Hidden Questions, Clinical Musings

M. Robert Gardner

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134892570
• Edition: 1
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

In Hidden Questions, Clinical Musings, M. Robert Gardner chronicles an odyssey of self-discovery that has taken him beneath and beyond the categoies and conventions of traditional psychoanalysis. His essays offer a vision of psychoanalytic inquiry that blends art and science, a vision in which the subtly intertwining not-quite-conscious questions of analysand and analyst, gradually discerned, open to ever-widening vistas of shared meaning. Gardner is wonderfully illuminating in exploring the associations, images, and dreams that have fueled his own analytic inquiries, but he is no less compelling in writing about the different perceptual modalities and endlessly variegated strategies that can be summoned to bring hidden questions to light.

This masterfully assembled collection exemplifies the lived experience of psychoanalysis of one of its most gifted and reflective practitioners. In his vivid depictions of analysis oscillating between the poles of art and science, word and image, inquiry and self-inquiry, Gardner offers precious insights into tensions that are basic to the analytic endeavor. Evincing rare virtuosity of form and content, these essays are evocative clinical gems, radiating the humility, gentle skepticism, and abiding wonder of this lifelong self-inquirer. Gardner's most uncommon musings are a gift to the reader.

Chapter One

A BUSMAN'S HOLIDAY

A Psychiatrist Goes to the Barber

 

 

 

M y barber's name is Charlie. When Charlie cuts hair he talks. He talks freely. Each time I sit down, Charlie says, “Well, Doc, no sign of baldness yet. Looks pretty thick. Wish I had hair like that.”

Charlie always says that. One day, after the usual, Charlie went on:

“What do you think of Harvard, Doc? Just can't seem to get started. I don't know what'sa matter. They used ta win 'em all. Anyway, most of 'em. Six, seven a year. In the old days.

“Had a lotta trouble last week, Doc. Eye trouble. Got somethin in my right eye, not too bad, so I go to the drug store and he can't do nothin so I go to the emergency room at the General and this intern starts fishin around, it musta been an hour, and then he says he ain't sure if he's got it out and I should come back if it bothers me. Jeez. So he puts this big bandage on me and I go home and when I get to my block I take it off cause I don't wanna worry the little woman. Ya know. But when I get in, she knows all about it cause this neighbor sees me in the street and tells her all about it. Ya can't win. The whole damn neighborhood knows. The missus makes me put the bandage back on and she keeps fussin about it and I say, ' Look, it ain't nuttin. Just a little thing. Stop worryin.' But you know how women are, Doc. She keeps fussin and fussin as if it wuz somethin.

“She's the same way, the kid cuts his finger. He's a demon. Always inta somethin. The other day, he needed seven stitches. I told the missus it wuz nuttin. She keeps fussin. He's some tough kid though. Always inta somethin. One night he gets up and starts playin wit his flashlight. Runnin all over the place. Puts this big sheet on and jumps out at his sister. She screams bloody murder. I unnerstan. I was the same way when I wuz a kid. But ya gotta crack down on em. I takes my hair brush and I put it to him. Not too hard. Just a little.

“My old man was a barber too, ya know. He sure couldn't see it when I said I wanna be barber. I jus got back from Service and wanna settle down. He says, 'A barber? No. A man comes over from Italy. He can be a barber. That's good. A man is born here, he can be anything. Not a barber—a lawyer, a doctor, anything.'I told him, 'No. A barber is good enough for me.'

“Ya know, Doc, a barber has gotta supply his own stuff. Scissors. Combs. Everything. Some people don' know that.”

When Charlie finishes cutting my hair, he says, “Well, Doc, that oughta pass inspection. See what the wife thinks. She'll like it. The women always know.” And then he says, “Have a good weekend, Doc.” Charlie always says that about the inspection, my wife, and having a good weekend.

Another time, Charlie said, “Well, Doc, no sign of baldness yet. Looks pretty thick. Wish I had hair like that,” and then he went on:

“Whadda ya think of this Anastasia business? Musta been Costello. Ya think? Howdaya like that guy? Probly like you and me. Coulda gone inta a respectable business. Just went the udder way. Then, poof it's all over. Just like that. Ya hear about how it happened? He's sittin in a barber chair. One guy comes in on one side. One guy comes in on the udder. They push the barber aside—they let him have it. Right in the chair. Fill him fulla lead. Jus' like that.

“I seen a lot of blood growin up. Hell of a lot. No exaggerate, Doc. Seen four differen' guys get shot. Jeez. How da ya like dat Anastasia? Pumped him full a lead.

“Ya know, Doc, I got a little trouble in my elbow dese days, the right one. Kinda sharp pain. Not alia time. Sometimes. When I move it too much. Whadda ya think? Bursitis maybe? Say, what's bursitis anyway? I'd hate ta have anything really wrong. I get it up bout this high and it starts to hurt.

