It seems oddly fitting that the words “caregiving” and “caretaking” mean precisely the same thing. Perhaps that linguistic oddity reflects the salient characteristic of care itself: a tension between our desire to receive it and our countervailing feeling of obligation to provide it. Human relations, generally, can be summarized as an on-going battle between those who provide care and those on the receiving end.
As a human child, you started out your life as the ultimate care-collection machine. Children are designed to make you want to provide them with care – and you’re designed, as an adult, to feel a profound impulse to provide children with care, especially your own children. It’s no coincidence that anything you identify as “cute” – i.e., feel an impulse to care for – will have child-like features, such as large eyes in proportion to its face and a large head in proportion to its body. These are all evolutionary triggers designed to make us feel like providing care.
The human instinct to care for youngsters transfers over to other young animals as well, and explains, at least in part, your relationship with “man’s best friend.” Everyone loves puppies – baby dogs. But with canines, the phenomenon extends further than that. Adult dogs retain many juvenile features – a phenomenon called “neoteny” – because by continuing to appear puppy-like up to and through adulthood, they can convince humans to keep wanting to offer them care. Dogs literally evolved to look young and cute just so you would care for them – and it’s worked! Unlike most species, the dog’s trick to evolutionary success wasn’t to display aggression, like a wolf. As evidenced by the wolf’s current struggle to survive in a human-dominated habitat, ferocity only gets you so far. For the dog, docility, rather than aggression, was the answer. By appearing cute – a bit like our own young – they mastered a strategy of symbiosis with another species, humans, with a strong instinct to provide care to their own young. The result is humans calling their dog “baby” and bragging to their friends that he’s “just like a member of the family.” In many respects, Fido actually is just like another child. Dogs are a bit like cuckoos in that respect – enlisting another species to do the work of raising their young – but in this case, by remaining young-looking throughout their adulthood, they lead another species to treat them like its own children for the duration of their lives.
Human children are also master care-harvesters – they have to be, because they remain dependent on adult care for survival for much longer than other species. Adult humans possess large brains, which could never fit through the human birth canal. Our children are thus, of necessity, born with a relatively tiny, undeveloped brain, leaving them utterly helpless and dependent on the care of others for many years. Humans thus possess a strong instinct to summon care as a child, but also a corresponding (and conflicting) instinct to provide care for helpless young humans. Awww…it’s a cute little baby. I want to take care of it.
Thus do we perpetuate our species. But this evolutionary arrangement sets up an internal battle between the child within you who’s hungry for care and the adult who feels obligated to provide it.
The People’s Therapist has joined the bloviating classes…I’ve now appeared as a talking head on a real live (sort of) television talk show – HuffPost Live.
Our initial task as client and therapist – our work during the first few sessions – resembles cartography. I begin, like a map-maker, drawing a square or a rectangle, then sketching the outlines of landmarks visible from afar – the mountains, the sea, the rivers. In limning a life, the prominent features are obvious – where you were born, and when, where you grew up, what you do for a living, who your parents were and what they do, your siblings, if you have any, and your relationships with them, your partner, if you have one, and your relationship with him. I get the big stuff down, then step back, and try to make sense of it all – take “the lay of the land.” Later, I’ll add shading and nuance, and fill in the details – tiny inlets and hillocks, copses and rills.
The first step in the process comes as a question from the therapist. The phrasing of that “first question” gets debated when therapists gather. I trained with a colleague who invariably asked the same thing at each first session: “So what brings you here today?” That feels twisty and indirect to me. I usually start with “So how are you?” or, depending on my mood, or yours, “So how’s it going?” Sometimes there’s serious upset taking place in the here and now, that needs attending to right away. Before I sketch the background – the mountains and the sea and the rivers – I need to know if there’s a battle occurring on that stony plain, a castle under siege, a forest caught fire.
On 
Psychodynamic work is vertical. It involves digging down into your past, looking for the root sources of your behaviors. When I work psychodynamically, I’m wondering when you started thinking or feeling a certain way. I want to make you aware of how the environment in which you grew up shaped the person you are.
If you have a phobia about flying in airplanes, I will likely employ cognitive-behavioral techniques to make you conscious of the thoughts – predictions – that are frightening you. These thoughts are like tapes that play in your head – if you become aware of them, you can turn them off, and play another tape that will soothe you instead of freaking you out.
