The medical student said she had used typewriter white-out fluid. Her teeth, too, were painted. Why erasing fluid on the ears? I wondered to myself. While driving together, my daughter once jokingly told me to turn up the music because it was too quiet and she could hear herself think. White noise. Hearing too much, thinking too much. I surmised that there was something this old woman could not bear to hear, and I told her my thought. Sadly, she replied that her son had died; he had killed himself shortly before she had come to the hospital.
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She was told all of this by her nursing home caretakers. The white-out was to get rid of his voice, to blank it out. I asked about her son. She sketched her story simply, with few words. He had been a good boy who worked hard at a job that was beneath him. He had loved his wife and daughter, and his wife left him for another man.
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He had never gotten over this grief, particularly not being able to see his daughter. He had come faithfully to see his mother; she had never known about his self-torture, he had protected her. He had always been this way. She looked back in regret over her lifetime as a mother: She had become sick when he was just a boy; she, too, had been in love with a spouse who had treated her wrongly.
Her poor boy had been on his own. He had been very handsome and independent.
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Perhaps his suicide was the result of her inadequacies as a mother. She told me she had swallowed the white out to remove him from inside of her. I had not expected this degree of insight; she no longer seemed psychotic. She was an old woman grieving her son, filled with regrets and guilt about her mothering, and she was just now beginning to give up her boy ….
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Now I see that in my making the central symbol a story about unbearable news and grief, which it surely is, I, nevertheless, simultaneously foreclosed another horror. My explanation both revealed and covered over. The whiteout symbol outstrips the story that I told. Indeed, by registering her story as a story, I focused on the symbolic attempt to obliterate bad news, that is, not to hear, to shut out the external—really, the internal—voice. But now I return to the symbolism: What is the point of using whiting out fluid?
Whiteout is bigger than white noise. White out fluid covers over mistakes, deleting them—but, covered over, the mistake remains beneath the surface, like the unconscious. It was as if her son were a mistake that she must erase! And just what is the arc of the history of her son as a mistake? And what is the milky white correction fluid in her story if not an anti-life fluid, a kind of anti-milk or even anti-semen?
Son as a mistake. Was her son perhaps born out of wedlock? Did her son look like her hurtful husband? I do not know—and will never know. In any event, the symbolism of the whiteout exceeds understanding in plain view, both revealing and at the same time resisting the intolerable, which is pushing for expression.
I had created a more acceptable narrative: I got the grief before I got the guilt. That is, psychotic, she is reversing time; she has taken her dead boy back inside of her, as if she were pregnant once again.
She was desperate to keep him going as a presence, even as she was desperate to put an end to his presence, effacing his existence, his voice, even as she memorialized him. Inside of her like a fetus; inside of her like a grown man. She was erasing him, aborting, and grieving him, even as she loved him—precisely because she did love him! In her madness she was displaying her grief and her sense of crime.
And this guilt—this misery—she painted on, for all to see, hidden in plain sight. Inscribed in the body, body as text: What a stunning display of body and word. This grieving woman treated her body as if it were a kind of text, and her son written on her body. She folded the word, she folded her son, into her body, that is, into the whole story, the whole history of her body. The story of a mother who bore a son inside, she authored his existence, and now she must correct the text, the story written inside!
In the polyphony of the unconscious, different registers are intertwined in elaborate multi-sensorial puns, like synesthesias, when the senses tangle and merge, as in poetic condensations.
This uncanny symbolic folding of the intolerable story into the body as text takes us to the next vignette. But first, a word about polyphonic awareness, pluralism, or, the music of infinite theory. An interviewer once asked an expert kayaker what, with all of his experience, had he learned over the years?
This captured my own attempts to try to kayak—with each mistake I became more aware of the world around me, things I had never noticed before. I began to apprehend wave patterns, shadows and white caps, and how they moved; I took note of the wind, of tide levels, of my boat; of temperature, of my response to temperature and the experience of beginning hypothermia; I became aware of me-in-my-boat-in-the-water.
My awareness of the world of water opened up—and with this I had a new respect for its beauty and hazards. I remain still very much a beginner. Our teachers and clinical theories, I submit, open our awareness. With this guidance our world expands, we realize we are not alone in our strange calling. When I go about my work—not self-consciously, but reflexively—I respond to a polyphony of almost infinite theories, a complex pluralism. If we had more time we could tease out some of the voices in the chorus of theories implicit in my vignettes—they are all here!
These theories are background, noticed more in retrospect. But in this next vignette notice how my perspectives seem to shift rapidly, even abruptly, moving from the biological, to the legal, to the social milieu of the wards, to the existential, to the interpersonal, to the psychoanalytic approaches to the intrapsychic and intersubjective including my appropriation of classical psychoanalysis, self-psychology, Kleinian, Lacanian, Bionian, relational understandings, and more.
On the inpatient wards, I usually do not foreground transference patterning in the unfolding conversations, rather, I listen for affect and the complex pull of unconscious processes and countertransference enactment. Where and when I feel it is helpful, I might bring these patterns into awareness in the hopes of extending mutual awareness and freeing the conversation to go where it will, together amending, elaborating, correcting, and opening up.
A clinician usually has many theories operative at a given moment, each opening up patterns of awareness and possibilities Margulies, Indeed, the satisfying complexity of clinical work is the simultaneous awareness of multiple patterns. Maybe the complexity of a field might be measured in the richness of its patterns that open awareness and ways of being for its practitioners. Just admitted, the patient has a long history of poly-substance abuse, and, in his 50s, he has no work, no friends, and he feels that he is a failure in life.
Things are dangerously out of control, and how can we help? The brutality of his scar pulls us into urgency. Slicing his neck becomes a shared symptom. Responding, we are inexorably drawn into an unconscious force field that enacts his essential struggle.
Are we witnessing the self-staging of his execution? Just who is this man I am about to meet? His shirt collar is opened to an extensive, angry, red scar, it is out there and meant to be seen, defining him and shaping anyone who comes close, whether acknowledged or not. I wonder: will we be able to connect—and do I want to? I thank him for meeting with me and the students, but, I tell him that he seems tired, is it OK for us to talk?
There is a light in his eyes, intelligence shining through and across some gulf.
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I think of Lazarus, back from the dead, someone in between, liminal, literally on the doorstep between two worlds, vacillating for a moment. When he nearly died, he tells me, he felt relief, no pain, and free from all the suffering. Life had become too hard. And here he wells up, sad—then, he gets sadder still, quiet, and struggling to hold back his tears.
He just hated me. I can hate myself. I want to punish and do away with myself he slashes his hand across his neck , and I call myself names: You bastard! Oh yeah! Inside of you, hating you. We are both back there—but he is back there, caught. And, yeah, I never wanted to hide that scar. I want it out there, all of the time. His symptom, I think, is also his badge, his identity, who he is; the scar defines him: He is the damned—and I decide to put this out there:. His father has come alive in the room, present to us both, a ghost; but father is also part of a scene from the past, replaying like an endless video loop.
Tears run down his face—and it feels as if we are back there, back then, but also right here, right now. He has taken me to the center of his symptom, his scar as a scene of abuse, his grief, his identity, his badge, his conflict at the heart of who he is.