Postcards from Hell:
The Act of Creation as Creative Enactment
Michael Pariser, Psy.D.
Introduction: The Bottom Drops Out
It was just another one of Janet’s phone messages, this one no different from all the other ones she had left me over the three years we had worked together, all variations on a theme of agony, begging me to save her from her excruciating fate. In this one, she told me that she was falling backwards into a bottomless black hole and describing in detail how her whole body was stripped of skin, her nerve endings on fire. I had heard it many times before, along with other tortures vividly described. Somehow, though, this one did the trick, although I’m not sure why or how. Maybe it was just like Bob Marley said: “Every day the bucket goes down into the well; one day the bottom will drop out” (1973). Maybe this was that day.
But maybe it was more, a confluence of events that provided enough energy to seriously perturb our analytic system (Coburn, 2002) and push me into innovation. The ensuing events could be seen as a creative act, or, on the other hand, as a defensive enactment. Maybe it was an enactment disguised as creation. My best understanding, though, is that it was a creative enactment, one that got us out of an uncreative one. I’ll try to explain. Let me begin with the case.
I had done this to her, Janet reminded me over and over. Every time I closed my door at the end of our session, I was just like her oblivious, alcoholic mother, who, when Janet was very small, locked her in her bedroom each night. Janet screamed and screamed, but her mother didn’t come back, and Janet kept on screaming until she collapsed on the floor, exhausted. The next morning, her mother would find Janet curled up behind the door, her little face crusted with dried tears.
No, actually I was much worse than her mother, because her mother was emotionally unconscious; but I was supposed to be a caring professional, and Janet had come to me, she said, because of my emotional receptivity, my willingness to go deep into the heart of her pain. I, more than anyone, ought to have known better. And yet I failed her, over and over again, because as Janet saw it, at the end of every session I not only closed my door, I closed my heart and mind.
Over time, we came to understand that she was convinced that once she was out of my sight, I was dancing with relief and scrubbing my mind clean of her loathsome presence. The thought of that positioned me as a tormentor who Janet had to scrub out of her own mind. The result was that Janet was, in Bromberg’s (1998) words, “going out of my mind”, which dropped her into blackness until the next session, when our relationship could finally be reestablished. And so it went, Janet destroying me each night, only to bring me back to life again the next day, a Promethean process of endless return.
In point of fact, it was not easy to get Janet out of my mind. I was seeing her five days a week, and most sessions were rife with tension, as she attempted ceaselessly to convince me to abandon my therapeutic role and love her back to health. She implored, she threatened, she raged, until I ran out of ways to respond in any useful manner. Sometimes we would fight it out, a brutal conflict between desperate desire on her part and equally desperate resistance on mine. Other times we just sat in stony silence, our impasse like steel jaws, trapping us together in immobility and impotent rage.
In between sessions, Janet’s messages came fast and furious. Postcards from Hell, she called them: voicemails, emails, and text messages exploding with emotional anguish, like the frenzied shrieking of a helpless baby animal being torn apart by rapacious predators. “Michael, I’m alone. Darkness. In so much pain. I’m dying. I’m falling backwards. Burning. Burning. Are you still there? Don’t let me go!”
Being not made of stone, I was deeply affected by Janet’s messages, but how might I best respond? I could call her back, in the hope of helping her feel she had not disappeared completely from my mind, but that would mean giving over my personal time and freedom to Janet’s needs. And would it even help? On the other hand, I could ignore the calls, so that she might learn to tolerate loneliness and separation, but how much pain could she take? And how much guilt could I?
Not knowing what was best, I tried many things. At first, I answered Janet’s messages, in the hope that some contact would assuage her emotional needs, but the messages only increased. So then I went in the other direction and told her I would discuss them only in session. Still they came, one after another. Of course, I talked with her about the meaning of the messages, which is how I came to fully understand her experience of door-closing as a painful repetition of exclusion and abandonment. I asked Janet what she wanted me to do with them. Of course, she said she wanted me to respond to them, all of them, immediately. Only total availability would do. In response, in line with Ehrenberg (1992), I talked about my feelings about getting so many messages and not knowing what to do with them. I shared with her my felt limitations and owned my unwillingness to be as available as she wished me to be. Ultimately, nothing helped. Janet’s postcards just kept coming, special delivery from the depths of her personal Hell.
