Saturday, December 05, 2009

Existential Psychotherapy 5

In The Dry Salvages (Number 3 of "Four Quartets") we read the memorable words:
"but the sudden illumination— We had the experience but missed the meaning."
Since I first read T.S.Eliot way back in the 1970s under the wonderful direction of Michael Paul Gallagher, S.J., an erudite and wise lecturer in English literature, I was captivated by the above quotation. Michael Paul introduced us to the magic and wonder of literature which has never ceased to captivate me. I have always been grateful that I was so lucky to have such a wonderful teacher. Michael Paul is now a professor of fundamental theology in the Universita' Gregoriana in Rome. He could equally be a professor of English literature. As well as that this erudite and humble man is a fluent speaker of at least three languages outside English.

Jesuits are great practitioners as well as thinkers. They reflect a lot on life - indeed, in their training they have a lot of time to do that. To reflect on lived experience is one way of expressing their very raison d'etre as an order in the Catholic Church and they can trace such a reflection back to their founder St Ignatius Loyola. Hence, the significance of the above quotation for Michael Paul, for the Jesuit way of reflection, for a modern way of doing theology - not theoretically from above (that is, starting with revealed dogma and imposing it on the human being), but practically from below, taking the reality of human experience and then reflecting upon it theologically and theoretically. Such a valuing of experience enhances and strengthens theology as a science firmly rooted among the social and human sciences. As one who is a qualified theologian, but has long left Catholic tenets behind, I still value the superb training I got to Licentiate level in a Jesuit College here in Dublin.

Be that as it may, let me now return to my topic, namely Existential Psychotherapy. The relevance of the above preliminary reflections is this: too few of us have the luxury or the time to reflect on lived experience. Also, too many of us lack the luck of having a secure and balanced centre of gravity. I speak here from personal experience. I had a nervous breakdown half-way through my STL and I felt myself abandoned on a terrifying sea of confusion, bereft of meaning, broken, fragmented and existentially adrift in a terrifying and tormenting mental ocean. There seemed to be no land (of meaning) ahoy. I did eventually recover and did manage to struggle ashore like some shipwrecked Robinson Crusoe on a small island in the sun to complete my degree with first honours under the direction of another wonderful, erudite and humble Jesuit, Dr. John Macken, who alas died all too young (51) in the mid nineties of the last century. I owe John a lot, both academically and personally. He was a wonderful man and gifted academic. Anyway, existentially, I was, during that particular period in my life, physically and emotionally unable to function, let alone reflect on my experience. Needless to say, I did get the opportunity to so many times later in my life.

Central to existential therapy is the lived experience. For us existentialists, the vicissitudes of existence is always prior to reflection. In the world of existentialism, we say that existence always precedes essence, that existing is simply prior to reflection which can only occur later. In a sense, the experience of living always defies efforts to capture it in thought, though we humans strive to do so by working, writing, composing - in short by being creative. Music is a most wonderful, non-cognitive way (to some extent, though I'm sure the act of composing needs good cognitive skills) of giving meaning to life.

Anyway, there I was last week working hard, doing too much as usual, feeling a little under pressure, if not a little stupidly and selfishly self-pitying, when I was graced by the presence of several suffering human beings. Firstly, there was young Tom (I've changed his name for anonymity), an academically weak adolescent boy with a diagnosis of Asperger's, mild general learning difficulties, severe anxiety and recently the added diagnosis of the scourge of OCD. This poor soul exists in an extremely anxious world of continually checking, checking, checking little things. He finds it impossible to relax and is a major worry for his poor mother. Let's call this woman Ann - she is full of anxiety about her son's angst if that not too tortuous a way of expressing my meaning here. She herself is feeling abandoned and powerless to do anything. Such a feeling of powerlessness is often at the heart of the existential nature of human living. I listened. My fellow resource teachers listened as did the school counsellor. We may not have solved any problems, but we did listen. Listening was all we could do indeed. But, such listening is the most importanr thing any of us can do for another human being. Never underestimate it!

Then there was Julian (also a pseudonym) who was/is equally lost. He is a young man, also diagnosed with Asperger's syndrome, who unfortunately has a severe kidney disease - he only has some 25% kidney function. He will either have to be on kidney dialysis or have a transplant by the time he is 25. Well, poor Julian came to me a few days ago and told me he has to have a heart scan in the next few days as the Doctor fears he may have some heart damage due to his very high blood pressure. This is existentialism in its very essence, if the reader will forgive the forced paradox. As I listened, I offered no consolations, no soft advice, now words of wisdom, absolutely nothing that would reduce Julian's sense of lostness. That was his to own and to express in his own unique way. That was his alone to make his sense of, and to make some meaning of in his own unique way. I was merely the listener, the facilitator of that act of making meaning. I was the sensitive ear, the listener, the rock on which Julian could sit for some 40 minutes or so. Of course, I did say some things, I did share some reflections from my own experiences, but I never offered any cheap answers. I am too old and have suffered too much myself and have done too much work in psychotherapy to have offered any cheap advice. I know how to sit and listen and how to carry and contain myself and any other who wishes to confide in or lean on my own healing brokenness.

