Left Eye Blind

I was there, an aqualunged conscript jimmying
through the blue-black abyssal, just one
in a queue, a dupe tossed overboard
one by another, to the
drenched cobalt in a boundless trench, a savage fissure
in the Arctic Furies. The ocean exsanguinous in
adamantine horror surrounds my protector,
my drifting monoquoc.

Yes, I was my vile flesh sinking, sinking
in the oleaginous clutch of gravity’s
grip, frigid, a grasp hostile to my
heart tight against her warm susurration.

A grasp of deceit, a clutch
of ambiguous stories floating in me like schools of
viridescent fish, stories with just the right lick
of imperious irony gnawing
these numb entrails, a scene so virulent
even Poseidon’s Trident offered no protection.

I swam with eyeless fish of luminous jade,
shimmering plankton drifting on brutal currents.
An ancient unicorn belly splayed, galloped in tightening circles
looping iron splinters ‘round my ruptured soul.

I rolled soundlessly with iridescent creatures immune
to the arrival of winter’s tenebrous silence, and me seeking desperately
their fraternity long secluded in unfeasible fissures.

I swam for those star fractured
gates, but gliding closed they rejected
my incipient derangement; turned it in on itself.

Is this the crimson region’s true madness: Onyx
smooth
loneliness drenched in Arctic satin?

It took years to swim against gravities imperative, claw
back to the heaving surface of that Cataleptic
Sea where combers stacked
gunmetal grey end
on end leaning high against the shattered
crystal of my will

But the ocean cold couldn’t calm the seductive
sway of a swivet-suckled mind. Can my scissoring legs
kick me free me from that siren song of satin’s onyx?

Will those gelid currents once again heave aloft that blue-black
menace to strap its undertow beneath my rising
archipelago of serrated sanity? Yes, that post-lucid search
beyond my crippled reach for everything, oh, god, yes, reach
for everything and
nothing at all.

It’s not so much what I do with a patient when I find myself bored, it’s, rather, what I do with myself. I have learned over the decades that when boredom starts making me susceptible to all sorts of more comfortable positions gravity has to offer than sitting upright, that I am either closing myself off to whatever is being stirred in me or the patient has stepped out of emotional contact with me; sometimes both as they are reciprocal behaviors and motivations.

As I listen to the patient I am also letting a part of my mind wander over and through me to see if there are any clues sprouting where an unconscious idea is pressing for awareness.

If I find myself being defensive I open myself to what that may be and the best evidence for this lies in whatever story s/he is telling us at any moment. I have found that if I temporarily disconnect it is always for defensive purposes that are surely also related to what is going on in my patient. If I listen closely about some social/psychological interaction the patient had, say at work, wherein the patient felt unheard, dismissed and all under the growing shade of abandonment fears.

I then think that my temporary withdrawal triggered those very same emotions in my patient that s/he had in an earlier encounter with a coworker. I then invite the patient to examine all this more closely, that is after I apologize for my temporary detachment.

I then encourage the patient to tell me whatever fleeting thoughts s/he had when s/he sensed something off with me. I confirm what is accurate about me and wonder with the patient about that which seems on the surface not connected to what had just happened between us.

I help the patient and me identify what each of us consciously and possibly unconsciously contributed to what we enacted between and with each other.

In short, boredom can be a partially open door encouraging us to open it more widely and see what is and isn’t there.

No, Amy, sugar or other substances don’t cause the psychosis of schizophrenia. This serious disorder is the result of very early and repeated failures between a mothering parent and the child. The dislocations start in infancy and repeat over the maturational years of the child.
Usually this starts in the unconscious of the “mothering” parent and is expressed unknowingly as anger, rejection or any of a number of different things that bedevil us as humans.
These “maternal” attitudes are usually quite unconscious and beyond the parents conscious recognition. In a really true sense, their conscious selves are ruled by the unconscious attitudes that would probably appall the parent if confronted directly with these unconscious feelings and ideas.
However, these destructive unconscious feelings and attitudes can and do fall heavily, usually on one unconsciously chosen child leading to the stagnant or destructive parental attitudes that the child needs to defend him or herself against. Often the defense is the bizarre quality of psychosis as the child tries desperately to deal with the terror engendered by the unconscious feelings and attitudes of the parent that often leave the child believing that there very existence is in mortal jeopardy.
Yes, there may be a genetic weakness that can make a child susceptible to the unconscious machinations of a disturbed parent(s) and thus the development of the more ominous psychopathologies, but the real causes of psychosis lie in the relationships within the family and particularly between parents and vulnerable child.

Yes, of course, I get attached, in truth, I get attached to one degree or another to every patient with whom I work. I work with people over multiple sessions weekly for years. Yes, I become attached as I find that to more or lesser degrees I fall in love with all my patients.

I long ago learned from a mentor who I talked to about having fallen in love with one of my patients. He told me how lucky the patient was that I had fallen for her as it seemed that neither of her parents had fallen in love with their own daughter.
I simply allow myself to enjoy the experience but also investigate with the patient how he or she feels about me, usually a transference, and my countertransference of falling in love with them. I work primarily with very disturbed, often psychotic patients and my falling in love is partly what is healing.

This does make terminating both wonderful and painful as, like any parent, or any psychodynamically informed psychotherapist working intensely with people, I have to let go of the patient and encourage their exploration of life away from therapy; I support, no matter how painful, the patient’s need to outgrow the therapy and me.

Like the parent I am, I’ve learned how to let go in the face of my own feelings of loss and pain as I want nothing more than a good life for the people with whom I’ve spent so many years.

In short, I don’t defend against my strong feelings of love and care nor the inevitable loss knowing that termination will be painful and growth producing for us both.