Little by little, I began to grow anxious after the sessions, because it was only a matter of time before I would be getting more Postcards from Hell. I began screening my phone calls so I would not inadvertently field another time- and energy-sucking plea for rescue with which I would be forced, unwillingly and incapably, to deal. But in the process of fortifying my protective barriers, my heart hardened as well, and my empathy was lost as part of the collateral damage.
Over time, I began to dread our sessions themselves, as did she, I believe, both of us privately predicting that the next one was going to be just like the last one and the one before that; but at the same time, both of us hoping against hope that maybe this time, if we said just the right words at just the right time and in just the right way, the other’s resistance would finally crumble. Once we got started, however, and saw the renewed energy each had brought to the encounter, our relentless hope (Stark, 2006) turned to rage at the other’s blind obstinacy and at our own pathetic ineffectuality. As Jody Davies (2004) has so painfully written, we became our own and each other’s bad objects. We hated each other, and we hated ourselves.
Increasingly desperate, I sought out those with more experience in these matters. I asked Bob Stolorow what he would do if his patient called and reported falling backwards with her skin on fire. He told me (personal communication, 2011) he would not want to leave any patient in such a fragmented state. Well of course. What monster would do such a thing anyway? And yet, Janet suffered in this way every single night. If I were to respond every time Janet fragmented, I was afraid I would become an analytic emergency service, on call 24 hours a day.
Moreover, a cautionary tale came from George Atwood (personal communication, 2011), who told me that when he had a patient like Janet, he did talk to her every night. Not just that, but when he was on vacation and absolutely forbidden by his wife from talking to his patients, he would sneak his cell phone into his pocket and go for very long walks with his dog. But I’m not built emotionally like George Atwood; when I go on vacation, I want it to be from my patients, not with them. Plus, I knew from the literature that this kind of contact could last not just days or weeks, but decades! That wasn’t what I wanted. But what was? What was it that might provide Janet some emotional holding, but at the same time, would not render me a virtual slave to her desperation?
The Act of Creation
It was while I was pondering that question that the phone call came in, the one that pulled the bottom out of the bucket. In it, I heard something I hadn’t before: the specific quality of Janet’s voice, which was very different from the one she used when she was in my office. She seemed to be another Janet altogether. I don’t know why I had never noticed before. We had certainly talked about her various self-states (Mitchell, 1993; Bromberg, 1998; Davies, 2004), the desperately hungry baby, the overwhelmed parent, the boy-crazy teenager, and the desperate woman in search of an emotionally available man. All of those, however, were different from the Janet who sent me frantic missives from her howling blackness.
Next session, I wondered out loud why she never brought this other state into the room, and in response, Janet told me that, of course, she didn’t feel alone in my presence, and it was the aloneness that triggered the fall. Duh. Also, that once she returned to my room, she was frightened of becoming a loathsome burden with her overwhelming pain. Thus, she stayed on good behavior as the imagined price for remaining in relationship to me. I found myself wondering, however, what would happen if she were able to slip into her horrifying blackness with me present. Would she feel less alone in it? Come to tolerate it better? Integrate it with other states? I didn’t know, but I thought it would be interesting and possibly useful to find out.
The idea that occurred to me then is not particularly earth-shattering, but there was no mention of it I could find in the literature, and when I asked colleagues whether they had ever thought about it, none of them had, so I was more or less on my own. In any event, in that moment, as I was struggling with how to integrate Janet’s fragmented experience into our work together, it occurred to me that I had the technology to do so right in my hands: my cell phone, which held her voicemails and text messages. I would simply play them back to her in session. As this idea formed in my mind, I began to experience a sense of excitement, elation even, because I believed I had stumbled upon a way to confront one aspect of Janet with the other and thereby create a space in which the two of us could stand together (Bromberg, 1998). I couldn’t wait to try it out.
In retrospect, I probably should have thought about it a bit longer before implementing the idea, because Janet’s reaction was not good. She reported a powerful sense of humiliation as she heard her dissociated, desperate voice for the first time, an experience that further concretized her sense of herself as monstrously defective. She then became angry and accused me of punishing her in order to make her stop sending me messages. On top of that, she reported guilt about the impact her calls had had on me, as well as fear that I was using this as a ploy to get rid of her.
