Category Archives: Psychology

Predoctoral Clinical Psychology Internships

For the last six weeks or so I was interviewing for a position with various predoctoral psychology internship programs. All Ph.D. candidates in Clinical Psychology are required to complete a one-year internship as a capstone clinical training experience (and a dissertation, the capstone of the research and scholarship side of the Ph.D.). It’s advisable to defend the diss before the late day of the internship, since one is a Ph.D. after these requirements are met, and hence one can start collecting postdoctoral training hours immediately after the internship ends. 1-2 years worth of full-time postdoc hours are required for licensure in most states and in the District, along with passing or scoring at a particular level on the licensure examination (the EPPP, or Examination for Professional Practice of Psychology). There’s also opportunity to apply for an advanced certification five years later (by the American Board of Professional Psychology), which saves a lot of trouble when you’re moving between states since it’s more transferrable than a regular state license and makes it clear that you are very highly qualified.

Internships are very competitive, as there are far fewer internship spots than there are applicants. “Accredited” internships, those that have been approved by the American Psychological Association, are the most desirable since having one of these means you won’t have trouble getting licensed (whereas for a non-accredited internship, you’re burdened to produce proof that your training was worthwhile) and increases the pool of jobs and postdoctoral positions available to you. Hence, these are typically the most competitive programs. I put a lot of work into this process (which involves carefully selecting sites based on recommendations from others and publicly available information, carefully calculating my total hours of relevant experience, and crafting multiple essays and cover letters that distill my qualifications, professional identity, and unique suitability to any particular site down to around 2500 words per application) and applied to a lot of sites, and I was offered a relatively large number of interviews, all at accredited sites.

Interviews themselves are quite variable, some lasting a couple of hours, some taking the whole day. They might include meetings with individual or two-person teams of staff members, a group interview with other applicants, a funny cocktail-party type mingle session, you sitting at the end of a table while twelve people wearing masks of analytic neutrality ask questions about psychoanalytic theory. Sometimes there’s a facility tour, sometimes there’s a non-evaluative meeting with current interns (always a good sign when the interns can speak freely about where they’re working), sometimes they give you lunch. Questions vary widely—I’ve discussed sample clinical vignettes, presented my own cases, responded to inquiries about what I do for fun, the last song I listened to (Beyoncé… too revealing?), and what a suitable metaphor might be for how I engage with a treatment team. I’ve been asked to talk about conflicts with colleagues and supervisors and how I resolved them. I’ve been asked about how I handle sexual and aggressive feelings I might experience toward my patients. I’ve talked about mistakes I’ve made as a therapist, my weaknesses, my hopes for the future. I’ve spoken carefully, attempting to appear confident but not narcissistic, competent but not unwilling to learn, about my strengths. I’ve been asked how I address crises and surprises, how I screen for suicidality, how I would feel about sending someone to the hospital against her will. I’ve talked about the challenges and self-exploration involved in working with clients who are culturally different from me, and times I would do things differently if given a second chance. I’ve responded to complex questions about what I imagine to be the mechanism for change in psychotherapy and what distinguishes my clinical position from others. I’ve talked about how I can be a feminist and like psychoanalysis at the same time, and where existential-phenomenological psychology fits into my current clinical practice. These are probing and tough questions and not all that easy to prepare for. Some questions are predictable, like “why do you want to work here?,” but there are often curveballs, so you just have to handle the pressure and know what you’re talking about.

The next step was to submit a rank-order list by the deadline (Feb. 2 this year). All of the sites submit rank lists, too. An online matching program, which I had to pay a fee to participate in, puts these lists together to give the candidate her highest ranked site that also ranked her/ is willing to work with her. Unless, that is, applicants who the site ranked more highly fill those spots because they did not match with a place ranked more highly on their own rank lists (most sites have 2-6 available slots, mode of 3 for the places I ranked). This is apparently done using the same algorithm that matches med students to residency programs. It causes a lot of distress among applicants trying to figure out whether or not the official instruction to rank in the order of their genuine preferences (excluding any site that’s so undesirable it would be worth going through this process all over again next year in order to avoid ending up with that internship program) is really the best way to end up matching anywhere, if not to their favorite site. An acquaintance conducting mathematical research in the area of ranking systems, introduced to me by an old friend who was aware of my dilemma, advised me to go ahead and rank based on genuine preferences, as did a number of friends from my graduate program for whom the system worked: “go with your gut.”

Although I anticipate a favorable outcome, I feel pretty worn down after this process. Overall, it’s inconvenient, expensive, difficult, and deeply stressful. It requires travel in December and January, most sites do not offer phone/ Skype interviews, as demand is high enough that they can require/ almost require (you might be regarded by a site less favorably, seen as not seriously considering the site, if you opt for a phone interview) people travel to BFE to interview. I didn’t make it to one of my sites because of snowstorms, and they were unable to accommodate me with a phone interview. A few places, aware that graduate students are typically not earning much of a living, nor are independently wealthy, waive this requirement and conduct no on-site interviews, but this is the exception. It’s also not an option these days to restrict one’s applications by geographic location too narrowly, and candidates almost always have to travel for interviews and relocate for the internship year (which occasionally turns into a second, postdoc year, or even a job, so the move can be worthwhile—this isn’t an option for most interns, though, and many don’t want to stay in the town where they land an internship). Applicants have to apply to a lot of places to make sure they get enough interviews to match, and each application costs something—the price per application goes up after a certain amount of apps, too, to discourage sending out a huge number of apps. This discouragement is supposedly justified by statistics from past years which show that more applications doesn’t equal a greater likelihood of matching after a certain number (because applicants get sloppy/ generic after so many applications? because if you’re not getting invited to interview at some of the first sixteen you apply to, then probably it means that nobody will have you?). It’s also meant, probably, to counterbalance applicant anxiety about applying to a ton of places to make sure you get plenty of interviews (I did this, but not as extremely as some, and felt justified because I was applying to many sites that are known for their excellence or uniqueness, and therefore are particularly popular) or to make life easier for the system—not having to handle a glut of applications, not having less attractive applicants crowded out of interview schedules by applications from more qualified applicants who probably won’t end up ranking their “fall back” sites very highly, anyway.

