Saturday, 18 July 2015

love, depression, psychotherapy

According to ISTDP (instensive short term dynamic psychotherapy) the transformative 'breakthrough' moment of therapy is the derepression of unconscious rage and guilt towards loved-yet-hated attachment figures.

According to RGTG (me!) the transformative breakthrough in therapy involves a reconnection with what I will for want of a better term call the 'idea of love'. Primarily a form or mode of experiencing rather than a thought, the 'idea' involves the rediscovery or re-entry to a lost garden of the heart, exile from which has been unwitting yet calamitous. 

In the barren landscapes of a loveless world the maladies of the soul proliferate. Without the light from the sun to animate them, creatures instead cannibalise one another for energy. Projective identification for evacuation and control becomes ascendant. Melancholic darkness descends.

The reason I call it an idea of love, rather than simply love, is that the entry ticket to this garden need not be a current loving relationship. A memory, or an upsurge of feeling towards an absent beloved, may do just as well. The important thing is for the memory, current experience or imagined encounter to be experienced fully; a memory that one has or has been loved, a merely entertained thought that one could, will not do, and this is not what I mean by talking here of an 'idea'. There is however something of the generality of love that makes apt here the idea of an 'idea'. Love, of course, is not an abstract matter: it is always and everywhere deeply personal, yet for all that is not something restricted to any one relationship.

Living within the balm of your love I can relax. Light and life bubble up, now, spontaneously from within. I need no reason to live of the sort sought and not found by the depressive. I'm living in the garden once again; what use have I of reason? Once again night and day, dreaming and waking, fantasy and reality, separate out from one another. The animal sleeps and is rested, wakes and can work or play; it knows without thought when it is time for what, it knows without thought how to move on, where to go.

An occurrent experience of the idea of love is the moment of transformational bliss. Underneath the pain and shame and betrayal and woundedness of unmet need and dashed confidence and rejection lies a yet-beating heart. Peel back the scar tissue and listen to it. Treat it carefully: it is very fragile. It takes time for it to grow in strength, time to learn who to trust, time for the courage to remain thus 'wounded' when out and about in the rough and tumble of the world. 

A striking thing that we encounter in psychotherapy is that it is precisely when the idea of love becomes thinkable that neurotic symptoms become intelligible to the patient. What the therapist has been saying, if they've been on the right lines, now makes sense. The transference interpretations no longer feel persecutory; instead they feel apt and thoughtful.

Christians identify God with love, and claim to enjoy a loving relationship with Him. They are preoccupied with forgiveness, they meditate on Christ's wounds. The person of Christ becomes a bridge between unthinkable eternal love and the worldly historical particular. 

Now the theological register does not really speak to me. But the religious idea of culturing a reconnection with Love is surely not too far from what I'm talking about. (I've capitalised 'Love' here to emphasise again that I'm talking about something which, whilst always deeply personal (i.e. necessarily involving particular objects), is yet a form or mode of experience which can take in different objects.)

A chance moment may reanimate this 'idea' in us. A patient of mine recently witnessed an ordinary moment of loving care between a parent and adult child: this was for a while enough for him to re-enter the garden, before the inexorably exiling mists of the latent expectation of non-recognition came rolling in again.

Here, to end, is the wonderful Morag Coate, sometime schizophrenia sufferer and author of Beyond All Reason, telling us (pp. 119-122) of the experience of going to see the film David and Lisa,
a film that tells the story of a mentally sick boy and girl in a school for severely disturbed adolescents. ... The central characters were presented with a reality that struck me as perfectly authentic, and with a sympathy that implied absolute acceptance. So, by involving myself in their experience as I did, I was not only accepting my past sickness, but feeling it accepted too. ... 
[Afterwards she] walked slowly along the river bank, and let the chattering groups pass me by. The black waters of a big river at night are threatening when seen in the context of insanity; I was not troubled by them now, but awed a little, certainly impressed. And a planet shone out in the clear sky above, as piercing in its light as a single sharp note of music, and the lights on the far bank were gay with a warming brightness, and I myself was feeling human and humane. 
My involvement in the film brought home to me how sick I had been in my past life at times when I had outwardly seemed well. I saw with sudden insight the relevance of minor neurotic symptoms, and I remembered the terrors of infancy which had been revived for me in my last time in hospital. I began to reach down towards the roots of a forgotten fear of absolute destruction and annihilation. 
I got home ... I was thinking of [my psychotherapist] ... in spirit I took him by the hand with the same confidence and comfort that a child holds someone's hand when retracing their steps to the place where they have had a terrifying accident. I pressed down into the darkly bright intensity of my hidden life and broke through to the perilous secret that my adult defences had guarded me from coming near. Dammed up and firmly sealed off down inside myself my primal, urgent need was still intact. And somewhere, in the uncharted time of early infancy, I had given myself and taken in return; I had needed and enjoyed and later felt that I had lost a mother's love. The sudden, living sense of need and loss came upon me so strongly that I wept. And then, refreshed as by a sudden storm of rain, I fell asleep. 
[Coate goes on to provide a moving description of her psychotherapy. Later her] sense of an urgent, overwhelming need for the doctor whom I freely loved and trusted subsided gradually as I worked through and left behind my childhood terrors.... Once that phase was over I could return to the interests and joys of normal adult life. But the personal relationship remained, giving a deep, warm sense of security that enriched all aspects of my life. Mind, body and spirit were now at peace with one another. I had been made whole.