In the face of Janet’s multi-pronged indictment, I had a complex reaction. On the one hand, I thought to myself that perhaps this pain was necessary in order to move the treatment forward. As Irwin Hoffman (personal communication, 2012) says, “The patient has to go through the tunnel of shame in order to get help.” I was also reminded of a thought from Winnicott, that “there is no end unless the bottom of the trough has been reached, unless the thing feared is experienced” (1974, p. 106). So maybe, Janet’s shame and pain were what was necessary for analytic progress.
On the other hand, there was no doubt that, despite my best intentions to free us from an encrusted enactment, I had most likely instantiated another one, and I began to examine my own motivations. Clearly, I wanted the messages to stop, but why was that so important to me? As I reflected on that question, the hatred and frustration that I had forgotten in the flush of my excitement made its way back into my awareness. Maybe I really did want to punish Janet for making me experience myself as bumbling and ineffectual and with no way to escape feeling that way.
And then I realized that a personal issue might be playing a central part in the impasse. I come from a family history of exploitation at the hands of a narcissistic mother, who forced all of her children, from the time we were about 10, to work 365 days a year in the service of her obsessional, 20-year home restoration project. My long indentured servantry had left me with a hyper-vulnerability to feelings of enslavement, which arose often in response to Janet’s intractable demands for love and attention. Looking from this perspective, I could see that, fearing eternal enslavement, I had dug my heels in deeply and was definitely a part of our long stalemate.
This new understanding brought to mind Stolorow, Atwood, and Trop’s (1992) notion of the “intersubjective disjunction,” in which “the therapist assimilates the material expressed by the patient into configurations that significantly alter its meaning for the patient” (p. 103). In this case, Janet intended her messages as means of connection, the only ones she could find in the long, lonely hours between sessions, when the links between us eroded for her and, severed from her safety ties, she plunged repeatedly into a burning Hell. By contrast, I experienced her messages as shackles that bound me to her emotionally at times when I longed to be free. My desperate desire to unfetter myself from Janet’s demands left her convinced that she would never be able to establish the kind of ongoing emotional tie that would keep her safe and alive. In other words, what kept me alive was repeatedly killing her.
Now a bit clearer, I decided to stop the message-playing, even though I had no idea what else to do. But before I could, I began to notice changes in Janet’s state, or states, of mind. To begin with, her different self-states had started to emerge and recede in a kind of rapid-fire oscillation, emotional worlds in the flux of destabilization. First the desperate, crying baby would clamor loudly for me to make her the special one. Then the overwhelmed mother would emerge to tell me how she hates the baby and wants to smash its head against the wall. Then the baby would come back, or the six year old, followed by the desperate one who was falling backwards, and even one I’d never seen before: a sad, lonely child who cried herself to sleep, now curled up on my couch.
At the same time, a different atmosphere was developing in the room: one that allowed for a greater emotional openness between us. For example, Janet began to hear my interpretations as attempts to be helpful, rather than only as ways I was thwarting her fantasies. More importantly, she seemed to hide less the parts of her personality she feared rendered her repulsive and unlovable; and now, with her “loathsome defects” in plain sight, she surrendered into the darkness from which she had been running all her life, her Personal Hell (Pariser, 2011). There, the screaming finally stopped. In its place came a profound silence, one in which we connected powerfully, and there, in her lonely world, I finally started to regain my empathy and my genuine care for Janet.
Oh, and the barrage of Postcards diminished considerably, which, in turn, allowed me to bend my own rigid rules. I agreed to take texts from her and return the texts with a brief message of my own. In that way, she didn’t have to tolerate long stretches with no contact, which would have risked the ongoing repetition of the eroding of our connection.
Clearly, looking back, Janet and I were engaged in an intractable enactment, one in which she felt to me like a screaming, voracious baby who would eat everything in sight, myself included, and I seemed to her like a stubborn, withholding bastard who had everything she wanted but refused, for uncharitable reasons, to give it to her. Our joint ossification, undergirded by dissociative and other defensive processes, had long since assumed the form of a rigid impasse marked by a struggle for control. Janet, for her part, came in feeling unseen and unloved and longing to have what she had never had in childhood: an experience of perfect safety and love. The way she found to try to get it from me, however, exacerbated my own fears of enslavement. That terror prompted a more resistant emotional stance on my part, which, in turn, left her feeling less safe and loved than she had felt before. We were caught in a vicious cycle. As Bion (1959) might have described it, the links between us, our own disparate aspects, and our ideas had been attacked and severed.