The overall process also involves a lot of waiting punctuated by stressful situations: first waiting for phone calls from interview sites, then waiting for interview dates to arrive (with highly stressful, competitive interviews every few days), then composing a final and obligating rank list (you must accept the site you ranked that offers you a position—if you turn down a match, there’s little chance that any program will accept an application from you in the future). I agonized over producing a rank list quite a bit and submitted my list close to the deadline. I even made a change to my list after this deadline and faxed it to the matching service (aside to psychology folk: you can do that, guys, but it has to be within a couple of days), and now have a list that reflects a stable set of preferences.

Following submission of a rank-order list, there’s about a three week wait to see if and where one has matched. The date is Friday, Feb. 25 this year.  If it’s a no-go, there’s a round two where any remaining spots/ remaining people scramble to hook up, like the last week before prom or something.  If you get one, especially if you get one of your favorite ones, it’s glorious.

Update: Yes, I got one!  I think it will be good.

Pascalian psychology

S’il se vante, je l’abaisse,
S’il s’abaisse, je le vante;
Et le contredis toujours,
Jusqu’à ce qu’il comprenne
Qu’il est un monstre incompréhensible.

If he vaunts himself, I abase him,
If he abases himself, I vaunt him;
And contradict him always,
Until he comprehends
That he is an incomprehensible monster.

Look what I found

I think this was the draft I sent. And so, the paper that (along with my other merits, of course) secured my position in this graduate program.

I’m surprised to see that I wrote about Jung. I must’ve been reading him because of the therapy I was in at the time. I thought I mentioned Don Quixote, but apparently not. I’m also struck by how much I read then. Not that I don’t read a lot now, but I do a lot of things other than read. Well, nostalgia trip.

January 2006
Application for the Clinical Psychology Ph.D. program at Duquesne University

“Write a personal essay in response to the following: Trace the development of your thinking with respect to psychology, emphasizing which theorists and which of their contributions have had the most important impact on you. Then discuss the convergence of your career goals and scholarly interests with the human science orientation of the Duquesne psychology graduate program.”

My undergraduate education took place at St. John’s College in Annapolis, a Great Books program made up almost entirely of all-required courses consisting of discussions of primary sources. I have read and discussed works by Plato, Kant, Hegel, Kierkegaard, Nietzsche, Dostoevsky, Tolstoy, Cervantes, Rilke, Shakespeare, St. Augustine, Pascal, William James, Freud, Jung, Wittgenstein, and Heidegger, among others. My education was general and emphasized no particular interpretation or school of thought. However, it was this education and my own experience from which blossomed my desire to study psychology with Duquesne’s human science orientation, and to become better acquainted with this field and enter into it. Herein, I will describe what led me to these conclusions, and why I believe that Duquesne is the best place for me to learn more.

Every year at St. John’s, students write a major essay on a particular text or question followed by an oral examination. My freshman essay was on a section of Plato’s Symposium, in which Socrates and various interlocutors make speeches about love. I wrote on the relationship between Alcibiades and Socrates in an attempt to discover what made Socrates the object of Alcibiades’ love alongside the broader question: What makes a person lovable? As I was writing, I observed that I was saying much more about Alcibiades, the lover, than Socrates, the beloved, in determining what made Socrates lovable to Alcibiades. “Lovability” was not an intrinsic trait, but something determined by the one who loved—it was something in Alcibiades that made him find Socrates lovable, and thus, he was the source of Socrates’ lovability; he provided meaning and content in the relationship between subject and object. I shared this during my examination, and my tutor (professor) Ms. Eva Brann told me this reminded her of the work of a later philosopher. Later, when I read the Critique of Pure Reason, I knew she had meant Kant.

The Critique allowed me to think further about how the subject could be the source of reality, or how it could be that meaning is created in our witnessing what is, rather than flowing from things to be intercepted by us. Though Kant is speaking directly of how the physical world is cognizable by us, issues about human beings as the source of order and meaning come up at other levels: What does it mean to live in a world in which we provide the meaning, i.e., a world which lacks essential meaning? How do we attribute meaning to things around us and ultimately build lives based on meaning? Another problem arose as well after reading Kant: the self, or the soul, becomes more complex, for when we turn our eye back to ourselves in order to observe ourselves the same way we do the world, we split into a subjective and objective self. The self seems not to be one thing, and only partially knowable as an object observed by the subjective self with no way of knowing whether the two are the same.

I found a comrade in Kierkegaard. I wrote my senior essay on his Philosophical Fragments and the adjoining work named after its pseudonymous author, Johannes Climacus. The latter work is a fictional biography and presents Johannes trapped between the real and the ideal, himself an abstraction—“a stranger to the world.” Kierkegaard uses him as an argument against “purely objective thinking,” in which one tries to remove oneself from the situation in order to observe from a distance. When Johannes attempts this feat all at once he faints, or loses consciousness. That is, he entirely removes himself from the situation, which is supposedly what one attempts to do when one “thinks objectively.” Kierkegaard explains that all conflict takes place within the subject’s consciousness, and any attempt to remove oneself will be unsuccessful. Furthermore, the implication that one will know more and perhaps come in contact with a grand ordering schema if one exchanges one’s individual struggle for a view of oneself from afar is a delusion. It suggests a grand ordering schema which the individual could comprehend if he abstracts himself from his own life and instead takes the standpoint of this higher system and observes himself within it. Even if such a system exists, Kierkegaard explains, it is not ascertainable to human beings.