Some psychotherapists – especially in the past – fought over the superiority of psychodynamic versus cognitive-behavioral approaches. That’s mostly old-hat at this point. The two techniques are considered tools in a toolbox – options for treatment, depending on what the therapist thinks is most likely to be effective and useful for the individual client in question. They are often complementary – two great psychotherapeutic approaches that taste great together.
“If I don’t pass this test, I’m going to lose it.”
People tend to ignore the bell curve. You prefer to see yourself as the hero of your own adventure – the blessed, untouchable protagonist who sails into success. Or you go too far the other way, towards powerlessness, and go martyr, seeing yourself as the unlucky recipient of a cruel fate, singled out for suffering at the hands of the gods.
I was chased down the sidewalk by a breathless woman.
No, I’m not going to spell out where “there” is – you know perfectly well and I’m not here to preach. I’m here to talk about consciousness-raising, not vegetarianism. Specifically, consciousness-raising around alcohol.
There is a curious passage in a recent book by Oliver Sacks, “Musicophilia: Tales of Music and the Brain,” in which Sacks discusses whether Sigmund Freud liked music.
It is not the last word, however, on whether Freud actually enjoyed music. His friend, Theodor Reik, wrote that he’d gone out to hear music on at least two occasions with Freud, and that it wasn’t only the mystery of music’s effects on the emotions that troubled Freud, but a fear of actually giving himself over to those mysterious effects. Reik felt that Freud’s resistance to music amounted to:
I get asked this all the time: “What if it’s only chemical?”
For subtler changes in brain chemistry, talk therapy – or maybe talk therapy in tandem with a drug treatment component – produces better results.
Your thoughts are also chemicals. When you admire a sunset, you are releasing chemicals which trigger electrical impulses that race through the circuitry of your brain.
This isn’t as far-fetched as it sounds. Here’s an example: If you are depressed and I tell you to go for a run because it will cheer you up, I’m not merely nagging. Aerobic exercise releases endorphins in your brain. These chemicals cheer you up, relieving depression.
When you get the words out, and feel your buried anger, new pathways will form between the ancient regions governing emotion in the center of the brain and more recently evolved cognition areas in the outer cortex.
Subtle changes have been made to the chemistry of your brain – to who you are, how you think, and how you behave with others.
One of my patients gets together sometimes for lunch with his ex. It’s always awkward, he says, and a bit melancholy, but there’s something nice about it, too, and so it’s become a ritual.
The next day she took out some old photos from their time together, and had a good cry.
It doesn’t make sense. You hate depression, but feeling sad can be okay – and everyone loves the blues.
We’ll never know the answer to that conundrum. You may lodge a protest, but life remains short, and only rushes by faster the older you get.
Why is that?
The Blues fight back. This is music that came up from African-American communities in the Deep South. Those people knew oppression – heck, they knew human slavery. But their souls were never dominated, even when their bodies might have been.
Sometimes they fight back by refusing to lose their sense of humor. Check out Sonny Boy Williamson in “Fridgidaire Blues”:
At the end of Beyond the Pleasure Principle, there’s a moment where Sigmund Freud pauses to admit he’s gone out on a limb exploring his own ideas:
I suppose there’s nothing wrong with doing things with a touch of formality – we all have our personal style. The mistake is when you start to think your way of doing things is the only way. That’s when you start making a pact with the devil.
The art in your therapist’s office doesn’t matter much either. I’ve moved paintings around and fiddled with the decor only to realize my patients never noticed or cared.
A pact with the devil.
Albert Einstein was puzzled by the mystery of his own fame. He was forever pondering with friends and associates why he – a physicist whose work was a mystery to most non-scientists – should have become the recipient of full-blown Hollywood-style celebrity. For whatever reason, Einstein chose not to discuss this issue with the father of psychoanalysis, Sigmund Freud, either when they met in person in 1927, or in their later correspondence. As one of Einstein’s biographers, Denis Brian, put it:
Why? Because that’s what most people assume they want, until they stop and think, and maybe come up with an answer that’s a little more meaningful.
Money, in psychotherapy terms, is a surrogate for security in love. A patient once told me if he won the lottery he would build a brick house that needed no maintenance and would stand for five hundred years, then he’d create a fund to guarantee that the taxes and every other possible expense would be paid for in perpetuity. He’d have a place, a safe place, forever, that no one could ever take away. He could finally feel safe and breathe free.
