately isolating, disconnected from relations with a real, live, other person.
A fundamental conundrum in marriage, it seems to me, is that we seek a steady, reliable anchor in our partner, and a transcendent experience that allows us to soar beyond the boundaries and limitations of our ordinary lives. The challenge, then, for couples and therapists, is to reconcile the need for what's safe and predictable with the wish to pursue what's exciting, mysterious, and awe-inspiring. That challenge is further complicated when the partners are on opposite sides of this divide.
When Mitch complains about the sexual boredom in his marriage, he points at Laura's lack of imagination. "She always does the same thing. It's so predictable, it doesn't even really arouse me. She doesn't kiss me, she has so little imagination. She doesn't know that the mind is the most important sexual organ."
"So what do you do with your mind?" I ask. "Do you go off into the imaginary when you're with your wife?"
"You mean think about other women?" he asked.
"That," I said, "or it could be about yourself when you were younger, or any other places you may go."
"No," he declared, "that would be accepting that she's not enough and that I need to compensate."
"You're talking about reality. I'm talking about fantasy. Fantasies open up the erotic realm. You complain that she's passive, but you're passive, too. You can be wherever you want in your own head, your wife is whoever you perceive her to be. The preservation of autonomy and mystery allows both of you to be apart in your fantasies, and together in your bodily experiences. It's your ability to go off on your own that enables both of you to maintain your interest in each other."
What I was saying to Mitch is that separateness is a precondition for connection. Sex is vulnerable and risky; in this sense, there's no "safe sex." There's a powerful tendency in long-term relationships to favor the predictable over the unpredictable. Erotic passion is defiant and unpredictable, unruly and undependable--which leaves many people feeling separate and vulnerable. As Stephen Mitchell, a New York analyst, used to say, "It is not that romance fades over time. It becomes riskier."
Challenging the idea that security is inside the relationship and adventure outside means pointing out that theÂ familiarity we seek to impose on the other kills desire. What would happen if we allowed ourselves to see our partner from a distance, with a wide-angle lens instead of a zoom? Of course, that distance isn't without risk: it also means stepping back from the comfort of our partner and being more alone. Maybe the real paradox is that this fundamental insecurity is a precondition for maintaining interest, desire, and intimacy in a relationship--bringing adventure home.
The irony is that even the predictability in the marriages of the dullest couples is an illusion. As Mitchell says, "Safety is presumed, not a given, but a construction." The conviction that one's partner is both safe and dull is an invention that both have tacitly agreed to and that give a false sense of security. People often end up in affairs to break from what they imagine is predictable boredom. Often, when the "dull partner" ends up having an affair, the other is surprised. This is because the supposedly familiar partner is in fact mysterious and unknown.
The ongoing challenge for the therapist is to help couples find ways to experience small transgressions, illicit strivings, and passionate idealizations in the midst of their predictable, safe lives. Adam Philips, an English analyst, underscores the point in his book Monogamy: "If it is the forbidden that is exciting . . . then the monogamous . . . have to work, if only to keep what is always too available sufficiently illicit to be interesting."
More Intimacy, Less Sex
It's often assumed that intimacy and trust must exist before sex can be enjoyed, but for many men and, yes, even women, intimacy actually sabotages sexual desire. When the loved one is invested with the fruits of intimacy, such as security and stability, he/she can become desexualized, no longer evoking the desire to pursue the fruits of passion.
Martha and Philip are trying to rekindle that spark they once had. When they met, Martha was the winning prize for Philip. "She was smart, beautiful, sexy. I couldn't believe she was interested in me. I coveted her and we had a strong sexual connection--until I was introduced to her family, that is," he recalls. "Something changed when I became accepted. I didn't tell her about this. In fact, I tried to deny to myself that anything was different. But pretty soon, I couldn't really get turned on by her and I immersed myself in anonymous bar-sex, masturbation, and porn." Needless to say, Martha was very disturbed by the loss of heat in their sex life, and she blamed it mostly on herself. Never very confident about her own sexuality, she, too, had been amazed by Philip's attraction for her, and now assumed he'd simply lost interest in her.
When I ask Philip for a sexual image that includes Martha, he conjures a picture of the two of them kissing romantically in the sunset. He adds that he has difficulty imagining her in a passionate, erotic way. He tells her openly, "I just can't see you in my mind anymore as a sexual object, and I feel bad about it, but it's just the truth."
To understand Philip's sexuality, one has to follow the direct link to his father, whose multiple sexual adventures hurt everyone in the family. "My father pursued pleasure without regard to others. It made me feel that life was out of control and not safe. My mother needed me for emotional support, and in order not to upset her any further, I became an asexual wunderkind. I was intensely moralistic and judgmental, but, somehow, that actually seemed to fuel my obsession with pornography and the urge to break the rules of what's considered proper. Sex, objectification, and transgression became as one for me."
Martha plays her part in the construction of this crucible. She avoids expressing sexual desire for fear of embarrassment and rejection. While Philip seeks affirmation on the outside, Martha's self-affirmation rests solely upon him and his response to her. Martha highlights a common way women order their sexuality, in that she makes him--and his desire for her--the centerpiece of her erotic and sexual identity.
When Martha does get up the courage to make advances to Philip, he feels pressure to be responsive and to take care of her. He fears the aggression in his desire, is ashamed of his need for anonymous, objectified sex, and feels guilty that he can't be more emotionally and erotically involved with his wife. It's his caring for Martha that stands in the way of his sexual desire for her. In the distancing and objectification, Philip seeks to create a separation between woman and mother, the erotic and the familial. After all, who wants to have sex within the family?
I point out the narrowness of their sex lives, combined with Philip's sexual adventures outside their relationship. I ask, "How about if you could bring some of the transgression and objectification into your erotic life at home?" They look shocked--they didn't expect this from a marriage therapist! "Martha, can you open yourself up to the eyes of other men, so that Philip isn't the sole source of your sexual validation?"
I suggest that they begin an e-mail correspondence to each other about their sexuality--their thoughts, conflicts, memories, fantasies, and seductions. This can elicit curiosity, intrigue, and a kind of wholesome anxiety. The built-in distance of e-mail allows space for fantasy and anonymity--a glimpse into the possibility of bringing adventure and unpredictability into the home.
Martha begins to practice seductiveness. She's playful and funny, not only with Philip, but with other men. Philip is intrigued by the new way she talks to him, "her new voice," a voice that sexualizes her in his eyes.
Martha starts off the next session by telling me, "Your urging me to get a sense of myself from other men besides Philip has been very good for me. I've started doing things with other men--going to concerts and galleries with male friends, and generally been more flirtatious. Nothing big, you know, but it's been fun to engage in these harmless encounters. And now, Philip's every word or look is no longer the most important thing in my life."
Martha also talked about her extremely conflicted feelings about Philip's extramarital sex life. "I was really hurt and angry about it, for sure," she said, "angry at him and angry at me. But at the same time, I also have to admit that when he had the affairs, I lusted after him more, because he wasn't necessarily mine. The anger at what he did and the fact that I know I could leave him--even though I don't want to--gives me more freedom and confidence. When I initiate sex now, I can feel almost brazen--and I like that. You want this, Philip? Take it! It doesn't have to be romantic or even particularly personal. I feel free, knowing that I choose to stay with him and, yes, knowing that he could leave me, too. That has freed us up."
Sex in Transition and Motherhood
Susan and Jenny came to see me about their sexual relationship. Susan, a longtime lesbian, set out to seduce Jenny right after she met her. Jenny responded, though it was her first lesbian relationship. They moved in together just as Susan was waiting for the arrival of a baby she was adopting. As soon as they were a threesome, Jenny thought they were a wonderful family, but completely lost any sexual interest in Susan. For this couple, sex was too weighted with meaning; eroticism and sexuality had been undermined by the need to build a safe, secure family unit that would endure. Jenny, already in some conflict about her lesbianism, couldn't be a second "mom" to the new baby, family builder, companionate spouse, and passionate lover all at once.
I said, "If you can divorce the fate of your relationship from having sex, then you may actually be able to have enjoyable sex, which will improve your relationship. Both of you are now mothers for the first time--Jenny is also a mother to Susan's child--and both of you are trying to be sexual with a partner who's a mother. And you're both trying, for the first time, to have sex with a mother as a mother.
"The transition to motherhood can have a desexualizing effect on women," I added. "The mother isn't an erotic image in our culture. 'Mom' is supposed to be caring, nurturing, loving, but, frankly, rather asexual--she's certainly not supposed to be overtly arousing. She represents the reproductive nature of sexuality, not the pleasure principle of eroticism.
"Being new parents can be pretty overwhelming. But can you try to add making love to the list of all the other things you enjoy doing together to unwind and relax?" I asked. "The idea is to make each other feel good. That's an offer you can't refuse."
At the next session, Jenny reported: "That really loosened us up. We can talk about it, laugh and not be instantly scared." Susan added: "I actually felt excited for the first time in a long time." As the session neared its end, I quoted a passage from Adam Philips's book and asked that they reflect on it together: "A sexual relationship is like learning a script neither of you has read. But you only notice this when one of you forgets your lines. And then, in the panic, you desperately try and remember something that you haven't really forgotten. You hope the other person will prompt you. You start to hear voices offstage. You bring on another character."
A Second Language
Physical pleasure offers a unique haven for many men and women; the soothing powers of the body make it the place for freedom of expression. It's only during sex that they're able to escape their anxieties and obsessive ruminations. The physical pleasure tunes out the numbing stress of the everyday. It provides solace and self-revelation, along with a sense of connection.
Returning to Mitch and Laura and their sexual boredom, I see all the drawbacks of their timid sexual imagination. Both describe their own and each other's sexual selves in stereotypical language. Mitch sees himself, and is seen by Laura, as the classic sex-obsessed man, demanding his rights regardless of how she feels. Laura, who is strong-willed and sometimes domineering in their everyday interactions, sees herself, and is seen by Mitch, as a sexually shy, inhibited woman, repeatedly rejecting his advances from some unfathomable feelings of disgust or contempt.
For Laura, sex is the sum of all the personal, cultural, and familial taboos, restrictions, and inhibitions she absorbed as a child. Her mother repeatedly warned her that sex wasn't for "nice girls." And the only comments about her body she remembers from her father were about her developing breasts. As an adult, she wears concealing clothes, including turtlenecks in the summer. Compliments or comments on her sensuality feel demeaning. Sexuality evokes fear in her; she's never been able to enjoy the pleasures of her body.
For Mitch, on the other hand, sex was always the place where he could feel utterly free, uninhibited, at peace. But in his marriage, he's come to feel awful about something he'd always experienced with confidence and pleasure. Meanwhile, Laura has come to feel completely deficient, ungenerous, and guilty.
In couples therapy, Mitch hears her story and understands for the first time that her alienation from her own body, her own pleasure, has nothing to do with him. This eases his sense of rejection, his anguish about being unable to please her. For her part, Laura learns something equally crucial about Mitch--that when the language of words fails him, as it invariably does in the realm of emotion, he communicates with his body. Mitch needs physicality to voice his vulnerability and delight, his yearning to connect; only in sex can he feel emotionally safe.
Laura, as she hears him, begins to realize, for the first time, how important the body can be as a medium for free, creative, and deeply personal expression. She'd always felt that Mitch's desire for sex had little to do with her; it was just crude physical release for him. For instance, when I ask him to say what he'd like and he says, "I want to sit on the edge of a hot tub and have Laura suck me," she recoils. "It's too raw, too coarse," she says. "It has nothing to do with me ." I remind her that it's her he wants to do it with--only her--and it's, for him, a very intimate act. "He's never gone anywhere else; it's you he wants."
By permitting him to speak only in her nonphysical language, rather than in his sensual language, Laura has blocked not only his ability to really "speak" to her, but her own view of her husband as he really is. She can see only the bully, not the yearning lover. And every time he opens his mouth, that bully reinforces her fears. He's reduced to his second, far less fluent, language of words. Meanwhile, her experience has robbed her of the capacity to speak and understand the body's language. For every person, the physical language is the original mother tongue.
As Laura tries to grasp Mitch's erotic fantasies, I try to steer her attention to herself. What are her erotic choices? Can she let her body communicate its wants to Mitch? Can she dare break through the vigilance, the guilt, and the disavowal that surround her sexual desires and the ideas and feelings associated with pleasing her own body? Can she look her mother straight in the eye and still maintain a sense of her sexual self, indulge in her own experience of eroticism without sacrificing her self-image as a "nice" or "respectable" girl?
Like many women, Laura battles the age-old repressions of female sexuality that have trapped a woman into passivity and dependence on men to seduce and initiate her into sexuality, to intuit what she likes and to bring her to fulfillment. Economic and professional independence not withstanding, Laura remains sexually dependent.
Together, Laura and I expose the tortuous conflicts between desire and denial, wanting and not having, fulfillment and repression. I invite her to engage with her fantasies, to own her wanting, and to take responsibility for her sexual fulfillment. I remind her that sex often evokes unreasoning obsessions rather than clear judgment, selfish desires rather than thoughtful consideration.
I suggest to Mitch and Laura that they're trapped in a language with too little imagination, a language too limited to contain their erotic life. Mitch bursts into tears. "I'm not angry," he says of all the times that his frustration has led to mean, hurtful words. "I'm heartbroken." I ask Laura to just hold him and I leave the room for a few minutes to give them the chance to connect through the pure language of physical touch. I think of my two boys, and how often they want me to hold them. No words can match touch; a hug can melt away many ill chosen words.
Laura's challenge--and that of many women--is to be able to eroticize and desire a man who's present, reliable, and needs her. The vulnerability and dependency that she accepts in her children have a desexualizing effect for her in Mitch. She associates potency and sexuality with the strong, aloof, unavailable man/father. Paradoxically, the erotic realm offers Mitch--and many men--a restorative experience of his softer, more dependent, side.
For Mitch and Laura, the issues that generate conflict in their relationship--control, power, dependency, and vulnerability--can yield sexual desire and mutual pleasure when eroticized. Mitch often resents Laura's overpowering personality in daily life, but would like very much to see its erotic expression. Laura, angered by Mitch's apparent "insensitivity," his power ploys, can find this sexuality erotically appealing when she realizes that sex is a language he wants to speak only with her--that it's she who touches him most deeply and personally.
So many of the couples who come to therapy imagine that they know everything there is to know about their mate. In large part, I see my job as trying to highlight for them how little they've seen, urging them to recover their curiosity and catch a glimpse behind the walls that encircle the other. Eroticism is the fuel for that curiosity, the experience of desire transfigured by the imagination.
As Mexican essayist Octavio Paz has written, eroticism is "the poetry of the body, the testimony of the senses. Like a poem, it is not linear, it meanders and twists back on itself, shows us what we do not see with our eyes, but in the eyes of our spirit. Eroticism reveals to us another world, inside this world. The senses become servants of the imagination, and let us see the invisible and hear the inaudible."
Esther Perel, M.A., is on the faculties of the New York Medical Center, Department of Psychiatry, and the International Trauma Studies Program, New York University. She is visiting faculty at the Minuchin Center for the Family and is in private practice in New York. Address: 307 West Broadway, Suite 5E, New York, NY 10013. E-mails to the author may be sent to firstname.lastname@example.org. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.
Barbach, Lonnie. For Yourself: The Fulfillment of Female Sexuality. New York: Signet, 2000. A key reference on female sexuality.
For Each Other: Sharing Sexual Intimacy. New York: Signet, 2001.
Badinter, Elisabeth. XY, on Masculine Identity. Trans. Lydia Davis. New York: Columbia University Press, 1995. This and Barbach's For Each Other are excellent books on the complementarity between the sexes and the exploration of male andÂ Â female identity.
Friday, Nancy. Women on Top: How Real Life Has Changed Women's Sexual Fantasies. New York: Simon & Schuster, 1991. A look at women's erotic choices by a leading figure in the field.
Giddens, Anthony. The Transformation of Intimacy: Sexuality, Love, and Eroticism in Modern Societies. Stanford, Calif.: Stanford University Press, 1992. A clear, concise, historical account of male and female sexual development and perspectives, sexual addictions, and contemporary relational alternatives.
Gilmore, David D. Manhood in the Making: Cultural Concepts of Masculinity. New Haven, Conn.: Yale University Press, 1990.
Paz, Octavio. The Double Flame: Love and Eroticism. Trans. Helen Lane. New York: Harcourt Brace, 1995. Illuminating and provocative essays on the connection between love, sex, and eroticism by the 1990 Nobel Laureate for literature.
Phillips, Adam. Monogamy. New York: Pantheon Books, 1996. Witty, brief reflections on the nature of erotic desire, trust, and transgression.
by Michael Hoyt
We therapists tend to worry a lot about boundaries, sometimes to the point that we forget that sharing our humanity can be a gift, not a distortion. Most of us have sometime or other been moved to share a personal experience, or quote a famous Zen story or Bible passage or maybe simply laugh or cry with a patient. We're connected and in sync. But when is it okay to go with our impulse and when is it wiser to hold back? And how helpful are all our therapeutic models in helping us decide? I remember sitting in a seminar 20 years ago with Erik Erikson listening to a therapist go into a convoluted analysis of the transference-countertransference dynamics of one of his cases. Finally, Erikson interrupted the theoretical discussion to ask, "Have you ever thought that maybe it's just reality?"
Consider the case of Bill and Maria, a Portuguese American, working-class, Catholic couple in their late fifties with whom I worked for several years. I initially met Maria, who sold cosmetics at a local department store, when she came to our HMO clinic distraught and depressed by the recent and tragic death of her son, who had died at the age of 20 under ambiguous circumstances. (His gun had somehow discharged while he was alone at a hunting cabin.) Maria was grieving terribly, of course, and kept questioning whether the death had been a suicide and what she could have done to prevent the tragedy. This was a natural human response, but Maria added, "I'm always feeling responsible and taking care of everyone. It's just the way I am."
Her husband, Bill, soon came in as well. He was a good guy--a truck driver, outgoing, friendly and a bit gruff in his way. "Doc, don't misunderstand me--Maria and I are both hurting real bad. But this is destroying us. We've got to find a way to go forward."
A couple of weeks later, Maria presented me with a gift--she had recognized a cologne I was wearing, called Lagerfeld, and brought me a large, expensive bottle. It seemed (to me) unnecessary and a bit excessive, and clearly fit her pattern of compulsive caregiving; but when I hesitated to accept it, she looked hurt. Bill insisted ("Come on, Doc"), and I felt uncomfortably ungracious. I finally accepted the gift, thanked them and we continued talking.
I had received occasional presents from other patients, of course--chocolates and homemade cookies at Christmas, or a small "forget-me-not" token of appreciation (such as a favorite book) at the end of a therapy. The gift from Maria seemed somehow different. Several times, she offered to bring me more cologne, and while she seemed okay with my "Thanks, but no thanks," I noticed that I would usually wear the cologne on the days when Bill and Maria were scheduled to come in.
I could almost hear the clucking disapproval of my internalized psychoanalytically-oriented colleagues ("Acting out!" "Countertransference!"). As I struggled to sort out my feelings, I found myself thinking about the cultural anthropology of gifts, of reciprocity and exchange and potlatch, as well as Kahlil Gilbran's lines from The Prophet about the grace of giving and receiving. I also recalled an old supervisor's discussing with me his once declining an expensive gift (a Mercedes automobile) from a very rich client. The patient had argued that the cost was inconsequential, given his wealth, but my supervisor had declined, he said, ultimately because the cost would have not been inconsequential to him--accepting it would have made him feel too obligated.
Over time, Bill and Maria consulted me about a variety of problems, some having to do with their grief, some with their marriage, some with dealing with other family relationships. The death of their oldest son was sometimes in the foreground, while at other times it receded, yet, still casting a long shadow. Life moved forward, slowly.
After many months, during a session, Bill and Maria told me about an uncanny experience. They had finally gone for a little vacation to Las Vegas, their first time away together since their son's death. It had been a good experience, but what had really gripped them was something that happened on their last night there. They were in a lounge and they both saw a young man who looked startlingly like their son. They knew it was not, but the resemblance was amazing. He was at a nearby table with some friends, laughing. Bill and Maria were mesmerized--they could not stop looking at him and, eventually, they even called over the waiter and sent an anonymous bottle of champagne to the table to keep the young party there so that they could watch longer. From their poignant description in my office, the experience had been magical and wonderfully bittersweet.
A year or more later, as our meetings continued, Bill and Maria came to see me in the midst of a very rough patch. They had gone through another anniversary of their son's death and were not getting along. Bill was having problems at work and Maria had been reaching out to a daughter who lived out of state and was distressed when her many phone messages went unanswered. They bickered and argued, Maria complaining that Bill wasn't really sympathetic, and Bill complaining that he felt neglected. "Of course, I care," he said, "but I'm getting awful tired." Their marriage appeared to be in trouble, but near the end of the hour, Bill mentioned that they were going out to dinner the next night, to the local Black Angus Restaurant, for their wedding anniversary.
After they left my office, I had an urge. It was not so much that I had to think of it--it was suddenly there, and felt right. I sat for a few minutes, musing, then smiled as I thought of my old mentor, Carl Whitaker, who had often encouraged me to listen to my heart and trust my instincts.
I saw my next patient, then got ready to leave. I picked up the telephone, called Information and got the address of the Black Angus. I drove over and explained to the maitre d' that some friends of mine were coming to dinner the next night and that I wanted to leave a present for them. I paid for a bottle of champagne and wrote out a brief note to accompany it: "Happy Anniversary! Love, Dr. Lagerfeld."
Â On the way home, I knew I had just done something unusual. I rushed into the house and told my wife about it: the couple, the kid in Las Vegas, the champagne, Dr. Lagerfeld and the cologne. "What will this do to the therapy? Should I call the restaurant and cancel my order? Will it make it so they can't express anger toward me? Am I invading their privacy?" I was very nervous. My wife looked at me and then said, "Honey, that's probably the nicest thing you've ever done!"
I did not call the restaurant.
A week went by. The following Thursday, Bill and Maria arrived for their appointment. We sat down in my office. I looked at them--first Maria, then Bill. Suddenly, Bill smiled. "Doc, I got to tell you, I don't usually let myself get too emotional, but what you did last week made me want to cry. Nobody's ever done anything like that for us. At first, when the waiter came to the table with the champagne, I thought it must be a mistake. Maria and I really enjoyed it, and I sat there and every time I looked at that champagne bottle and at Maria, I thought about how much we've been through and how much I love her. I don't know what else to say. Just, I really want to thank you."
This did not resolve all their problems, of course, and the work went on. I'd like to think my gesture--and the abiding feeling it signified--may have helped them weather the storm. Was it countertransference? Transference? Reality? Love? Maybe it was just me--and them.Â
Michael F. Hoyt, Ph.D., is a senior staff psychologist at the Kaiser Permanente Medical Center in San Rafael, California. His most recent books are Some Stories Are Better than Others and Interviews with Brief Therapy Experts . Portions of this article originally appeared in M.F. Hoyt, "Connection: The Double-Edged Gift of Presence," Journal of Clinical Psychology: In Session 57, no. 8 (2001):1-8. Â©2001 John Wiley & Sons, Inc. Reprinted by permission. Address: Kaiser Permanente Medical Center, Department of Psychiatry, 820 Las Gallinas Avenue, San Rafael, CA 94903. E-mails to the author may be sent to Michael.Hoyt@KP.org. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.
by William Doherty
Once every decade or so, we therapists awaken from our cultural slumber to see a problem that previously had no name in our clinical lexicon. In previous decades, we came to see sexism and racism as problems deeply rooted in the larger culture and spreading tentacles into family and personal life in ways we could no longer ignore in our work. I have a nomination for the problem of this decade: for many kids, childhood is becoming a rat race of hyperscheduling, overbusyness, and loss of family time. The problem is all around us, but we haven't noticed how many of our children, especially middle-class kids, need daily planners to manage their schedules of soccer, hockey, piano, Boy Scouts and Girl Scouts, baseball, football, karate, gymnastics, dance, violin, band, craft clubs, foreign-language classes, academic-enrichment courses, and religious activities. Parents have become recreation directors on the family cruise ship.