I drew from Kierkegaard’s work that philosophy should not deal in abstractions, but should concern itself instead with the human predicament and inner states of human beings. In other words, it must shift from an objective to an admittedly subjective stance. Throughout these works, Kierkegaard emphasizes that it is the individual who at stake in a problem, and what matters is the individual’s relation to philosophy and his being in the world. It became clear to me that the study of individual human beings, then, bears the most primary significance. I also understood that the way we study human beings must be different than the way we study anything else.

Later on, I found further concord with respect to how we are to study human beings (particularly myself) through Carl Jung. At the beginning of his autobiography, he writes, “I cannot employ the language of science to trace this process of growth in myself, for I cannot experience myself as a scientific problem.” I take this scientific method to be one in which we observe disinterestedly and according to a set system. But, when the object of study is ourselves the approach must be different than when we study something that is other, distinct and separate from us. It is not fitting to stand at a distance and watch ourselves; it is impossible for me to alienate myself from myself and become purely objective. It is that very humanness, the thing that we cannot separate out and that prevents us from being objective that we desire to know.

I gained some insight into the nature of these human problems from Dostoevsky’s Brothers Karamazov. Herein, the vulgar, pleasure-seeking, buffoonish Fyodor is told, “above all, do not lie to yourself.” The thought that this man’s outward superficiality and disregard for things meaningful to others might ultimately be a lie raised many interesting thoughts and questions for me, primarily, what does it mean to lie to oneself? A duplicitous self reminded me of the split subjective and objective self, in which one self lives and the other self observes the living without engaging in life. A self formed this way seems an expression of uncertainty that life is wholly worth living, or that one is wholly worth living life. This self is only partially engaged in life while a part persists in doubt; a condition I have come to think of as “tentative existence.” I saw that the most important, basic problem a person faces is deciding, or discovering a reason, to live wholly and authentically.

Another question arose alongside this one, regarding the consciousness a person has of his lie. In Beyond Good and Evil, Nietzsche describes “philosophical prejudices,” the prejudged end to which a philosopher directs his philosophy while claiming to make an inquiry with the unknown and undecided truth as the end. These philosophers certainly would not admit to lying, and I wondered to what extent they are aware of their lies. If they are not intending to deceive others for another end, they themselves must be deluded. The possibility of an obscured part of the self, especially a motivating part, inspired further questions, regarding how to get past this complex to the rest of the self that the complex had hidden away.

Again, I later found elucidation from Jung, particularly his description of complexes: automatic patterns of behavior that make a person into an automaton, robbing him of his freedom and engaging him in a determining script. Tolstoy’s Ivan Ilych, living a life directed toward an outward appearance of success, seems a prime example of a person consumed by a complex. It is not until his last days that the realization awakens in him that he has not really lived. It became clear to me that one of the most important things a person can do is to learn one’s lie and reclaim his life. To get back to the obscured self, one had to attentively and artfully find ways for this self to come to consciousness, for it was already clear that the self could not be approached in the manner of other objects of study. Dream analysis as a way for obscured parts of the self to come to light was especially interesting to me. I even became the patient of a primarily Jungian analyst for a few months this past year in order to look for any aspects of myself that I may have obscured and explore techniques for recovering it.

Alongside my own brief experience as a patient, I explored clinical psychology through reading case studies. The most inspiring, and what ultimately made me take an interest in becoming a practitioner, were those of Irvin Yalom. He provided detailed, moving accounts of helping patients assume responsibility for their problems, thereby restoring freedom to them and enabling them to live more authentic, meaningful lives. This freedom, this ability to be in the world fully, seems to be the origin of a great deal of other problems. I became convinced that the skilled therapist did not offer mere coping strategies for these offshoots of the fundamental problem, nor take responsibility for the problem himself (which would simply reinforce the patient’s problem), but could travel alongside his patient and explore the problems of living.

For the past six months, I’ve been guiding students of all ages through intensive programs to increase language expression and comprehension, including reading and sometimes speech therapy exercises. This experience has reinforced my belief that it is best to treat clients individually. Many of my students have been diagnosed with learning disabilities and ADD/ ADHD or are on the autistic spectrum. I am often struck by how much my students are able to accomplish despite their diagnoses. When treated as individuals rather than offered a prescribed course for their particular diagnosis, i.e., regarding them not as utterly determined by their diagnosis, they could achieve more than they were thought able. Some of these students had even been diagnosed prematurely. For example, some children diagnosed with ADD were, in fact, having difficulty comprehending language at some level and so appeared to be distractible.

This shows me that psychology has become too focused on quick diagnosis and often fails to sufficiently explore the source of a patient’s complaint. The present emphasis in treatment seems to be on brief therapy and psychopharmacology. I see clinical psychology facing further limitations and pressures if psychologists are granted the ability to prescribe medication. The job of the therapist seems especially important now because individuals have more freedom and a greater range of choices than ever before. The burden of this freedom is great, and the transformation of this burden into a source of meaning is an urgent and extremely important duty. I want to preserve the great traditions in psychology and psychotherapy that help human beings make use of their potential.

This is also what leads me to Duquesne: the human sciences approach recognizes the dignity and complexity of the subject matter of psychology and recognizes the uniqueness of psychology’s approach as a science. My scholarly goals are broad. I wish to become better acquainted with various traditions which arise from psychology as a human science and become better acquainted with the field up to recent times, enough that I may make my own contribution. I have explained my interests in this paper and the strands leading me to psychology as a human science, and I am certain that further interests within this field will arise as I become more knowledgeable within it and refine myself as a specialist.