However, although my decision to play Janet’s messages back to her was, without a doubt, a concrete enactment that embedded significant defensiveness on my part, it was, perhaps, a more creative enactment than the one in which we were intractably mired, and it at least enabled some further movement on the part of the dyad. In complexity terms, it perturbed the system, and in the period before the elements could regroup into their customary attractor state, we moved to emotional places we had not been able to access before. In interrogating our interaction, we may be able to unravel the specific strands of the underlying action that finally pulled the bottom out of the bucket. Obviously, there is no way to determine that with complete certainty, since we are dealing with much that is unconscious. Moreover, as Freud (1913) famously pointed out, “psychical acts and structures are invariably overdetermined” (p. 100,) so that whatever shifted was most likely the result of more than one affective source. Nonetheless, several candidates emerge as possible causes.
To begin with, it is conceivable that, as I had consciously hoped, the simultaneous presencing of formerly incompatible self-states shattered long-established dissociative barriers. While the boundary dissolution was not complete, it did allow for a more integrated sense of self, at least for short periods of time. It also led directly to the rapid-fire oscillation of discontinuous dimensions of Janet’s personality, as well as the emergence of a previously invisible and unintegrated self-state: the wounded child.
In addition, my playing the messages perhaps confirmed for Janet that our connection really did not stop at the closing of the door. To the extent that such awareness took place, it might have disconfirmed her long-established and powerful organizing principle that her presence is a loathsome burden, as well as its corollary, that as a result, I cannot wait to be free of her. Saving the messages and thinking about them between sessions demonstrated manifestly that she was in my mind after all.
Another possibility is that her awareness of my working on the issue on my own time, my taking a risk by playing the messages, and my being willing to take seriously her emotional responses all demonstrated that she had made a real impact on me. In the past, Janet had never sure about her impact, but she commented on it now. Further, my actions made the impact clear in a concrete way that simply talking about emotional effect, even structured as interpretation, might not have been able to do.
Without a doubt, not all of the impact we had on each other was positive. My “creative” solution, for example, was a powerful expression of my frustration and anger at her “failure to improve” and my resulting sense of ineffectuality, and our ensuing emotional-systemic chaos was very difficult for us both to tolerate. Furthermore, another possible factor in Janet’s affective shift is exactly what led to her most intense experience of shame: her seeing her negative impact on me. Through her empathic connection, I think she was able to grasp viscerally what it might be like for me to receive her Postcards on a daily basis, especially given my history of enslavement (of which she was familiar through my writings and public presentations). Nonetheless, the combination of the actions I took and the resulting emotional exchanges between us might, in Janet’s mind, have amounted to an implicit message that I cared enough about her to act in a way that was risky and provocative. That is, my taking a chance by being less overtly supportive and more overtly confrontational might have demonstrated to Janet that she really did matter to me.
One factor that, in retrospect, seemed to be of critical importance was my willingness to take seriously Janet’s emotional reactions to my intervention and, in response, my efforts to earnestly interrogate my own creative decisions. I believe my doing so helped Janet to see that I was not being dogmatic about my approach or insensitive to her feelings. I was instead trying to hold my theory as lightly as possible (Orange, 1995,) and in my observation, my flexibility communicated willingness to remain within the bounds of what was tolerable for her. As such, it helped enable her to remain longer within the shame that she needed to work through in order to reach a more integrated emotional organization. I believe that made a critical difference. Because she was not blinded by a need to escape overwhelming pain, Janet was more able to see the potential benefit of this new course of action. Ultimately, although it was my creative decision to play Janet her messages, it was Janet who, by staying the course and not backing away from engagement with her own dissociated voices, made real change possible.
There may be other emotional shifts implicated in the alteration of Janet’s affective organization — perhaps many others. We can never know with complete confidence. In fact, the search for definitive answers leads quickly into areas of great uncertainty, not only about therapeutic action, but about the essential nature of the intervention itself. Even the most cursory examination of the interaction reveals that my playing the messages was not a simple, emotionally unencumbered act of creation, but rather a complex relational and affective interaction; and given the profoundly inseparable dynamics between Janet and myself, involving intense and ongoing manifestations of both the repetitive and developmental dimensions of the transference (Stolorow et al, 1987,) I would describe what happened between us as a creative enactment that got us out of a less creative one, and it was beneficial in that it opened up awareness, reflection, and the potential for alternative action between both participants.