Stephanie, age 16, was living in the belly of this beast. The presenting problems in therapy were marital conflict and family tensions related to starting a new stepfamily. Stephanie was having trouble tolerating the supervision of her new stepmother, and was becoming alternately withdrawn and angry. I asked her about something I'd never have inquired about in the past: her schedule. When she recounted her typical day, the hair on my neck stood up. Out of bed at 5 a.m. to get across town to high school, home at 3:30, off to swimming practice from 4 to 7 p.m., then grab a quick dinner from whatever was in the refrigerator, and homework till midnight. Nineteen-hour days during the week. Saturdays were taken up with swimming meets. And yes, religious-education classes on Sundays, plus church youth-group events throughout the year. Stephanie admitted to being tired all the time, and acknowledged that she'd found it easier to accept her stepmother last summer when she wasn't so tired.
It isn't just teenagers like Stephanie who now live in the fast lane. A pediatrician told me that some of his young patients wanted him to convince their parents to let them quit a sport so that they could be home more often. Teachers describe a generation of young students weary from schedules that many adults couldn't handle. A second-grade teacher from a community near Albany, New York, used strong language: "This is an abused generation," she said at a public meeting. She went on to explain that, after 30 years of teaching the same age group, she's never seen children so tired and burdened from being up too early in the morning, going to bed too late at night, and being crunched in between by extremely competitive activities.
This fast-tracking of childhood is fairly new on the cultural landscape, having come upon us in the last two decades or so. A national time-diary survey conducted by the University of Michigan's Survey Research Center in 1981 and 1997 has documented this change in children's schedules and family activities. During those 16 years, children lost 12 hours per week in free time, including a 25 percent drop in playtime and a 50 percent drop in unstructured outdoor activities. During the same period, time in structured sports doubled and "passive, spectator leisure" (watching siblings and others play and perform) increased sixfold--from half an hour per week to more than three hours. Time spent on homework increased by 50 percent.
Partly as a consequence of children's new schedules, families spend less time interacting. According to the same survey, household conversations between parents and children--time for just talking and not doing anything else--nearly dropped off the radar screen of family life. Another national survey plotted a one-third decrease in the number of families even claiming to have family dinners regularly.
Kids themselves are recognizing the problem. A recent national poll of 746 children ages 9 to 14 conducted by the Center for the New American Dream found that fewer than a third of children say they have a lot of time with their parents. When asked about the barriers, they pointed to parents' work schedules and their own activity schedules. A national YMCA poll of teenagers taken in 2000 found that more than 20 percent of American teens rated "not having enough time with parents" as their top concern. For a new book, therapist Ron Taffel, one of our best observers of youth culture, interviewed 150 children attending preschool through sixth grade, and found that the one wish expressed by nearly every child was that their parents spend more time with them. Some of this "time famine" stems from a problem familiar to therapists--parents' having to work more hours and more jobs. But another, unnamed and insidious, factor is also at work: the overscheduling of kids.
In other words, we now know that children have a lot less free time, connect with their families less often, and live busier and more structured lives. This change in American family life is deep and broad, most strongly affecting the middle class, but cutting a wide swath across income and ethnic groups. (The very poor don't have the resources to overschedule their kids, but they face their own challenges in finding time to connect as a family.) And it has come upon us with amazing speed.
Is this change unwelcome? Academic researchers are just beginning to study the effects of overbusy family life on child development. Studies have shown the importance of regular family dinners, one of the chief casualties of hyperscheduling. The national Adolescent Health Study of American teenagers found a strong link between regular family meals and a wide range of positive outcomes: academic success, psychological adjustment, and lower rates of alcohol use, drug use, early sexual behavior, and suicide. On the flip side, not having regular family meals was associated with higher risks in all those areas. The University of Michigan study of children's time found that more meal time at home was the single strongest predictor of better achievement scores and fewer behavioral problems. Mealtime was far more powerful than time spent in school, studying, going to church, playing sports, or doing art activities. Results held across all types of families and all income levels.
When I first began to notice the impact of kids' schedules in my clinical practice, it came through mundane problems with scheduling appointments. When a couple I was seeing wanted to bring in their children for family therapy, I was able to offer them a precious 5 p.m. slot, having persuaded another client to give up that hour. I was perplexed when they replied that their son had one of his three hockey practices per week at that time. It would be unthinkable for him to miss practice every other week for family therapy. But they'd be willing to take him out of school without hesitation if we could schedule something earlier in the afternoon. I was flummoxed, and switched the family to an earlier slot. I then began to notice in my supervisees' clinical practices how hard it was becoming to schedule whole-family sessions, including the siblings, not because of parents' work schedules, but because of kids' activity schedules. It seemed intolerable to parents and kids alike that a sibling should miss an event or practice to attend a family therapy session. The therapists capitulated to the new cultural norm. More than managed care or the medical model, kids' soccer may be the dagger in the heart of conjoint family therapy.
When I began to talk with other therapists about the problem of overscheduled kids and underconnected families, I found an interesting divide. Therapists currently raising children often reacted defensively; those whose kids were grown up, or who didn't have children, agreed wholeheartedly and seemed relieved to be talking about the problem. One colleague, bragging about her athletic daughter, told me with pride how she was able to work her afternoon schedule to do a 30-minute dash from the office to take her daughter from gymnastics to soccer, return to see her next client, and then pick up her daughter after soccer to dash home and throw together a quick meal. When I muttered, "What a schedule," she looked at me incredulously, pointing out the opportunities her daughter had that she herself had lacked, and noting that I'd raised my children in an earlier generation. (My kids, it seems, grew up in the ancient world of the 1970s and early 1980s, before the deluge.) This was the busy new world of family life, she observed, as inevitable as long winters in Minnesota.
Older therapists I talk to bemoan what they see in culture and their clinical practice. They're befuddled when their own grandbabies are enrolled in three classes per week and frustrated when they can't get on their older grandkids' schedules. They see their adult children's families as being too focused on outside activities, and too caught up in their children's extracurricular successes, but they lack a language to talk about it without seeming like old fogies. Therapists I admire for their cultural wisdom, such as Peter Fraenkel and Mary Pipher, have begun to speak out about the corrosive influence of frantic schedules and the resulting time famine on family life. In her new book for young therapists, Mary Pipher observes that when she started out as a therapist in the 1970s, she was treating clients' sexual problems; now she's treating their schedules.
Outside the world of therapists, when I speak publicly about the problem of overscheduled kids and underconnected families, the stories and sense of outrage come fast. A Houston mother told me about a friend who recounted with pride a scheduling breakthrough with 6- and 8-year-old sons, Timmy and Matt. Their afterschool and evening schedules were already crowded with sports and music lessons, but Timmy needed tutoring for reading, and Matt had trouble finding time for his homework in the evening. The solution was creative: the mother found a tutor who'd meet with Timmy at 6:30 a.m. while Matt did his homework outside in the waiting car. This allowed for an efficient use of the early-morning hours and no interference with afterschool and evening activities. The mother was proud of this scheduling coup.
What's going on here? Well-intentioned parents are acting like professional agents for their children. Many tell me they don't enjoy this scene that much, but are afraid that their kids will be left behind when the achievement train leaves the station. The result is that for the first time in human history, family life revolves around children's optional activities rather than these activities revolving around the family.
Many parents mourn the older priorities about family time, but feel helpless to get off the merry-go-round. I hear parents complain about running all the time, having one-handed dinners in the car between practices, and losing summer vacations to sports tournaments and specialized camps. Although children get used to whatever family life they're raised in, some are beginning to ask to slow down. A 6-year-old got her first daily planner, and then asked for time to just play. A 9-year-old boy, in his top-10 list of birthday presents, placed "more time at home" as number three. A 12-year-old sheepishly asked her parents if it would be okay not to try out for the traveling soccer team because she's tired and misses playing with the kids in the neighborhood.
Searching for Causes
How did we get here as a culture? There are many explanations, many factors contributing to the problem. I've asked thousands of parents at community events for their explanations of this social change. Here's what some of them say. One straightforward factor is that there are simply more opportunities for children, especially for girls. A mother in Northfield, Minnesota, said that she counted 14 community activities for 3-year-olds. In addition, these activities, particularly sports, are far more intense. Sports used to be seasonal; now many are year-round. Traveling teams were unheard of 25 years ago, outside of varsity sports. As one veteran coach told me, we've lost the distinction between competitive sports and recreational sports. And this has spilled over to activities such as dance programs and gymnastics, which travel to compete. Practices for all kinds of activities now occur three or more times per week, with weekend competitions. And this even for 7-year-olds, who are actually becoming old-timers now that competition has moved to the preschool years! We now have organized soccer for 2-year-olds in St. Paul, Minnesota. I hesitate to ask about diaper-changing breaks!
Another factor is more working parents. Parents need to fill children's time after school with structured activities, although it appears that stay-at-home parents overschedule their kids just as frequently, partly because there's no one for their children to play with after school. Many parents tell me that they've heard that busy kids stay out of trouble, and they'd rather their child be in structured activities than watching TV or playing video games all day. A good point, I reply, but does this require the schedule of a CEO?
Some parents say that they schedule their kids to the hilt because they don't want them to be playing outside in an unsafe neighborhood. While some parents are indeed raising their children in unsafe neighborhoods, for others, the danger is more perceived than real. There are about 130 stranger-abductions in the whole country each year, a figure no higher than 40 years ago, before CNN and Amber Alerts. And the majority of victims are teenagers, not young children. I know parents who won't let their children play in their fenced backyard in safe neighborhoods without an adult present.
A big fear I hear from parents is that their children will miss out on opportunities or fall behind their peers. This fuels early, intense involvement in activities, with parents worrying that delaying the start of a sport or musical instrument may doom their child to not being able play competitively at all in the future (a concern that's often well founded). Contemporary parents feel terrific pressure, not only to have their children succeed, but to have them show promise at young ages. This is a generation of children and parents who are preoccupied with visible signs of success, from having to know the alphabet and colors before going to school, to worrying about a college rÂ´esumÂ´e in sixth grade, to having to compete at high levels in athletics. Three- year-olds leave preschool at 4 p.m. to be driven to their math class because not enough preschools teach about the radius and circumference of the circle. When I was growing up, you needed just one skill before first grade: how to use the potty.
Most of these influences are mediated through parental peer pressure. Parents watch other parents and listen to what other parents say. Look at how holiday letters glowingly describe the plethora of activities the children are involved in--the more activities and successes, the better parent you are. How many say that the family is in more balance this year, spending more time together? And look at the parental pressure on the sidelines at sports events. One father described how another father quietly bragged that his son made the traveling soccer team and was also planning to go out for baseball. Then came the question, "Is your son going to be on the traveling team?" Fortunately, the first father could answer "yes" to traveling soccer, but had to answer "no" to the follow-up question about whether the boy was going out for baseball. The other father smiled and asked, "Isn't he good at baseball?" Later, when the son decided to quit traveling soccer in favor of a less intense league, his father and mother--both psychologists, by the way--worried that he might lack the competitive edge to be successful in life.
The big picture behind this phenomenon is that the adult world of hypercompetition and marketplace values has invaded the family. Parents love their children as much as previous generations did, but we're raising our children in a culture that defines a good parent as an opportunity provider in a competitive world. This is parenting as product development, with insecure parents never knowing when they've done enough. Keeping our children busy at least means they're in the game and we're doing our job. I believe that a small percentage of parents have fully bought this cultural model and drive the intense competition of childhood activities, and that most other parents are just trying to keep pace, worrying that if their children fall behind, they'll lose self-esteem and the ability to compete.
A parent told me recently that in her upper-middle-class community, people no longer brag about the size of their house or the model of their car--they brag about how busy their family is. When one parent, in mock complaint, says, "We're so busy right now," another parent tops it with a more extreme story. And in a market-oriented, money-driven culture, we can point more readily to things we pay for--equipment, registration fees, traveling expenses, coaches' salaries--than for low-key family activities like hanging out together on a Sunday afternoon or playing a board game on a Friday night. It's the same with children's playtime: we don't easily assign ourselves "parent points" for providing our children with time to daydream and make up games to play with the neighbor kids. Parenting has become a competitive sport, with the trophies going to the busiest.
This is what makes time-starved childhood a taboo subject to talk about, even in therapy. If giving our kids more and better opportunities is a good thing, how do we question it without sounding judgmental or appearing to be out of step with the modern world? How exactly did that guy broach the embarrassing observation about the emperor's new clothes?
In the case of Stephanie, the 16-year-old with a CEO's schedule, only the stepmother thought her activities were excessive. Her father was proud of her athletic ability and her stamina, seeing these as important for her success in college and later life. When I asked Stephanie if she'd considered cutting back on her swimming, she replied that she didn't want to quit at this point because injuries had kept her from improving on her times since age 13, and she wanted to see if she could top those times. She had too much invested, she was saying, to quit now. The stepmother wisely noted that Stephanie was weary and needed down time, but what do you expect from a stepmother who doesn't have the same passionate investment in the girl's future success? Stephanie stayed in swimming, the parents got into marital therapy, and Stephanie and the family coped as well as they could with their schedules.
Kathy, a California mother, made a different decision by downsizing her son's schedule, and paid a price in the community. After Little League baseball for 11-year-old Josh reached a fever pitch of scheduling one year, she and her husband said "Enough." Family dinners were vanishing. Evening and weekends were spent on the road and at ball fields. With two working parents, another son's activities to schedule, and a community with overcrowded highways, baseball was putting everyone on "tilt." The parents decided to reclaim family time by not enrolling their son when the new season started. They didn't know that they there were violating a community standard for good parenting, as evidenced by the shock and dismay of other parents that such a good player had been summarily removed from the Little League team. When Kathy told another mother at the local supermarket about the family's decision to pull their son off the team, the stunned neighbor replied, "Can you do that?"
Second-wave feminists faced a similar challenge in getting the larger culture to see a problem in the domestication of women's lives in the post-World War II era. The cultural norm declared women to be privileged if they stayed out of the work force. In writing The Feminine Mystique, Betty Friedan's goal was to show women that their privilege was actually their prison. Today we have the soccer mom, who's likely to be employed, and the hockey dad, who shows his love for his children by coaching their teams. We have parents who brag about their children's exploits in half-a-dozen activities, but who rarely have a family meal or a leisurely Sunday afternoon at home. They've come to define commitment to the team as more important than commitment to the family, or even to a balanced childhood.
Do you think I'm exaggerating? A family therapist told me that when he confronted his daughter's coach about a letter of complaint to his 12-year-old daughter about the daughter's "lack of commitment" because she attended her Confirmation preparation weekend instead of a soccer tournament, the coach was unapologetic. When the father said that soccer was important, but church was too, and that they wanted their daughter to have a balanced life, the coach replied, "I don't believe in balance." The girl was devastated and the parents angry. And then there's the rest of the story: missing her friends on the team and the sport, the girl asked her parents if she could return to the same team and the same coach. And they let her. Parents who'll confront a teacher for the slightest insensitivity to their child's needs become complete wimps in the face of a coach and the "needs" of their children to be on the team.
Naming the Problem
In my own practice and in my community work, I'm now naming the problem that had no name. I'm calling it "overscheduled kids and underconnected families." Then when I listen, the stories come out. A stressed 7-year-old whispers to a neighbor parent that she wishes her mother would let her quit Scouts. A mother remarks ruefully that her family lives so much in the minivan that she should decorate it! A coach, trying to bring balance to his community, is dismayed when he comes upon a schedule for 11-year-old boys who practice at 10 p.m. on Thursday nights, at a facility 45 minutes from home. Parents say they hate these schedules, but don't know how to change them without depriving their children of opportunities. Everyone's afraid to be the first to cut back. A sane lifestyle looks strange in an insane world.
Like sexism and racism, this is a cultural problem that we now know is also a clinical problem. It shows itself clinically in overwrought kids and families, and in couples who have no time whatsoever for their marriage. (If the family gets the dregs left over after individuals are scheduled, the couple gets the dregs of the dregs.) We've got to regard this as a cultural problem with an upstream source, rather than just a clinical problem ripe for our theories about why each family's own pathology got them into trouble.
As clinicians, we influence clients and the wider culture by what we ask about in the therapy room--and by what we choose not to ask about. We have to start inquiring about kids' schedules, and not just our usual suspect--parent work schedules. Does Johnny have any time to hang out and be a kid? Could his ADD be exacerbated by scheduled family hyperactivity? Does Linda ever have the chance to eat a leisurely meal with her parents and siblings? When a father brags about his son's football prowess in an intense program, the therapist, instead of politely saying "good for you," can ask the boy, "Do you like what you're doing?" It took a journalist to inspire me to ask this question. When she asked this question to a star athlete in front of his doting father, the boy replied, "No, I don't enjoy it anymore." Jaws dropped around the room. I'd never thought to be so bold in therapy, but I am now.
When spouses say they feel like ships passing in the night, do they really mean they're chauffeuring their children on diverging highways? Instead of smiling benignly and saying, "Yes, kids can sure take a lot of work," we can ask whether they've chosen this lifestyle or feel compelled to follow it. Do they feel like booking agents for their children? Who created these crazy rules for parents? I tell parents that my own parents never attended my games (the same was true for my friends), and that I'd have been mortified if they'd showed up. ("Doherty's mother is here!") I speculate out loud about when the law got passed--sometime in the 1980s perhaps--mandating that parents attend every game and half of their children's practices. And the same law said to forget about carpooling with other parents so that some parents could stay home and cook a family meal or have one-on-one time with another child.
It's like with sex, money, and race--if we don't ask, our clients usually don't tell. Through our curiosity, we signal what's appropriate to talk about in therapy. The key is to raise these questions first from a cultural perspective, not a clinical perspective. In family therapy, we can comment that today's families seem to be under a lot more scheduling pressure than in the past. We can ask whether little Jessica's friends all seem to be as busy as she is. We can empathize with how hard it is to have time to eat and play together as a family with these intense activity schedules. We can say that we see lots of families struggling with the same level of stress and fatigue, and that we think something's out of whack in today's world. At each point, of course, it's important to pace these comments and questions with how the parents and children are responding. My experience has been that parents often respond with a chorus of "Yes, it's a crazy world now." Kids, who don't know a different way of living, are often open and curious as long as you don't sound like you're making decrees about their schedules. The key is to put the problem on the table in a nonjudgmental way and make it legitimate to talk about. Sometimes, families will continue for a while with a stressful schedule but decide to cut back during the next summer or school year. Sometimes, I suggest taking a sabbatical for a semester or summer from all optional outside activities, to rest, recoup, and learn what to do as a family, and then decide about their subsequent schedule.
In adult and couples therapy, the same approach can be useful: begin by asking questions about schedules, and stop regarding frenetic lives as normal and inevitable. Starting with the cultural conversation can sidestep personal guilt for the moment and open the path to exploration and problem-solving. Instead of suggesting that a couple's chauffeuring pace with children is how they avoid unresolved issues with each other (a ready-made clinical interpretation), we can note that a great many couples today struggle with how to have time for a marriage in a world divided between employment and parental traffic-control. When I refer to parents today as recreation directors on the family cruise ship, nearly all parents light up with recognition. This can lead to a conversation about social pressures to sacrifice everything, including one's marriage, in order to provide opportunities for children in a competitive world. I tell stories of family Thanksgiving dinners yielding to extra practices. We laugh and shake our heads together about the craziness of it all.
By first externalizing the problem in this way, we can join with clients as members of an out-of-control culture that's unfriendly to marriage and other adult unions, rather than meeting resistance by tangling with couples over whether they're running from their relationship by overserving their children. Of course, there are couples who'll do anything to avoid spending time alone, but when the average child-rearing couple in the land is experiencing a problem, there's more going on than clinical pathology. Good therapy must have a good dose of cultural criticism.
Needless to say, we have our own homework to do as therapists before we can be change agents with our clients and within the larger culture. Solidly middle class by dint of our education (if not always our income!), we're swimming in the same river as our clients, teaching our kids multiple swimming strokes, searching for the best instructors, and hoping for that college scholarship at the end of the pool. But if we're prepared to do our own soul-searching, we can stop conspiring with our clients and our culture, and start sounding the alarm in our offices.
If the source of the problem is in the culture, however, it's not enough to talk about it in our offices. We're like physicians treating kids with symptoms of lead poisoning from the paint in their house. We can't be satisfied with just advising individual parents to stop their kids from eating the paint chips; we have to address the environment--the landlords, the paint companies, and the government regulators. But most of us weren't trained to work the streets, and it can feel overwhelming. Keep in mind that by dint of our professional status, we have access to the public arena. We can speak to parents at the local PTA or the adult forum at a local religious congregation. (Believe me, these groups are always looking for speakers.) We can cultivate relationships with journalists and offer to do interviews for local newspapers and radio stations. When we gain this access, the key is to step outside our comfort zone of psychological and family-systems talk to name the cultural pollutants in our communities. If we touch a chord in parents' experience, they'll resonate and feel more empowered to speak up for their children and families. Cultural change occurs one conversation after another, in ripples that we can help start and keep spreading.
There are ways to be even more public, such as participating in activities of Take Back Your Time Day, a national event on October 24, 2003, and partnering with local groups of parents for collective action. The stakes are high. We're facing a new threat to childhood and family life, one disguised in the costumes of fun, achievement, healthy competition, and keeping busy. It's a false cultural god, this colonization of childhood by market forces. If we name it, we can begin to talk about it. If we can talk about it in therapy and in our communities, we can be part of the change that must come.
William Doherty, Ph.D., is professor and director of the marriage and family therapy program at the University of Minnesota. Address: Family Social Science, University of Minnesota, 290 McNeal Hall, St. Paul, MN 55108. E-mails to the author may be sent to email@example.com. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.
by Mary Sykes Wylie
In the early 1980s, soon after the publication of psychologist Carol Gilligan's In a Different Voice , Lauren Slater, later to become the author of such daringly autobiographical works as Prozac Diary and Lying , was an unfocused psychology graduate student at Harvard, struggling (and failing) to write fiction. She decided to take Gilligan's lecture course in developmental psychology, a decision that changed her life. "Even in this large lecture hall, she created this sense of connection and intimate discovery," recalls Slater. "Listening to her, I could suddenly see that my difficulty wasn't that I had writer's block or no talent or a lack of motivation, but that I was disconnected from myself and my own particular voice. Fiction, for me, was all about artifice, wearing masks, putting words into made-up characters' mouths, and making up 'pretend' voices. I had spent much of my life talking in a 'pretend' voice, and I needed to say things straight, in a voice that was my very own."
This dawning revelation of a long-suppressed private self simmering below the surface is exactly what legions of women felt while reading In a Different Voice by Gilligan, which today remains among the most influential feminist works ever written, as Zeitgiest-altering in its way as Betty Friedan's The Feminine Mystique . Gilligan's In a Different Voice has sold more than 750,000 copies (an astonishing feat for an academic book), and has been translated into 17 languages. After 20 years, it's still a staple of virtually every gender-studies reading list in America.
Now, Gilligan, after coauthoring and coediting five books with her students, has written The Birth of Pleasure, which is, she says, the "culmination of a trajectory" begun with In a Different Voice. Where Gilligan previously called for a different voice, now she's writing in a different voice. She draws on her research with adolescent girls and also her work with young boys and adult couples in therapy to highlight a path of resistance to the losses of voice and relationship that she documented in her previous work. With the Psyche and Cupid myth, which she uses to frame her discussion, and a range of plays and novels, poems and diaries, she places evidence drawn from contemporary research in a broad cultural and historical context to explore the psychology of love and the relationship of tragic love stories to patriarchal cultures. Again, she's working in the tradition of clinical analysis and narrative research, rather than statistical analysis of numerical data. In joining research evidence and literary examples, The Birth of Pleasure is cut from the same cloth as In a Different Voice, even if the weave is more intricate, the structure more complex, the design more sweeping.
So, why is it that critics seem either to love or hate this book? There's been virtually no neutral response. University of Cambridge psychologist Terri Apter in the Times Literary Supplement describes the book as a "thrilling new paradigm." Robert Coles chose to run a long excerpt from the book in Doubletake under the title "A Radical Geography of Love." In the Boston Globe, columnist Ellen Goodman calls it a "bold and boundary-breaking book." Eve Ensler, author of The Vagina Monologues , says that "Gilligan's book does no less than reconfigure what it might mean to love and be loved, a revolutionary act in itself."