I wish most of all to explore clinical work and different types and developments in therapy. I am currently attempting to secure an internship in clinical psychology and plan to spend time later this year as a patient, as I believe that this is an indispensable experience for anyone wishing to become a therapist. I am fascinated by the extraordinary challenge and intricacy of psychotherapy, a calling in which one is an educator, a friend, an explorer, a doctor, and mostly, as Irvin Yalom says, “a fellow traveler,” because, as he explains, “there is no therapist and no person immune to the inherent tragedies of existence.” (The Gift of Therapy). I also wish to make psychotherapy more affordable and widely available, since I notice that many communities do not adequately care for the mentally ill, and insurance coverage makes it difficult for most people to engage in the long-term therapy that would be most beneficial to them. I am also interested in teaching and someday adding my own insights and innovations to the field. Above all, I want, of course, to make a study of the human soul.

What I Do as a Psychotherapist

I am writing this entry in preparation for my clinical work in my second year of graduate school in clinical psychology, having completed around seventy hours of work with individual clients and some as yet uncalculated sum of hours of supervision, training, and clinical writing. My program provides a background in the philosophical and theoretical background of psychology, particularly the existential-phenomenological and psychodynamic traditions; qualitative research; and clinical practice. These three pillars more or less relate to one another, and it is, of course, up to the individual to find a golden thread. One of the important connections to make is between how one acts as a therapist and what one believes about the nature of man and the good life. (One is eventually asked to lay this down officially as part of the comprehensive examinations, in the clinical position paper.) This is not the place that I will go deeply into what I believe about what we are or ought to be, nor will I even discuss whether therapy is possible. This paper will simply give a description of what I find myself doing in therapy sessions, and perhaps an attempt at explanation of why I do these things.

I will discuss what I tend to notice and respond to when I am in the position of the psychotherapist, what I recoil from, what I feel during sessions in general, and my evolving “theory of therapy.” I’m not sure whether I fit into a certain school– I am probably closer to the humanistic therapies than anything else, although I feel I regard patients with a psychoanalytic eye. By that, I mean that I see many parts of an individual hidden from that individual, and many motives that are not clear to the person enacting them. There is an unconscious force at work. On the other hand, the unconscious is not hidden at all, expressing itself in every gesture, in the person’s comportment toward every situation. It is hidden on the surface. Anyway, theories of psychology should arise from clinical practice, so here is what I tend to do and to notice:

When I first talk with a new patient, and for our first sessions (sometimes for a while), I find myself listening for ways that the person “makes sense.” For example, I had a patient who felt unconfident in making decisions for herself. She related a few times when she had attempted to make her own decisions and encountered negative consequences from others, primarily the loss of support. Thus, her anxiety surrounding making more decisions makes sense. Her difficulty did not arise from nowhere– it is situated. This is also a way I establish rapport with my patient. She sees that I am attending to her closely and that I don’t think she’s “crazy,” but that what she’s doing somehow “makes sense.”

Related to this, I try to get a sense of my patient’s world. What is her experience like? What are some essential components of her life? I learn this by looking for patterns. I look/ listen not only for patterns in events she relates, explicit or oblique (here is a loose example of what I mean: explicitly, she might date the same “type” of man, more obliquely, she may date men who are in some way like her father), but for patterns in words and phrases she uses, in her body language, or in other styles she uses. I had one patient who often said “I’m done with that/ them,” but then would continue on in the situation/ with the person nonetheless.

Another way I try to get a sense of my patient’s world, at a more advanced level, is to discover ways that the pattens manifest themselves. I try to look at the therapeutic situation, and more the assessment session, as a microcosm. The patient’s world will be recreated in the therapy room. How she deals with some situations will reproduce itself in the assessment. The patient has a particular world, this world is structured in a particular way, and this structure will reproduce itself on micro- and macro- levels.

I also tend to remember a lot. I remember general and particular things my patient tells me, including words and phrases she uses often. I remember events in her life, including former challenges and problems. I sometimes remember exemplary events– “the time the worst thing happened,” or “the time what you were afraid would happen did not happen,” and so on. In this way, I treat therapy sessions as somewhat continuous. What the patient brought up three sessions ago may relate to what she brought up in this session. I often point out connections– “that sounds like the situation from your dream” or “it seems like you experienced disappointment about not getting the job in the same way you experienced it when you didn’t win the game” and so on. Sometimes this forms a narrative or whole that was not present before, and helps with “making sense.” Sometimes it helps the patient feel understood. Sometimes it helps to consider events in light of other events. Overall, doing this ends up helping the person to notice patterns, and perhaps to observe these pattens in action.

I try to point out ways that the structure of the patient’s world is reproduced in the therapeutic situation (I think this may legitimately be called transference). The first time I do this might be in the assessment session. For example, if the patient has an angry outburst when she is unable to put together a WAIS block design, and has come in to therapy concerned about a possible break-up with a partner due to her angry outbursts, this would be an opportune moment to observe and discuss what happens in these moments. Other opportunities may come up in therapy sessions, such as how a patient reacts to the therapy room, contingencies like noises outside or a lack of air conditioning, or for a particularly dramatic example that happened to one of my patients, finding her ex in the waiting room. I also sometimes point out a patient’s reactions to me– how she seems to feel about me, what our relationship is like– but I find this more difficult, both because it’s intimidating, especially when a patient is angry or disappointed with me, and because I don’t want the patient to feel unsafe or invaded. This last move requires a great deal of trust and rapport.