“Hey, I jus got an idea, Doc. Whadda ya say I brush it up here like this? See how it looks. Pretty good, huh? That's how ya oughta do it, Doc. Looks great. Up like dis. Ya see? It fills in that, uh, uh, lil hollow place. We let it grow a HI longer here and nobuddy'U know what it covers. Ya can do yaself evry mornin. Train it up like dat. Funny I never thought of dat before. Yeah. That's great. You'll be a reglar movie star, Doc. Me, I'd need stilts. But one time I saw George Raft right up close. Jeez, he's no bigger than me.

“Well that oughta do it, Doc. Pass inspection. See what ya wife thinks. The women always know.”

And then he said, “Have a great weekend, Doc.”

_______________________________

AFTERTHOUGHTS

This previously unpublished piece was written in 1957. It was set down in my journals in a collection of entries called “Free Associations of Everyday Life.” My original intention was to combine those entries into a book. “Charlie,” however, is the sole survivor of periodic housecleanings.

Following “Charlie” are a few cryptic comments about his concern with “hidden damage,” his compensatory tonsorial activities, and his tensions between friendly and hostile intentions toward his father and his customers. Those comments are followed by several cryptic questions: “Why is Charlie talking standing up as if he were talking lying down? Does Charlie know I'm a psychiatrist? If so, is that why he is talking as if he were a patient lying down and I a psychiatrist seated behind? Is Charlie only driven or is Charlie driving at something?”

That last question-“Is Charlie only driven or is Charlie driving at something?”—could have served as the title of this current collection. I gather I was wondering about the immediate organizers—inquisitive organizers—of Charlie's apparent outpourings from his depths. I gather, that is, that I was wondering what Charlie was wondering. My latent preoccupation with ways in which we are at once both driven and driving—and with the hidden questions that reflect the tensions between the two—appears, or almost appears, then disappears, then reappears, or almost reappears, throughout this present collection till it becomes, after many years, a manifest preoccupation.

Chapter Two

ON PSYCHIATRY AND OTHER SCHOOLING

In 1917 Alfred North Whitehead reminded the Mathematical Association of England that mathematics is a science and that education in mathematics should be a scientific education. He defined scientific education as

a training in the art of observing natural phenomena and in the knowledge and deduction of laws concerning the sequence of such phenomena … There are many types of natural phenomena and to each type there corresponds a science with its peculiar modes of observation and its peculiar types of thought employed in the deduction of laws.

Many of us here today believe that psychiatry is sufficiently peculiar to justify its inclusion as a science, or, as Dr. Hendrick terms it, a basic science. Mr. Whitehead had a special interest in what he called the rhythm of education, the sequences and duration of stages in learning. He said, “Different subjects and modes of study should be undertaken by pupils at fitting times when they have reached the proper stage of development.” He continues, “You will agree with me that this is a truism never doubted and known to all, but I do not think this obvious truth has been handled in educational practice with due attention to the psychology of the pupils.”

I mention Mr. Whitehead to stress that the problems of teachers in other disciplines are not entirely different from those of teachers of psychiatry, and to stress another obvious truth: that the first concern of any teacher-and I think this applies as much in the arts as the sciences—is to foster observation and the understanding of what is observed.

All of us who have shared in the “Psycho” experience have shared in a tradition of disciplined exploration. This tradition seems to me to distinguish a first-rate educational institution from an information center. The major concern of those who have honored this tradition has not been with pontificating abstractions nor with dispensing rules of thumb for the do-it-yourselfer but with learning and teaching the basic moves: the methods of observing, the ways of organizing observations, and the ways of understanding the relationships of the observed phenomena. I believe this is not simply adherence to a principle of psychiatric education or even of scientific education, but adherence to a principle of any education. Whether there is a general recognition that science is more than physical science, that psychiatry is or can be basic science, does not concern me so deeply as an acceptance of the right and obligation of workers in any field to observe and think about their observations in ways useful to this field, no matter how bizarre or confusing the particular modes may seem to those who work in other fields.

There is some evidence that in actual practice in psychiatric education we do not always live up to our high ideals and sometimes work directly counter to them.

Dr. Hendrick has presented in detail his observations of the current psychiatric scene and his recommendations for the improvement of psychiatric education. In discussing his comments, I cannot possibly do justice to the breadth or the depth of his presentation, but I know that Dr. Hendrick will want us to say what we think of a few of his ideas and not simply to treasure them all as beautiful packages not to be opened until some future date.