As a child, you can gauge your parents’ investment in you – their love – by whether they are paying attention. You learn to do everything you can to keep their eyes on you as much as possible – like a kid at the playground, calling to his mother, making sure she watches each and every trick he performs on the jungle gym. Attention is like food for a young child.
There’s evolutionary history behind our desire to be rich and famous. It traces back to the fact that humans, with their gigantic brains, take a long time to reach maturity. An orangutan reaches adolescence at about age four. He’s in contact with his mother’s skin almost without break for much of that time, then soon becomes independent. A human doesn’t reach adolescence until thirteen. He requires more than a decade of childcare – too many years to rely solely on the care of parents. The human child senses instinctively that his life might depend upon summoning care and attention from others.
The problem with chasing wealth and fame is that it’s a child’s mission, not an adult’s. At some point you must step out of childhood – that long, helpless period of your life – and move onto the independence of maturity. Instead of needing reassurance that you are loved, you can achieve independence by learning to love yourself. That big step into adulthood is an affirmation that you deserve love, and deserve to receive it from those you call friends or partners.
It’s interesting that one of the most famous photos of Albert Einstein features him sticking his tongue out. You’ve probably seen it a million times on postcards or posters on dorm room walls. It seems to speak volumes about Einstein’s naturalness and lack of pretension – his being in touch with his child. Perhaps that’s true. It was photos like that – and his crazy hairdo – that helped make Einstein an icon of approachable, lovable brilliance.
The original, un-cropped version of the photo gives a slightly different impression from the familiar cropped version. The original includes the people around Einstein, who are trying to hurry a sick man home through a crowd of reporters. Perhaps, when he stuck out his tongue, Einstein the adult was simply annoyed and exasperated at a mob harassing an aging, unwell physicist whose work none of them could even understand.
My patient was in a tizzy about a relationship:
I’m amazed at how quickly my patients begin to feel overwhelmed by relationships. That happens because they rush things – stare out at the distant horizon instead of staying in the moment and concentrating on today, the time you’re sharing right now with another person.
There’s no rush to get “established” in a relationship. A relationship never has to be anything other than a choice you’re making because you’re enjoying it – something you want to do, today, for yourself.
My patient was clearly miserable in her job as a graduate student and laboratory scientist. But she’d worked very hard to get into this position. And she was only 3 years away from a PhD.
be the next Beyonce.
With the arrival of agriculture and domesticated livestock – and much greater population densities – greater specialization arrived. The Middle Ages in Europe saw the rise of guilds – early unions for skilled laborers. There was also more leisure time – at least for the wealthy classes – so artists and musicians began to appear. A king or a duke might hire you simply to set gemstones on snuff boxes, so he could hand them out as keepsakes.
The real question, then, isn’t how you can find something you can do. It’s who are you, and what is the job that reflects your authentic identity.
Sometimes we run from the truth of who we are. My graduate student patient had ended up studying science mostly because it was practical. She was an immigrant from China, and pretty good at math and science, and she needed something practical, that could get her to the United States, but didn’t require perfect English skills.
I had a patient who went to law school and struggled to make a career as a corporate attorney, but he was miserable. The odd thing was that his entire family worked as teachers. I finally asked him why he hadn’t become a teacher like everyone else. He thought about it and said he’d wanted to be different. Being a teacher seemed like giving up and admitting he was like everyone else in his family.
A lot of people thought Ludwig van Beethoven was an unpleasant person.
I am happy to admit I do not know what lies at the farthest reaches of outer space, I do not know what happens after I die, and I do not know how long my relationship with my partner will last.
For example, we live out our lives stuck to a round ball of rock by a mysterious force known as gravity. If we keep traveling in any direction, we end up back where we began. Just like your childhood neighborhood, that reality might feel safe and normal. But simply because the Earth is designed that way doesn’t mean the universe is – space may well continue on forever. Yes – without end. Forever.
One of my fond memories of attending Harvard University was studying with Stephen Jay Gould, the brilliant paleontologist. Gould’s specialty was blowing his students’ minds by reminding them that their assumptions might not be generalizable to every situation. He gave a lecture on how things would look if you were only a quarter inch – or 40 feet – tall. My assumption – like a child’s – was that things would be pretty much the way they are now, except I’d be smaller or I’d be larger – essentially I’d be looking up at stuff or gazing down at it, but that would be that.
As a child, relationships were supposed to last forever. Mommy and Daddy – the two relationships that mattered above all else – were necessary for your survival, and you took it as a matter of faith that they had to be there or you would perish.
The People's Therapist 