Observations from Psychotherapy on How Using Social Software Influences How We Structure Our Worlds

Through a surge of new acquaintances who quickly dispersed to their separate locations across the continent (colleagues from a brief summer job in New York), I’ve been pulled back, hard, into the Facebook. I want desperately to keep in contact with these wonderful people, and this is the way I know how. (Letters? Too slow– and who writes letters? Phone calls? Too personal– and what if the sentiment wears off? And what if I’m there for one of social softwares’ less noble uses, such as observing/ spying on my new friends and trying to learn about their other identities/ who they are in their real lives?). Anyway, one thing leads to another (as they say), and now I’m one hell of a participant-observer.

Social software keeps coming up in my clinical work. It appears in two major ways: 1) as an extension of my client’s social life, i.e., an ex-boyfriend made a change on his profile intended to publicly humiliate her, and 2) as a manifestation of neurosis or self-perception. What I mean by those rather vague expressions may be illustrated by a client who is perpetually dissatisfied with what his social software profile expresses. It is either too honest and revelatory of his faults, or conceals too much, making the imagined audience (people with whom he might end up becoming romantically or sexually involved) suspicious. He is displeased with his digital body, as he is with his “real life” expressions of identity and his physical presence. Nothing outward seems pleasing.

I was disappointed at first when I concluded that there’s nothing new under the sun– that more or less, the internet recapitulates what’s out here. Sure, there’s no need to express class/ race/ age/ gender/ whatever on the internet, and you can choose not to state those things, purposefully deceive or get around giving a straightforward answer about your categories, or perhaps somewhere out there create an identity that doesn’t rely on these categories at all (yes, this is why I’m interested in the furries); BUT for the most part people get as close as they can to making a digital representation of what they are out here, consciously or no. I realize, though, that the representation itself is quite interesting and can be a great metaphor for how one views oneself/ wants to be viewed by others. The second person I mentioned above gave me a great image for his way of being neurotic when he described changing his profile a few times a day. What an incredible resource for a psychotherapist.

There is one real change I’ve noticed that follows the widespread use of social software. A serious social-software user has a different sort of lifestyle than a person who does not participate. This makes knowing about social software not just a fun bonus or a resource for a therapist, but an essential piece of knowledge if she is working with the youth (anyone in the youth culture) and is to understand his world. I’m a little confused about the phenomenon I’m about to describe, as I think a lot of people who have noticed this phenomenon are, as indicated by articles I’ve read about how damn narcissistic the youth are these days. Social software promotes living a public, externalized life. Facebook is the worst at this– I still hate the newsfeed, which is a stream of gossip and an implicit privacy invasion (for more elaboration on how the newsfeed invades privacy see danah boyd, here: What goes on the internet– one one’s profile, blog, etc.– is subject to an audience. We get used to acting for an audience and displaying ourselves. Profile pages are advertisements for ourselves, even when we’re not using the network for dating or getting to know students at the college we want to attend (how people used the Facebook back in the day before everyone was allowed on, so I’ve heard).

Is this a cultural change or an opportunity for narcissists/ a promotion of the pathology known as narcissism? I was bothered earlier this year by a friend who had this whole relationship online– his partner lived in the same town, and yet it still seemed that most of their relationship happened on Facebook. I knew their every move through heart/ broken heart symbols, wall posts, and the like. Facebook became the primary way he communicated what was up with them, meaning that something would be announced on the internet, and the next day people would ask him how he was doing. I thought there was an implicit contract where a piece of information spread through “real life” social channels and then one’s profile was made to match– the representation follows the actual. For him, the representation was the actual. This odd shallowness is social software narcissism. Clearly, it still creeps me out a little, and I like to think I’m beyond it (see my earlier post called “pending,” referring to the then-pending deletion of my facebook profile).

On the other hand, the semi-anonymous audience of one’s peers may be the great contribution of social software. MySpace presents you with a bunch of kids your age who you know in “real life” to various degrees, and definitely does not include your mom. What better place to experiment with a developing identity? What safer place to out yourself, as whatever you can’t be in high school? How awesome is it that so many people can be impressed by my taste in books and film, and that people I barely know can write congratulatory notes on my “wall” when I get my M.A.? I feel like I’m tapped directly into the zeitgeist, updated to the minute. I wonder, though, whether this is a good way to engage with others, as a gigantic mirror. Back to the old question of whether the internet marks an evolution of how humans live and communicate, or whether it just gives us a way to indulge ourselves that we couldn’t before.

A Teleological Exploration of Anorexia Nervosa

This is a “weekly reflection” paper written for my psychopathology class.

What is the experience of an anorexic person? In the case of anorexia, as with other disruptions and disorders, I find this a more interesting and precise question than asking about the origin of the disorder and more useful for transforming it. How is it that the anorectic perceives the world (what sort of a subject is she, and what sort of an objectivity does the world have), and as an extension from this question — as we often ask in class — what is it that she is trying to accomplish/ what is the telos of her disorder?

To get closer to this question, I have been watching video diaries and “thinspiration” (( These show images of very thin women and words of encouragement to support one in her quest to “stay the course” of anorexia. Statements about what one may accomplish by being thin — popularity, power, being a “symbol of perfection” — accompany the images. )) video clips on put together by young anorexic women who label themselves “pro-ana.” Their videos have an idealistic, cold, militant tone. Members of the community leave comments on one another’s productions, encouraging one another to keep up the hard work. They speak aggressively about outsiders and “posers” — those who do not meet the criteria for anorexia. I see evidence of the stubbornness Gabbard and Malan describe — the difficulty of establishing and maintaining a therapeutic relationship, her unwillingness to begin to speak, hiding suicidal wishes, etc. They seem to mistrust outsiders and speak constantly of others’ misunderstanding or weakness as shown by their inability to be anorexic themselves. The young women in this community typically have a great deal of knowledge about the diagnostic criteria for eating disorders (which they use to debunk posers) and the medical risks, which are taken as the price one must be willing to pay rather than as deterrents. Accepting these risks is a sign of one’s seriousness. To these anorectics, as if they were spokespeople for the anti-psychiatry movement, anorexia is a lifestyle choice and not a disease equivalent to a cancer on the soul in terms of the freedom and ownership involved for the sufferer. Having anorexia, or rather, being anorexic, is a source of pride and strength.