And yet, other reviewers seem to be taking part in a public stoning, attacking her book with the ferocious glee of the Taliban cornering a heretic. " The Birth of Pleasure fails on nearly every level . . . a sticky paste of unproven assertion, anecdote-as-data and swaths of memoir," writes journalist Emily Nussbaum in The New York Times. Reviewer Judith Warner of The Washington Post found the book "horribly dated. . . . It rambles . . . it meanders. . . . It is solipsistic . . . . I couldn't make heads or tails of it." "Smudgy thinking . . . poetic obscurantism . . . psychology gives way to mystagogy," writes Margaret Talbot in The New Republic.
Controversy is one thing, and by no means a bad thing, for a writer with a history of challenging received opinion. But, the reaction to The Birth of Pleasure seems extreme, often veering from criticism to outright contempt. Catharine Stimpson, dean of graduate students at New York University, wonders in a recent article for the New York Observer (titled "Who's Afraid of Carol Gilligan?") why reviewers of The Birth of Pleasure, itself a "hopeful vision of happiness and love," appear to be taking part in a "cultural blood sport," whipping up "some of the most disparaging reviews I've ever seen." What's this orgy of journalistic abuse all about? Is the book really so terrible? Or is there something about the message in The Birth of Pleasure that makes it even more disturbing than In a Different Voice or Meeting at the Crossroads --both of which were also attacked, although not with the same venom. Or are we living in a different era in which the kind of feminism that Gilligan represents now seems out of synch with what today's tough-minded, presumably long-since-liberated women want to read?
IN A DIFFERENT VOICE challenged theories of psychological development--based on studies of men and boys only--that, since the time of Aristotle, had assumed women were inferior to men in their capacity for moral reasoning and lacked a clear sense of self. Gilligan showed how women's voices, once heard in their own right and with their own integrity, change the conversation by drawing attention to aspects of human experience that previously were dismissed or silenced. The different voice was a relational voice. In contrast to an ethic of justice linked to ideals of autonomy, independence, and self-sufficiency, Gilligan described an ethic of care linked to realities of relationship and enjoining responsiveness, responsibility, and carefulness rather than carelessness toward oneself and others. It was an ethic based on a more psychological understanding of the human world.
After the social explosiveness of '70s feminism, Gilligan's book didn't initially seem all that radical. Low-key and nonpolemical, In a Different Voice didn't catalog outrages against women or attack men or male supremacy. Yet it effectively challenged the supremacy of an intellectual tradition built on the idea that, literally, psychology is the study of man . The book struck an emotionally-resonant chord in a whole generation of women, who recognized themselves in its pages--their own vague and undefined sense of not being heard, of learning to put on their own "pretend" voices. "Gilligan's book changed my view of feminism," says Carol Hekman, professor of political science at the University of Texas at Arlington, who had already written her own book about feminism. "She challenged the idea that there is one, singular and absolute path to either philosophical or moral truth. In fact, her view of feminism challenges the entire Western tradition--you can't get more revolutionary than that."
The claim doesn't seem entirely exaggerated. Gilligan's work inspired a flood tide of research and scholarship in fields ranging from psychology to ethics, literature to law. Gilligan's research with girls following the publication of In a Different Voice similarly led to a wide range of educational, artistic, and cultural projects designed to encourage girls' voices and build on their psychological strengths. Primary and secondary schools throughout the country responded to Gilligan's call to help girls resist conventions of femininity that were psychologically and intellectually costly (conventions that required girls to be nice, to silence an honest voice, and suppress vital parts of themselves) by developing more girl-friendly curricula and teaching methods. She's often credited with being the spirit behind the 1994 Gender Equity in Education Act, which banned sex-role stereotyping and gender discrimination in the classroom. Her work also gave a big boost to the study of differences in the way men and women communicate, resulting in both serious scholarship and pop-psychology sensations like Deborah Tannen's You Just Don't Understand and John Gray's Men Are from Mars, Women Are from Venus.
Not surprisingly, as one of the few academics who also has become a popular superstar, Gilligan has come in for numerous honors. The first Graham Professor of Gender Studies at Harvard and a recipient of the prestigious Heinz award for her contributions to understanding the human condition, she also was named "Woman of the Year by Ms. Magazine in 1984, and one of "America's most influential people" by Time Magazine in 1996. In fact, Hollywood superstar Jane Fonda was so taken by Gilligan's work that she donated $12.5 million to Harvard in Gilligan's honor to create the Harvard Center for Gender and Education. The coauthor and editor of a series of books on gender and development over the past two decades, Gilligan initiated the Harvard Project on Women's Psychology and Girls' Development, a program called Strengthening Healthy Resistance and Courage in Girls, and retreats for women educators and therapists called "Women Teaching Girls/Girls Teaching Women." She also became artistic codirector of an all-woman theater company, The Company of Women, and founded the Harvard Project on Women's Psychology, Boys' Development and the Culture of Manhood. Recently, after nearly 35 years at Harvard, Gilligan moved to New York to become University Professor at New York University, where she's affiliated with the law school, the graduate school of arts and sciences, and the school of education.
In The Birth of Pleasure, her first solo-authored book since In a Different Voice, Gilligan shows how the tragic love story reflects a process of cultural initiation and is tied to an ancient agenda (think Abraham and Isaac, Agamemnon and Iphigenia) that even now is played out in the fears of connection that shadow the lives of men and women. Why, Gilligan asks--and sets out to answer--do we keep reliving this old story, generation after generation; why do we reinstate the contradiction between democracy and patriarchy that dates back to 5th-century Athens? Why are so many couples afraid to truly open themselves to each other? Why are there such walls of silence between men and women? Why do boys, at 4 or 5, begin to hide their vulnerability and cover up their feelings in order to become "real" boys? Why do girls, at 12 or 13, begin to conceal what they're really thinking, stop "seeing what they see, knowing what they know," and begin second-guessing themselves?
The short answer is that emotional truths and the ability to "say what we see, know what we know" go underground in the interests of the long-standing patriarchal order we call civilization. Gilligan defines feminism as the movement to end the age-old contradiction between democracy and patriarchy. Patriarchy, in her view, isn't a battle between the sexes but a system that constrains both men and women; literally, it means a rule of fathers, separating some men from other men, fathers from sons, men from women, thus "introducing hierarchy in the midst of our most intimate relationships, between parents and children, between lovers." The stifling constraints of patriarchy are passed on, generation to generation, and compromise our psychological development from early childhood, hobbling love, making pleasure dangerous, and enforcing taboos against truth-telling.
The Birth of Pleasure is reminiscent of Freud's Civilization and Its Discontents --but with one striking difference. Where Freud sees tragedy as inescapable (symbolized for him by the Oedipus myth), Gilligan sees a history of psychologically driven resistance, as manifested in the myth of Psyche and Cupid---a myth that ends with the birth of a daughter named Pleasure. She observes that as patriarchy forces a break in intimate relationships, thus inhibiting love, so love holds the power to uproot patriarchy. People can, and do, resist society's iron framework; they can find a true voice within themselves and heed what they know through experience.
The Birth of Pleasure isn't an easy read. It's a complex, idiosyncratic, many-chambered labyrinth of a book. The style is often elliptical, with sections linked together more by association than logical sequence. In fact, it may be that the book's critical reception--both positive and negative--stems as much from its medium as its message. Catharine Stimpson suggests that Gilligan is bucking a literary trend; these days, people have grown suspicious of bold, intellectual leaps, preferring straightforward, linear argument, written in plain, muscular prose, and backed up with scads of numbers. The Birth of Pleasure is clearly not that kind of book.
Despite the initial hailstorm of attack, The Birth of Pleasure may well be considered, as the positive response suggests, as much a classic in the realm of psychology and social commentary as In a Different Voice. Though it's too soon to have hard sales data, the book appears to be selling well--perhaps as well, or better, than In a Different Voice, when it first came out, and Vintage Press will soon publish a paperback version. Networker readers will have an opportunity to gauge their own response to Gilligan's message when she delivers a keynote address based on The Birth of Pleasure at our annual Symposium next March in Washington, D.C.
In a recent conversation, Gilligan, no stranger to public controversy, seemed cheerfully philosophical about the polarized response to her new book. Looking elegant and youthful--with her long skirt slit up the side and silver bracelets--she seems to have more affinity with the world of art and theater than social science. She laughs often as she speaks and has a way of drawing out the people around her, inviting confidences that makes it only too easy for the interviewer to want to tell her about his own life story. In the following interview with Networker editor Richard Simon, she talks about some of the connections between her life and work that she hasn't discussed in print before and offers her view of the historical transformation she believes we're now undergoing. Throughout. she projects a calm certainty, seeing her work as part of "a quiet revolution in the human sciences" that holds the potential of changing our view of ourselves and our lives.
-- Mary Sykes Wylie
Psychotherapy Networker: Here I'm sitting with the Tiger Woods of interviewing. Can you give me some pointers. How do you approach the people you interview in your own research?
Carol Gilligan: I approach them with a desire to learn from them or to discover with them what they know. Research is very different from therapy, in that therapy starts when someone arrives with a problem, a desire for help, a wish to sort out something. Research begins with the researcher's question. So I begin by asking a question and then I listen--and the way of listening is key. How do you listen when you want to discover another person's inner world, as opposed to figuring out where someone falls on your map of the world? In the research leading to In a Different Voice, I wanted to discover how people speak to themselves about themselves and about morality at a time when they're facing an actual choice, meaning one in which they'll have to live with the consequences of their decision. I was going to interview Harvard students--men facing the Vietnam draft--but then the draft ended and the Supreme Court legalized abortion, so I interviewed a diverse group of pregnant women who were considering abortion.
In the kind of discovery research I do, the relationship is critical. A woman once said to me: "Do you want to know what I think, or do you want to know what I really think?" How do you approach someone when you want to know what they really think? I think I have a good ear for the rehearsed story, and then I listen for the story under that story. I find that when I tell someone, "Here's my question, this is why I'm here, this is what I'm interested in learning from this conversation," and then listen as best I can to what they're saying, I can ask almost anything in pursuing my question because the lines of the relationship are clear. The more I speak for myself, I think, the more they're likely to do the same.
Here's a good example. At the end of a five-year research project, I met with the girls who had participated to ask them how they wanted to be involved, publically, now that we were presenting our findings at conferences and preparing to publish a book. I was meeting with the girls in 9th grade, who had first been interviewed when they were 9. Their first response was, "We want you to tell them everything we said and we want our names in the book." But then Tracey, imagining encountering her 9-year-old self in a book, says, "When we were 9, we were stupid."
There are many things I could have said at that point; I could have paraphrased what she said, or repeated it back, or tried to reassure her by saying, "No, you weren't stupid." Instead, I said what I was thinking: "You know, it would never have occurred to me to use the word 'stupid' because what struck me most about you when you were 9 was how much you knew." At which point, Tracey said: "I mean, when we were 9, we were honest."
I've found that if I say what I'm really thinking and feeling, people are more likely to say what they really think and feel. The conversation becomes a real conversation.
PN: Isn't trusting your own reactions in that way tricky for a researcher? How do you make sure that your own biases and assumptions don't color the answers you get?
CG: That's a good question, and it goes to the heart of how I think about research. I think of research as a relationship. If you stick to your list of questions no matter what the response, if you cover your own thoughts and reactions, then how will this kind of nonresponsive relationship color the answers you get? I don't think there's a psychologically or culturally neutral situation. If you say nothing, you leave prevailing cultural biases and assumptions in force, and the people you're studying will have their own biases and assumptions about what you're after. You could try to fool them by deceiving them, but I think people are pretty savvy in reading the human world. So I try to negotiate my relationship with people and for myself; I strive for a kind of Zenlike innocence, where I work from a genuine position of not knowing.
In The Birth of Pleasure, I write about a couple in which the husband is obsessed with whether his wife has had an affair. He says that his "ultimate nightmare" is "her in the arms of another man." Now, I know the culture of male honor, and in this sense, I understand what he's saying, but I also can think of worse nightmares. So I say: "Why is this the ultimate nightmare?" And he says, "I guess the ultimate nightmare, really, for me, was to never have the opportunity to show her how I really feel and to be a family man, to open my heart, and to love her." I was taken completely by surprise. I never imagined this response, but it's the moment that interests me most, when a gap opens between the "I" and the culture. The moment when a voice that has been held in silence suddenly speaks. What's key here is that my question was a genuine question.
PN: What do you mean by a genuine question?
CG: Something I'm genuinely curious about, so in that sense it's a real question, something I don't know the answer to or even the range of possible responses--because I never would have anticipated the husband's response. Sometimes, one question builds on another. Once I discovered how astutely girls can read the human world, I wondered can't boys do this, too?
PN: Reading the hostile reviews of The Birth of Pleasure, you'd think that feminism isn't only dead but has become almost a dirty word. One critic dismissed the kind of feminism you represent as "horribly dated," and others have taken you to task for laying all our social ills at the feet of patriarchy.
CG: To me, it's ironic to pronounce feminism dead at the point in history when women's votes are determining the outcome of elections, when most American families no longer resemble the Dick-and-Jane patriarchal family, when more women are gaining an economic foothold, when feminism has opened a new conversation about domestic violence and sexual abuse, and when so many women worldwide have no effective voice and are living in poverty. I define feminism as the movement to end the contradiction between democracy and patriarchy, and I see us now as being in the midst of this struggle. Patriarchy means a hierarchy, a rule of priests in which the priest or hieros is father. It separates some men from other men, fathers from sons, and all men from women. Patriarchy isn't dead--look at who runs the Fortune 500 companies and Congress--but it's in trouble. Look at Enron and WorldCom, and the scandal in the Catholic Church and the FBI and CIA.
I say in my book that the most volatile moment in therapy is when people begin to envision the new. Then it's very tempting to turn back, because at least the old is familiar, "I love my neurosis, I know the whole script." So, given all the remarkable changes that began with the Civil Rights movement of the 1960s and have led to social and cultural shifts that are on the scale of the Protestant Reformation, it doesn't surprise me that we're now seeing something akin to the Counter-Reformation, and even the Inquisition.
PN: Let's go back 20 years to the publication of Â In a Different Voice, which was for many people a landmark book that brought a feminist voice into the social sciences. How did it occur to you to write that book?
CG: At the time, I was in my thirties, had finished my Ph.D., and had no intention of going on in psychology. I was the mother of three small children, a member of a modern-dance troupe, an activist in the Civil Rights and the anti-war movements. My husband was a psychiatric resident and I taught part-time to make some money so I could have some help in the house. I had the opportunity to teach with Erik Erikson at Harvard in his course on the life cycle and then with Lawrence Kohlberg in his course on moral and political choice. In the course of teaching, I became interested in how people respond to actual situations of conflict and choice, and I started doing some research with a few graduate students, focusing on turning points in people's lives, times when the "I" surfaces around the question of "What do I want to do?" and morality comes into play around the question "What should I do?" I interviewed people and I listened for a first-person voice and also for moral language, words like should and ought and good and bad and right and wrong.
In 1975, we moved from Newton to Brookline, and I stayed home that year to help my three young sons settle into a new school and neighborhood. I was interviewing pregnant women who were considering abortion, and I remember sitting at my kitchen table reading over the interview transcripts and suddenly hearing a difference between the terms of the public abortion debate (right to life vs. right to choice) and the women's concerns about acting responsibly in relationships, because for many women, the abortion dilemma was a dilemma of relationship. Listening to these women, I heard a conception of self and of morality that differed from Erikson's and Kohlberg's theories.
I remember my friend Dora came in and I said to her, "I can see why these women don't fit into Erikson's or Kohlberg's stages--they're starting from connectedness rather than separateness. And Dora said, "That's really interesting. Why don't you write about it?" So I did. It was the first time I wrote something that wasn't for school. The essay, "In a Different Voice: Women's Conceptions of Self and of Morality" was published in the Harvard Educational Review in 1977. In a Different Voice came out in 1982.
PN: When did it first dawn on you that this book was going to have the sort of impact that it's had?
CG: On the day I went to pick up the retyped manuscript from a woman who lived in a working-class neighborhood in Somerville. Harvard press had sent it to her, and when I arrived, she said that she hoped I didn't mind, but she'd given it to her cousin upstairs to read and her cousin wanted to meet me. It was at that moment that it occurred to me that the audience for the book might be much wider than I had ever imagined.
What many people don't know is that when the book first came out, it got very mixed reviews. Kirkus Reviews said, in effect, "Nothing new here." The Â Times reviewed it, which was great, but the review was mostly lukewarm, except for one very strong, positive sentence, which then was widely quoted. Arthur Rosenthal, the director of Harvard University Press, made a brilliant publishing decision to bring it out very quickly in paperback and price it low so it could be a second course adoption. An editor at the press told me that what I wanted was slow, steady sales, which is what happened.
And then people I didn't know began talking to me about the book. A woman working in a local store asked me, "Are you the woman who wrote that book?" and then said that I had explained her marriage; a Globe reporter stopped me on the street and said that I had explained his divorce. Many women have told me they remember where they were when they read the book, and how they felt suddenly that what they really thought or felt about things made sense. The book spoke to and also about a voice inside them that told them they were wrong or stupid or crazy; it challenged the legitimacy of that voice. So many women felt heard and able to speak in a new way. And the book also legitimized for men a voice that had been associated with what were seen as women's weaknesses, but which I identified with human strengths.
PN: So what was it like to become revered suddenly as this feminist icon?
CG: I don't see myself as an icon. I was very moved by the response to my book; it brought me into relationship with many people whom I otherwise would not have met. I also discovered that in becoming a public figure, I became a focus for all kinds of projections that had little to do with me. And then I became a focus of political attack, because In a Different Voice was seen as encouraging women to listen to their own voices--like the Soccer Moms in the 1996 election who didn't vote with their Republican husbands.
What many people don't know is that at each step along the way, my work has been both celebrated and contested. After In a Different Voice came out, a symposium was held at the next meeting of the Society for Research in Child Development. Three leading women psychologists were on a panel organized to criticize my work. There was no voice of support, and I was to respond to my critics. The symposium was held in the ballroom. I felt I was being invited to the Star Chamber. After Meeting at the Crossroads, the book I wrote with Lyn Mikel Brown about our research with girls, I was attacked in cover stories in The Nation, The New Republic, and The Atlantic, two of which were entitled "Gilligan's Island," as if in working with girls, I had separated myself from reality.
PN: What were the main criticisms and how did you answer them?
CG: They had to do with my use of the word "different" and also with questions of method. I had said very clearly in In a Different Voice, that the "different voice I describe is identified not by gender but by theme." My point was that including women changed the voice of the conversation, leading both women and men to hear themselves and one another differently. Including women shifted the paradigm--this was what I demonstrated in my book. Just as the girls' research revealed girls' resistance to an initiation into ways of seeing and speaking that made it hard for them to say what they saw or know what they knew through experience.
I think the response to my work was due to the fact that so much of what I said rang true. I remember Catherine McKinnon saying to me, "What I hate most about your work is that it's true," meaning women often do speak in the way I describe, which she saw as the result of women's oppression. Psychologists criticized my research because I didn't do statistical analysis, but my questions weren't statistical questions--how much, how often, how many. As a colleague who studies language pointed out, to illustrate a difference, all you really need is one example.
My question was, given that the major theories of psychological development had been written on the assumption that man=human, what difference does it make to include women? What can be learned by listening to women and girls? And my writing offered an answer to those questions. But it was a little crazy-making for me to hear people describing the differences I heard and then arguing that there were no differences. Eleanor Maccoby subsequently apologized to me for this, but I remember her introducing the panel at SCRD by saying "A colleague, male of course, stopped me on the way to the ballroom and said 'I'll see you at the shoot-out at the OK Corral,'" which got a big laugh, and then she proceeded to read her paper, which basically said there were no sex differences.
PN: So that was the intellectual side of the controversy. But emotionally, how did you handle all this hubbub?
CG: You have to remember, I had been active in Civil Rights, in the anti-war protests, and in the women's movement. I was a Swarthmore College graduate with a deep appreciation of the Quaker tradition of simplicity and a suspicion of conventional markers of success. I saw the controversy over my research in political terms, as a fight about a paradigm shift that had widespread implications. I also was embedded in relationships that sheltered me from the controversies of the academic world. I spent a lot of time with my children, my husband, and my parents, who were still alive at the time. It was a very different time. In June, when school got out, I'd take my kids and go to Martha's Vineyard for the summer. I never worked in the summers. My identity didn't center on my position at Harvard, which was very part-time for many years. I wasn't invested in becoming a member of the Profession of Psychology. But psychology, small p, fascinates me--understanding the human world and how it works.
PN: In a Different Voice was a direct challenge to two extremely distinguished academics with whom you had worked very closely, Erik Erikson and Lawrence Kohlberg. How did they respond to having their work called into question.
CG: You want to know how the "fathers" responded? I had taught with each of them after finishing my PH.D. I respected their work enormously and learned from them--about the importance of placing life-history in history, about the necessity of talking about questions of value. I didn't see myself as challenging them but challenging the paradigm or theoretical frame. This is where they didn't agree with me. Larry and I taught together after In a Different Voice, and taught explicitly around our disagreement as to whether the differences introduced by women's voices could be accommodated within his theoretical framework, or whether they implied a paradigm shift.
I used to tell women graduate students, half-seriously, that the role of slightly rebellious daughter was one of the better roles for women living in patriarchy. And as I loved my father, I felt very warmly toward both Erik and Larry. Larry wrote a blurb for my book. But if I had to paraphrase what they thought, I'd say: "I like her, she's bright, she writes well, she's fun to be with, and it's important for women to study women. But change my theory--you've got to be kidding."
And then, because my work implied a change in theory, there was a concerted effort to discount or refute that challenge, which Larry Kohlberg and his supporters were involved in. I remember hearing after the meeting of my tenure committee that Larry had represented the psychologists' response to my work as entirely negative, which wasn't true. He ignored the strongly positive review of In a Different Voice in Contemporary Psychology and the journal articles supporting my findings. To get tenure, you had to do work that changed the field and, clearly, I had done that. So I confronted Larry and, using his language, said it wasn't fair--that I had done as much as he had done when he was tenured. He asked me what I wanted him to do (by this point, the dean had taken him off the review committee) and I said I wanted him to write a letter saying this and supporting my tenure, which he did. I think he had become too identified with his theory.
PN: In The Birth of Pleasure, you describe discovering your memories of pleasure with your mother and also some of the difficulties in your relationship at the time of your own adolescence. She seemed to be the primary bearer of cultural messages about femininity.
CG: My discovery that Anne Frank, when she edited her diary, omitted her descriptions of pleasure with her mother led me to ask myself how I had edited my memories of my relationship with my mother. What surprised me was how accessible my memories of pleasure with her were, once I found the key. It was a Proustian experience.
For Proust, the lost time that he recovered was a time in early childhood. For me, it was early adolescence. These are times of heightened risk in boys' and girls' development, and through my research, I came to connect this risk with the initiation into patriarchal gender codes that occurs earlier for boys than for girls. Proust saw his mother as carrying the burden for this initiation, and I saw my mother as doing the same.
Once I recalled my memories of pleasure with my mother, I could understand better the confusion I experienced when she'd shift from being in relationship with me to teaching me what I needed to do in order to have "relationships" in the world at large. There was one incident around In a Different Voice, when she spent an entire day reading galley proofs with me, which was so meaningful to me, especially given the substance of that book. We sat on the red sofa in my living room together, and then after we finished, she picked up one of the pillows and said, "You have to remember to fluff up these down pillows," which I heard as a criticism of my housekeeping. So there it was, both sides of our relationship.
PN. So much of your work has been about voice and the psychological costs of feeling silenced. You've just described people taking issue with your voice. What was it like to have your own voice challenged in that way?
CG: The hardest times for me were not when people challenged what I said, but when I felt my voice was not heard. When people talk about me or my work in ways that have little or nothing to do with me or with what I've written, or when they speak about me as though I don't know the first thing about research, I wonder what's going on. For example, In a Different Voice isn't a book about how all men differ from all women--I give examples of men using the "different voice" and of women speaking about rights and justice, and say clearly that I'm contrasting two ways of imagining self and relationship that leads to different ways of speaking about moral problems. My title is In a Different Voice, not "In a Woman's Voice"--the question is different from what, and I contrasted women's voices with what was then the voice of psychological theories. The danger, for me, lies in starting to doubt my own writing. Virginia Woolf writes about this danger for women writers, when the infection enters the sentence and you begin within your sentences to double-think yourself in anticipation of not being heard.
