Advice Not Given

by Mark Epstein

  There is an extraordinary strength in a person like Debby who regularly refuses food. The Buddha was aware of this when he gave his initial teachings on Right Effort because there was a rich tradition in ancient India of ascetics refusing all kinds of comfort and nourishment in the pursuit of spiritual growth. Right Effort, as a concept, was used to counter the influence of these ascetics and to find a middle ground between self-denial and the rampant materialism of the newly empowered merchant classes of his day. The Buddha described an optimal middle way between sensory indulgence and the rigors of self-abasement. Little did he know that several thousand years later, the founder of psychoanalysis would come up with a similar formulation in his descriptions of how to listen to his patients. Freud was not so concerned with finding a balance between sensory gratification and self-denial, but he was exquisitely attuned to how therapists could modulate their attention. They should not be too eager to step in and they should not be too remote and reserved. In describing evenly suspended attention, Freud came up with his own version of the Buddha’s instructions. “To put it in a formula: he must turn his own unconscious like a receptive organ toward the transmitting unconscious of the patient.” He used the newly invented telephone as a model. In his formulation, Freud anticipated Winnicott’s notion of good enough parenting. Too much attention, in the form of indulgence, amplifies a child’s anxieties, while too little attention, in the form of withdrawal, becomes neglect.

  Debby knew nothing of the Buddha’s teachings about Right Effort, or even of therapy, in her college years and proceeded, with very little outside help, to pursue her adult life while still in the grip of self-denial. After graduating from college, she moved to New York City, entered the workforce, and, uncharacteristically for someone with anorexia, gradually got better without significant therapeutic intervention. She was helped by her move to the city. In New York, Debby had a blank slate: she was free to configure herself outside of her familial relationships. A chance encounter with a friend led to a job in the fashion industry that put her in the middle of a community of young people. Her weight began to normalize as she felt more accepted by, and involved with, the people in her new life. She had a relationship or two and then got married and found that her eating issues, already on the wane, faded while she was raising her children. She loved being a mother and had good, strong relationships with each of her kids. Her own mother was still alive and living in another state, but her relationship with her had stalled at the time of her anorexia, if not before. Debby felt that their relationship, which she remembered as very close when she was a child, had never recovered. Her mother was ashamed of her, she thought, and had dealt with her illness mostly by ignoring it and hoping it would go away. That this strategy had worked was of little comfort to Debby. Her anorexia had receded, but so had her closeness with her mother. She missed her, even at this age, but rarely made the trip to visit her.

  The issue with her mother had been brewing for a long time. I had a sense of it when Debby first came to see me several years before and urged her to visit as Mother’s Day approached. But it was a tangled relationship. One morning, Debby relayed a complicated story about a conversation they had just had about her grown daughter’s upcoming visit to her grandmother’s house. The possibility of Debby joining her daughter had been raised, but it was not an easy discussion for Debby to have with her mother. Debby was, in essence, waiting for her mother to ask her to join them. She did not want to intrude on her daughter and did not want to make her mother uncomfortable. When her mother did, in fact, say something like, “Why don’t you come, too?” it did not feel like a real invitation. It was too late, too off the cuff, and did not sound as if it really came from the heart.

  “It feels like she doesn’t love me,” Debby said, and she was upset.

  I had a little trouble, at first, taking her level of distress seriously. We knew that her relationship with her mother was strained. We had talked about it a lot. In relaying her current feelings, Debby was speaking as if she had never had this thought before. Why should it now be such a surprise that it feels as if her mother doesn’t love her? Hadn’t we gone over this already? I had to remember Right Effort in order not to get in the way of what Debby was trying to tell me. My initial reaction of “We know this already” was threatening to interrupt or derail her. Only when I restrained myself from reminding her of what we had already figured out could the therapy proceed. Once I kept myself quiet, Debby began to speak in a different way. Up to this point, we had talked a lot about her mother’s aloofness. But now Debby was turning it around. She blamed herself for her mother’s lack of attunement and responsiveness. She was fundamentally at fault. While she had difficulty saying exactly what it was about her that made her so unlovable, it was clear that this notion had been simmering for a long time.

  It is always tempting in such situations to be reassuring and supportive. “Of course you are not unlovable!” I wanted to insist. “Let’s keep the focus where it belongs. If your parents had not been so self-involved, we wouldn’t even be having this conversation.” Yet these kinds of comments would not have helped Debby much. She might have been grateful for my support but still stuck in an alienated and self-critical place, one that I would be subtly dismissing in my attempts to be positive. Debby needed to see how her own tendency to blame was holding her hostage. It did not really matter if she blamed her mother or herself—in searching for a concrete explanation for the flaw she felt in her relationship, she was actually hoping to magically repair it. If I aligned myself on either side of her argument, I would still be reinforcing an impossible wish. We could blame her or blame her mother or not blame her or not blame her mother, but we would still be heading in a backward direction trying to undo something that had already happened. I did not jump in with any such comment, however, committed to holding my tongue to see where things went.