I sympathize and even agree with them to some extent (indeed, to the same extent that I agree with anti-psychiatry). It does not seem that one can ever experience mental illness as one experiences cancer — as we have discussed, we make meaning from our mental lives, the experience is simply not equivalent, even if a mental illness is similar causally to cancer as a product of biology/ genetics or the environment. As such, this manner of being in the world is worth understanding. (This is another reason why etiology does not interest me nearly so much as, and sometimes even seems irrelevant in light of, a subject’s interpretation of her experience.) However, there seems to be at least one essential misunderstanding at the core of anorexia and simply leaving it unresolved does the anorexic person a disservice and makes it clear that her disease is not so much a matter of choice as a conclusion based on faulty premises.

In the case of eating disorders, as with most (if not all) of the disorders we have discussed in class thus far, there seems to be some kind of a split involved. One part of the patient is not communicating with another part which becomes an unknown influence, one bit of ego is split off and pitted against another bit, or a process has started that was not carried out, leaving part of the patient’s soul lingering in the past, in all cases presenting an un-integrated human being/ soul. An anorectic seems to live under a similar split, and it seems key to bring this split to her conscious attention for her to see that anorexia is not as much a matter of choice or control as she thought and thus paradoxically to stop choosing anorexia.

I am drawn to the “pro-ana” community as a source of understanding anorexia because they display a different side of anorexia than the one I typically hear described by observers (though they may not be representative of all eating-disordered persons). Szekely and DeFazio discuss how most accounts of anorexia “fall into either psychological or sociological reductionism,” (pg. 374) simplifying or distorting the situation. Observers sometimes paint the anorectic as someone who is an utterly passive victim of her society damned to attempt to achieve impossible beauty standards (really, anorexics reach beyond these standards, making a mockery of American ideals). From her side, the anorectic is not nearly so weak — in fact, she is powerful, strong, superior, engaged in a mission few dare to undertake (as I will discuss shortly, this seems to be based on a bad understanding, though this does not seem to mean that anorexic women are passive or weak). Observers also seem to make anorexia into a perceptual disturbance — the anorectic “thinks she is fat” and even “sees herself as fat.” The image here is an emaciated woman looking at an obese reflection in the mirror, as in Seligman’s interpretation of her patient’s distorted self-portrait.

Based on the evidence I have gathered from internet field observations of “pro-ana” young women, they are highly sensitive and aware of how they look and place an enormous amount of significance on it, but do not seem to misperceive their appearances. As one of the anorexic women in Lintott’s article describes it, bony knuckles are a sign of strength. It seems that the anorectic’s body is magnified or distorted in terms of significance, but not that the body is literally seen as fat. This is to simplify the anorectic’s perception.

The misunderstanding for the anorexic person, rather, seems to be based on the divide between the visual/ objective/ symbol-laden body and the felt/ subjective/ personal body. While I find Boss’ essentialism and rigidity in terms of what is normal/ right/ good as disturbing here as I have found it in his other writings, the case histories I read for this week helped me sort out the distinction between the specular body and the felt body, and what seems to differentiate eating disorders from psychosomatic disturbances. Psychosomatic symptoms are displaced from the soul to the body, revealing that the boundary between them is permeable if present at all. “How else could the intestines of our patient have been so completely in accord with her attitude or her world-relationship…?” (Boss, 152). These are disorders of the felt body, the body that is me. Anorexia seems to be a disease of the specular body, or the body that is other — indeed, the disease may be that subject-body is replaced by the object-body.

While some of the readings point to this conclusion in terms of a young girl who does not differentiate into a true subject because her mother is too close to her (superficially, this seems to be the explanation for just about every disorder we’ve studied so far!), Lintott’s Sublime Hunger provided the most help in my teleological examination of anorexia. The body is the source of disease because the appearance of the body is highly important in our culture; it is a carrier of symbols, so overdetermined that one may wish to leave it behind (this is part of my support for internet communication, as I discussed in my last reflection — it actually provides the opportunity for us to abandon or re-create our specular bodies, by which others impugn us with stereotyped identities, so that we might communicate more authentically, for instance, without limitations others impose on our race or gender). As Lintott describes it, anorectics work on their objective bodies. They transcend their bodies and work on them from beyond, disconnected from them and living in a transcendental Kantian realm. The moral rigidity, alexithymia, and perfectionism all point to a beyond-human existence in which the body is “other.”

An eating disorder is purposiveness without purpose: a way of being that is blind to its true telos. As Lintott says in reference to the concept of the sublime from Kant’s Critique of Judgment, “The sublime is not meant to be a way of life” (pg. 6). Forever reveling in the divine disrupts (eventually ends) being. I once asked a friend who had just written his undergraduate thesis on that book what stopped people from staring transfixed at beautiful objects, and he said, “they get hungry.” In other words, earthly needs take over, the body in its mortal/ felt/ subjective sphere commands attention. The telos of an eating disorder seems to be, as Lintott states, “complete perfection — total domination of will over matter” (pg. 6). The impossibility of this telos is the blindness of an eating disorder and the logical error I referenced above. As one of the anorexic women in Lintott’s article states, “’I just can’t win for losing.’” Here is a moment of identification: in a way that she was not before, this woman is her body. Felt body comes to life. She sees that “to use an eating disorder to perpetuate the feeling of the sublime is to foreclose on the future possibility of that feeling” (pg. 6) and “strength and freedom cannot be sustained in a body too frail to hold itself up” (pg. 8). This identification and integration is the beginning of healing.