PN: Critics have either loved or hated The Birth of Pleasure. How do you understand the intensity of the reaction?
CG: Well, I'm writing about pleasure and also about leaving patriarchy, which are two fraught subjects. I link tragic love stories with the initiation into patriarchy and then show how the findings of contemporary research provide us with a map showing points of resistance and ways leading out of destructive cycles. It isn't surprising to me that people might disagree with me or argue that the evidence I present doesn't support my interpretation. What surprised me was the vehemence and the personal nature of the attacks, which had little to do with the argument of the book, but more with my past work or with the structure of the book, which was incomprehensible to some readers. But I was writing about dissociation, how to break through a wall that separates you from what you know, and I followed an associative method, because you can't argue your way out of dissociation. The structure of the book is orchestral, or like a tapestry with different threads woven together to show a pattern. I wanted to recreate for the reader the journey I had taken in coming to see what I saw. My title, The Birth of Pleasure, reflects the importance of the research I did with girls in leading me to these insights (the Psyche myth that frames the book ends with the birth of a daughter named Pleasure) and also announces a paradigm shift--from a paradigm grounded in experiences of loss ( The Birth of Tragedy ) to one grounded in experiences of pleasure. One colleague speaking of her own experience in reading the book, said: "This book unsettles an adaptation," which is what I intended.
PN: Over the past 20 years, lots of thinkers and practitioners have been trying to bring a feminist perspective to bear on therapy. What are you saying in The Birth of Pleasure that hasn't been said before?
CG: What I can add to this very important conversation about therapy are findings from developmental research. What I think is especially relevant is the discovery that voices that can be clearly heard among young boys and preadolescent girls then become covered by other voices, so it's difficult to remember accurately without actually hearing the voice that's become dissociated from oneself or that's being held in silence. The remembered voice is very different from the actual voice of times before dissociation sets in. A second contribution has to do with realizing the extent to which psychologists have read culture as nature, so that adaptations to patriarchal structures are taken as inevitable facts of human existence. Here my research is instructive because it highlights a resistance that isn't ideologically driven but is like the immune system, a force for psychological health.
PN: You end The Birth of Pleasure by saying: "We have a map. We know the way." What does that way look like?
CG: It's a way of staying in relationship with the different parts of oneself, with others, and with the world. It means not giving up relationship, which is part of our birthright, for the sake of having "relationships."And the key here is pleasure. It's hard to fake pleasure, although perhaps for this reason, pleasure has gotten something of a bad name, becoming associated with license or irresponsibility rather than with joy and with freedom. Pursuit of happiness. It's part of the Declaration of Independence. The loss of a voice grounded in experience, including experiences of pleasure, compromises love, but it also compromises democracy.
PN: I know that The Birth of Pleasure isn't a clinical book, but is there any advice you'd offer therapists that might be helpful to their work with clients?
CG: I'd encourage them to listen for the untold story, which is often a story about pleasure. When I joined Terry Real as a cotherapist working with couples, I was struck by how often a story about pleasure lies underneath a story about loss. Anger at mothers--which is crucial to hear and respond to--is often closer to the surface; what often goes unnoticed are memories of pleasure. A man I call Dan was coruscating in his descriptions of his mother's intrusive behavior, and it would have been easy to overlook his saying, almost in passing, "My mother and I were buddies, we were pals."
I'd tell therapists to pay attention to resonance, because voice depends on resonance. We're surrounded by cultural resonances that affect what can and can't be said and heard. If a therapist wants to hear a voice that's been ignored or discredited, he or she will have to create a resonance that signals the possibility of this voice being heard. We know this now with respect to trauma. The Birth of Pleasure does this for love.
PN: What's particularly interesting for those of us who identify you with your research with girls and women is how much of your new book is about boys and men. I was especially struck by your statement, "Within a patriarchal society and culture, mother and son are a potentially revolutionary couple."
CG: I speak from experience, as the mother of three sons. What's revolutionary is this relationship. If sons stay in connection with mothers and mothers with sons, the patriarchal plot cannot go forward, because it depends on breaking this relationship. I know how often I felt pressured in the name of psychology or for the sake of my sons' masculinity to separate myself from them or them from me, as if our knowing each other would stand in the way of their becoming men. It would stand in the way of their seeing the world through a patriarchal lens, which loses the interiority or subjectivity of women. Olga Silverstein has written very powerfully about the courage it takes to raise good men. And many of us have now done this, and the implications are revolutionary, calling for new ways of structuring both work and family life.
PN: So here's my final question. How does The Birth of Pleasurer reflect your own experience of marriage?
CG: I knew you'd get around to that. I write about my own dreams in the book because if something is true psychologically, it's true for me, too. And the same is true with pleasure. Like many people of my generation, meaning those of us who married before all the rules changed, I've been in many marriages with the same person. When I think about marriage I think of the infant research, showing that relationships follow a tidal rhythm--finding and losing and finding again. So Jim and I will lose our experience of pleasure with each other, and then we'll find it again, and it's the finding that's crucial. What's important is not to get stuck in the loss, to resist the pull of tragic love stories. And then sometimes pleasure comes in unexpected ways. I remember Jim showing me the opening of his first book and my intense pleasure in reading it. He was describing his experience as a boy growing up in Nebraska, looking up at the night sky and seeing the Milky Way, and the writing was so exquisite and naked and emotionally true, it was the voice of the man I had fallen in love with, a voice I find irresistible. And there it was on the page in front of me.
I see The Birth of Pleasure as a hopeful book. I hope it's not foolishly optimistic. I wanted to encourage people to listen for the voice of pleasure in themselves and in others, to stay with the vulnerability of joy, and to cast a skeptical eye on tragic love stories.
Mary Sykes Wylie, Ph.D., is a senior editor of the Psychotherapy Networker .
Richard Simon, Ph.D., is the editor of the Psychotherapy Networker and author of One on One: Interviews With the Shapers of Family Therapy . Letters to the Editor about this article may be sent to Letters@psychnetworker.org.
by Joshua Wolf Shenk
After he has awoken, from uneasy dreams, to find himself transformed in his bed into a giant insect, Gregor Samsa's first encounter with the world outside his bedroom comes in the form of his mother's voice. "Gregor," she says. "It's a quarter-to-seven. Hadn't you a train to catch?" When he opens his mouth to answer, Gregor hears a peculiar sound. The voice is "unmistakably his own" but has a "persistent horrible twittering squeak behind it like an undertone that left the words in their clear shape only for the first moment and then rose up reverberating round them to destroy their sense." And so, having at first thought that he would "explain everything," Gregor says only this: "Yes, yes, thank you Mother, I'm getting up now."
In The Metamorphosis, a story about alienation, the first rupture is one of language. Gregor Samsa cannot make himself known to the world. Just as his body has become unrecognizable, inexplicably Other, so has his voice. In this image--more clearly, even, than in Gregor's grotesque physical form--I feel the presence of the author. "I am constantly trying to communicate something incommunicable, to explain something inexplicable," Kafka wrote of himself. He was alienated from language, and even felt trapped by it. But words, metaphors, and stories were his only way out.
When I was a small child, about eight I think, I ripped apart my bedroom in a frenzy. I threw the pencil sharpener off my desk. I pulled the sheets and blankets off my bed and turned over the mattress. I pulled clothes out of their drawers, drawers out of the bureau. Eventually the bureau itself toppled. A few moments later, my mom stood in my doorway and said, with aplomb, "Looks like a tornado has been through here."
Five years later, I stood on the lawn of my father's house, just home from summer camp. My oldest brother drove up the dead-end street in his gray Fiat, and turned left into the short driveway. I ran over to see him. I recall, as I ran, feeling a false expansiveness. I wore a too-wide smile, like a clown scripted for a pratfall. As I began toward the car, my brother leaned over and rolled up the window on the Fiat's passenger side. Then he backed down the driveway and drove away.
When I was seventeen, I carried these and other fragments up the stairs of an old Victorian home in Cincinnati. As I sat in the waiting room of a psychiatry practice, I knew I was lonely, unhappy, even desperate. I did not know I was depressed. But that was the word that waited for me, a diagnosis that physicians since Hippocrates have been trying to elucidate and one that I would inherit.
The Hippocratic writers believed that gloom, abnegation, and misanthropy could be traced to excesses of black bile. Unlike the other three bodily humors (blood, phlegm, and yellow bile), black bile was never actually observed. Today, we know no such substance ever existed. Still, the Greek words--for black ( melan ) and bile ( khole )--dominated the language of inner states for more than two millennia.
In 1905, the influential American psychiatrist Adolf Meyer proposed that "melancholy" and "melancholia" be retired from the clinical vocabulary. He believed that the terms were used too broadly. They described "many dissimilar conditions" and also "implied a knowledge of something that we did not possess"--that is, the causal role of black bile. Meyer preferred the word depression. Other physicians followed him, as did medical texts and the lay culture.
In the hands of modern writers, "melancholy" has recently experienced a renaissance. In Darkness Visible, William Styron charges that Meyer "had a tin ear for the finer rhythms of English and therefore was unaware of the semantic damage he had inflicted by offering 'depression' as a descriptive noun for such a dreadful and raging disease." The word depression, Styron continues, has "slithered innocuously through the language like a slug, preventing, by its very insipidity, a general awareness of the horrible intensity of the disease when out of control."
It strikes me as telling that writers--for whom words are tools and imprecision deathly--knowingly use a term that is literally untrue; and that they use "depression," "melancholy," and other imperfect words interchangeably. These are two of many indications that the experience they describe has no true name. Styron, for instance, readily concedes the paradox that his memoir of melancholia is but a hazy shadow of something "indescribable." Most accounts of depression will have this sort of disclaimer. Others disclaim implicitly through dependence on metaphor and allusion.
Perhaps depression is simply hard to convey--even, as Styron says, "indescribable." But I'd like to suggest another possibility: That what we call "depression," like the mythical black bile, is a chimera. That it is cobbled together of so many different parts, causes, experiences, and affects as to render the word ineffectual and perhaps even noxious to a full, true narrative.
It is ironic, given the criticism directed at him, that Adolf Meyer seemed to have in mind the limits of single-word diagnoses when he proposed that depression replace melancholy. Meyer believed the former word, obviously inadequate, would force doctors to tailor their descriptions to individual cases. "Nobody would doubt that for medical purposes the term would have to be amplified so as to denote the kind of depression," Meyer wrote. (Italics added.) Perhaps Meyer even liked the insipid quality of "depression," believing it would announce (like a blank canvas or the blue screen on a film set) the absence of material to come.
If so, what transpired over the century can be counted among the great tragicomedies in the history of language: Somehow, we have come to believe that "depression" is the art, is the phantasm of special effects, is the evocative detail or phrase or story rather than a mere placeholder. The DSM-IV lists only a few qualifiers for "major depressive disorder." Psychiatrists and medical texts treat depression as a discrete entity, and assume it adheres to a particular course and treatment. Ads for drugs, herbal remedies, and nutritional supplements refer to depression as though it is a foreign invader, unrelated to the authentic self.
In lay culture, meanwhile, the word is often used with no context at all. A New York Times report on the rising suicide rate in Japan notes that the cause might be "depression," but does not offer even a single phrase to elaborate. In conversation, otherwise imaginative, articulate speakers toss around the words "depressive" and "depressed" as if they capture a person's essence. In his story "The Depressed Person," David Foster Wallace gives the eponymous character no other name, which I take as sardonic reflection on the way we drape over diverse sufferers a label that hides more than it reveals.
Perhaps, for many, staying hidden is part of the point. I think of Tipper Gore, who first spoke publicly of her depression in a front-page interview with USA Today. After her son recovered from a nearly fatal accident, Gore explained, she saw a social worker and was told she "had a clinical depression and one that I was going to have to have help to overcome."
She continued, "What I learned about it is your brain needs a certain amount of serotonin and when you run out of that, it's like running out of gas, it's like you're on empty. When you get to this point of being seriously depressed or what we call 'clinically depressed,' you just can't will your way out of that or pray your way out of that or pull yourself up by the boot straps out of that. You really have to go and get help, and I did. And I was treated for it successfully, I'm happy to report."
Gore did not describe in what way she felt depressed, nor how it affected her life only that she had a "clinical depression . . . and I was treated for it successfully." Her reticence might have been motivated by discretion, or a wish for privacy, and I do not begrudge her these. I appreciate her candor, insofar as many would choose to say nothing. Still, like so many public figures who have made similar confessions, she hinted at intimacy then quickly withdrew behind a wall. The word depression was that wall.
It is inevitable that we abbreviate and simplify. (It is apparent even in this essay that I see no way around the words "depression" and "melancholy.") But it is one thing to use shorthand while straining against the limits of language. It is quite another to mistake such brevities for the face of suffering. Each year, seventeen million Americans and one hundred million people worldwide experience clinical depression. What does this mean, exactly? Perhaps they all have deficits of serotonin, feel hopeless, ruminate on suicide. But why? What wrinkles crease their minds? How are they impaired? For how long--two weeks? a month each year? an entire life? And from where does this depression come?
Rather than acknowledge these variations and uncertainties, many react against them, taking comfort in language that raises the fewest questions, provokes the least fear of the unknown. Such is the case with the equation of emotional problems and mechanical failure. Phrases like "running out of gas," "neurotransmitter deficits," "biochemical malfunctions," and "biological brain disease" are terribly common, and are favored by well-intentioned activists who seek parity between emotional and somatic illnesses. Pharmaceutical companies also like machine imagery, since they manufacture the oils, coolants, and fuels that are supposed to make us run without knocks or stalls.
This language not only reflects, but constructs, our reality. When we funnel a sea of human experience into the linguistic equivalent of a laboratory beaker, when we discuss suffering in simple terms of broken and fixed, mad and sane, depressed and "treated successfully," we choke the long streams of breath needed to tell of a life in whole.
Just as we hear music through intervals, experience is often easiest to understand in terms of contrast. And so despair is often best expressed in terms of what has changed. "I used to relish crowds on the street, but now people repulse me." Or, "I used to wake up with a feeling of expectancy. Now I can only wrap the pillow around my head and pray for more sleep."
When I began psychotherapy late in high school, I had a clear and persistent sense that something was wrong with me, but no vocabulary with which to describe it. I could not draw on contrast because I didn't remember a time when I felt differently or better. I did not have seasons of happiness followed by epochs of misery, or fall off cliffs and climb back up among the daisies. I felt as I felt for as long as I could remember. I did not go to therapy to understand, or to get through, an episode. I needed to understand and get through my life.
Since my "condition" is so deeply rooted, much of my personality grew out of it and developed to cloak it. This made expressing myself even harder. I did well in school, stayed out of trouble, behaved like a son my parents could be proud of. I wrapped myself in a skin of normalcy and success but grew more hidden, from others and from myself. In high school, I wrote in a poem that I wished "to be a slug," to have an exterior that expressed what I felt. Like Gregor Samsa, I greatly desired to speak the whole truth. Instead, much of the time, I merely said, Thank you, thank you, I'm getting up now--going to school, going eventually to college and the bright future that everyone expected. But the present, which I tried so hard to dodge, could not be dodged.
In Seeing Voices, his book on the language of the deaf, Oliver Sacks notes that philosophers have long dreamed of "a primordial or original human language, in which everything has its true and natural name; a language so concrete, so particular, that it can catch the essence, the 'itness,' of everything; so spontaneous that it expresses all emotion directly; and so transparent that it is incapable of any evasion or deception. Such a language would be without (and indeed would have no need for) logic, grammar, metaphor, or abstractions--it would be a language not mediated, a symbolic expression of thought and feeling, but, almost magically, an im mediate one."
I hoped for such fluid, full, direct communication in therapy. I tried to express the relentless stream of criticism that I directed at myself and others, the way I felt split in two, the dull and sharp aches that moved around my body as though taunting me. I wished to plug a probe from my brain to the doctor's, so that he could see--without mediation--how I stood outside myself, watching and criticizing, and could never fully participate in a moment. How I felt bewildered, anguished, horrified.
Instead, I often found myself silent. When I spoke, it was with stumbles and stammers. Words-- unhappy, anxious, lonely --seemed plainly inadequate, as did modifiers: all the time, without relief. Ordinary phrases such as I feel bad or I am unhappy seemed pallid. Evocative metaphors-- My soul is like burnt skin, aching at any touch; I have the emotional equivalent of a dislocated limb --were garish. Though this language hinted at how bad I felt, it could not express what it felt like to be me.
I suppose the combination of words, body language, and silence did in some measure convey the message, because my first therapist was able to offer me a helpful phrase. "Is it," he asked, "as though you have a soundtrack of negative thoughts in your head--the volume rising or falling, but never going silent?" I pictured an old reel-to-reel tape machine, sitting alone on a table in an empty room. I lingered over the image, comforted especially by the acknowledgment that it never stopped. And I felt a spark of recognition, a kind of introduction to the meaning of my own experience.
The soundtrack image was an imperfect one, as I do not "hear voices" in the sense of hallucination; nor are the bad feelings that echo inside me always in words; nor can I always discern the difference between "self-criticism" and observation, between a gratuitous self-slap and a guide to truth.
But of several hundred afternoons in that Cincinnati office, this moment stands out--the offer and acceptance of a liberating, idiosyncratic metaphor, one that would need many revisions, but at least got me on the page. By contrast, I have no memory of hearing the word "depressed," which was how I was described at that time to my parents and to insurance companies.
In his exhaustive survey, Melancholia & Depression: From Hippocratic Times to Modern Times, the historian Stanley W. Jackson concludes that "no literal statement" can convey the experience. But he found that, over 2,500 years, two images recur most often: "being in a state of darkness and being weighed down." If we consider "melancholy" and "depression" as condensations of these images--as more than diagnoses--they retain enormous power. One of my earliest attempts at essay writing dwelled at length on an image of a dark room lit only by the space beneath the closed door. I did not make a habit of spending time in such rooms. The image of darkness imposed itself upon me, as it has for so many, as a symbol of distress.
And my dislike for the word "depression" does not mean that it has no application to my life. I am often "bowed down greatly" (from Psalm 38), feel weighed upon, feel myself on lower than level ground. Compared with others, it seems, I get less pleasure from what's pleasurable and have a harder time with what's hard. My sex drive is often muted (even without antidepressant medication, which exacerbates this problem). Work and activity that require some suspension of self-consciousness--like playing team sports--are difficult, bordering on impossible. I've tended toward activities in which self-criticism can be an asset, like writing. A tightness, an anxiety, a desperation usually grips me when I wake, relaxes its hold only occasionally through the day, and accompanies me when I lie down.
But, even as metaphors, these words are too thin to contain a life. For example, the times when I do pass from withdrawn to talkative are often quite unpleasant. Darkness aches, but light blinds.
At this point I encounter in the margins a note from my editor asking for further explanation of what is written above. And I shudder from the memory of moments like this: I am trying to explain myself and I encounter "Why?s" and "What do you mean?s" questions I fear can't be answered. I imagine the seams of this essay splitting, and the meaning and emotion I am struggling to convey here falling out like beans from a sack.
And so I remind myself: An imperfect word is sometimes better than silence, a pale metaphor better than suicide. Researchers and therapists want to understand problems in their broad dimensions; families and friends want to make sense of their afflicted loved ones; and, of course, those who suffer in isolation, starved for connection, mad with the sense that they will never be understood and never find relief, need to say something, even if it's wrong, or not wholly right.
Still, while we cannot be silent, or forsake the available word or metaphor for the perfect one that eludes us, we also cannot stop at those less-than-perfect words and metaphors. Insufficient or overused phrases--which resolve eventually into clicheÂ´s--lose their power to evoke a fresh, startling image. They stop tapping into the field of primal meaning that precedes language and to which, through language, we are forever trying to return. Worse, poor language can cripple the capacity to imagine. "A man may take to drink because he feels himself to be a failure," George Orwell writes, "and then fail all the more completely because he drinks."
The failure begins when words intended to codify or categorize, what Maurice Merleau-Ponty calls "empirical speech," actually disrupts or preempts "creative speech," or "that which frees the meaning captive in a thing." Every breath and word is an effort at translation and, at times, that effort can seem impossible. But poems, lyrics, stories can do an end run around the stubborn distance that separates us, helping us feel what it is to be alive. Words can create meaning, teach us our own thoughts, and perhaps even describe a life. But we have to plumb, with curiosity sustained over time, with toleration of uncertainty, the unsettling, elusive stories that make us who we are.
Letters form meaning from lines and curves. Words form meaning from letters. Metaphors form meaning from words. None of these units are large enough to encompass, to identify, to "diagnose" a person. If pressed, one could call Ahab "mad," or Bartleby "depressed." But to know these characters, you must read the story. To tell a life, you must tell a story.
Which is not by any means a straightforward task. Freud's idea of "repression" suggests that unconscious experience is like water pressed against a dam, that we need only remove the blockage and allow our memories to pour out. This is a dominant image of emotional healing in our culture. I think of it as the Hawkeye Pierce model of psychotherapy, after the last episode in M*A*S*H, in which Alan Alda's character has been confined in an asylum and is coaxed into retelling a traumatic episode. One by one, the authentic details emerge until he remembers the repressed memory of a small child's death. He cries. He is healed.
The psychoanalyst Donnel Stern, in his book Unformulated Experience, suggests another way of thinking about "repression." He uses the metaphor of the rock at the bottom of a lake, which requires great and sustained effort to recover. Perhaps our lives are many such rocks. Perhaps we have to raise the ones we can, imagine the rest and then, with these images and memories and emotions laid before us, find the patterns and shapes.
We are all natural storytellers. Even as we think we are just seeing a concrete image or hearing a distinct sound, we are in fact filling in gaps, putting material in context, constructing a narrative. That muted howl from the apartment next door--is it a woman crying, or a child laughing, or the laugh track from a television set? We make such choices at every moment, usually without conscious thought. We tell stories about other people, and we tell one big story about ourselves.
But sometimes, for some people, the story is torn. The essential sense of who we are, of what the world means, becomes lost. All the bits of life's evidence that must be sifted, digested, or passed over, instead fly like shrapnel. This happened to me a long time ago. In high school, when I first saw my name over small stories and articles, those words "Josh Shenk"--in ink against newsprint--struck me with dumb shock. I was thrilled and horrified at a small glimpse of what it meant to be real. It may seem strange that someone haunted by the inadequacy of words would become a writer, but I've often felt no other choice but to struggle and claw for what should be a simple birthright: to tell myself and others who I am.
Like everyone, I start with a handicap, which is that I don't know my own beginnings. Births and early infancy precede memory. Many later memories, which we should in theory have access to, are still as elusive as mist. So we become historians of our own lives, dependent on unreliable, reluctant sources. I can describe with precision the home I grew up in, its brown paint and simple brick, the gnarled limbs on the trees outside. But what did it feel like to live there? How did it form me?
I need to find these feelings, because the facts communicate so little. For instance, I was the youngest of three children and my parents divorced when I was seven. This is a story too common to be distinctive, but too important to be ignored--the slow leakage of affection and kindness from my parents' marriage, the grim entrance of resentment, confusion, and anger. The unspoken rules of the house forbade expressing these emotions, and this remained true after the divorce.
My brothers fled the home as best they could. I, the adoring younger brother, tried to follow them. But they had no interest in me, except as an occasional object of humiliation. I suppose I reminded them of what they hated in themselves: the vulnerable, longing, suffering son of their parents.
When I tried to let out my own feelings--tearing apart that room, for instance--my family pretended they were invisible. I learned to not speak how I felt, soon stopped knowing, and slowly but certainly developed a way of being--a sense of being split, an aching numbness, a cascade of critical voices--that would keep things that way. Some psychiatrists have described this as "depersonalization." It is a diagnosis listed in the DSM-IV in the category of dissociative disorders, along with post-traumatic stress and what used to be called multiple-personality disorder. Depersonalization, the manual says, is characterized by persistent or recurring feelings of "detachment or estrangement from one's self, a sensation of being an outside observer of one's mental process, one's body, or parts of one's body."
"Often," the manual continues, "individuals with Depersonalization Disorder may have difficulty describing their symptoms."
No diagnosis can tell my story. Still, depersonalization has the advantage of nicely announcing what is missing. To treat this "disorder" requires nothing less than removing the "de" to find the person--whatever is real beneath.