As I write I am listening to RTE Radio I which is broadcasting a wonderful programme on an Irish musician who is losing her hearing: Documentary on One:Beethoven and Me where Flautist Elizabeth Pectu talks about the hearing loss that led her to leave the RTE Concert Orchestra and her passion for the arts. See this link here: Documentary on One This programme nicely summed up the human predicament - namely, our powerlessness over much that happens us in life. Think of the irony or paradox of being a musician or composer of music and to be losing your sense of hearing. This must surely be a dreadfully disorienting cross to carry in life. Yet this programme also heralds the strength of the human spirit in transcending that loss. Like Beethoven, Elizabeth Pectu is transforming her life into something wonderful and beautiful by continuing with her work, by continuing to play her instrument despite her hearing gradually being lost. She has sought out new hearing devices, devised by recent medical research, which can at least give her some sense of sound. This search for meaning, be it indeed very anguished, is in itself a central part of the existential nature of life. That is, we humans must, if we are to survive in this life at all, seek to give meaning to our lives, seek, in fact and in strife, to make our own meaning. If we give up in this task we will succumb to the bottomless pit of depression and possible suicide. The existential task of making and creating ourselves is always at the heart of the very project that is life, that is living. This is in itself the very essence of the existentialist project which we all experience in the here-and-now of our own lives.

"Angst", that central word of existentialism, sometimes called dread, anxiety or even anguish is a term that is common to many existentialist thinkers. It is generally held to be the experience of freedom and responsibility. The archetypal example is the experience one has when standing on a cliff where one not only fears falling off it, but also dreads the possibility of throwing oneself off. In this experience that "nothing is holding me back", one senses the lack of anything that predetermines one to either throw oneself off or to stand still, and one experiences one's own freedom. Or again, having attended a lot of lectures on autism we are told as resource teachers that practically all autistic people experience such a deep sense of anxiety that it is akin to the feelings of petrification a person who fears flying experiences who is about to board a plane, with this essential difference that the poor autistic person feels that way all the time when faced with the seemingly frightening world of other human beings. In that very real sense, then, "hell is others" for the autistic.

One of the major offshoots of existentialism as a philosophy is existential psychology and psychoanalysis, which first crystallized in the work of Ludwig Binswanger, a clinician who was influenced by Freud, Edmund Husserl, Heidegger and Sartre. A later figure was Viktor Frankl, who had studied with Freud and Jung as a young man. His logotherapy is a form of existential therapy. Frankl's most famous book is called Man's Search for Meaning which he first wrote slowly and deliberately, word by word, sentence by sentence, in his mind to keep himself alive in the hell of the Dachau concentration camp. In effect, his logotherapeutic method grew out of his practical lived experience, in his ability to create meaning even in the hell of meaninglessness, in the very heart of evil and suffering.

An early contributor to existential psychology in the United States was Rollo May, who was influenced by Kierkegaard whom I have already discussed at length in some previous posts in this blog. One of the most prolific writers on techniques and theory of existential psychology in the USA is Irvin D. Yalom whose contributions to this area of therapy I have also discussed before in these entries and to whom I intend to return before long.

Now, the importance of anxiety or angst in existentialism makes it a popular topic in psychotherapy. Therapists often offer existential philosophy as an explanation for anxiety. The assertion is that anxiety is manifested of an individual's complete freedom to decide, and complete responsibility for the outcome of such decisions. Psychotherapists, using an existential approach, believe that a patient can harness his anxiety and use it constructively. Instead of suppressing anxiety, patients are advised to use it as grounds for change. By embracing anxiety as inevitable, a person can use it to achieve his full potential in life. Humanistic psychology also had major impetus from existential psychology and shares many of the fundamental tenets. Terror management theory is a developing area of study within the academic study of psychology. It looks at what researchers claim to be the implicit emotional reactions of people that occur when they are confronted with the knowledge they will eventually die.

As I come to an end of these reflections, I am all too conscious of how scattered and broken and fractured these thoughts are in themselves. Maybe that in itself is appropriate as I am deeply moved by the scattered, shattered, broken and fractured nature of the human animal itself. We are simply "not made whole" at any stage of our human existence never mind at the age of Christ if I may quote from the Irish poet Thomas Kinsella
I read that I have looked my last on youth And little more; for they are not made whole That reach the age of Christ.
The challenge is to integration, and indeed to re-integration, in trying, however unsuccessfully and partially, to put "Humpty Dumpty" together again as best as we can. No perfection exists in the world of human making and human longing. There is too much angst, anguish and anxiety associated with the desire for perfection. We live in an all-too-imperfect world. Yes, indeed, let us look for excellence and desire it, but never, never, never, confuse it with perfection, which surely does not exist.

The most we can hope for is a wholeness that includes our very imperfection and brokenness at the heart of living and being in this all too sad, if at times beautiful and exhilarating world.

Above a black and white version of the famous painting called "The Scream" by Edvard Monch, one of my favourite works of art.