It was an enactment in that our impasse was born out of mutual defensive processes designed to protect us from our respective unbearable affect states. Janet, for her part, could not tolerate separation, which felt to her like a permanent abandonment that would lead to death. At the same time, I could not tolerate her demands for connection, which seemed to me to require everlasting obedience and a life of enforced servitude.
It was creative in that the ongoing flow of our normal creativity had become clogged in an impasse, and through a flash of innovation, I was able to come up with an extra burst of creativity to unblock our progress. I felt truly excited to have stumbled upon this idea.
It was an enactment in that the “creative” act that cleared the way for further movement itself embedded a defensive process, in which I wanted to push past, rather than analyze, both her resistance and my own. My action no doubt stems, in part, from my discomfort with remaining within a vulnerable emotional space and a concomitant need to find a solution that might “guarantee” success.
It was creative and developmental in that my observation of Janet’s emotional reactions, my self-reflection and my ongoing interrogation of the secondary impasse required me to bear feelings I had not before. Janet’s emotional movement was also developmental, in that it rested on a kind of trust that she did not need to have concrete connection in order to believe that, when the door closed, she continued to be held in my mind.
And yet, after all the positive emotional shifts, the question remains: might even our most creatively inspired movement be part of another impasse, another enactment? Probably, but if so, then that will hopefully spark another round of creativity; and in the end, that is the best one can do, to continue to be creative and then interrogate that creativity, because there is no doubt that creative enactments and their resulting explorations are better than uncreative ones and the impasses they create. This is an understanding that can be a useful spur to clinical humility in that it cautions us as analysts to continually interrogate even our most creative “solutions”. By taking their limitations seriously, the resulting attitude of ongoing exploration can open our eyes to opportunities not otherwise grasped. That is, even our most creative acts, if they are assumed to necessarily contain elements of defensiveness on the part of both participants, can be seen as doorways to new avenues of emotional growth and human understanding.
The Tao of Creation and Enactment
In 1979, the case was put forward by Stolorow and Atwood (1979/1993) that “the subjective world of the theorist is inevitably translated into his metapsychological conceptions and hypotheses regarding human nature” (p. 5). Thus, as they demonstrated convincingly, the metapsychological formulations of Freud, Jung, Rank, and Reich arose from their personal histories and to a great extent, afforded them ongoing protection against emotional retraumatization. The same observations could be made (and doubtless have) of Marx’s economic theories, Aristotle’s philosophy, John F. Kennedy’s politics, Einstein’s physics, or just about any innovative body of work in any field of human endeavor.
Not overtly stated in Stolorow and Atwood’s (1979/1993) formulations, but certainly implied by them, is that it is not only a theorist’s overarching themes and major oeuvres that serve protective functions. Even the smallest act of creation can likewise be an expression of its creator’s underlying emotional issues. That is, acts of creativity and innovation on any scale are not simple, value-neutral events that happen by chance or a stroke of brilliance. Rather, they, along with the creative process itself, can serve not only innovative, expansive, and developmental purposes, but may also function to wrap their creator in an emotional cordon sanitaire.
Moreover, as (Stolorow and Atwood ) point out, creative acts, like all psychological phenomena, are emergent from the complex dynamics operating in the intersubjective field of which the creator is an integral part; and the most important elements of that field are relational. For that reason, creative ideas, while appearing first in one person’s consciousness, are not the artifacts of that person’s isolated mind, but, in line with contemporary analytic thinking (e.g., Mitchell, 1988; Stolorow et al, 2002), as a the creative product of a fully relational process. To paraphrase Coburn (2002,) ownership of creativity is necessarily ambiguous.
I believe this phenomenon to be most easily observed in the specific work of fine artists. As an example, think of Picasso’s famous portraits of his various wives and mistresses, many with tears in their eyes. He’d made them cry; that much is certain. But did his painting them provide him with an antidote to his guilt for having done so?