There is no drug for depersonalization, which leaves me adrift in an era where pharmaceuticals offer identity: If Ritalin or lithium or Xanax ease your symptoms, you can fit into the narrative of the corresponding disorder (attention deficit, bipolar, anxiety). If an anti-depressant helps, you can toss off the four letters preceding the hyphen and proudly affix to yourself the word that remains. I haven't been helped by medication. Many have. But I wonder if all of us are depleted by the way brand names, dosages, and combinations have eclipsed talk of agonies, fears, and dreams. Good stories must be reined in from chaos (the whole truth), which our imaginations are too feeble to comprehend. But good stories are never simple or precise. To shape and order our lives, without molding them into caricatures, is to hew a course between the poles of chaos and cliche--the course of authenticity.
This is a truncated memoir, an introduction to my own introduction to my story. I still need to imagine my life, to find my story by living it, following moments of emotional clarity through life's maze. I look for help in therapy, in relationships, and faith in its broadest sense--the faith of the gardener, the faith of the lover, the faith of the writer. The faith that I can experience what is real about the world, that I can hurt plainly, love ravenously, feel purely, and be strong enough to go on.
At the end of As You Like It, Shakespeare's famous "melancholy" character Jaques hears that a duke has "put on a religious life/ And thrown into neglect the pompous court." Jaques instantly declares, "To him will I/ Out of these convertites/ There is much matter to be heard and learn'd." It is a striking contrast to his earlier cynicism that "All the world's a stage/ And all the men and women merely players." It is the declaration of a character intent on finding some meaning.
But, in contrast to the smug assurance that passes for faith on the "700 Club," the truest faith reckons with uncertainty. It must account for the inevitable mystery, must survive the tension between the familiar and the shocking unknown (and the shocking unknowable). If one were forced to choose a single word to describe Jaques--who anguishes at the death of animals, wishes for love, longs for a fool's easy laughter--perhaps "melancholy" or "depressed" would be a good choice among poor options. Shakespeare chose "melancholy," but then had Jaques proclaim that he has neither the scholar's melancholy, nor the musician's, nor the courtier's, nor the soldier's, nor the lawyer's, nor the lady's, nor the lover's. Jaques has, he insists, "a melancholy of mine own, compounded of many simples, extracted from many objects." And off the stage he walks. Having hinted at his story, he goes to live it.
Joshua Wolf Shenk has contributed articles, essays and reviews to Harper's Magazine , The Nation , The Economist andÂ The New York Times . He is a past fellow in mental health journalism at the Carter Center. He lives in New York City and teaches writing at the New School University. His first book, The Melancholy of Abraham Lincoln , will be published in 2002 by Viking Press. Address c/o Psychotherapy Networker, 7705 13th Street, N.W. Washington, D.C. 20012; e-mail address: firstname.lastname@example.org. This essay first appeared in the recently published Unholy Ghost: Writers on Depression (William Morrow, an imprint of Harper Collins), edited by Nell Casey, and is reprinted by permission. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.
by Karen Smith
I'm sitting on a metal folding chair in the corner of a large, open room watching my son misbehave. I'm trying not to interfere. He is being tested by Rebecca, an occupational therapist, but he is not cooperating. She asks him to imitate a simple sequence of hand movements: she taps the child-size table where they are sitting with her right hand once, then with her left hand, then with her right hand once again. Evan flashes her a beautiful 5-year-old's grin, but then beats out his own rhythm on the table. She calmly repeats the instructions and tries again, with no success.
Next, she demonstrates a sequence of foot stomps. He ignores her and asks if he can play on the mats in the center of the room. I wonder, "Does he understand what he is supposed to do?" I suggest that I show him how to do it. Rebecca indulges me and I carefully copy her alternating foot movements. Evan just laughs at us both and runs off.
I cringe. This is exactly why we're here: He won't follow directions. For weeks now, Susan, his Montessori preschool teacher, has been greeting me with a furrowed brow when I arrive to pick him up each afternoon. She catches me on the playground and, with increasing agitation, catalogues the ways in which Evan refuses to follow the routine, respond to direction or make any apparent attempt to stay out of trouble.
He bumps into other children, steps on their work, makes loud noises, jumps and wanders aimlessly around the room, refuses to stand in line or join the group at circle time. He talks about poop and penises, obsesses about Scooby-Doo, generally acts the fool. When told to choose among the array of activities lining the shelves of the classroom, he rejects all of the options. When asked to sit on the back porch of the school building where his noise making won't disturb other children, he explodes. When forced to talk about his misbehavior, he shows little remorse and avoids looking Susan in the eye.
I am struck silent by these descriptions of Evan. As a child psychologist, I've heard parents of so-called oppositional children describe similar behavior, and I've made scores of recommendations about how to handle these kids at home and at school--how to set limits, define boundaries, support change. My practice is full of parents and children burdened by their individual and shared failures; and I have based my efforts to help them on the unspoken belief that good parents raise good children, despite the inevitable problems that come their way. But, now my child is failing. Now, I'm questioning whether I know how to be a good parent. What can I tell Susan? I'm not the expert here. I have no suggestions to offer about how to entice or coerce my own son to cooperate.
For months, I have been feeling helpless as a mother and utterly without grounding as a psychologist and family therapist. I watch myself get tangled up in power struggles with Evan. I hear myself bully him in ways that I could never admit, let alone recommend, to my patients. I ask myself how I can expect a preschooler to control himself when I'm so out of control. I joke, half-heartedly, that the day is coming when I will have nothing more to offer families than a sympathetic ear and a sad story of my own.
At home, my husband and I constantly argue with Evan about the simplest everyday things: getting dressed, washing his hands, picking up his toys, turning off the TV, taking a bath, brushing his teeth, going to sleep. He ignores us, then complains, whines, resists, falls on the floor, cries, screams. Really screams. We try being firm, we try being playful, we repeat ourselves over and over again. Then we give warnings, threaten, yell.
Nothing is easy at our house. Everything is hard.
Now as I watch Evan with Rebecca, I recognize the battle lines that are being drawn. She reminds him of the rules. He insists that he needs a snack. She bargains with him and promises a break after he does more work. He falls out of his chair onto the floor. I roll my eyes. She asks, "Does it feel good to fall?" He doesn't answer, but the question intrigues me.
I'm reminded that six months ago Evan rolled around on the floor at the Parents' Breakfast while his classmates stood in two neat rows singing Woody Guthrie favorites. At the time, Mr. Warren, the director of his school, characterized Evan as a "contrarian." He meant this in a vaguely complimentary way, and I actually took some comfort in his description. I could imagine a contrarian growing up to be a social activist, an artist, even a Pulitzer Prize winner.
But in the fall of Evan's second year of preschool, Mr. Warren's view of my son's future took a turn. He began describing him as "disruptive," "aggressive" and, on one occasion, "violent." He hinted that his school might not be the right place for Evan and suggested that we get a "behavioral analysis" at the university psychology clinic. I was furious--and grateful--that he didn't seem to remember that I analyze behavior for a living.
In our culture, we don't take kindly to children who refuse to do what they are told. We label them with euphemisms, such as difficult, willful or spirited. When these kids show up in my office as early as age 3 or 4, their parents--often tearful, angry, guilt ridden--want quick advice about how to win the battles they are losing. In single-minded pursuit of control, they contort themselves and try to twist their offspring into whatever shape fits their idealized notion of how parents and children should behave.
Sometimes these families don't seek help until the children run into trouble at school. There, where the rules don't bend, kids who push against the system are punished for their resistance. And parents are held culpable if they can't, or won't, make their kids knuckle under.
If their defiance persists, we call these kids maladjusted, antisocial or delinquent. We send them to the principal, to the school counselor, to a therapist--perhaps to their physician and a pharmacist. When these efforts fail, we send them to the judge, to the parole officer, to the warden.
I remember clearly the day my father asked me if Evan might need to see a psychiatrist. His well-intended suggestion landed on me like a slap in the face. From his point of view, Evan's misbehavior seemed pathological. But, as I saw it, the standard psychiatric tools were unlikely to be helpful. I knew the DSM-IV forward and backward, and our situation didn't fit into any of those boxes. This was not Depression, nor was it Anxiety. It was not Post-Traumatic Stress Disorder, Pervasive Developmental Disorder or Attention-Deficit/Hyperactivity Disorder. Maybe it was Oppositional Defiant Disorder, but what was a psychiatrist going to do about that?
One day as I was driving Evan to school, he said, "I wish Maria Montessori was in my class." I looked at him quizzically and asked why. "Because then maybe I could have a good day," he explained. As he saw it, only the benevolent spirit of the founder of his preschool could help him. The rest of us were clueless.
A week later he was sent home from school for slapping Susan in the face. I held him in my lap and tried to comfort him as he cried hysterically.
"We have to take down the school," he sobbed. "We have to, Mom. All the boards and all the nails. We have to take it down."
"Why?" I asked.
"Because I'm always bad there," he insisted.
These conversations--and many more just like them--devastated me. Every night, I fell into bed, exhausted by the day's failures, by my confusion, by the unrelenting struggle. And Evan was unhappy. "I wish God didn't make me to do bad things," he lamented one night just before he drifted off to sleep. As I groped in the dark for a reply, he added, "I think God feels sorry for me."
I imagined that my life would be spent clearing a path for my son in this world. A path where he would not be penalized for his obstinance. But I didn't feel up to the job. I was tired of pushing him through each day, trying to keep him on track, telling him every step to take and then arguing with him about why he had to take it. How could I expect his teacher or anyone else to tolerate his constant resistance?
Near desperation, I followed a friend's suggestion and called her son, a newly licensed neuropsychologist with a small practice and time to talk. That conversation led me to a murky netherworld outside the DSM-IV, where I discovered alternative diagnoses such as nonverbal learning disabilities, regulatory disorders and sensory integrative dysfunction. I wasn't sure where we were headed, but I knew that the map I had been using for years as an expert on children and families couldn't get us to where we needed to go.
This is how we came to Rebecca. Cautiously. Skeptically, even. I knew that occupational therapists sometimes worked collaboratively with psychologists; yet, in five years as a staff psychologist at one of the leading pediatric hospitals in the country and eight years in private practice, I had never met an OT. I had a vague notion that they helped babies with feeding problems, children with fine-motor delays and survivors of traumatic injury. What was an OT going to do for my precocious, uncooperative son?
In my first conversation with her, I sensed that Rebecca knew something about Evan that I didn't know. She was the first person who suggested that he wanted to please me, but couldn't. That in most situations he was doing his best. That many things that seemed simple and reasonable to me were, in fact, impossible for him. That there might be reasons for everything he did--and didn't do. That there was help.
She tested him on 17 different tasks that measured visual skills, coordination between the right and left sides of his body, balance, sensitivity to touch, accurate positioning of his body in space, imitation of movement and the ability to follow a sequence of instructions. Initially, the tasks were nonverbal but highly visual, like recognizing a picture embedded within another picture or copying geometric designs. Then she asked him to do things like move his finger from one spot on a map to another--without looking at the map--or to stand on one foot with his eyes closed. At first, he seemed to do pretty well, despite his reluctance to participate. But when he was forced to rely on touch, balance and sensory information coming from his muscles and joints rather than from his eyes and his ears, he flat out failed. For example, when Rebecca lightly touched one of his fingers without allowing him to look at his hand and then asked him to identify which finger she had touched, he couldn't do it. In most instances, he chose the wrong finger.
I was shocked. Evan was a creative, vivacious character who could talk circles around anyone on almost any subject. I had never thought of him as anything other than gifted. "He escapes into language," Rebecca explained. "He uses it as a distraction from tasks that are too difficult." Tasks too difficult? For Evan? With that comment, my understanding of my son began to change dramatically.
Several days later, my husband and I sat with Rebecca in her clinic. She reminded us that she had not evaluated Evan's intelligence, only his ability to process sensory information. And she confirmed that she had, in fact, found evidence of sensory processing problems. He was extremely sensitive to touch, but he often couldn't tell where he was being touched. As a result, he responded to tactile sensation defensively. His balance was shaky and his upper body was weak, so he often held his left arm bent and close to his body to stabilize himself. Because of this, he didn't use the right and left sides of his body in a coordinated manner. He also had a great deal of difficulty with what Rebecca called motor planning--the ability to plan, organize and carry out new or unfamiliar movements. She explained that these weaknesses interfered with his ability to pay attention, follow basic directions, participate in group activities and engage in purposeful, independent activity. They were also likely explanations for his emotional reactivity, his resistance and his sense of helplessness.
According to Rebecca, Evan was not oppositional by nature. (And he had not been poorly parented.) He was at the end of his rope, trying to meet the behavioral expectations of a typical preschooler's world without the neurological equipment required. Trying--but failing--to please his parents, who were dragging him through his life oblivious to the challenges he faced every day.
For most of us, the delicate interaction between the brain and body known as sensory integration (SI) is nothing short of marvelous. It allows us to move purposefully through the world without being driven to distraction by the cacophony of sensory experience that bombards us each minute we are awake. It is how we can sit at a computer, concentrating on abstract ideas without thinking about how to position our body in the chair so that we don't fall on the floor, or where to move our fingers on the keyboard without looking at them or when to ignore the sounds of the wind at the window and the barking dog and when to tune in to the ringing telephone or the crying child.
Rebecca talked to us about "sensory integrative dysfunction," a malfunction in the brain's translation of sensation into meaning and action. For example, the brain might not automatically recognize that pressure on the skin and muscles of the abdomen is coming from a too-tight waistband. It may not judge accurately whether the sensation is important or trivial, dangerous or benign and, therefore, may not respond logically or efficiently. It's like there is a traffic jam in the lower brain. Important information that needs four-lane access to the thinking centers of the brain--like the awareness that you're about to lose your balance--can't get through. Other information that should be diverted into a parking lot--like the feeling of a shirt tag rubbing against your neck--gets full attention, creating havoc and confusion.
When brain-body connections are intact, the lower brain constantly interprets input from sensory receptors all over the body and responds with motor reactions. Those actions create more sensory feedback, which provides self-correcting information to the brain in a never-ending cycle. Thankfully, this occurs outside of our awareness in most instances. We are free to focus on conscious thoughts, while our subcortical brain and its agents, literally, keep us from bumping into walls.
Children like Evan are not so fortunate. They vacillate between states of over- and under-stimulation and, as a result, often act in ways that are erratic and inconsistent. Everyday tasks--washing their hair or brushing their teeth--quickly overwhelm them. Complex tasks--learning to ride a bike or cleaning up a messy room--totally confound them. They become discouraged, irritable, whiny, explosive.
Because we assume that these children are neurologically and physiologically capable of doing what we ask them to do, we may describe them as inattentive, hyperactive or clumsy and complain that they are stubborn, angry or oppositional. In fact, they are all of those things--but for a reason. That reason is faulty sensory processing. Sensory integrative dysfunction is not a diagnosis like AD/HD, which is merely a list of symptoms that can be identified reliably. Rather, it is a conceptual framework for understanding what is causing some of the symptoms on that list (and others).
I was flooded with sadness and relief as I listened to Rebecca's descriptions of Evan. Through her eyes, I saw a boy who couldn't-- absolutely couldn't --stop thinking about the seam of his sock, or the waistband of his underwear or the tag on the back of his shirt. A boy who didn't yet button his pants, zip his jacket or fasten his seatbelt because he wasn't able to determine which of his fingers were touching the things he was handling. A boy who constantly made noise in order to screen out noise. A boy who had to bump into things or keep moving in order to maintain his balance. A boy who felt under attack by his skin, by smells, by noises. By his friends. By his father. By me. No wonder he was pushing back. His body was in a constant state of alert--and he was putting out tremendous effort just to get through each day.
It was the first explanation of Evan's behavior that made sense.
We quickly learned to recognize the obvious examples of sensory interference in his life. His consistent, adamant refusal to hug his grandparents because of his fear of losing his balance and the confusion and discomfort that light pressure on his skin created. His extreme reaction to the least little bump, scrape or cut. With Rebecca's guidance, we learned to detect the more subtle clues: the times he was driven under the dining room table by the smell of a fish stew, collard greens or even fresh bay leaves. The severe meltdown following a friend's crowded, noisy birthday party. The way he avoided schoolwork that involved tracing or writing because he couldn't discriminate between his fingers and couldn't control a pencil.
We started taking him to Rebecca for twice-a-week therapy sessions, but I would have taken him once a day if she would have agreed to it. She predicted that he would respond well to treatment, but that it would take time--at least a year. This was not magic: it was hands-on, developmentally oriented therapy based on the notion that the brain is shaped by experience. Through play, Rebecca provided Evan with sensorimotor challenges difficult enough to be appealing, but easy enough to be attainable. She said that these experiences would build upon one another, gradually laying the neural pathways between body and brain that were necessary for more efficient sensory processing.
Watching Evan and Rebecca together, I had to remind myself that they were shaping his brain. To my untrained eye, it looked like they were just having fun--crawling through tunnels, spinning in tire swings, diving into bean bags, tooting on horns, jumping through hoops. But surreptitiously, she was working him. Decreasing tactile sensitivity. Increasing upper body strength and postural stability. Encouraging bilateral coordination. Practicing motor planning. Building self-confidence. Developing a sense of mastery.
Meanwhile, life at our house was still hard. Power struggles persisted and temper tantrums were a regular occurrence, usually just before dinner, when the accumulation of the day's irritations crashed in on us all. Even though we couldn't always figure out what was causing him to crumble, we no longer blamed Evan for his frustration. We eased up and tried to listen.
With encouragement, he began to describe the peculiarities of how his body worked. Over a peanut butter snack one morning, he said, "Andrew is allergic to peanut butter, but I'm allergic to things on my skin." After we gave in to his request to wear the same pair of soft cotton shorts day after day, he happily said, "I love smooth. It's my favorite thing." When I asked him what happened when kids at school accidentally bumped into him, he replied, "Oh, I have to fall down to get away from them."
One of the children I wished he could get away from was a boy in his class named Jack. I didn't like Jack. He was loud and disruptive and annoying--and Evan was drawn to him like a pig to mud. Each morning, just as Evan was settling into some methodical Montessori-style activity, Jack would cavort by, chanting some nonsensical rap, tapping him on the head, knocking over his carefully arranged work. And Evan would be off in a flash. The two of them would bound around the classroom together, working each other into a frenzy that would usually get them both sent to time-out.
I was fighting my unfriendly feelings one afternoon as Jack stood in front of me in a new hooded sweatshirt. I dug deep to find something nice to say. "That's a great red jacket," I offered lamely. His mom, Terre, overheard me.
"Jack has just started treatment for sensory integration problems and we've discovered that he's very sensitive to noise," she explained. "He likes to wear jackets that he can pull up over his ears, even when he's inside."
I was stunned. I had dismissed Jack as a troublemaker, but now I could see that I had been wrong. He and Evan had the same fundamental problem. No wonder they couldn't resist each other.
Terre told me that Jack had been a difficult child from early on. As an infant, he didn't sleep, he couldn't breast-feed, he was restless, hyperactive, difficult to settle. From the first moment that he could crawl, he sought out small, enclosed spaces where he could hide. Even though she had raised two older children, Terre didn't know what to make of Jack's unusual behavior. Before she knew about sensory integrative dysfunction, she had gone to see a family therapist, who had recommended a behavior modification program to decrease Jack's "aggressive behavior." It hadn't worked (just like a sticker chart I'd designed for Evan hadn't worked). "I felt desperate," she said. "I didn't know what to do. I had this underlying fear that if we didn't do something, we were headed for medication."
Jack was 5 years old when a family friend who was the director of an OT training program told Terre about sensory integrative dysfunction. She had Jack evaluated and immediately started him in therapy with Rebecca. For the first time since her son was born, Terre felt hopeful.
Fortunately for both Jack and Evan, their teacher, Susan, was interested in learning about sensory integration. She read everything that I downloaded off the Internet about school-based interventions for SI kids. She created work spaces away from the noise and activity of the busy, open classroom. She allowed us to set up an old refrigerator box as a sensory shelter, which we decorated and called the "chill zone." She consulted with Rebecca whenever their opposition to a task puzzled her. Most important, she maintained her composure in the face of their sensitivities.
Within a few months, Evan stopped hating school. He started to recognize his own weaknesses, which made it easier for him to calm himself when he got upset, rather than exploding or disintegrating into a crying heap. When the din of the classroom became too intense and he started to get jumpy and loud, he asked for permission to go into the refrigerator box for a break. As his sensory processing became more efficient, he was able to focus on learning and enjoy its natural rewards.
"I'm so busy doing work at school that I don't have to try to be a good boy," I heard him tell his grandmother one afternoon.
His body was now working for him rather than against him, and he gradually developed the ability to ignore little discomforts. Because he was less sensitive to touch, getting dressed was no longer a painful chore. One morning, with wonder in his voice, he told me, "Mom, when I put on my underpants, they were too tight. But by the time I got downstairs, they were just the right size." Habituation--the brain's automatic modulation of sensory awareness--is no small miracle, when you think about it.
Emotionally, a vulnerable side of him emerged. "I don't want anyone to be mad at me," he said when he heard even the slightest irritation in my voice. This was the boy I had so recently thought of as impervious to my wishes. It was now painfully obvious that he had always wanted to do the right thing.
One night at dinner I found myself repeatedly correcting him: Lower your voice. Don't lean back in your chair. Stop teasing your sister. You know you can't have dessert until you eat your food. No singing at the table. Don't interrupt me. Suddenly, my patience ran out and I yelled at him before I could stop myself. He cried inconsolably, a wellspring of discouragement and self-doubt.
"Oh, I just hate it when this happens," he wailed. "What if it starts happening all the time? What if all my nights are bad nights? What if I never have a good night again?"
In my therapy office, I began to recognize children who were similarly misunderstood. Children described as angry now sounded hopeless; kids whose parents complained that they were stubborn seemed stuck. Defiance became a red flag for me--as did explosiveness and even hyperactivity. My map was changing: perhaps being out of control was a survival strategy for some kids.
Now I frequently hear myself defending kids' best intentions to their exasperated parents: Nothing would make your son happier than to please you. He wants to, but he can't-- and it's up to us to figure out why. I find myself comforting parents who blame themselves for not being in charge of their children: It's not your fault. You have not caused this. I tell them honestly that I know how it feels to say things to your child that you deeply regret. I give them permission to ease up: It's okay to give in. Love is more powerful than control.
Parents willing to accept alternative explanations for what appears to be misbehavior respond eagerly to my suggestion that these problems are not evidence of personal failure. "I'm hoping you'll tell me I'm not the worst mother in the world," the mother of an uncontrollable 4-year-old boy with significant sensory integration problems recently said to me. Once she and her husband recognized the source of their son's difficult behavior, they were able to appreciate his predicament, alter their expectations and rethink their ideas about how to discipline him. I encouraged them to accept and support him as he was , and to adopt a lifestyle that would accommodate his many needs. In consultation with their son's OT, they learned to control his environment in order to prevent sensory overload as much as possible.
But I'm still learning myself, and I'm not always certain when sensory integration is a reasonable framework for understanding behavior problems. When kids persist in everyday battles, I routinely inquire about their over- and under-sensitivity to sensory experience. I recommend an OT evaluation before a medication consultation for most hyperactive children. I don't want to overidentify sensory integration problems; on the other hand, I don't want to ignore the possibility that some kids cannot follow the rules, earn the points or honor the family contract despite considerable effort on their part.
I've discussed the possible connection between oppositional behavior and sensory integrative dysfunction with physicians, teachers and therapists--many of whom are considered authorities on the topic of disruptive behavior. Not one of them has been well informed about sensory integration theory. Most of them dismiss it out of hand because it has not been empirically validated. I find their closed-mindedness puzzling.
Therapists forced to appease managed care administrators are understandably hesitant to embrace alternative diagnoses. "Unproved" treatments are unlikely to be authorized. However, our track record for treating angry, defiant kids is not impressive. What I am discovering is that many difficult, oppositional kids can be helped. Not all of them have sensory integration problems, certainly, but a large number of them may. If they could be identified and treated early--before they get labeled as "behavior disordered," before peer problems develop, before they alienate their teachers, before their relationships with their parents get tangled up in guilt and rage and shame, before they lose faith in themselves--they might be spared the social, emotional and psychological repercussions of repeatedly failing to meet the expectations of adults.
