The Silent Patient

by Alex Michaelides

We are born with a brain half-formed – more like a muddy lump of clay than a divine Olympian. As the psychoanalyst Donald Winnicott put it: ‘There is no such thing as a baby.’ The development of our personalities doesn’t take place in isolation, but in relationship with another – we are shaped and completed by unseen, unremembered forces; namely our parents. This is frightening, for obvious reasons – who knows what indignities we suffered, what torments and abuses, in this land before memory? Our character was formed without us even knowing it.

Somehow grasping at vanishing snowflakes is like grasping at happiness; an act of possession which instantly gives way to nothing.

we are made up of different parts, some good, some bad; and that a healthy mind can tolerate this ambivalence and juggle both good and bad at the same time. Mental illness is precisely about a lack of this kind of integration – we end up losing contact with the unacceptable parts of ourselves.

Murderous rage, homicidal rage, is not born in the present. It originates in the land before memory, in the world of early childhood, with abuse and mistreatment at a young age, which builds up a charge over the years, until it explodes – often at the wrong target.

Unexpressed emotions will never die. They are buried alive, and will come forth later, in uglier ways. Sigmund Freud

Someone who has never learned to contain himself is plagued by anxious feelings for the rest of his life; feelings that Bion aptly titled ‘nameless dread’. And such a person endlessly seeks this unquenchable containment from external sources – he needs a drink or a joint to ‘take the edge off’ this endless anxiety – hence my addiction to marijuana.

‘Choosing a lover is a lot like choosing a therapist,’ Ruth had said. ‘We need to ask ourselves, is this someone who will be honest with me, listen to criticism, admit making mistakes, and not promise the impossible?’

‘About love. About how we often mistake love for fireworks – for drama and dysfunction. But real love is very quiet, very still. It’s boring, if seen from the perspective of high drama. Love is deep and calm – and constant.

we weren’t loved when we needed it most. It’s a terrible feeling, the pain of not being loved.’

Remember, love that doesn’t include honesty doesn’t deserve to be called love.’

No one is born evil. As Winnicott put it: ‘A baby cannot hate the mother, without the mother first hating the baby.’

She was the most interesting person I’ve ever met. Most people aren’t alive, you know, not really – sleepwalking their way through life. But Alicia was so intensely alive … It was hard to take your eyes off her.’

I mustn’t put strangeness where there’s nothing. I think that is the danger of keeping a diary: you exaggerate everything, you are on the look-out, and you continually stretch the truth. Jean-Paul Sartre

Though I am not naturally honest, I am sometimes so by chance. William Shakespeare, The Winter’s Tale

The aim of therapy is not to correct the past, but to enable the patient to confront his own history, and to grieve over it. Alice Miller

Something I knew about – the emotional effects of psychological wounds on children, and how they manifest themselves later in adults. Imagine it – hearing your father, the very person you depend upon for your survival, wishing you dead. How terrifying that must be for a child, how traumatising – how your sense of self-worth would implode; and the pain would be too great, too huge to feel, so you’d swallow it, repress it, bury it. Over time you would lose contact with the origins of your trauma, dissociate the roots of its cause, and forget. But one day, all the hurt and anger would burst forth, like fire from a dragon’s belly – and you’d pick up a gun. You’d visit that rage not upon your father, who was dead and forgotten and out of reach – but upon your husband, the man who had taken his place in your life, who loved you and shared your bed. You’d shoot him five times in the head; without possibly even knowing why.

If I justify myself, mine own mouth shall condemn me. Job 9:20