Dr. Hendrick has made a number of points about research. Since this is a charged subject, perhaps it is a good place to start. Dr. Hendrick speaks of a peril that confronts psychiatry, that is, the spreading idea that the future of psychiatry as a science depends chiefly on laboratories, statistics, or the social sciences. He offers some evidence that this attitude is widespread and perhaps on the increase. I am not sure of the general prevalence or rate of growth, but I can say that antipsychological and anticlinical attitudes seem common not only outside of psychiatry, but among persons who call themselves clinicians in the ranks of eclectic psychiatry, dynamic psychiatry, and psychoanalysis. And, yet along with this, there seems to be another development, the appearance of a number of laboratory workers, statisticians, and social scientists struggling to gain an appreciation of the potentialities and limits of their own fields and of clinical psychiatry. I also see psychiatrists, clinical and nonclinical, involved in an effort to understand the value and limits of the clinical approach and of the methods of the laboratory workers, statisticians, and social scientists. Efforts of those in each group may eventually provide a better atmosphere for work, an atmosphere in which there is less tendency to sanctify or ritualize formal psychotherapy, or the statistical approach, or the social sciences, or the physical laboratory. In keeping with this, I think a case can be made for participation of a psychiatrist, at some point in this education, in interdisciplinary research. I see this as an effort to understand techniques of observation that may not be appropriate to or possible within the clinical setting and to grasp something of the uniqueness of clinical possibilities, that is, to see through experience that there are special opportunities for observation and study within the clinical setting and special opportunities in other settings. I say this with considerable bias in favor of the clinical approach as the basic approach to be learned by all psychiatrists. But I think the primary contribution of research in the early years of education should be a contribution to the development of a sounder appreciation of the potential of clinical and nonclinical work, and of psychological and nonpsychological approaches.

Much as I would hope that resident participation in research could make this contribution, I have found that this is not the case. Early exposure to work on an interdisciplinary team or to nonpsychological or nonclinical research does not appear to me to lead to such desirable developments but to have quite opposite effects. There is the matter of dissipation of energy to which Dr. Hendrick has already called attention. There is another problem. The resident who does not have sufficient clinical and psychological experience tends, when he participates in research, to see the clinical and the nonclinical, the psychological and the nonpsychological, as antagonistic. This may be reinforced by the reality of conflicting time demands and by the reality of conflicting demands of antagonistic teachers. Residents involved in research in their early years seem to become swept up in an increasing process of overrating the nonclinical and nonpsychological and downgrading the psychological and clinical, or to become defensively preoccupied with proving the superiority of clinical and psychological methods yet unlearned and with devaluing other methods. The peculiar paradoxical effect of too early concentration on team research is a strengthening of the wall between clinical and nonclinical and between psychological and nonpsychological workers.

As for the early participation of residents in research in clinical work, and in particular in psychotherapy, this seems to deteriorate in most instances into a stereotyped preoccupation with one detail of psychotherapy at the expense of a grasp of the real complexity of the situation. In other cases it becomes the vehicle for undisciplined technical innovations in an attempt to improve methods that have not yet been learned. Surely a resident may do genuinely creative and original work, but a one-sided preoccupation with creativity and originality may interfere seriously with learning in general and with the delicate interplay of discipline and spontaneity necessary for creative effort. The rush to communicate the first casual observations and to preserve these for posterity in the form of a paper, often the first of a series of papers announcing the intention to study the facts more carefully tomorrow, seems to be one of the occupational diseases of our field. The predisposition to this disease may be seriously increased by an exaggerated stress on research in the early years of the psychiatrist's education.

I do not know what constitutes too early or too intense involvement in research. What is too early and too intense for some residents may not be so for others. I urge serious consideration of the proposal to postpone formal research in most cases until after the second or third year of clinical experience. There are those who fear that if the resident is not exposed early to formal research that he will spend his career in a clinical ivory tower dully repeating the dogma and rituals of his predecessors. It is not, I think, sound clinical work that threatens progress; but not the least of the real threats to progress is the sanctification of the clinical by some and of the nonclinical by others, and the early enlistment of the resident in a destructive holy war.

Dr. Hendrick has spoken of the effects of premature exposure of medical students and residents to theoretical abstraction, and, I would add, to second-hand observation—in short, the tendency of a small dose of attenuated information, along with the booster effects of some kinds of teaching, to serve as an effective vaccine against direct observation and learning. Undoubtedly, the curricula of residency, of medical school, of college, and even of secondary and primary school are involved. Premature exposure to the theoretical abstractions of psychiatry and to second-, third-, and fourth-hand observations is more than a curriculum problem; it is a fact of life. Today everybody psychologizes. Psychological cliche and pseudoobservation are, of course, not mid-20th-century inventions. But pseudoanalysis and quasi-technical jargon are enjoying a remarkable vogue in all spheres of ev...