Evan is a different child today than he was 18 months ago, when I first sat on that chair in Rebecca's clinic watching him fail. Collaboration between a talented occupational therapist, a sensitive teacher and parents who were willing to be flexible opened up new possibilities for him. He is a happy, successful first grader in a public school. He makes it through most days without a serious problem. He is kind and funny and affectionate. He is still clumsy, and he will probably never be athletic; but he has developed an astonishing talent for art. Best of all, he believes in himself.
The other morning as I drove him to school, we were talking about all the things he can do now. "I just might be the best person there ever was," he said dreamily. I smiled at him through a sudden mist of tears and kept driving, convinced that we're heading in the right direction.
Karen Smith, Ph.D., is a clinical psychologist in private practice in Athens, Georgia. She is currently writing a book about the possible connections between disruptive behavior and sensory integrative dysfunction. Address: 892 Prince Avenue, Athens, GA 30606; e-mail address: email@example.com
Sensory Integration: A Primer
The theory of sensory integration (SI) attempts to explain a process so integral to our experience that few of us are aware of it--the organization, interpretation and utilization of the continuous stream of input from our eyes, ears, skin, tendons, muscles and joints. As Evan recently commented: "Your brain is all over your body." Once we understand that, we are on our way to appreciating the many ways children's lives can be disrupted by sensory integrative dysfunction.
SI theory is the life work of the late Jean Ayres, an occupational therapist and educational psychologist whose observations of neurologically impaired children caused her to wonder about the contribution of the senses to behavior. She was particularly interested in the "hidden senses"--those that provide information about balance, the position of our bodies in space, touch, pain and temperature. Her work at UCLA's Brain Research Institute in the 1960s convinced her that irregularities in sensory processing, which she called sensory integrative dysfunction, could lead to a vast array of problems, such as inattention and poor self-regulation, over- or under-sensitivity to sensory input, disturbances in activity level, floppy muscle tone and lack of motor coordination, emotional reactivity, speech and language problems and oppositional behavior.
Ayres developed a battery of tests (the Sensory Integration and Praxis Tests or SIPT) to assess the fundamental components of sensory integration: touch reception, balance, processing of input from the muscles and joints, form and space perception, visuomotor coordination, bilateral integration, sequencing and motor planning. Results from the SIPT, which was recently standardized on a large sample of American children, provide a profile of a child's strengths and weaknesses and can be used to set specific treatment goals.
The SI framework suggests an explanation for many of the symptoms associated with an assortment of behavioral, emotional and academic conditions, including specific learning disabilities, Developmental Coordination Disorder, Reactive Attachment Disorder, Fetal Alcohol Syndrome, Schizophrenia, Pervasive Developmental Disorders and Attention-Deficit/Hyperactivity Disorder. It offers promise for understanding difficult children without a specific diagnosis, like Evan and Jack.
SI treatment is based on the concept of neuroplasticity, the nervous system's capacity to modify its structure and function in response to environmental demands. There is increasing scientific evidence of the brain's capacity for reorganization throughout the life span. SI therapists believe that purposeful activities that stimulate sensory receptors in the inner ear, skin, muscles and joints enhance the nervous system's ability to process and integrate sensory information, which in turn make higher levels of functional behavior possible.
Does SI treatment actually lay new neural pathways and reorganize sensory processing circuitry? Because we can't map or measure the complexity of neuronal connections, we can only infer neurological changes by observing a child's behavior. There is a great deal of anecdotal, clinical evidence of dramatic improvements in kids' emotional, social and academic functioning following SI treatment. What has caused those changes is unclear. Was it a natural process of maturation that would have occurred with or without occupational therapy? Was it the unconditional positive regard of the therapist? Was it the change in family dynamics once the parents understood the child's problem? Was it the SI treatment?
These are empirical questions and, admittedly, the empirical literature on sensory integration is limited. Occupational therapy is still a "young" discipline without a solid scientific foundation. Findings from studies of SI treatment outcome range from negative, to contradictory to positive; but many of those studies fail to meet the rigorous standards of scientific methodology. Nevertheless, a growing number of OT researchers are focusing on basic questions, such as how to reliably identify and classify children with SI problems, how to define SI treatment and how to select reasonable outcome measures. Until these questions are addressed with well-designed research, we will not have clear guidelines about when to recommend SI treatment and what to expect from it.
The fact that more progress has not been made in the 30 years since Jean Ayres first proposed her ideas about sensory integration is no reason to reject them outright. It wasn't so long ago that the empirical and theoretical underpinnings of psychotherapy were similarly shaky. SI theory could be a diamond in the rough, an unpolished gem with great potential value, a dream come true for many unhappy, unsuccessful children who are not receiving the help they need.
To consult with an occupational therapist who has a solid background in sensory integration, start by contacting local hospitals, pediatric rehabilitation clinics or early childhood intervention programs and asking for a pediatric OT with expertise in SI treatment. To refer a child for an SI evaluation, contact Sensory Integration International at www.sensoryint.com or call (310)320-2335 for a list of SIPT-certified occupational therapists in your geographical area. This organization also offers courses for parents, OTs and other professionals about SI theory and treatment. Another good source of information about SI research, clinical work and treatment resources is the website www.sinetwork.org, which is sponsored by the KID Foundation in Littleton, Colorado.
For more information about occupational therapy in general, refer to the American Occupational Therapy Association's website at www.aota.org .
by Katy Butler
Freud once said that four people--two mothers, two fathers--lie in bed with every couple making love. If only that were all. Hugh Hefner is under the covers with us, and Carl Djerassi, who invented the birth control pill, and Alex Comfort, who wrote The Joy of Sex. Shere Hite is there taking notes, and a doctor from the Centers for Disease Control, and Pope John Paul II and Kenneth Starr. Cindy Crawford's perfect body may float in space above us, or Long Dong Silver's, daring us to turn on the light and look at how we don't measure up.
When a man sleeps with a woman, he sleeps with her past as well, including her memories of pregnancy, date rape, abandonment or shame. When a woman sleeps with a man, she sleeps with the young boy caught reading his father's Playboy magazines and the teenager in the back seat, expected to know everything without being shown. Each of us in the industrialized West carries into the bedroom not only personal memories, but collective ones: we are layered with exhortations, like sedimentary rock. Sex, the Victorians told our great-grandmothers, is dirty: Save it for the one you love. The mature female orgasm, said Freud, is the vaginal orgasm: That comes only to women who resolve their penis envy. Women's sexuality, said the marriage manuals of the 1950s, is problematic, like the delicate wiring of an old MG: Husbands must be master mechanics. Vaginal orgasm is a myth, said the feminist theorists of the 1980s. Find the clitoris. Now.
Sleeping around will ruin your reputation, we were told in the fifties: Why buy the cow when you can get the milk through the fence? Sleeping around will free you, we were told in the sixties: Smash monogamy. Men and women are pretty much alike, we were told in the seventies. Men are from Mars, women are from Venus, we are told today.
Many of us enter the bedroom now as if we have been told we are about to play a high-stakes game. There is no rule book, or else it's been hidden. Everyone else, we think, knows how to play. We charge down the field. We pass the ball. A whistle blows. The rules have changed. The teams are being shuffled. We'll be playing with a shuttlecock now instead of a ball, and the goalposts have been moved to the other end of the field. We start running and the crowd roars, but we're not sure what we did right. Now we are on the bottom of a pile of bodies. We are given five different rule books and told to choose one that suits us. (We have no idea what book the other team is playing from.) Bleeding from the shin, we strap on our battered equipment again and once more run down the field.
We lie down with all of this, and more, when we lie down in bed with each other. We sleep with the war between men and women fueled by patriarchy and differences in physiology, and with the uneasy cease-fire in the erogenous zone that followed the feminist and sexual revolutions. We sleep with the legacy of the 1970s, when you could find, on many a middle-class nightstand, the dry, clinical bestsellers of William Masters and Virginia Johnson, the pioneers of behavioral sex therapy. The bright lights of their science were supposed to banish our fears and superstitions, like crucifixes held before a vampire. Yet the fear of pleasure, and of being discovered having pleasure, still runs beneath our bedroom floors like an underground river.
For most of us, our first sexual act was also an act of secret rebellion against our parents. The memory of this defiant split lives on in our cells in the disembodied, suppressed yet obsessed way our culture approaches sex today. Few of our fathers talked to their sons about how to enhance a woman's pleasure or prolong their own; few of our mothers ever told their daughters about the delights or even the location of the clitoris. We found out anyway, and paid the price.
In the dark recesses of our mental closets lies a negative cultural dowry--the muumuus that missionaries gave the naked Polynesians; the penitentes' cat-o'-nine-tails; the chastity belt; and the confessional--all the trappings of the Augustinian Catholic tradition that declared sex a dirty distraction on the path to God and the source of original sin. ("As the caterpiller chooses the fairest leaves to lay her eggs on," wrote the poet William Blake two centuries ago, "so the priest lays his curse on the fairest joys.") All of this we bring into the bedroom.
When we sleep with each other, we sleep with images we've absorbed and, without knowing it, those our lovers have absorbed as well. Like fast food, images of other people's orgasms, stripped of context and connection, are now available 24 hours a day and consumed alone and on the cheap. They demand of us a bravado we rarely feel. They lurk eternally on the Internet and in the phone-sex banks, at the corner video store and in the Congressional Record . Our bedrooms are colonized by them. When a woman lies down in bed with a man, a light show of images plays over her body without her knowing it: red-satin garter belts, perhaps, or beaver shots or Marilyn Chambers or Monica Lewinsky or the Penthouse Pet of the Month. When a man lies down with a woman, images of imaginary men play over his face without his knowing it--the hero of Tristan and Iseult, perhaps, or a Tammy Wynette song or a romance novel. No wonder we feel split within ourselves and from each other. We expect sexualized romantic love to carry a greater psychological burden than does any other culture on earth while we simultaneously denigrate the sexual. And so we reverberate between sexual obsession and sexual shame.
Last September, we found on our doorsteps newspapers full of the details of the president's intimacies with Monica Lewinsky--the thong underwear, the cigar, the joke sunglasses, the rejected girl crying in the rain. It didn't matter what the details were or the context in which they occurred. All that mattered was the telling of them. Opening the paper, some of us imagined how our own intimacies would read some morning, printed in black and white and dumped on our neighbors' doorsteps.
What we read in the papers that day reflected the impoverished language we bring to sex. In 1931, the English novelist Virginia Woolf wrote in The Waves, "I need a little language such as lovers speak, words of one syllable." But we can speak of lovemaking everywhere except the bedroom. For the delicate skin that touches our lover's most tender places, we have no words except the pornographic, the childlike and the scientific. We speak of vaginas, labiae, clitorises, cunts, hair pies and "down there." We call it a prick, a dick, a sledgehammer, a penis, a pee pee or Mr. Happy. Our worst insults are sexual: cunt, slut, whore, dickhead, pussy-whipped, cocksucker.
And so we lie in bed with each other, reaching for pleasure, tenderness and connection, with both too much and too little to guide us: Hustler on the newsstand, Dr. Ruth or Dr. Laura on the radio and Debbie Does Dallas on the VCR. "You do not have to be good," wrote the poet Mary Oliver. "You do not have to walk on your knees for a hundred miles through the desert, repenting. You only have to let the soft animal of your body love what it loves." But that's a big only. No wonder we are sure that someone, somewhere, is having better sex than we are. No wonder someone, somewhere is pretending to have better sex than we are. No wonder we fear we will never get it right.
Yet sometimes we do get it right--or it gets us right. Many of us have experienced something in bed that the languages of pornography, sex therapy, feminism and the double standard could not contain. It might have been the afternoon we washed our partner from head to toe in the shower, kneeling under the spray to scrub even the soles of her feet, until washing became a ritual of tenderness and awareness. It might have been a dawn when we woke from a dream experiencing what the radical psychoanalyst Wilhelm Reich called a "full-body orgasm," in which we were the wave and also a body drifting at the water's edge, pulsating to our fingertips as the wave broke on the shore. It might have been a night a man looked into our eyes and stroked our nipples for hours until we gave in to our own responses rather than following what we imagined to be his timetable. Or a night a woman looked into our eyes while we were coming and we felt safe, seen and known.
In these moments, lovemaking is sensed as healing, wholesome and holy. Our focus broadens out beyond orgasm. Our small selves are no longer in command, and we give ourselves over, little boats on a deep river. The fear of not performing well disappears, the ghosts are banished from the bedroom and the present moment absorbs us. The West's self-created divisions--between sacred and profane, heart and pelvis, male and female, victim and predator, body and soul--are temporarily healed. We understand what Walt Whitman meant when he wrote, "If anything is sacred, the human body is sacred," and what the 16th-century Anglican marriage ceremony meant when it included among its vows, "With my body, I thee worship." Our bedroom is no longer hostage to the porn palace, the sex lab or the unfinished war between men and women. For a moment, the bedroom becomes a ritual space where we enter trance and forget time.
For most of us, such moments are rare and random, despite the mixed sexual blessings of the past three decades. The sexual revolution rightly told us that sex could be a domain of pleasure and self-expression. But its prescription--quantity over quality--did not free us. The feminist revolution challenged the practice of sex as a ritual of loving female submission and encouraged women to speak of their sexual desires and sexual violations. It lit up ancient chasms between the genders, but did not bridge them.
Modern sex therapy helped thousands with simple, effective behavioral techniques, usually focused narrowly on achieving erection, intercourse or orgasm. Yet few of us have much of a clue about continuing to create the more profound joys of sexuality--especially after the first six months to two years of a relationship, when hormones subside and desire fades. We may move from arousal to contentment or indifference or contempt. We may not know how to contend with softer, slower erections and other changes related to aging. A surprising number of stable couples stop making love much, or altogether. The ghosts return to the bedroom. We may lie down in resignation in the bed we've made together, or walk once more out the door.
Or not. Some of us will embark instead on a quest for a fuller experience of intimate sexuality. We will use whatever tools we can, depending on who we are and the decade in which we set out. We may enter Reichian therapy, wrap ourselves in Saran wrap, read Nancy Friday, follow The Rules, or repeat phrases from Men Are From Mars, Women Are From Venus, but we will not give up. We want to banish the bedroom's ghosts or at least replace them with more benign presences. Risking the humiliation our culture visits on those who speak of their own sex lives rather than other people's, we will try to decolonize the bedroom. We sense that this quest requires not "more of the same"--not more sexual perfectionism or ever-more-exotic partners or positions--but a broader context, a change at the metalevel. If we embark on this quest today, we may buy a book, watch a video or go to a weekend workshop on Tantrism, which is now the West's most popular form of adult sex education.
Presaged by the popularity in the 1960s of the Kama Sutra of Vatsyayana, a 3rd-century Indian sex manual, Tantra has become a postmodern hybrid. On the most prosaic level, it is nothing more than a pastiche of positive sexual attitudes and techniques drawn from Western humanistic psychology, Chinese Taoist sexology and classical Indian Tantrism--a wild sexual and religious tradition that influenced both Buddhism and Hinduism and flourished in India about 500 A.D.
This esoteric system used breath, visualization and other yogas to arouse, channel and transform energy throughout the body. Its meditations often took the form of visualizing gods and goddesses in sexual union. In India, adherents of the tiny sect of "left-handed" Tantra took things a step further: in secret rituals, they broke all the rules of their caste-bound society, consuming taboo foods, such as alcohol and meat, sounding yogic bijas or sacred syllables and coupling with one partner after another. In contrast to monastic traditions that suppressed sexuality and avoided women, Tantrikas welcomed the energies of aggression and sexuality and transformed them. Men did not ejaculate, and the goal was to move arousal up the spine to the brain in an explosion of enlightenment and bliss. Sex was not a dirty detour from the path to God, it was the path
Today, Tantra's esoteric practices are being pressed into the service of goals that are tamer, more domestic and less religious: uniting sexuality and intimacy, and enhancing sexual pleasure for long-term couples. It's not the techniques that count so much as Tantra's enlargement of the context in which sex is held--as pleasurable, inclusive, healing, and holy. This widening of the lens was apparent as soon as modern Tantrism first registered on the American cultural radar in 1989, when a 450-page book called The Art of Sexual Ecstasy: The Path of Sacred Sexuality for Western Lovers tried to sweep the clutter of negative sexual images out of the Western bedroom. Written by Margo Anand, a writer and sex workshop leader who had studied psychology at the Sorbonne and meditation in India, it was like no sex manual the West had ever seen. She spent eight pages alone describing how to prepare a bedroom for lovemaking. Think of the bedroom as a "sacred space," Anand wrote. Vacuum the bedroom and take out the newspapers and coffee cups. Bring in plants, flowers and candles. Drape a scarf over the bedside lamp to create soft lighting. Walk three times around the room with your partner, misting the air with a plant sprayer of scented water while saying "As I purify this space, I purify my heart." This, Anand implied, was as much a part of sex as kissing.
The suggestions might seem impossibly precious. But ceremonially cleaning the bedroom and bringing in flowers and soft lights contained a metamessage: You do not have to go somewhere else or become a sliver of yourself to have sex. You don't have to "do the nasty" while hiding in the dark from your disapproving parents. When you bring flowers into the bedroom, you bring in more of yourself as well, and that can make you realize how much you had previously left outside the bedroom door. And if the bedroom is already inhabited by ghosts, why not bring in flowers as well?
In the place of pornographic slang and Latin words, Anand suggested Taoist phrases that were free of negative Western sexual connotations. Try saying "jade stalk"or "wand of light" for penis, she suggested; for vagina, substitute "cinnabar cave" or "valley of bliss." Or call them "yonis" and "lingams," after the Sanskrit words used to describe the stone sculptures of sexual organs that are still bedecked with flowers and worshiped in rural temples in India. "Behold the Shiva Lingam, beautiful as molten gold, firm as the Himalaya Mountain," she quoted the "Linga Purana," a Hindu ode to the penis of the god Shiva, Lord of the Dance. "Tender as a folded leaf, life-giving like the solar orb; behold the charm of his sparkling jewels!" It was heady stuff for a culture where "testosterone poisoning" is a running joke and the only goddess worshiped is a virgin mother. And it cleared the decks for something new.
Anand and other teachers of modern Tantra suggested that sex could involve all of us, including the warring inner parts we think we've transcended but have merely avoided: the lustful and soulful; the wounded and voracious; the slutpuppy in her Victoria's Secret lingerie and the good girl in her flannel nightie; the sensitive postfeminist man and the crude teenage boy.
Last October, at a five-day, $795-a-person workshop for couples at the Esalen Institute, yoga and Tantra teacher Charles Muir wove these warring inner and outer sexual worlds together. On the first night, he spoke about his own sexual upbringing to 23 couples sitting before him in a circle. His listeners ranged in age from 22 to 73. Among them were two Latin American academics, four lawyers, a black woman doctor, two construction managers, two women who worked in television, several massage therapists from the Esalen staff and an Irish farmer. Some sat as entwined with their partners as trailing vines, while others betrayed, in their gestures and body language, uneasiness with each other and an inequality of love or desire.
Muir, who is now separated from his wife and coteacher, Caroline (she wanted sexual fidelity; he didn't), runs the Source School of Tantra in Maui, Hawaii, and leads frequent workshops around the country. He was wearing a silk shirt and an amethyst pendant. He was slim, in his early fifties, with brown hair, protuberant eyes and spatulate fingers that gave him the look of an elongated frog. His language was closer to New York street than Hindu temple.
He had come of age in the Bronx, he said, during "The Great Fuck Drought of the Fifties." Everything he knew about sex, he said, he had learned from Johnny Patanella, the leader of his childhood street gang: Get it up, get it in, and get it off. Fuck 'em hard and fuck 'em deep. Muir said that before he discovered Tantra, he was a yogi on the mat and a "sleazebucket" in bed. He said that men give nicknames to their penises because they want to be on a first-name basis with the one who makes all their important decisions.
There were shocked laughs, a snigger. The men thought they were long past this. The women didn't want to think their men had ever thought this way.
But there was a method to his crudeness. Once Muir bonded with the part of the men that had eternally remained the teenage boy, he gently, without emasculating them, brought them into the sexual realm of context, emotion, feeling and intimacy traditionally defined as female. "In lovemaking, women lead with their hearts," he went on more softly. "Men lead with their second chakra [their groins]. We hurt each other."
Tantra, Muir said, could help them make love stay. "The average couple makes love 2.3 times a week for the first two years," he said. "After two years, the average couple makes love once a week--and making love can be a well of energy and healing.
"Chemistry is temporary. You're going to learn to base love not on chemistry--which lasts six months or two years, if you're lucky--but on alchemy. When the chemistry is no longer there, alchemy says you take what is there and you change it. Become a master alchemist."
Easier said than done, given some of the histories that the couples revealed in private conversations. One couple came to Esalen to put the "pizzazz" back in their marriage; later they acknowledged they'd hardly made love in the nine years since the birth of their son.
Paula, a Mexican American academic in her fifties who was there with Carlos, the professor with whom she lived, had not had an orgasm in the year since her hysterectomy. She had been raised a Catholic and was date raped in college. She still couldn't shake off a notion her mother had given her--that only bad girls are good at giving men sexual pleasure; at night, she still put on her pajamas behind the bathroom door. Carlos was in his forties; he had been divorced twice and had been raped and tortured a decade earlier in a South American prison.
Russ Solomon, a retired San Diego real estate developer, had raised four children with his wife, Liz, during 40 years of marriage. They looked as comfortable together as old shoes and clearly liked and respected each other. But sex, they said, had been disappointing on their wedding night when they'd both been virgins and disappointing ever since. "All I knew," Russ told me one day, "was that I was to get my penis in her vagina, and that was it." He had lain back, expecting Liz to arouse and satisfy him.
She said nothing that night, and nothing for many nights to come. She had no language then, no woman had language then for what she felt or wanted. "When you were born in 1937," she says, "it wasn't your place to show him."
Since then, they had rarely taken more than 15 minutes to make love. She spoke frequently, in front of Russ, of "40 years of shit and disappointment in the bedroom." Russ didn't treat her like a woman, didn't measure up. "I would love a flower on the pillow or a note," she said one day. "But Russ cuts articles out of the newspaper that he thinks I would be interested in. And I am. But it's not the intimacy I long for."
Couples like these could have taken their "sexual dysfunctions" and marital issues into the private confines of a sex therapist's office. But they were seeking something that Western sex therapy, for all its strengths, does not provide. Sex therapy's pioneers, Masters and Johnson, had brought thermometers, charts and transparent vaginal probes mounted with tiny video cameras to the study of sex. Sexual problems, they argued, weren't usually rooted in intractable intrapsychic or interpersonal conflict; they could often be solved by learning new behaviors. They, and those who followed them, taught women to masturbate to orgasm and men to squeeze their penises just below the coronal ridge, before they reached the "point of no return," to resolve premature ejaculation. Their techniques often worked with amazing ease, and they drained sex of some of its shaming power by making things seem as brisk, practical and scientific as a good recipe for apple pie.
But they also drained sex of magic. If their governing metaphor was the bedroom-as-medical-lab and sexual practice as an antiseptic medical-behavioral prescription, Muir's guiding metaphor at Esalen was the bedroom as temple and sexual practice as worship. And if sex therapy was predicated on healing people so that they could have sex with each other, Muir suggested that sexual pleasure itself could be healing.
In the course of the week, Muir gasped, held his breath, bugged out his eyes to demonstrate how men could use yogic breathing, pauses in lovemaking and finger pressure on their perineums to delay or forgo ejaculation. He and his coteacher, yoga practitioner Diane Greenberg, showed women how to take a man's "soft-on" and "use it like a paintbrush" to stimulate their clitorises and outer lips, or stuff it softly into the vagina. And he extolled the sensual pleasures of the half-erect penis. Referring to the Kama Sutra , he talked of varying strokes, pressure and speed. "If we go straight down the fairway--deep deep deep--we'll only be stimulating one area, guys," he said one afternoon, stroking a Plexiglas wand inside an anatomically correct, purple-velvet and pink-silk "yoni puppet" from San Francisco's House of Chicks. "Try shallow, shallow, shallow, deep! The more variety, the more information floods the brain, and the more you wake up."
A sex therapist, or in a more enlightened society, a sex educator, could have said the identical words, but the context--playful, normalized and semi-public--would not have been the same. A miniature culture, as transient and self-contained as a dewdrop, was being formed. For a handful of days, as the couples strolled the Esalen grounds above the Pacific, moving from cabin to hot tub to class, nobody was too busy or too tired to have sex. Nobody read anything about Kenneth Starr, or looked at the Sports Illustrated swimsuit issue or downloaded pornography from the Internet. Every night, in their TV-free, phone-free cabins, they looked at and touched each other's flesh-and-blood bodies rather than electronic images and paper dreams.
