The Silent Patient

by Alex Michaelides

Once you name something, it stops you seeing the whole of it, or why it matters. You focus on the word, which is just the tiniest part, really, the tip of an iceberg.

He that has eyes to see and ears to hear may convince himself that no mortal can keep a secret. If his lips are silent, he chatters with his fingertips; betrayal oozes out of him at every pore. —SIGMUND FREUD, Introductory Lectures on Psychoanalysis

prurient

Love this word

The real motivation was purely selfish. I was on a quest to help myself. I believe the same is true for most people who go into mental health. We are drawn to this profession because we are damaged—we study psychology to heal ourselves.

As human beings, in our earliest years we reside in a land before memory. We like to think of ourselves as emerging from this primordial fog with our characters fully formed, like Aphrodite rising perfect from the sea foam. But thanks to increasing research into the development of the brain, we know this is not the case. 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 others—we are shaped and completed by unseen, unremembered forces; namely, our parents.

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

But that’s how therapy works. A patient delegates his unacceptable feelings to his therapist; and she holds everything he is afraid to feel, and she feels it for him. Then, ever so slowly, she feeds his feelings back to him.

It’s odd how quickly one adapts to the strange new world of a psychiatric unit. You become increasingly comfortable with madness—and not just the madness of others, but your own. We’re all crazy, I believe, just in different ways.

She used to say 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.

She was a statue; a Greek goddess come to life in my hands.

I felt an unfamiliar happiness just being in her company, as though a secret door had been opened, and Kathy had beckoned me across the threshold—into a magical world of warmth and light and color, and hundreds of orchids in a dazzling confetti of blues and reds and yellows. I could feel myself thawing in the heat, softening around the edges, like a tortoise emerging into the sun after a long winter’s sleep, blinking and waking up. Kathy did that for me—she was my invitation to life, one I grasped with both hands. So this is it, I remember thinking. This is love.

Unexpressed emotions will never die. They are buried alive, and will come forth later, in uglier ways. —SIGMUND FREUD

I suppose what scares me is giving in to the unknown. I like to know where I’m going.

When we have sex, I always feel an insatiable hunger for him—for a kind of union between us—something that’s bigger than me, bigger than us, beyond words—something holy.

All kinds of theories have been put forward about the origins of addiction. It could be genetic; it could be chemical; it could be psychological. But marijuana was doing something much more than soothing me: crucially, it altered the way I experienced my emotions; it cradled me and held me safe like a well-loved child. In other words, it contained me.

The psychoanalyst W. R. Bion came up with the term containment to describe a mother’s ability to manage her baby’s pain. Remember, babyhood is not a time of bliss; it’s one of terror. As babies we are trapped in a strange, alien world, unable to see properly, constantly surprised at our bodies, alarmed by hunger and wind and bowel movements, overwhelmed by our feelings. We are quite literally under attack. We need our mother to soothe our distress and make sense of our experience. As she does so, we slowly learn how to manage our physical and emotional states on our own. But our ability to contain ourselves directly depends on our mother’s ability to contain us—if she had never experienced containment by her own mother, how could she teach us what she did not know? 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. 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.

My old therapist used to say intimacy requires the repeated experience of being responded to—and that doesn’t happen overnight.”

But that’s what Alicia did for you. Her silence was like a mirror—reflecting yourself back at you. And it was often an ugly sight.

“Choosing a lover is a lot like choosing a therapist. 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. I imagine you do give Kathy love—in the true sense of the word. Whether or not she is capable of giving it back to you is another question.”

one of the hardest things to admit is that we weren’t loved when we needed it most. It’s a terrible feeling, the pain of not being loved.”

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

Sometimes it’s hard to grasp why the answers to the present lie in the past.

“Like therapy, music is about a relationship, entirely dependent on the teacher you choose.”

But we soon discovered that geographical distance counts for little in the world of the psyche. Some things are not so easily left behind.