Solitude and Hope: Y'all Come Visit!

A number of years ago, I did my pre-doctoral clinical psychology internship at Manhattan Psychiatric Center in New York City, a huge (more than 1,300 long-term patients) state psychiatric hospital. It was located on Ward's Island in the Hudson River just east of Harlem, and it was common then for patients to remain in the hospital for many, many years.

One of my fellow interns was Michael Fenichel, a younger relative of the deceased psychoanalytic pioneer, Otto Fenichel. Dr. Fenichel now has an outstanding website devoted to mental health care, internet resources and (one of his deep interests) photography. His website can be found at: http://www.fenichel.com.

Among the many photographs that are available from his site are those shown below (Michael gave me some of these pictures many years ago, which I highly value):


Times Square (early 1980's)



Paris: Boulangerie



Turkey: Peach Peddler

Please click on the link below to visit Dr. Fenichel's excellent website:

It has long been too common to make a dichotomous distinction between the internal and the external. This kind of polarity includes posited divisions such as innate characteristics versus the experiential; intrapsychic versus interpersonal; fantasy or imagination versus perception; psychic reality versus material reality; inner world world versus outer world; asocial versus social.

It is quite probably more the case that the internal plays a role in shaping the external and the external plays a role in shaping the internal. Proposing a distinction between the two is deceptive, unless it is actually recognized that each contributes to the shaping of the other. Deciding where the emphasis should lie in a particular instance depends upon a sense of heuristic art.

With the foregoing in mind, it still remains the case that we all have inclinations and abilities for self examination, while at the same same time we all have disinclinations and disabilities. We are always at the edge of awareness of trying to self reflect. We are always trying not to do so.

We are always more self inquiring than we think, and always less. We are always both more and less keen to examine what we regard to be the best in our natures. Self reflection is neither the crisis activity of the painfully troubled, nor the distinguishing flourish of a highly intellectual elite. It is the everyday activity of everyone. A most pressing kind of business, which we are always both for and against.

Finally, in the full range of self examination we are always synthesizing what we call self and other. Even if some of what we refer to seems only about "inner," and some only about "outer," all is really about both. It is always self/other inquiry. We cannot examine ourselves without also thinking of what surrounds us, nor of our surround without reflecting upon ourselves.

"I cry and I cry, and very bitterly I cry."

-Anonymous

A case study has recently been published (reviewed as "brilliant and richly detailed") that describes an analyst's close and empathic work with an adolescent boy, whose reported history of emotional deterioration reached a grievous state when, after becoming severely distraught, he climbed onto the roof of his two-story home and threatened to jump. Not long after that, he began to engage in in self-mutilating behaviors, displayed increasing obsessions and rituals, turned increasingly physically assaultive toward adult caretakers and became extremely destructive to property in the home, resulting in thousands of dollars in damage.

Examples of his self-destructive behaviors included turning on a gas stove and putting his head over the burner (scorching his hair in the process). In desperation, he finally began cutting himself to write notes in blood that he left around the house, which pleaded for someone to help him. After psychiatric hospitalization, he entered long-term therapeutic group care.

In residential treatment, he seemed to indicate a sense that there had been a lack of emotional attunement with important adults in his early life. This fueled an incessant, often nearly unbearable tone of heated, aggravated and rageful complaint from him during much of the early stages of his care. Over time, many staff members exposed to his bitterness reacted with defensive wishes to reject and punish him, a counter-transference difficulty that others have noted in writings about working with similarly difficult young people in group care.

Eventually, the analyst working with him was able to come to understand his ongoing, adamant, rageful complaints as a special kind of protest, reflective of a desperate hope that things could be better for him in the present, that he need not be doomed to constantly reliving the sense of emotional abandonment associated with his past. Stuart Pizer (1992) described similar observations when he noted, "As I see it, protest, like the 'antisocial gesture,' is a sign both of anger and of hope--the hope for a negotiable environment that will heed the protest as a signal of distress. Protest...is the [young person's] act in the present to renegotiate relational failures of the past...." The Forsaken Child: Essays on Group Care and Individual Therapy (2000, pp. 107-143) also provides a movingly compelling description of the potential associations between enactments of massive feelings of rage and the emergence of a growing sense of hopefulness.