Existential Psychotherapy 4

I would like to continue talking about psychotherapy, and especially about its existential variety. Therapy has long, and indeed widely, been practised and advocated in the United States of America, while we here in Europe, and especially in Ireland, laughed at the thoughts of it. This showed our childishness, of course, and our immaturity. We were a young nation just finding its feet and rattling our adolescent-macho sabre.

Of recent years we have come of age as a nation. We have left our adolescence behind in the wake of (i) our financial crisis caused by both the international recession and our own more culpable domestic recession caused by the sheer greed of ruthless investors, builders and speculators who were in league with corrupt politicians and bankers, (ii) the fall of the Roman Catholic Church - the hierarchical model - in the wake of the child abuse revelations of some members of its clerical caste and the obvious cover-ups of the same by its hierarchy and (iii) that corruption and cover-ups are also prevalent in the medical, legal and other professions. The ideals which all these sectors of society professed and proclaimed and continue to profess and proclaim are all too ideal and very far away from the daily morality or immorality of some of their members. Please note that I have said "some", and this qualification is important because we don't want to paint everyone with the same brush. There are many morally upright people in all walks of life. However, the growing minority of corrupt members in any sector of our society must be ruthlessly excised.

So, we have come of age, and that is good. Coming of age means the opposite to covering up; the very opposite to being squeaky clean for public appearance only. It means an openness to self-appraisal, a willingness to see the bad as well as the good in ourselves and others with the intention of improving the lot of everyone in society. There is no better way to come of age than to go into therapy. I have studied psychotherapy for some years, have also been in counselling and therapy and continue to read much and reflect deeply on the area. Now, one does not necessarily have to go into paid therapy to improve oneself - one can engage in what I call "soul-work" by engaging in many authentic and self-making activities like composing and playing music, writing poems and stories, drawing, sketching, painting, sports of all kinds, helping others, travelling, and the list goes on and on. What's needed is an openness to face the abyss of the self.

Now, let me return to the latest book of the great contemporary psychiatrist and existential psychotherapist Dr Irvin D. Yalom, namely Staring at the Sun: Overcoming the terror of Death (Jossey-Bass, 2008, 2009). Let me begin by referring to his use of some of the ideas of Schopenhauer - Arthur Schopenhauer (1788 – 1860) was a German philosopher known for his atheistic pessimism and philosophical clarity. At age 25, he published his doctoral dissertation, On the Fourfold Root of the Principle of Sufficient Reason, which examined the fundamental question of whether reason alone can unlock answers about the world. Now, Yalom refers to what he terms "a triplet of essays" by our man Schopenhauer. The insights of these essays are wise with respect to the human animal's desire to amass possessions through power and success. How many of us have been lost in the overwhelming desire to amass possessions, and how many of us still know so many equally lost to these base desires? Yalom proposes that the insights of Schopenhauer can liberate us from these desires. Let me quote the learned psychiatrist's words here:
Basically the essays emphasize that it is only what a person is that counts; neither wealth nor material goods nor social status nor a good reputation results in happiness. (Op. cit., 112)
Essay 1: We are not what we have, though a lot of us swallow that lie. Material things are a "will-o'-the-wisp" and are like "sea water" - the more we drink, the thirstier we become. In the end we don't possess our goods - they possess us.

Essay 2 Reputation. This is another lie that many of us swallow wholesale. Think once again of all the cover-ups and down-right lies to which I alluded in the first few paragraphs of this post. The people who covered up and who lied bought into reputation hook, line and sinker to use a cliché. Reputation is as evanescent or as illusory as material wealth. Like material wealth we cannot take it with us when we die, as my late father used always say. Yalom quotes Schopenhauer's words here:
Half our worries and anxieties have arisen from our concern about the opinions of others.... We must extract this thorn from our flesh.
Why do we care about what others think? Why? Because we buy into the lie of Reputation. You only have to read the papers, listen to the radio, surf the net or look at the television and you will see the many, many followers of the religion of reputation. In this, all these people are made slaves to what other people think, or what they appear to think - for we can never, as Yalom wisely says, know for certain what they actually think.

Essay 3. What we are. It is only what or who we really are that counts. A good conscience, Schopenhauer says, means more than a good reputation. An old lady in my mother's nursing home, Eileen says that she sleeps well every night become she has a clear conscience, as indeed I'm sure she has as she is a lovely old thing. Another thing this old lady says every night I meet her is "Your health is your wealth. Sure, that's all that counts in the end." Our greatest goal should be good health and intellectual wealth, which lead to an inexhaustible supply of ideas, insights and wisdom and a good solid moral life.

Our Interpretation of Things: An interesting insight from Schopenhauer's third essay as reported by Yalom is the statement that "it is not things that disturb us, but our interpretations of things. To conclude this post, let me return to the summary words of Yalom on the insights of our man Schopenhauer:
This last idea - that the quality of life is determined by how we interpret our experiences, not by the experiences themselves - is an important therapeutic doctrine dating back to antiquity. A central tenet in the school of Stoicism, it passed through Zeno, Seneca, Marcus Aurelius, Spinoza, Schopenhauer, and Nietzsche, to become a fundamental concept in both dynamic and cognitive-behavioral therapy. ( ibid., 113 -114)
Above, the stern and wrinkled face of Arthur Schopenhauer.