I want, I want, I want!

There is too much to want!

My professor told me a story about her son when he was two years old.* They were in the toy aisle, and he picked out a toy, saying “I want it.” She refused and calmly put it back. He repeated this with another toy. Each refusal led him to pick a new toy, in greater frenzy until he began running through the aisles yelling “I want, I want, I want!” before she caught him and he began sobbing. Her interpretation is that the toy aisle, plus her repeated refusal or foreclosure of particular toys/ possibilities, suggested so many possibilities—so much potential for future action—that there was no one choice. She says “He felt overwhelmed by the infinite possibilities of all he could want.” Here is a model for Heideggerian resoluteness that presents the mammoth nature of this task; one must choose in the face of infinite possibility, and to the annihilation of all other possibility. Eva’s son was awash in the future possible, transforming him into desire without an object.

My God, how I don’t want to foreclose! (How I want to live forever!) To the point that on occasion I wish I hadn’t been put in a position to choose at all—the fearful neurotic position, as Otto Rank** describes it, “A neurotic is one who refuses the loan of life in order to avoid the debt of death.” I have the freedom to be anything (a god), fewer bars surround me than ever historically—in the world’s history and my own history. My activity so far, generally, has been about opening more possibilities. Though these shut down others (had a disturbing conversation with Mr. Sinnett, my lab teacher and later senior essay advisor at St. John’s College, early in my freshman year on the topic!), none has felt conclusive. I want to do everything, in lieu of that, the best thing… when that isn’t available, I am subject to the madness of decision, and often resign to a “tentative existence,” equivalent to refusing the loan of life, and simply going forth, zombie-like.

(Do you see why existential psychology?)

*Dr. Eva-Maria Simms, in Phenomenology of Human Development at Duquesne University, fall 2006 semester, and in her paper “Because We are the Upsurge of Time: Toward a Genetic Phenomenology of Lived Time”

** Will Therapy, p. 19 See more progress on: read everything (from 43 Things)

On Two Experiences of Looking

This post first appeared on my St. John’s alumni blog on 10/11/2006. It describes an early encounter with phenomenological thought here in the clinical psychology program at Duquesne. Since I began the program a few months ago, I’ve been trying to reconcile the kind of thinking that goes on here with what goes on at St. John’s. I’ve been meeting it with variations of ambivalence and delight. Here’s a taste:

Is anyone familiar with the history of how Erwin Straus’ “Upright Posture” ended up in our freshman lab manuals? I’m reading this paper again next week in my Phenomenology of Human Development class. There are a lot of connections between this class, which in part aims to teach phenomenological observation (teach our vision to unfold all the meanings in an appearance, to “really look!”), and freshman lab. Drawing flowers and magnolia trees is certainly an exercise in retraining vision, with the message that the first step in building a science or making the world comprehensible is perception. In my first lab class, Mr. Sinnett dropped a book in the middle of the lab table and said, “What do you see?” In our bewilderment, what recourse did we have but honest looking, and to take note of the meanings, the schemas we employed, and to discard them (or at least, put them in parentheses)? Especially when answers like, “I see that the book is on the table,” yielded responses like, “What do you mean by ‘on’?”

This is like and unlike the experience and lesson of my first day of Phenomenology class. Dr. Eva-Maria Simms put a rock in my hand and said, “Tell me about the rock.” Meanings unfolded, associations, memories, perceptions, desires and actions. A few of us wanted to hold onto the rock, or throw it, or pass it between our hands slowly. I put the rock on the desk in front of me and revealed my inclination to observe the world from a reasonable distance and with a pen in my hand before testing it’s weight, size, shape. The rock was ripe. It produced infinite associations– it belonged to as many worlds as we could name.

I’ve been trying to articulate the differences between these two instances of looking. The rock observation was all about what was happening between me and the rock. It was certainly a more romantic exercise. I was much bigger in that room, and as our looking went on, the space between the observers and the observed diminished. Eventually we were discussing co-existentiality, the ways in which we reached toward or “intended” the rock. We discussed embodiment, how being in a body changed how we saw the rock– we were intensely present in all our details, the phenomenon was happening in the (perhaps illusory) space between us. It was impure, frustrating in its fluidity, inconclusive/ unconcludable, and admitted felt silly or childlike. This exercise was, in fact, partly intended as an introduction to the experiential world of the infant and young child…

Reading Habits.

Witness this phenomenon in my reading habits: While reading one book (in this case, Philip Rieff’s “The Triumph of the Therapeutic”), it occurs to me that it would be advantageous to my understanding and ability to work intellectually with this book to have read some other book (in this case, Freud’s “Civilization and Its Discontents,” referenced frequently in Triumph of the Therapeutic, and probably on Rieff’s mind throughout). Thus, I will put reading the first book on hold, and begin the other book. This book marks the place of the first book, since when I finish it, I will return to the first book where I left off.

Since no better name comes to mind, I’ve deemed this the book taco.

Now, book tacos are but the visible endpoints of a much greater construction. I could have a few book tacos going at once on various topics; one taco perhaps wedged in another taco, or more than one book wedged into another book at different points. In fact, that Rieff book (of the psychology and/or psychology+culture taco) is “tacoed” (coin!) in Simone de Beauvoir’s “The Second Sex,” which I began reading independently of the other books as part of a separate topic, on feminism. When I got to chapter two in The Second Sex, however, the topics merged, since that chapter is about psychoanalysis. I realized that it may be preferable to complete my psychology book taco before going on to further my readings on feminism. You see the emerging effect—initial books will get further and further away, and primary information will continue to build.