A similar observation was made much earlier by Winnicott (1956/1992), who pointed out, "The antisocial tendency implies hope. Lack of hope is the basic feature of the deprived child who, of course, is not all the time being antisocial. In the period of hope the child manifests an antisocial tendency...the understanding that the antisocial act is an expression of hope is vital in the treatment of children....Over and over again one sees the moment of hope wasted, or withered, because of...intolerance."

Adapted from: "Psychotherapy in Group Care: Making Life Good Enough," (2003, pp-10-11).

Please visit the link below for more detailed information about this book:

Yesterday, I was thinking of an adolescent young man (diagnosed with Aspergers Syndrome) with whom I work and about how richly human and brilliant he is. At the same time, I reminisced about how reciprocally warm and affectionate our relationship has been during the time we have known each other.

Later that night, thoughts about Steven Wiltshire (born 1974) came to mind. Wiltshire is an accomplished architectural artist who has been diagnosed with an autistic spectrum distorder. Wiltshire's work has been the subject of many television documentaries; neurologist Oliver Sacks praised his artistic work in the chapter 'Prodigies' in his book "An Anthropoligist on Mars."

Stephen Wiltshire's published art books have included "Cities" (1989), "Floating Cities (1991) and "Stephen Wiltshire's American Dream" (1993).

Recently, a previously unknown poem written by Tennessee Williams ("Blue Song") was discovered by chance in a New Orleans bookstore. In 1937, Williams was a troubled young man at Washington University in St. Louis who was about to fail his Greek exam. On the back of his exam booklet, Williams quickly jotted a 17-line poem and then left the room.

At this time, we do not know the entire contents of the poem, but the beginning reads:

"If you should meet me upon a street do not question me for I can tell you only my name and the name of the town I was born in."

It has been suggested that these beginning lines suggest a despairing state of inner emptiness and a barren sense of self. This may have been related to a gnawing sense of confusion regarding his sexual identity, or to his desperate attempts not to acknowledge it at that time.

Deeply unhappy and depressed living in St. Louis, he moved to New Orleans two years later, in 1939. After moving to New Orleans, Williams went on to write plays that included: The Glass Menagerie, Summer and Smoke, A Rose Tattoo, Cat on a Hot Tin Roof and Camino Real.

The undertone of his writings was always the examination of the passions and forces that drive people who live at the very margins of society.

The underlying current for many informed contemporary thinkers is that no one has access to ultimate truth. There are minor situational exceptions, of course, such as the reality that I have written this and that you are there reading it. On the other hand, it is still the case that there is no ultimate truth about the interaction between my writing and your reading of it, about my meaning and your own interpretation.

So it is with "love," or "being in love": the paradoxical perspective offers celebration for the complexities that abound in our attempts to specify the particulars of those states.

"I paid the price of solitude
But at least I'm out of debt."

Bob Dylan, "Dirge"

As a member of a training institute's curriculum committee, I was asked to give my opinion about whether to include a course about Melanie Klein. I responded that I thought it would be important for the students to learn more about her psychanalytic theory and actual case material (here, I noted that I vehemently opposed much of both---that her aggressive and disarmingly deep interpretations to young children bordered on emotional abuse).

This reminded me that I had many years ago seen the intensely moving first stage production of "Mrs. Klein," with a brilliant performance by Uta Hagen, at the old Theater de Lyse on Christopher Street in Greenwich Village. The play was striking in its presentation of Klein's own pathology, dooming her to a life that could well be described as attacking, bitter, and extremely lonely.

The play illustrated how vigorously Klein tried to prevent her own children from separating from her and becoming their own individual beings. She prevented her son, Hans, from attaching to any women other than herself. It has been speculated that he may have attempted to subvert her narcissistic hold by turning to intimate relationships with men, and ultimately by committing suicide.

In the play, Melitta (her daughter) accused Klein of constantly bullying her and Hans as an effort to own both of them. This pathological behavior was highlighted at the end of the play when Klein gave Melitta a cruel "freedom through rejection" by turning to a daughter-substitute who would obey her cruel, ongoing domination. A very sad, sad life.