  My mind did go in an unexpected direction, however; I was not exactly silent inside my own head. Debby’s therapy session came shortly after a provocative radio interview I had listened to by chance. I was driving in the car one morning, flipping impatiently through the stations programmed into the radio’s memory, when I suddenly heard a familiar voice speaking in what seemed to be an unfamiliar context. It was a deep male voice that I soon recognized as Bruce Springsteen’s. He was talking about how hard it is to raise children when one’s own childhood was less than perfect.

  “We take what is good from our parents and leave the rest. That’s how we honor them,” the voice was saying.

  I was struck by the wisdom of Springsteen’s comment.

  There was a Buddhist flavor to it—a homespun way of talking that reminded me of Right Effort. In meditation, we are trained to not push away the unpleasant and not cling to the pleasant, but this was a little different. Not rejecting one’s parents because they were imperfect, not trying to force them to acknowledge their shortcomings, not rejecting becoming a parent because of what was done to us, not dwelling on the scars one’s parents created, not forcing oneself to pretend that one’s parents were fine when they were not, but simply being able to take what was good while leaving behind what was not. Wasn’t this awfully similar to letting go even when you knew you were right?

  The source of forgiveness, Springsteen seemed to imply, lies in the realization that we are not solely products of what has been done to us, that there is something essential within us that is not necessarily tarnished by calamitous experience. While this contradicts many of the assumptions that a hundred years of psychotherapy has helped create in our culture, it is a notion that finds much support in the spiritual traditions of the East. In Buddhist cultures, there is a more willing acceptance of a capacity for generosity that is not dependent on external circumstances, not compromised by trauma or mistreatment, and capable of surviving destruction. While the classic Eastern route to accessing this inherent selflessness is meditation, Springsteen’s comments suggest that the Buddha’s choice
of music to illustrate Right Effort may not have been accidental.

  I did not relay any of this to Debby; I did not really need to. She did not experience my silence as indifference and she did not find my lack of supportive comments to be withholding. I think she felt my attention to be what it was: warm but not indulgent, receptive but a bit suspicious of her rush to criticize herself. She was giving inappropriate weight to a conclusion that, once brought into the light of day, revealed its immature roots. I could see Debby seeing this for herself, a certain equilibrium rising within her to meet it. Her tendency to blame herself did not disappear as a result, but she was able, in that session—perhaps for the first time—to recognize its spurious nature. This was the beginning of a gradual undermining of her deeply seated conviction about her own unworthiness, an erosion that would slowly and repeatedly take place in her subsequent therapy. She began a series of visits to her mother’s house that allowed them to move past the frozen feelings of forty years earlier into a territory neither of them had envisaged. Her mother, now in her eighties, was more open than Debby remembered her. There was a lot to catch up on.

  The working through of Debby’s connection with her mother allowed hidden aspects of her relationship with her grown children to emerge as well. Debby had found much joy in being a mother but she was aware of secret fears that her children might reject her the way she had rejected her own mother. She told me in a subsequent session how uncomfortable she was driving home one evening after having had an enjoyable dinner with her twenty-eight-year-old son, the eldest of her four children. He was leaving for a year in Europe in a week or two and she was overcome with a bad feeling after parting with him.

  “What kind of bad feeling?” I wanted to know.

  There was a discomfort in Debby’s face that suggested something deeper than a mother’s natural worry for her grown child’s safety or her sadness at being separated from him. She had a difficult time describing her feeling, in fact. It was complicated for her. She felt alone and sad—that much was clear—although she was going home to her husband and had a good relationship with her other children, all of whom she was in regular contact with. But there was a level of distress coming through as she tried to answer my question that put me on alert. It was as if she were having a premonition that something terrible was going to happen when he went away.

  Before talking too much more about the feeling, though, she told me how the rest of the evening had progressed. Upon arriving home, she had gone straight to the kitchen and eaten potato chips and ice cream. It was not the first time she had mentioned compulsive eating to me, but this was not something she brought up regularly. She was a vegetarian who was generally very careful about what she ate. On this evening, though, she had thrown caution to the wind. The potato chips and ice cream had put her into a kind of a daze.

  “I was numbing myself,” she said.

  This was an interesting comment. What was she numbing herself from? It was murky. She did not exactly know. I encouraged her to look more closely at what might have been going on rather than just castigating herself for her culinary indiscretions. She must have been anxious, she finally said. When she got home and started eating compulsively, she must have been having anxiety. We could start there.

  I knew she was having anxiety, of course, but I might have been tempted to rush right by it or to label it for her, depriving her of the experience of naming it herself. I might have assumed that she knew she was having anxiety when, in fact, it was not at all clear to her what she was feeling. As therapists have found, the naming of the feeling is different from the feeling itself. Feelings can percolate under the surface and make us act in ways we do not completely understand. When the feelings are named, the compulsive actions are often not so necessary. Buddhism plays something of a double game with this fact. Sometimes, when people are lost in their stories or in their repetitive thoughts, they are encouraged to come out of their thinking minds, out of the story, and into their bodies and their feelings: to experience them more directly and to appreciate how their emotional bodies are in continuous flux. But other times, when people are subject to inchoate feelings that push them around, it is more important to know the emotions accurately. Naming the feeling helps make it intelligible. It robs the emotion of some of its power and gives a person some space from it. Rather than proceeding, without thinking, straight to the compulsive behavior, naming the feeling allows for a pause.