A more elaborate example of a single work is provided by Bob Dylan’s (1965) song, “Positively Fourth Street,” in which he brutally excoriates a woman who he experienced as having betrayed him. It is true that he expresses his feelings powerfully and creatively, but consideration of his publicly-revealed and not-insignificant emotional issues might lead one to conclude that there could be more to that story than met the young Dylan’s eye. He left out, for example, the woman’s point of view, his own dissociated empathy for her, the history of their struggles together, and their respective emotional issues that made their encounter so fraught to begin with. Moreover, he omitted any consideration of his own contribution to the ending of their romance. Perhaps most importantly, since anger is generally a secondary emotion, what is clearly missing is the hurt behind Dylan’s fury. His writing, then, was not designed to achieve a nuanced understanding or to resolve differences, but rather to make Dylan feel good and to protect him from the challenging feelings that might have arisen had he allowed himself a more emotionally vulnerable view of the encounter.
This understanding, that creativity embeds defensive processes, is the obverse of the, by now, general consensus in contemporary relational thinking that even the most defensively motivated enactments also embed creative solutions to interpersonal affective problems between patient and analyst. As a typical expression of this sentiment, Bass (2003,) citing Loewald, emphasized that “analyst and patient exercise considerable, and often quite unconscious, creativity in how they act on each other, molding the experience into one that will facilitate growth” (p. 660).
In fact, to take a step further, sometimes there may be no line at all between creativity and defensive enactment. Single phenomena may be considered creative or enacted or both, depending upon one’s perspective. For instance, there is much that patients and therapists want to tell each other that, for reason of inability or unwillingness, cannot be made the province of open dialogue. Tongue-tied, they must find other, more creative, ways to communicate. Among many other things, patients show up late, miss sessions, insult the analyst, break the furniture, and agree to outrageous fee raises, while analysts, double-book, “forget” appointments, raise or lower fees precipitously, provide extra-session contact, or try to take over the patient’s life. Enactments? Yes. Creative? Yes, too.
In other words, creativity and enactment necessarily work together to form the therapeutic process; creativity can embody the defensive, and enactment can also be creation. It makes me think of the interpenetrating duality of the Tao, the symbol of which is the circle divided into equal areas of black and white. The key, however, often overlooked, is that in the white area is a small circle of black, and in the black area is one of white. Thus a move into one area automatically gives birth to the other, in a never ending cycle. That notion applies well to the interpenetrating duality of creativity and enactment, or to the repetitive and developmental dimensions of the transference (Stolorow et al, 1987,) that arise and recede in endless combinations for the entire life of an analysis.
In an effort to show the ways in which even those creative solutions experienced as clear spurs to analytic progress can also embed protective processes, I apply Stolorow and Atwood’s (1979/1993) psychobiographical approach to an individual act of clinical creativity. Profoundly relational from start to finish, this moment of creation was generated in the context of an extended impasse in which my patient Janet and I were locked. It is therefore my own history and emotional issues interpenetrating with hers that were implicated in the co-creation of the clinical deadlock, the attempted solution, and the subsequent course of the analysis.
Postscript: Footprints in the Dark
I would love to say that playing the messages was a magic turnaround, and that it was all easy afterwards, but that was not the case. Many more emotional oscillations followed. But of course, that would be predicted by any model in the image of the Tao. Nonetheless, playing the messages clearly triggered a major shift in the course of our work. In that sense, perhaps it really was the time the bucket went down into the well, and the bottom finally dropped out. In any case, an incident took place not long after I began playing back Janet’s postcards from Hell, one that seems to point to the benefit of risking enactment by being actively creative.
One day, she reported that she was home, deep in her usual lonely blackness. This time, however, she noticed something different: footprints appeared in the dark, glowing just a little. And as she looked at them, she recognized them as mine. This was not an overwhelming epiphany for her; she did not suddenly leap for joy. However, she experienced herself as on somewhat more solid ground than she had before, and just a little less lonely.
As we talked together about this, it occurred to both of us that somehow I had insinuated myself into her aloneness. I had not been wiped out of her ongoing existence, and she, in turn, had not gone out of my mind. Recognizing that, tears came to my eyes. Janet noticed and reported feeling deeply calmed and connected to me. Whatever else our creative enactment had created, for a brief moment, it enabled us to find each other in the dark.
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