In class, Muir held out to them the possibility that sex could be more than a source of pleasure: it could be a source of intimate bonding as well. He taught them how to lie together spoon-fashion and breathe in unison. Sex, he said, could be more even than emotional intimacy: it could be an interplay of invisible energies that coursed through each lover's body and radiated beyond it. Every day, he led participants in yogic breathing and stretching, and then asked them whether they could feel an "energy hand" the size of an oven mitt growing beyond their flesh-and-blood hands. He had them fluff and clean their "auras" by sweeping their hands in circles a few inches from the body.
He acted not only as sex educator and yoga teacher, but priest. He taught them to chant one-syllable Sanskrit mantras designed to activate each of the body's seven chakras or energy centers that are believed to ascend the body's core. And he formed them into slow Tantric circle dances in which the men and women stared into the eyes of partner after partner while visualizing sending love and healing to virtual strangers.
If the West has defined male sexuality as the norm and female sexuality as the problem, Tantra glorifies the female: a woman's orgasms are said to increase her capacity to act as a channel for the flow of shakti, the universal female energy that powers the universe. And by deemphasizing the moment of ejaculation and emphasizing energy and context, the workshop provided the women with more of what they often complain is missing from standard-issue sex--love, sensuous touching and intimacy.
Under Muir's tutelage, lovemaking was not, as some feminists put it, a recapitulation of the power inequalities of rape, but a worship of the female and a reenactment of the drama of Shiva and Shakti, the Hindu god and goddess whose lovemaking created the universe. Partners were to see in themselves the flow of divine fundamental energies; the act of love as reproducing the first stages of the creation of the world.
Women, Muir declared, could and should have multiple orgasms, while men were depleted by ejaculation and should sometimes try the "valley orgasm"--orgasm without ejaculation. And he transcended the no-win squabble Freud started over the virtues of clitoral versus vaginal orgasms by teaching effective techniques for vaginal stimulation of the G-spot; he declared that women, too, could ejaculate when sufficiently stimulated.
This is a tall order for a culture in which 24 percent of women surveyed say that they, like Paula, have not had an orgasm during the previous year. A complex history lies behind this statistic. If the sexual lives of many men begin with repeated sexual rejection and shame, the sexual lives of many women begin in choicelessness: breasts stroked in a laundry room by a best friend's father; the struggle lost in a back seat; the unwanted kiss from uncle, teacher, boss or neighbor. When women sleep with men they sleep as well with their fear or memory of the peeper, the flasher, the child molester, the rapist, the Don Juan, the womanizer, the sexual predator, the horrible first husband and the just plain jerk. Women, too, have a double standard: we divide men not into virgins and whores, but into predators and marriage material. In a reverse of the fairy tale, we fear that while we lie in bed, our lovers will metamorphose from Beauty to the Beast.
Such memories and fears, Muir suggested, are embedded not only in the brain, but in the cells of the body. His cure was a sexual ceremony to be held in the privacy of each couple's bedroom on the third night of the workshop. In a men-only meeting beforehand, he showed videotapes and coached each man on how to do for his lover what no therapist or body worker could do--massage her "Sacred Spot," the G-spot inside her vagina.
The G-spot, Muir said, is a little known and widely misunderstood area of sexual sensitivity--a raised, furrowed area of tissue about the size of a quarter, an inch and a half inside the front wall of the vagina, against the pubic bone. When stroked, it can become erect, firm and responsive and can trigger vaginal orgasms and ejaculation of a clear liquid. But it is also the dark closet in which old sexual pain is stored. "Sacred Spot" massage, he said, might release ecstatic sexual pleasure. It might also release old memories: the women might complain of numbness or bruising, or explode in fear, sobbing or rage. "This is Tantra kindergarten," he said, coaching the men to simply be loving and to be there, no matter what. "You get an A just for showing up."
After supper, before the ceremony began, the men fanned out to their cabins all over Esalen to take on the traditionally female task of "preparing the space" for the ceremony. While Liz and the other women relaxed and giggled in the Esalen hot tubs, Russ cleaned their cabin, combed his white hair and took a shower. In another cabin, one of the construction managers lit incense and paced his room. On the other side of the garden, one of the lawyers scattered rose petals on the sheets. Carlos, the Latin American academic, arranged a vase full of flowers he had cut from the Esalen garden, cued up a CD on his laptop, lit candles, put on a formal Mexican shirt called a guayabera , turned back the sheets and waited for Paula.
When the couples shared their experiences in the group the next day, it was almost as though the sexes had exchanged roles. "Carlos massaged me so gently so tenderly," Paula said. "The other times he had massaged me it was like, let's hurry up and get this over with." After an hour or so, she said, Carlos had turned her over and asked permission to stroke her "sacred spot" with his finger. Not long afterward, she had her first orgasm in a year. "I just had a whole strand of pearls full of climaxes," she said. "It kept going on and on, the pleasure."
One woman--whose husband had left her for another woman 14 months earlier--was floored by the tide of anger and fear the exercise released. It was, she said, "like a bad acid trip." Other women came close to bragging about having multiple orgasms and ejaculations (one woman had 22 over an hour and a half), while their men were quiet, tearful and open. The men had taken on the traditionally feminine role of focusing wholeheartedly on the pleasure of another, and it had changed them. The construction manager cried, describing how he'd waited nervously for his girlfriend, terrified that he wouldn't measure up. Another man told the group that whenever he'd made love before, his consciousness had zigzagged back and forth, first checking in on his own erection and then checking in on his partner. "Last night, my presence was so totally focused on Andrea that I didn't have to worry about myself at all," he said. "When she came, I was wailing with her like I was having the biggest orgasm of my life, and I was totally limp."
Here, in a context where differences between men and women were not only acknowledged but glorified and mythologized, and where men's performance fears were out in the open, women were getting what they wanted.
The next evening came the turnabout. After supper, Muir took off his amethyst crystal pendant, blue silk shirt and oatmeal jeans. He lay on pillows on the floor in his boxer shorts, holding a clear black plastic wand from a magic store at his groin like a surrogate penis. One man pushed his girlfriend to the front of the crowd. "I don't want you to miss any of this," he said.
Diane Greenberg knelt between Muir's legs and showed the women an unbelievable range of ways to pleasure a man's penis. She was competent and sure. She twirled her fingers around the wand like a feathery screw. She squeezed it at both at the top and the bottom, explaining that this way the blood wouldn't be forced out. She slapped it and tapped it and pretended to use it like a microphone. She clasped her fingers and encircled the wand, running her thumbs in circles up and down the frenulum as though winding a bobbin.
She was leading the women into the dangerous territory of the slut goddess. If some women's sexual lives begin in choicelessness, others begin with an inner war: lying on a blanket on a hill on a warm night, grabbing at the hands that give such pleasure and pulling them away, worrying what the owner of these hands will call her to his friends the next day-- slut, pig, whore. There are years of this, and then the rings are exchanged, the rice is thrown, the church doors open and the woman is expected to become as sexy and free as the bad girl she struggled for years not to be. Fear of taking on the slut archetype can persist through years of financial independence and supposed liberation, narrowing the range of pleasure a woman dares to give a man in the bedroom. By way of antidote, Muir and Greenberg spoke of Uma, a Hindu female divinity who "wears her sexuality on the outside." They lauded Hindu temple dancers and sacred prostitutes, and urged the women to try on this aspect of the powerful divine feminine. They encouraged the couples to let loose with noise--Esalen had heard lots of it, they said, and if couples got too self-conscious, they could shout or wail into a pillow.
Then Greenberg coached the women on the coming evening's ceremony. This time, the women would "honor" the men, first massaging their bodies and their penises. ("First get him hard, ladies," Muir interjected. "Then he'll agree to anything.") Next, Greenberg said, the women were to insert one finger into their man's anus and stroke and stimulate the exquisitely sensitive "sweet little hollow" at the base of the prostate. This, she cautioned, was a delicate business. "Rather than me entering him, I'll have him sit on my finger," she explained.
Then Greenberg turned to the men. "You're going to be penetrated, guys" she said, "as we are penetrated."
As Greenberg pulled the women into new territory, Muir took the men into the unknown as well. "Every man has gone through a war of his own that has robbed him of his yin [female aspect]," he said. "Each young boy is taught that men don't cry, don't feel. The job of reclaiming your yin is sweet. You won't wake up the same guy in the morning. Tonight, you get to be the illogical one. You get to have feelings tonight. Ladies, I want you to show up big. He may test you, he may be irrational. He may become terrified.
"You give and you're strong and you fix things." he said, turning to the men. "You're gigantic. How much can you let yourself be small and feel? Allow yourself to be penetrable and vulnerable? Five million homosexuals can't be wrong. There must be something up there that's good."
When Carlos and Paula described their night's experience in the group the next morning, Carlos was in tears--deep, strong tears. During the ceremony, he had reexperienced being raped and tortured in a South American prison and had not "left his body," as he had when having flashbacks before. He had also experienced something beyond the personal as though a great wind were blowing through him and breathing his body for him. And Paula had faced something she'd once held at arms' length. "Being raised Mexican Catholic, women who do that are sluts," she said, referring to the way she'd stroked Carlos' penis and penetrated his anus. "I gave myself permission not just to touch it with my eyes closed, but to look at it and be there in all my glory, and I felt pure."
On the last day of the workshop, Muir urged the couples to try a "10-day test drive"--to connect somehow sexually, physically and emotionally for at least 10 minutes every day. By the time the couples were packing their bags, few of the men displayed the sexual bravado they'd come in with--the bravado this culture trains them for. One man, a lawyer, had told the group the first night that he'd come to the workshop because he wanted to experience a 30-minute orgasm. He left muttering about "Tantra kindergarten."
His desires had become simpler and more ambitious: to only connect with his wife of 22 years. One busy day he left work, met his wife at their son's soccer game and drove with her to the far end of the field, where they kissed and held each other for 10 minutes in the car.
Some couples--like the pair who told me brightly that they wanted to put the "pizzazz" back in their marriage--left with little. Others took away all the bells and whistles you'd expect from a sex workshop: sobbing, wailing, energy releases, multiple orgasms, female ejaculations. Others left with something perhaps more precious: the understanding that good sex--wholesome, healing and holy--is an accumulation of small mercies, beginning with whatever mercy you need right now. Like being able to take off all your clothes in front of your lover, and touch his penis in all your glory and feel pure.
They went home--to San Diego and Cleveland and Denver, to the impeachment hearings and football games and a larger culture reverberating, more publicly than usual, between sexual obsession and sexual shame. Ghosts inevitably reentered their bedrooms. Old marital squabbles reared their ugly heads again. But sometimes old disappointments were held in a new way.
If anyone had come to understand the meaning of small mercies, it was Liz and Russ. On the night that Russ had pleasured her, Liz had come to their cabin door and found him still in the shower. Something about that melted her heart. "I brought to last night 40 years of lack of trust and feeling I'm not seen as a woman," she had said in the group next day. "I've stayed in the relationship oftentimes with doubt."
"I was so touched Russ was washing his body for me, that he would even be late to do this," she said. "All the resentment and fear was gone. I felt like a woman. It was enough."
"He put on a Japanese robe," she told the group, turning to her husband. "You looked very manly in it. I wore a white silk Dior nightgown and felt like a bride. When we slipped it off, I loved the look of my body. If we had only done this on our honeymoon, what a difference it would have made."
"She could have said, 'This is your obligation,'" said Russ. "But she dismissed all that. We didn't shout and cover our faces with pillows, but it's nice to know that it's possible. We take away the hopes and stories we've been told. I pray that we will remember."
"It was enough." said Liz. "Russ was willing, after 40 years of marriage, to try something. That was enough."
When they returned home, they followed Muir's suggestions for the "10-day test drive." Every day, she and Russ lay down with each other in the morning and the evening, and snuggled and held each other. "It's been wonderful," Liz told me. "There's been no anxiety, no repulsion. It's not about making love. It's about breathing together, holding hands, the eye contact, touching the heart, the forehead. We are doing our homework. But I'm not sure we're doing it right."
In her last sentence, I heard the reverberations of our culture's sexual perfectionism. She and Russ had returned to a society with bigger work to do than any person or couple can do alone. Yet they had grasped the essence of classical Tantra as practiced in India nearly two thousand years ago, and that essence is not purely sexual. At its base, it involves welcoming and transforming all energetic and powerful states, even negative and difficult ones, by holding them in a different context.
That context involves knowing that Saint Augustine and all his intellectual and spiritual heirs, including our parents and Larry Flynt and Kenneth Starr, were wrong: Sex is neither a nasty secret pleasure nor a sin, but a part of the pattern of the universe. To put it one way, the desire to make love, connect, procreate and survive has been programmed, along with pleasure, into our genes and dreams. To put it another: Sex is sacred--intricate and dangerous and pleasurable and utterly ungraspable.
Networker associate editor Katy Butler, a former reporter for The San Francisco Chronicle, has contributed to The Los Angeles Times, The New Yorker, The New York Times Book Review and The Washington Post. For more information on Charles Muir, write to P.O. Box 69, Paia, HI 96779. Correspondence to Katy Butler may be sent to the Networker .
by Michael Yapko
IT WAS MID-MORNING ON THE FIRST DAY OF THE LARGE Psychotherapy conference when I first began noticing the small white buttons with their pithy little saying sprouting on the lapels of conference attendees: "DEPRESSION: IT'S AN ILLNESS, NOT A WEAKNESS." By late afternoon, the buttons, dispensed at an exhibit booth for a large pharmaceutical company, were everywhere. I glimpsed them affixed to collars, pockets, belt loops, purses, backpacks, folders, any spare inch of apparel or appurtenance. It was startling to see how quickly a slogan could capture the allegiance of so many of my colleagues, especially when so many of them shared a common preference for brief, solution-oriented psychotherapies. Why were they so willing to make a public endorsement of the saying? For one thing, the slogan is catchy. It seems to suggest that we've moved beyond an era of superstitious belief and finally uncovered depression's "true" nature. The idea that depression is a clear-cut illness, caused by a "chemical imbalance" that can be cleared up with a daily dose of Prozac or Zoloft, now threatens to become a widely accepted clinical mantra and a popular shibboleth, repeated in best-selling books, mass-circulation periodicals and morning TV talk shows.
Currently, the most common mental health disorder in America and one of the most costly depression racks up a staggering $54 billion a year in costs from work absenteeism, reduced productivity, lost earnings and treatment expenses, according to a 1995 study by the National Institute of Mental Health. Depression is also among the most medicalized of psychiatric diagnoses; indeed, family doctors, not psychiatrists, write up to 70 percent of antidepressant prescriptions, with a wide array of meds to choose from. With the lion's share of mental health research dollars going into psychopharmacology during the past 15 years, there are now five major classes of antidepressants on the market. Seven new medications have been introduced within the last 10 years alone, and about 15 more are now being tested by the pharmaceutical companies.
But does the wide prevalence of depression, the staggering popularity of drugs to treat it and the obvious zeal for medicalizing the whole problem constitute prima facie proof that it is a disease? Can we now reduce the complex phenomena of depression, with all its emotional, cognitive, relational, social and biological elements, to a simple neuro-chemical mistake? Or is it possible that most depressed people are not "sick," and that biology only represents one component in the reasons for their depression and the way they experience it?
While thesymptoms of depression, at least as officially described in the Diagnostic and Statistical Manual, may seem to many to be fairly clear-cut and predictable, its origins and antecedents are not. Genetics, childhood trauma, unconscious guilt, neurochemical imbalance, poor interpersonal skills, learned helplessness are all potential "ground zeroes" by one school of therapy or another. In fact, the way therapists regard and treat depression might be considered as a kind of professional Rorschach test, revealing far more about their theoretical allegiance than about the true condition of their depressed clients. Analysts are trained to think of depression as the consequence of unresolved childhood developmental losses; cognitive therapists look for errors in thinking and belief that reinforce negative emotions; behaviorists help clients extinguish habits that contribute to depression; and family therapists study systemic or interpersonal triggers for depressive symptoms. However different the methods and the philosophies of their proponents, all these models provide valuable insights into the hydra-headed entity of depression, and none can stand as the final, defining word. But of all of the methods for treating depressed clients, biological psychiatry is today in the ascendancy, due largely to the proliferation during the last 15 years of effective medications for treating depressive symptoms with fewer side effects than ever before.
The rising fascination with evolutionary psychology and biological determination has led some experts to proclaim, without much evidence, that all emotional states (including depression) are ultimately based on biology.
One study published in Psychological Science in 1990 by Robert Plomin, Robin Corley, John DeFries and David Fulker, for example, suggests that one's amount of television viewing may be genetically determined. A 1992 study in the same journal by Matt McGue and David Lykken indicates that the tendency to divorce is also biologically determined. Do we really have genes for TV and divorce? Where and how in human history would we have acquired such genes (that only seem to have been activated in the last 30 or so years)? Indeed, as psychologist Stanton Peele writes in Diseasing of America, it is currently fashionable to view all kinds of self-defeating personal behaviors, including eating disorders, excessive shopping and too much sex, as evidence of disease.
The push to redefine depression as a disease is aided and abetted by the managed care industry, which encourages the use of antidepressant medication as a treatment approach. According to psychiatrist Matthew Dumont, "It seems that if we so much as inquire whether a depression might be related to the stresses or losses of life before blasting it with a chemical, we are virtually guilty of malpractice."
But this devaluation of therapy that inevitably accompanies the new emphasis on biological approaches is wrong-headed on two fronts. In the first place, epidemiological, social and cultural data indicate that, for most people, depression is not a disease of biological origin. Increasing in prevalence among all age groups, it is growing most rapidly among late adolescents and young adults. The average age of onset for a first major depressive episode has been steadily decreasing and is now the mid-twenties. Since gene pools and biochemistry do not tend to change so markedly in so short a time, the evidence supports an argument for social and cultural causes for depression in most cases. Since 1945, when the first of the baby boomers, who suffer dis-proportionately from depression, were born, our cultural mores have changed profoundly. The breakup of the family, explosive technological growth, dwindling resources, violence, terrorism and the threat of nuclear disaster have undermined our sense of social stability and cast deep shadows over future expectations. Writing in the Archives of General Psychiatry in July 1985, psychiatrist Gerald Klerman and his colleagues identified some of the social stresses they believe account for the higher rates of depression. These include urbanization, changes in family structure, new gender roles and occupational shifts. All of these trends unsettle people, uproot them from traditional mores and meanings, confuse them about who they are and what is expected of them and create many new opportunities for experiencing inadequacy and failure. Psychology researcher Martin Seligman suggests that, as a people, we tend to be more self-absorbed than our forebears, and thus more hypersensitive to each transient mood. Seligman thinks that we may also have unrealistically high expectations of ourselves and others, even as we increasingly feel both more helpless and hopeless about controlling our lives.
This dichotomy is even more confounding for our own emotional well-being, Rates of depression and symptomatology vary widely from culture to culture and between genders, also lending support to the theory that the interplay of social, cultural and psychological factors is generally more important than biology. The Amish, for example, have considerably lower rates of depression than do other Americans. Their lower incidence of depression presumably relates to cultural factors, including vital religious beliefs, close-knit community ties and a reliance on their own labor rather than technology. Women in this country are two or three times more likely to be diagnosed as depressed than men, in part for biological reasons (reproductive events like postpartum depression and possibly premenstrual syndrome), but more likely because of systemic social inequities and cultural conditions.
There is no question that genetics and biochemistry play a part in depression, but the best data from identical-and fraternal-twin studies indicate that genetics can be identified as a cause of unipolar depression less than 20 percent of the time. But, if, as the evidence now shows, cultural and social forces contribute more to the onset of depression than does biology, medication is only a partial solution.
More important, there is now abundant evidence that therapy is as effective or more effective than drugs are for treating depression, with lower rates of relapse. In the January 1994 issue of American Psychologist, Ricardo Munoz, Steven Hollon et al. reviewed guidelines for treatment of depression developed by the Agency for Health Care Policy and Research (AHCPR) that compared thousands of treatment outcome studies using drugs alone, psychotherapy alone or a combination. Evaluating the guidelines, the authors concluded that psychotherapy was at least as efficient as drugs for relieving depression. And, on many measures, including treatment-dropout rate, social adjustment, symptomimprovement and relapse rate, psychotherapy performed better than meds. Several metanalyses of many controlled studies involving thousands of patients have reached the same conclusion. One is a recent review by David Antonuccio et al. of numerous studies comparing drugs to therapy and the value of both approaches combined, published in the December 1995 issue of Professional Psychology: Research and Practice, which reports substantial evidence for the superior effectiveness of therapy. There is "no stronger medicine" for depression than psychotherapy, writes Antonuccio in a recent issue of the American Psychologist. So, while medications can help relieve symptoms, and possibly help clients take better advantage of therapy, the reputation of Prozac or Zoloft as miracle cures for depression, rendering therapy obsolete, is simply not supported by research.
Late last year, the position of therapy was buttressed even more by the largest survey ever conducted of people who had undergone outpatient psychotherapy treatment, published in the November 1995 issue of Consumer Reports (See Around the Network, January/February 1996 Networker) and based on extensive reader-response questionnaires submitted by 4,000 subscribers. Unlike standard efficacy studies, with their random assignments of clients meeting rigid eligibility requirements to standardized treatments, the Consumer Reports survey caught the experience of therapy as it really is for most people with therapists who typically offer an eclectic mix of approaches and adjust their work to individual clients.
Of respondents to the survey, 87 percent said they felt better after treatment. There was no significant difference between psychotherapy alone and in combination with medication for any disorder, including depression. And social workers, psychologists and psychiatrists all had roughly the same rates of success. Most surprising, perhaps, to a field giving increased emphasis to brief therapy, respondents reported better results for longer treatment. Among those with similar levels of emotional difficulty, those who stayed in therapy more than six months said they made greater progress than those who left earlier. Not surprisingly, people whose choice of therapist or whose length of treatment was dictated by insurance coverage improved less than those who freely chose the clinician and modality.
Although the Consumer Reports study is not without problems low response rate to the questionnaire, lack of specificity to the depression diagnosis and other possibly distorting factors it broke new ground. By going directly to the mental health consumer, it produced the most naturalistic view of the actual experience of therapy of any study of the field ever conducted. According to psychology researcher Martin Seligman, principal consultant on the survey, writing in the December 1995 American Psychologist, "[The survey] is large-scale; it samples treatment as it is actually delivered in the field; it samples without obvious bias those who seek out treatment; it measures multiple outcomes . . .; it is statistically stringent and finds clinically meaningful results ... Its major advantage over the efficacy method for studying the effectiveness of psychotherapy and medications is that it captures how mid to whom treatment is actually delivered and toward what end. ... It provides a powerful addition to what we know about the effectiveness of psychotherapy and a pioneering way of finding out more."
While medications are often invaluable for symptom relief of depression, their effectiveness is not evidence for an underlying physical pathology. Medications work because they have a relevant chemical effect, indicating a correlation between their impact on specific neurotransmitters and mood. But while there are some cases in which medications may help depression sufferers without additional treatment, the consensus among most depression experts is that only prescribing medications is generally a disservice to the client. Most people require much more substantial psychotherapeutic help to learn the skills necessary for solving problems and avoiding future difficulties, if their medication-improved mood is to endure.
What is it about psychotherapy that makes it so vital to treatment, that gives depressed clients something they cannot obtain from medications? People become and stay depressed partly because they tend to explain life's ordinary defeats and disappointments in terms of their personal inadequacies and failures, and then believe their own negative opinion of themselves. Others have deeply pessimistic worldviews that influence their mood states and tend to engender self-fulfilling prophecies. A healing relationship with a therapist can provide the kind of personal support and teaching that can clear up the misperceptions that contribute to the negativistic view of life typical of depressed people. Therapy can help clients see life events from different perspectives and reattribute experience by assigning alternative explanations for life events that are less damaging to themselves than the typical depressive worldview. The ability to see and interpret events from new perspectives is critical to mental health.