  “Oh, this is anxiety. What can I do about it?”

  In Debby’s case, parting from her son had precipitated her anxiety, but there was something intolerable in the feeling. It was not a simple thing for her. Her lack of clarity about her anxiety indicated to me that she might be uncovering something from an earlier time. It was tempting to go back to her childhood and question, once again, how secure she might have felt with her parents, even at a young age. This was fertile ground for conjecture, and in many of our previous discussions we had certainly fleshed out Debby’s early history. It had put her anorexia in context and made it more understandable, less something that had just descended out of the blue. But in the back of my mind during this discussion was Bruce Springsteen’s advice about Right Effort. I wanted Debby to be able to take what was good from her parents and leave the rest so that her relationship with her own children could be less encumbered. I did not orient the conversation around the past but tried to keep Debby focused in the present.

  As we talked, it became clear that Debby was adding a toxic overlay to the separation from her son. Not only did she fear that the farewell would be permanent, she blamed herself for causing it, just as she had previously blamed herself for her estrangement from her parents. She was at fault, she had caused the disruption, and there was something the matter with her. The ice cream and potato chips protected her by putting her into a daze, but at the same time they gave her another reason to feel bad about herself. They made it very concrete. She felt nauseated and bloated and castigated herself for getting fat. And there was shame at her behavior. She was proving to herself what she had long feared: that there was something wrong with her that made her unlovable. We were at a familiar place. Here was another opportunity for Debby to see this particular pattern.

  The inspiring thing about Debby was that she could see all this even while being held in its sway. I could talk to her from a psychological place and also from a Buddhist one. The parting from her son was hard enough, I told her. Why not try to experience it just as it was, without the toxic overlay she seemed to be creating? Did she have to project her badness onto every good-bye? Did she have to be lovable all of the time? Why not use mindfulness to help? Mindfulness was one of the Buddha’s main meditative tools. It was designed to help people cultivate self-awareness so that they could stay more fully in the moment and not be at the mercy of their most destructive thoughts. It discouraged clinging to the pleasant or pushing away the unpleasant. It could help with this kind of thing.

  Here is one interesting thing about mindfulness, though. In the original Buddhist texts in which it was presented, it was often described as “mindfulness and clear comprehension,” not simply as “mindfulness.” The balance between immediate apprehension and conceptual understanding, between knowing the feeling and naming the feeling, was there from the beginning. In asking Debby to use mindfulness to examine her troubling emotional experience, I was also asking her to investigate it thoroughly, without jumping to conclusions. I thought of a case study I had long admired in which Winnicott made a similar point. While his imagery might seem shocking at first, his thesis was that therapists often sabotage their treatments by trying too hard to be helpful.

  “The basis of the treatment at the present time is my silence,” Winnicott wrote in his 1963 report. “Last week I was absolutely silent the whole week except for a remark at the very beginning. This feels to the patient like something she has achieved, getting me to be silent. There are many languages for describing this and o
ne of them is that an interpretation is a male bursting across the field, the field being the breast with the infant unable to cope with the idea of a penis. The breast here is a field rather than an object for sucking or eating, and in the patient’s associations it would be represented by a cushion rather than a source of food or of instinct gratification.”

  I love that Winnicott turned his silence into a field, a breast, and a cushion. He was not thinking about mindfulness or about Buddhism, but he still ended up imagining his patient upon a pillow, just as she might have been if she were practicing meditation. The pillow was his present-moment attention holding her while she explored what she was feeling. His psychosexual associations came from earlier work with mothers and their infants. One mother would offer her breast and allow her baby to find it for herself. She held the space open (like a field) and let the infant have the experience of discovery. Another mother forced her nipple into the infant’s mouth. That baby had a completely different experience, more like that of a phallus (in Winnicott’s vernacular) than a breast. In Winnicott’s way of thinking, the first mother, who offers her breast, is, while the second mother, who forces the feeding, does. In my work with Debby, while not being as resolutely silent as Winnicott, my attention was functioning as a breast that is. It was a field and a cushion and it made room for her to unwind. This allowed her to be skeptical of her old ways of seeing things. Her issues did not turn out to be only about separation.

  One of the things Debby discovered in paying attention to the comings and goings of her adult children was that these partings were infinitely more complex than they had initially seemed. When she thought back to herself as a young child, things seemed relatively simple. The loss of closeness with her mother had made her anxious. Fifth grade was a problem. From early adolescence, her anxiety made her worry that something was wrong with her, a notion she acted out on her own body. And now that she had children of her own, she could see that she was projecting that conclusion onto them. But as we worked with her childhood fears and anxieties, she had to acknowledge that being a parent filled her with other feelings as well. In a certain way, her childhood memories had been obscuring the intensity of her coexisting adult emotions. Many routine meetings with her children left her with an undercurrent of unnervingly poignant feelings. She had tended to overlook them, or to interpret them as nothing but reflections of her childhood estrangement, but we found that this did not do them justice. Alongside Debby’s anxiety was the intense, if excruciating, love that a mother has for her children.