I must add to this that my own long-term psychotherapy has certainly helped me with this emotional constellation at the heart of my work.

Of course, when you are a private practitioner who’s livelihood depends on collecting fees for service it can be annoying, but shouldn’t. If you have a cancelation policy, the patient will have already agreed to pay for non-rescheduled or failed appointments.
Annoyance short-changes the therapy. I always recommend to new therapists to allow themselves to simply sit when a patient is late or fails to attend. I ask them to notice whatever is going through their minds about the patient and the missed appointment. In essence, I suggest free-associating to the failure. Often a surprising thought or insight presents itself that the therapist can use in the next scheduled session. Often, the therapist is able to approach the possibility that their behavior or attitude shaped by counter-transference may be at the root of the missed session and the patient, by failing, is communicating something that they have yet to be able to put into words
In essence, failed appointments are an opportunity for therapist and patient to delve into deeper layers of communication, and thus, change involving both.

I’m not sure this will answer your question as your inquiry was rather broad. I will say this: I have very often while listening to a patient’s awful circumstances in the present or past will leave me with tears in my eyes and often with the tears rolling down my cheeks. This is often accompanied by a temporary inability to talk. I believe that my tears are far more expressive than anything I could say.

My tears have been met with a variety of responses: astonishment that I would feel that strongly; a desire to protect me from the more horrifying instances of abuse; but, mostly, a sincere gratitude that I, too, can feel how horrifying their experience(s) were. Their feeling of thankfulness for affirming through my emotional response that if I can feel it so directly just through the patient’s words and emotions, these patients can then have even more empathy for themselves.

Not having an obvious emotional response to the horrors of evil that so many have endured would be worse than disingenuous. At the end of therapies where I have periodically displayed my deepest feelings, the patients with whom that has happened say that those moments of shared horror, grief, sorrow, wonder, joy, fear, etc. were the most healing for them, and a few have even said they thought those moments may have been healing for me, too.

How perceptive and right they were.

3.7k Views · View Upvoters · Answer requested by Louise Matthias

Mark Maginn
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As a survivor of narcissistic abuse, I sometimes feel destroyed by a negative comment. How do you tell the difference between healthy and unhealthy criticism?
Mark Maginn
Mark Maginn, Psychotherapist, poet, memoirist, blogger, (2012-present)
Answered just now
I’m pleased you reached out here, Trish.

I think being able to tell the difference between healthy and unhealthy criticism difficult under normal circumstances. But for you, now, after a period of abuse, the distinction between the 2 was probably erased for you by the person responsible for harming you.

Though I’m not sure what you mean by “narcissistic abuse,” I can guess, and on that flimsy platform of an informed( I have treated many people with varying degrees of damage to their normal narcissism) guess

Any time any one is abused, their orientation to reality has been damaged and that damage by the perpetrator was inflicted for all manner of horrible motivations but chief among them, & mostly unconscious to the abuser, is the sadistic desire to drive the victim mad. The abuser wants to “fuck” with the victim’s sense and hold on reality. He wants to drive the victim into the veryyyy madness that captured the perpetrator long ago.

This, Trish, is my way of laying the groundwork for writing to you about the possible lingering damage from the abuse. I suspect your abuser was, in part, unconsciously motivated to destroy that part of your healthy narcissism we know as well established self-esteem that allowed you to recognize harmful, deceitful criticism from healthy, and yes, helpful criticism.

That is the damage that comes with possible PTSD resulting from your abuse. It is the aftermath of the abuse that you will, with good help, need to work through. From that work you have regained your confidence and the firm self-regard that will protect you once again from those who wish to harm your self-esteem.

That’s a very timely and pertinent question, Rachel. Mental health services are under attack at the fed, state and local level with many mental health centers shuttered as politicians decide that tax revenue needs to be kicked up to those who need it least.

Working with people with extreme emotional disturbances is difficult: there are huge emotional demands; time demands and pressure from mental health clinics and insurance companies to end the treatment as soon as possible and kick the patient loose.

This coupled with a paucity of training, especially for those of us who know psychodynamically oriented psychotherapy with a well trained therapist and, if needed psychiatric back up for periods when medicine support for the patient is indicated, is a very, very effective treatment.

However, short term therapies are usually the only ones most insurance carriers will fund.

It’s also problematic that many people on the extreme edges of madness often don’t have the funds necessary to support intensive treatment.

However, there are some of us in private practice willing to see these people at a reduced fee, often based on a sliding scale. This, however, can be difficult especially during stormy periods during the therapy where the patient is truly captured temporarily by the underlying madness and the stress on the therapist can be extreme. It is then that we wonder what on earth are we doing this most challenging work for less than our usual fee.

That however, if the therapist has been well trained and well “therapied” him or herself and has ongoing consultation and or therapy to help the therapist with his or her normal, and not so normal, anger and desire to retaliate. Maintaining boundaries is also difficult as these patients in their desperation will not be able to end the sessions on time as the separation from the therapist is felt as catastrophic.

In short, working with people dwelling in the near suburbs of madness or living inside its city limits all too often, is very demanding, draining, & often draining & exasperating work.

Yet, those of us who do work in the vicinity of Madness, USA find the work exhilarating, often magical, and an offered journey deep into ourselves as we accompany the citizens of Madness on their journey of rage, fear, annihilation, brushes with suicide and through it all, an emerging emotional contact with the therapist who, for the most part has not given up and withdrawn, nor has s/he lashed out in fear, anger or rage.

But, instead, the patient gradually finds a therapist who can contain all those feelings of the patient until those inflamed emotions cool to warm embers and provide a space to be truly alive and connected to someone else. Maybe still damaged and sometimes fragile, but an expatriate of Madness USA.