Many items, visible and invisible, books and information, online articles, films, certain discussions I’ve had, even plans and future events are tacoed in such a manner. Some objects encountered in the past are half-digested: they await their proper context. helps me keep track. I can list books (and other media—hence the “all consuming”) I’m “consuming,” have consumed, or intend to consume. I can name the order in which I intend to consume them, and tag them with their topic/ taco title. It’s a rudimentary brain organizer, allowing better organization than just making physical tacos can (for practical purposes—you know, the books fall out once you go so far). But it can only do so much, as I’ll explain below.

The building of book tacos tends to follow some trends. The newer books get moved backwards, and the older books that supported them move closer (the inside of the taco). I’ve been lead back to Plato more than a few times. Specific information gets further away, and more abstract information gets closer. I had to pause to consider that one for a moment, but it makes sense—you’re studying a specific topic, find that the specificity is better understood from a broader frame of reference, and find the more abstract information that surrounds the specific before you return to it. Information becomes a means to greater information. Everything is considered in context.

There’s also a symbolic connection. Looking at information this way makes it possible ask someone, “What is your taco shell?,” which means, “What is that for which you aim; what is your sense of the last thing?” or even, “In what context are you considering everything else?”

This mode of operation creates a sense of urgency. The builder clambers to get to the outside, and to consume the new item before the one that inspired its consumption fades from mind (especially with regard to the connection it has to the new item, or why it inspired the consumption of the new item in the first place). In a way, each new book is less and less significant. They are all efforts to get to the outside and stand in the way of reaching that furthest information, the one toward which they build.

I must admit, this can be a pretty miserable state—the distance from the truth, the urgency/ anxiety, the uneasiness, and the perpetual state of inconclusiveness are tiring, and the journey takes increasing amounts of work. The inability to keep up with it all and the fading connections that have not been transferred to long-term memory can give one the sense of having poor memory (Method will attest), or not feeling quite in touch with things, or all there. One has a lot of tentative information in one’s head—a lot of remembering context, or knowing something in such a way that it can be readjusted. External storage systems (e.g., AllConsuming, your PDA, the huge mind map on your bedroom wall [though I’m thinking more about that last one], etc.) can only help so much, because this information has to be held in mind to some extent because it’s so fluid. It can’t be filed anywhere permanent because it awaits its ultimate place in the developing system, i.e., it only has a true place once the item that contains it has a place, and on upward to that taco shell that grants meaning to the rest of it all.

I was surprised when I found out that a lot of philosophy works that way, more as time goes on. Instead of going further, the philosopher claims that the one he refutes has found his beginning in an appearance, mistaking it for the ground, the true beginning. His biases have caused him to make a false attempt and his entire investigation is crippled. The refuting philosopher takes a big step back and builds from his true(r) beginning. The tendency, as I’ve noted, goes from the specific to the general, from the particular to the abstract, and from the contemporary to the prior shaping events. In short, away from what is most desirable and useful.

But to get to those better things, to return to the here and now where we are most powerful and present and all the information is more significant, we have to navigate through the rest. There are some shortcuts. Certain items can be eliminated due to insignificance (There’s a margin of error here, of course. Some things can be judged irrelevant pretty accurately, others might just barely lose out, and you can’t really be certain about those.) Some are adequately contained in other items and don’t really need to be tacoed in. Some things can be taken in fast or in a condensed form. Organizational tools make for the most efficient order of consumption, and allow one to make a plan. It’s always better to do these things in order—makes for less loose, floating bits of unattached information, if things can be filed as you go into bigger chunks of unattached information. Maybe there’s some way to defrag, if you will.

I think that sometimes the frustration and buildup can become so much that people go crazy or just stop. And stopping does clear the air—one has to take a meditative moment to remember the outermost layer, what one is aiming for. (Going crazy means something like falling out of the system altogether; leaping totally out of any context to be free of it.) Then again, another strategy is simply not to aim. Then each piece of information takes on its own significance; in a way, that individual has reversed his book taco, since each book leads him not away from the first book, but to new ground. Indeed, this is the construction of the St. John’s program—beginning at the beginning (until you get impatient and start aiming, or shaping up to aim… when the outermost layer becomes political philosophy, say, and everything is accepted or dismissed, and interpreted, based on that context). Working this way seems to require a guide, though, to tell you where to go next. Otherwise clueless floundering/ library surfing is all you’ve got.

One common solution is to choose a stopping point. Find an ultimate context that isn’t too broad—specialize. The temptation to stop short has a formidable opponent in the desire to know everything, but that in turn has an even more formidable opponent in death. Everyone hits this point sometime, it might be wise to choose it so as to gain some compromised satisfaction. Again, early retirement is the accusation the new philosopher makes of the old.

I’ve also seen a response to the whole system taken as a blur. An insight into the universe precedes. All that stuff looks unmanageable, unbearable, a vast mystery that is too much for an individual (so judges that individual). Taken in all at once, it’s terrifying and amazing. He lives in wonder—a blur, perhaps momentarily latching onto certain points of entry, and then giving up again. A tedious person; though he may possess true wonder, most of his output consists of description or regurgitation without synthesis, and exclamations akin to “Fascinating!” The more honest ones may develop a wide-eyed, mystical attitude about the incomprehensibility of the universe and radiate unsubstantiated appreciation. (Note to self: This can’t be the same as phenomenology, can it? See below.) At best, endearing and childlike, at worst, cynical and blasé.

Now, this is a curiosity: what about the one who claims this fluidity as a principle, the one who rejects an ultimate context, whose information extends to infinity? The one who, even when given immortality, would not be able to satisfy his ends? The taco shell is contextlessness. Whoa. More later.