As we become increasingly a nation of wanderers, our lack of steady and sustained social connections and consequent lack of competence in relationship skills provokes even higher rates of depression. Our ethos of extreme individuality and personal rights over collective responsibility and social accommodation increases the likelihood that we will be lonely and depressed, without the deep ties to family and friends that can immunize us against alienation and despair. But there is no disease here, just a way of responding to life that is proving ever more toxic to our individual and collective psyches.
As therapists, what can we do in the face of this rising tide of depression, which deeply implicates not the faulty biology of millions of people but the depressing nature of our civilization? And how can we counter the myth of pharmaceutical omnipotence that undermines our own confidence in therapy and our appreciation for its irreplaceable role? We must be aware that therapy works with depressed people because it draws on the clinical skills and adaptability required to understand a complex disorder skills no pill can mimic. Therapists also need to emphasize active, solution-oriented treatments over pathology-based passive ones. Rather than search the dim past for causes of presumed deficits, we need to actively teach clients the specific skills they need to manage their feelings and develop what author Daniel Goleman calls their "emotional intelligence."
Martin Seligman, in his book, The Optimistic Child, writes that antidepressant skills for interpreting and responding intelligently to life events can be taught at a young age. We can prevent later misery by teaching children to be more flexible in their interactions and empower them to solve problems before they lead to entrenched, self-destructive patterns of behavior. Similarly, Robert Ornstein and Paul Ehrlich, in their book New World, New Mind, argue cogently that learning to think preventively acquiring a refined sense of the relationship between "this" course of action and "that" predictable consequence helps people avoid being sucked under by their own moods and emotional reactions. In short, therapists are badly needed to help people learn the tried-and-true skills that used to be considered the hallmark of adulthood. They include the ability to think ahead, critically consider alternatives, anticipate consequences, recognize when to give precedence to the heart or the head and, perhaps most of all, create and maintain solid and satisfying personal connections to other people.
Just as there is no single cause for depression, which is the personal and idiosyncratic response of individuals to a multitude of biological, psychological and social factors, so there can be no all-purpose panacea, like the simple act of taking a pill, that resolves life's difficulties. The idea that depression is a disease reflects, in part, the benign intention to destigmatize the suffering it causes and, less benevolently, the economic pressures to find a cheaper cure. Americans have a history of valuing quick-fix solutions to difficult problems. But this simplistic approach to depressive disorders underestimates the remarkable human capacity for self-transformation. We have the ability to use imagination and intelligence to change our life circumstances, our attitudes and emotions, even, to some extent, our personalities. It is the privilege of our profession to be able to help troubled people along this path, and though medications may make this journey less arduous, in the long run, therapists are indispensable for getting their clients to this destination.
So, for the sake of your profession and your integrity, watch out for facile explanations of depression and pluck off those buttons that reduce complex issues to catchy slogans. Your clients will thank you, and you'll feel better about your vital role in treatment.
Michael Yapko, Ph.D., is a clinical psychologist and marriage and family therapist in private practice in Solana Beach, California. He conducts workshops nationally and internationally in hypnosis and brief therapy methods, and is the author of the new book Breaking the Patterns of Depression (Doubleday). Address: 462 Stevens Avenue, Suite 309, Solana Beach, CA 92075.
by David Waters
It was the kind of tense stalemate between an angry, critical father and an increasingly withdrawn teenage son I'd seen many times through the years. Greg was a single parent who seemed to regard every exchange with his shy, 14-year-old son, Tad, as an opportunity for a "corrective experience." But they were both bright and articulate, and therapy started off with both of them readily agreeing to spend more time together.
Having contact isn't the same as making contact, however. Greg routinely ended up angry and disgusted with his son, rarely missing an opportunity to find fault, much like his description of his own father's behavior. Rather than focusing on Tad, Greg spent many of our sessions talking about how bad his father had been. In short, therapy wasn't going anywhere.
Finally, in one session, I decided to get Greg's full attention. As he launched into yet another rant about his father, I said, "Forget your damn father, Greg, and focus on helping your son!" I tried to say this with just enough mock exasperation that I wouldn't sound like a critical dad myself. I went on, "You came here because you couldn't connect with your son, but every time you approach him, you get tangled up in all your old anger toward your father. It's time to cut it out! Your father's already done enough harm. Don't let him come between you and your son."
Greg was stupefied, and incredulous. "Forget my father ? Stop having these feelings ? What the hell kind of therapist are you?"
"Good question," I replied. "I'm the kind of therapist who hates to see the same painful pattern repeated over and over, and, today, I'm a therapist who hates to see long-dead fathers ruin the bond between their sons and grandsons. So your father isn't welcome in this room, for the time being. I don't want to hear a word about him until further notice. I want all of your attention on your son, and on the present. I want you to focus on doing what your father couldn't do, instead of repeating what he did."
This wasn't a well-rehearsed therapeutic routine. It was improvisation, with a purpose: to flip an all-too-repetitive moment into what I like to call a Big Moment, a therapeutic event that raises the stakes and deepens the possibilities, creating the climate for a conversation that might otherwise never happen. In this case, I knew from Greg's response--a mix of startled anger and hesitance--that I'd gotten his attention with my statement in a way I hadn't been achieving with therapy-as-usual.
As a younger therapist, I'd have thought that this moment with Greg was an unadulterated triumph. I'd have basked in the feeling of new energy between us that I sensed when Greg was caught off guard, and I'd have assumed that Greg had been stimulated to consider a new way of behaving. Basically, I'd have thought my job was all but done and transformation was just around the corner. For, as a younger therapist, I was convinced that the challenge of really getting the client's attention couldn't be overstated. In those days, I didn't ask questions about the larger context of a Big Moment--how it could be employed in the totality of a client's life. I believed there were just two kinds of cases: your usual, low-level-of-attention cases, in which clients put in their time, did their homework, and incrementally moved out of their old ruts, and the far more interesting, high-attention-level cases, in which clients embarked on a project, a therapeutic undertaking that seized clients' imaginations with the potential to alter them on every level. I also believed that these two types of cases were mutually exclusive.
I'm writing now to document my discovery that they are, in fact, not mutually exclusive, but that both approaches, combined, produce the best results. This is a story of learning the hard way.
Big Moment Addiction
I used to get very excited when I thought that clients were about to embark on what I called a project--a course of action that crystallized a problem into a unifying undertaking; a Big Moment extended over time. Here's an example.
Tammy's family came to see me after moving to Charlottesville, Virginia, to get 16-year-old Tammy away from Tony, the boyfriend-from-hell who'd slept with her and later given them all a pregnancy scare. But moving the family hadn't changed gorgeous, talented, spoiled Tammy's feelings about ne'er-do-well Tony. While the parents lectured and cried, she stayed absolutely glued to her dream of true love. This in spite of her admission that Tony cheated with other girls and had walked away when she feared she was pregnant, saying, "It could be anybody's."
When I couldn't get the family off a fruitless repetition of the same battle over changing their daughter's mind about Tony, I decided to see Tammy alone. In these individual sessions, I appealed to the princess in her--a major feature, to say the least. I asked her how a guy should treat a girl in general. Her answer included every romantic clichÃ© from flowers and jewelry to spaniel-like devotion. I had to fight the temptation to point out that Tony hadn't met a single one of these criteria. Instead, I asked her to muse about how it looks when a guy comes through, how it looks when he doesn't, and how a girl can tell the difference.
As Tammy became increasingly involved in our discussions, a project emerged: Tammy would go on a field trip back to her previous hometown to see whether Tony could pass this test of how a guy should treat a girl. I didn't bring up this excursion directly, because she needed to come up with the idea and structure the "test" herself. When she did, I was very skeptical, and made her think through every ramification. She listened to me and plotted her "data collection" with an energy and verve I'd never have thought possible in the early, listless stage of our work together. I began to see a maturity and level of insight I hadn't suspected she was capable of. Once she'd considered every aspect of the visit, we planned how to go to her parents with this outrageous idea.
When she did approach parents, they hit the roof, as we'd expected. But she was able to convince them that she really had to see for herself whether Tony was a creep. So, with lots of preparation, we sent her back to spend the weekend seeing her old boyfriend.
The week of the experiment, her parents and I had our hearts in our mouths. Then Tammy came back reporting that Tony was "okay," but there was now a noticeable shift; she no longer seemed to feel any real excitement about him and had no plans to continue the relationship. The project seemed to have gotten her into a new mode of thinking--critical and observant, rather than mushy-headed and romantic. The more she talked about Tony, the clearer it became that she didn't particularly like him. We all breathed a sigh of relief, and I felt great that the project had worked so well.
But then the unexpected happened. After the project was over, Tammy dropped back into her funk. She got into meaningless struggles with her parents and lost the spark that had made her an attentive, excited collaborator. I couldn't get her interested in taking on any other challenges and, ultimately, lost the family to their resigned sense that they'd done all they could. After our creative leap, it seemed, no real change happened.
Why didn't it work? Why did I lose Tammy's interest? While the trip to see Tony had captured her imagination, once that adventure was over, she was again staring out the window and asking whether the session was up yet. Tony wasn't the white knight she'd imagined, but she remained obsessed with finding one. This quest was far more interesting to her than working on boring issues of self-worth and empowerment, which had been important only in the context of the "Tony test." I couldn't translate the excitement generated by our project into an ongoing interest in growing up. So what I'd thought of as the beginning of the work turned out to be the end.
Now I understand that I was expecting too much of a 16-year-old. She'd faced a challenge and met it, and this increased her awareness. She wasn't going to grow up according to my timetable. I was paying more attention to my goals than to her life and her teenageness. Perhaps I should have suggested that she and the family digest the experience, and that we meet again in six months to compare notes. Almost certainly, she'd have pursued another white knight with similar results. Then, with work, I might have been gotten her to perceive the repetition and begin to root out the white knight myth. But I was so enthralled with our Big Moment, our project, that I couldn't get focused on how to keep her interested in growing up. Once the excitement of the project was over, both Tammy and I got bored with the grunt-work of change. I failed to understand that if I wasn't excited with gradual growth, I couldn't expect excitement from my clients.
Learning to Fly
What first made me fall in love with being a therapist was the idea that I could make a living by having conversations that cut through everyday pretenses, got directly to the heart of the matter, and helped people change their lives. This was profoundly appealing to someone who came from a reticent, emotionally avoidant, WASP family that was devoted to the creed "If you do have to feel something, for God's sake don't let on." Unfortunately, I entered grad school in the late stages of the psychoanalytic hegemony, when therapeutic impact was thought to derive from the therapist's ability to remain silent for years--not exactly what I had in mind. As a result, my early supervisors diagnosed me with poor impulse control. My play-therapy supervisor used to say to me, "Dave, 'play' refers to the child, not the therapist!"
But I wanted to make things happen! I was too impatient to wait while a child came up with his own version of a game, so I'd help him out a little by teeing it up for him. After watching him roll the same car back and forth in the sand tray for three sessions, I'd say something like, "Let's race the cars around the track and see which one goes faster." I just knew that this would give me good data about how he dealt with competition (read: Oedipal drama). But my supervisor didn't agree, insisting that I merely reflect and validate the child's play, however poky it might be.
Adult therapy went pretty much the same way. That supervisor would say things like, "That was an excellent interpretation, Dave, but six months too early." And I'd think, "I'm supposed to sit on that idea for six months?!" They didn't understand: I wanted to earn my keep--a lifelong anxiety--and have clients get excited about what we were doing. It was less about my ego (a not inconsiderable factor) and more about my need to prove, to myself and my clients, that this work could make a difference. I believed that the possibility of breakthrough should always be at the forefront. But in most of the therapy I saw and experienced, there was little place for novelty and few indications of real impact. It made no sense to me to move so cautiously through the valuable therapeutic hour.
Luckily, just as I was starting out in the profession, the whole field of therapy began to shift. A cacophony of raucous new voices started drowning out the quiet, refined tones of the psychoanalytic old guard. In this heady new world, my impulse-control problem suddenly became an asset. Spontaneity, energy, imagination, daring were now therapy's new watchwords. The low-decibel collective drone of analytic therapy morphed almost overnight, it seemed, into encounter groups and T-groups with exotic and radical ways of working, often led by people without much knowledge and expertise. The basic idea seemed to be that restraint was old-fashioned and unnecessary, and that people needed encouragement to listen to their healthy, but usually ignored, impulses. I still recall my Student Health Therapy Group petitioning me to meet as a nude encounter group, in order to "get past the charade of self-presentation." My supervisor nixed the proposal in a heartbeat (more's the pity), but it still represents for me the freewheeling zeitgeist of the period.
Even psychoanalysis, that conservative bastion of methodical control that had set the rules for so long, experimented. There were schools like Direct Psychoanalysis, in which, for example, the therapist would bombard a psychotic patient with interpretive feedback to break through defenses. "So you want to fuck your mother?" the direct analyst would ask the patient, often repeatedly, as the patient got more and more upset. I couldn't imagine how it could work, but it was certainly exciting to see even the hoariest old schools of thought join the creativity parade.
To me, the most radical and interesting innovation was family therapy, with people like Jay Haley and Salvador Minuchin and Carl Whitaker doing things that scandalized the therapeutic old guard. Imagine my excitement when I discovered this brand-new, brave new world! At the family therapy workshops and externships I began attending, film clips would be shown of dramatic breakthroughs and amazing turnarounds. Minuchin would create stunning metaphors on a stage, in vivo, that visibly changed the family. Harry Aponte would have an outright battle with a child or an adult about their part in the problem. Whitaker would say crazy things. One time, he said to a recently discharged young man, who was looking at a chair before sitting down for a family session, "Don't sit there, I think there are little pieces of shit all over it." The man bonded with Whitaker immediately.
As I sat in workshops and watched these little miracles happen, feeling terribly mundane and unimaginative by comparison and wondering whether I'd ever have what it took to say and do such remarkable things, I got hooked on the Big Moment. Like many others in the field, I became enamored of the point in therapy when the problem is transformed or the solution is achieved in a flash. The creative breakthrough became the moment of therapy for me. Everything else led up to it, supported it, or built on it.
All of a sudden, I felt a new freedom as a clinician. I stopped waiting for people to bring things up and started leading the way; I stopped settling for small gains and started pushing for more, trusting that there'd be more. True, what I did might not seem thrilling now, but against the backdrop of total analytic quietude, it seemed daring and exciting.
Once, for example, I pushed a timid, intimacy-phobic husband to give his wife "a real hug" at the end of a hard session. He gave her a tepid, A-frame hug worthy of a distant cousin. Although hug therapy was already a radical departure for me, I made myself tell him it wasn't good enough and ask him to give her a real, "I'm-crazy-about-you," hug. He claimed it was Â a real hug, and told me to leave him alone. That didn't deter me. I asked his wife if the hug felt "real" to her. In her nice gentle way, she indicated that she was eager for more contact. He tried again, and three minutes later, when they were definitely getting the hang of it, I slipped out. I wasn't going to upstage Minuchin with work like this, but I think it helped more than a few of my clients find some new potential in themselves. I know I did.
The Limits of Creativity and Change
That was then, and this is now. Today as a profession--and as a society--we're much more fearbound and rule conscious than we used to be. Many professionals live in terror of making a mistake, getting sued, and being politically or socially or bureaucratically incorrect. It's become a lousy atmosphere for creative leaps and Big Moments, or even for reaching beyond "approved" forms of interaction. Yet the sacred space of the therapy room is the ideal place to really exercise your creativity. What individuals can accomplish together in a private, protected undertaking is as amazing as it ever was.
In spite of the current restrictive atmosphere of fear permeating the therapy profession, I've hung on to my early passion for change and impact. However, Tammy and many other clients have taught me that after a breakthrough moment in therapy, it can often be quite difficult to interest a patient in the work necessary to maintain the gain or put the new ideas to work. All too often, patients drawn to the Big Moment have started immediately looking for the next one, rather than focusing on the hard work of applying and embodying more fully what the Big Moment had revealed. In this way, patients are no different from us--just as we go to workshops hoping to learn how to do magic, patients often come to therapists hoping to have magic practiced on them. Slow, hard struggle is much less appealing.
The danger is that the therapist and/or the patient can get hooked on creating the Big Moment and lose the will for the hard work that can slowly change unfulfilling habits. The real challenge, I began to realize, isn't just to create interest and intensity in a session, but to incorporate the movement generated by sessions into habits of thought, feeling, and action that patients can establish as part of their lives.
Having become disillusioned with the Big-Moment approach to therapy,Â I made a classic mistake of overcorrection. I began to look longingly at the CBT manuals and their methods for hammering home therapeutic gains. I became envious of the clear protocols presented by workshop veterans of one school or another. Even totally programmed therapies like EMDR began to seem appealing. I started distrusting my creative impulses and began to seek out some reliable way to really change people.
Of course, this kind of search for new tools and more dependable methods is common in this field, a profession in which it's so easy to develop doubt about one's effectiveness. An older psychiatrist I admired a lot once described therapy as "the only profession that gives you five or six chances a day to feel like a failure." At this stage in my career, my self-doubt became so strong that even when things went well, I'd often ask myself, "Would it have gone that way anyway? Did the therapy make a difference, or was I just on the scene when the improvement happened?" I'd hear my friends describe great outcomes and wonder if I'd ever helped anyone that much.
Then I began to place my bets on the more formal, structured rigor of getting people to actually do what we were talking about. In couples therapy, for example, I'd always spent a lot of effort helping people connect in my office through physical contact, honest revelation, and taking chances with each other in ways they couldn't do without me. Call it Relational Creativity 101. But it never included much by way of homework, carefully checking back about what actually happened, or discussing what had helped most in getting someone to really do things differently. So I decided to start placing more emphasis on giving couples small but consistent actions they could take home and build on.
I began giving a homework assignment I called the Shape-Up, inspired by what happens on the docks every morning when stevedores gather around to divvy up the day's responsibilities and make sure everyone is pulling their weight. I asked couples to have a Shape-Up time every evening when the second person came in the door. They were to meet, shoo the kids away, and take just 5 to 10 minutes to check in with each other: How was your day? What do you need to get done tonight? How can we help each other? What happened today that we both need to know about, especially kids-wise? What other preoccupations are you carrying?
I soon found, however, that even after a wonderfully connected session, many couples only managed to do the Shape-Up once or twice. Even when I exhorted them to build this ritual into their lives and they agreed enthusiastically, they often got sidetracked and never went back to it. I began to wonder why I could get couples over a huge barrier in the session, but couldn't help them make a small, day-to-day adjustment.
Certainly, part of the reason was that I wasn't at home with them to encourage and enforce change. But I also realized that scheduling the daily Shape-Up felt too small and inconsequential, too ordinary to make a difference to them. People will reach deep for a moment of high drama and poignancy, but won't go upstairs to make the small contact that might change the course of an evening--and cumulatively, over time, a relationship.
So I decided to make much more of the small follow-up steps with clients --to try to get the level of involvement from them at home that I could get in the office for big changes or enactments. But it's hard to get people to pay the same attention, take small steps seriously, and really commit to gradual change. It was a replay of how I felt about the difference between the energy of making small changes required to get out of a rut and that of undertaking a project when I first did therapy. They couldn't get very interested, and, at first, I felt a little foolish following up our breakthroughs with nickel-and-dime exercises. It felt rote and unimaginative, not creative enough. But I noticed that when clients did take the exercise seriously enough to follow through on it daily, it often made a bigger difference than the Big Moment.
If I were showing tapes at a workshop, like everyone else, I'd be more apt to show the point at which I was able to create the dramatic change than the difficult negotiations needed to get couples to sign on for the Shape-Up. But clearly, there's a place for both models--breakthrough and working-through--in our work. The Big Moment is good for getting people's attention, but we always need to bear in mind what we're getting people's attention for. The role of the creative leap in therapy is to establish a strong involvement with an issue and engage clients fully in the difficult and laborious business of change. But however valuable creativity can be in setting up the conditions in which transformation may take place, change itself requires repetition and commitment to altering habits and revisiting an issue over and over and over again. People often need a startling moment of awareness to build the small changes around, but the startle itself usually won't suffice to shift lifelong patterns
Consider the case of Kelly and Jack, who've been married 20 years, during much of which they've agreed on only one thing--they don't want a divorce. They both felt "truly married for life," even if that life was a big pain in the butt. They fought more or less nonstop--mostly niggling little put-downs, punctuated by occasional nasty battles. One particular source of conflict was how to raise the kids, and every evening was a pastiche of disagreements and rolled eyes over the right way to do things. I tried to mediate and deflect their arguments; I got them agreeing on better ways to work with the kids; I tried to institute the Shape-Up. In short, I worked to help them make a lot of small changes that could have made a difference, but didn't.
One day recently, they were starting to repeat the old mantras of criticism and disgust, in their usual playful manner, when I had an idea. "Slide over on the couch, Jack, and put your arm around her," I requested. He moved one inch and laughed. I pushed on this request for several minutes, in an atmosphere of growing tension. They both said it was artificial and forced and not worth bothering with, but I held my ground. The tenseness increased. Finally I said, "You just can't do it. Admit it. You're afraid to get really close. You're both scared of intimacy, and you maintain this game of playful meanness as a substitute; but you're not comfortable with actually being close." They froze.
Neither said anything for what felt like 30 or 40 seconds, and I wasn't sure whether they felt attacked or helped. Then Jack said, very slowly, "It's absolutely true. I can't get close to her. I sometimes admit to myself that I'll pick on her and start a fight if things are getting too cozy." Kelly was surprised by this admission, but then copped to the same pattern. "I know I can always get his back up by talking money."
The younger me would have felt like we'd cracked the case, and moved on from there toward the next breakthrough. But as a veteran of far too many Big Moments that ultimately led nowhere, I realized that what had just happened was merely an indication that Jack and Kelly needed to spend time doing all the little things required to break that pattern. Fear of intimacy and their unconscious contract to stay together but not close became the focus of our therapy sessions. Then we began working on the small steps needed to change these ingrained patterns.
We went back over the Shape-Up, the rules of engagement around the kids, and the ways they could help each other out. We looked repeatedly at how to deal with the moments in which they have to choose how to be with each other. We talked about their having the courage and presence of mind to do something different. We examined the roots of their avoidance of intimacy, with an emphasis on patterns of thinking and reacting, and how to change those. The shock and dismay they felt at seeing the issue starkly became a touchstone for making these small changes.
We now had a project together that synthesized the Big Moment and the day-to-day work of getting out of a rut. Without the big issue in our sights, I wasn't able to keep them focused on moving toward something better. But at the same time, without the small changes and the ongoing attention to doing little things differently, the creative leap we'd shared was an interesting insight, but wouldn't have changed anything.
In these days of Managed Care and Therapeutic Minimalism, my biggest concern about therapy is that we don't ask enough of it. Too often, we don't push ourselves or our clients hard enough to make the changes that make a real difference in people's lives. It's taken me more than 30 years to realize that it's the combination of two strange bedfellows--imagination and repetition--that holds the key to change.
I still cherish and nurture my ability to sometimes make a dramatic intervention that gets my clients' attention, but today, when it works, I immediately recognize that I have a new task: keeping it in our sights. How do we tie it in to the day-to-day realities of life and get our insight to play out in real ways? Often that's harder to do than the original breakthrough, but that's what makes our job as therapists challenging. I realize now that, for many years, I was letting myself off the hook too easily by thinking, "Now that I showed them the way, my work is done." Today I know that good therapy requires a whole second sequence that builds on insights and carries clients forward in a variety of ongoing, daily events.
To move clients out of their ruts, their numbness, and their stuck places, we need to get their attention and start their adrenaline going at a rate that wakes them up and helps them to experience the fullness of life again. Creative Big Moments can be indispensable for this. They also get us out of our own ruts and make us feel more alive, making them a great antidote to the pitfalls of this profession and the perils of burnout. Intense, vibrant, liminal, human interaction--experience that goes off an edge and soars--is wonderful stuff for everybody involved. It's something to strive for in therapy, to recognize and cherish when it occurs, and to help clients build upon in their daily lives. But the Big Moment needs many little moments to make it stick.
That may sound like an underwhelming conclusion, but something else I've learned as a therapist and a man is that the simplest things to say can be the hardest to do, and can take the better part of a lifetime to learn.
David Waters, Ph.D., is a professor of family medicine, psychiatric medicine, and psychology at the University of Virginia in Charlottesville, Virginia. He's practiced family and marital therapy for 30 years. Contact: firstname.lastname@example.org. Letters to the Editor about this article may be e-mailed to email@example.com.