Shutter Island

Say what you will about how psychoanalysis is outdated, but how could we make a good horror movie without the stock characters of the Freudian unconscious? The suffocating mother, the castrating father, the lover who steals one's soul - Martin Scorcese's new movie "Shutter Island" is cast from The Interpretation of Dreams. The only cliche it avoids, that famous cigar, finds ample substitution in cigarettes and even these, it turns out, may be poisonous. "Beam me up, Melanie Klein," I was thinking.

It's a poignant time for a movie that ultimately argues for depth psychotherapy of the very ill and uninsured. As health care reform succumbs to the sexy argument that we should get by with less care, third party payors don't reimburse for insight. If medication can make you feel better in thirty days, that's good enough. No wonder Shutter Island is set in the 1950s, when mental hospitals could still provide psychotherapy.


Stop here is you want to be surprised by the plot twist in the movie. Because on Shutter Island, the battle between the risks of insight and those of social conformity is stark and dangerous. Can a clinician help Teddy, a man lost in a delusion of his heroism, face his unbearable trauma before the men in the white coats take over? The harsh technique of institutional psychotherapy -- a Nazi doctor armed with insinuation, contempt, and a hypodermic -- has not reached the protagonist. Time is up. "When you see a monster," the doctor intones, "you must stop it." Instead, Teddy's illusions are finally breached by his analyst's willingness to surrender his authority and become his patient's loyal sidekick in his fantasy.

There is plenty to appreciate in this movie is you are an analyst sacrificing the rock-hard stability of a one-person psychology to dive into the shifting tide of a relational treatment. No wonder a hurricane is needed to shake protocol in the movie. Our institutions loathe the uncertainty and expense of human understanding and depend on the security of the empirical. Yet, in the novel from which "Shutter Island" is adapted, Teddy's belief in his delusion falters at the moment he notices his doctor's eyes are not implacable, but weary. It is the uncertainty of human connection that makes its occurrence such a potent force for change.

These are the moments we clinicians treasure: the dawning idea that the rules one has lived by belong to a time long past. The moment is tragic, too. It brings not only relief but regret for all one has misunderstood. Knowing more is seldom an easy thing, a truth with dramatic effect in the movie. Teddy says, "which is worse: to live as a monster or to die as a good man?"

How Betty White can save your life

As a lonely pre-adolescent, I often found comfort perched in front of the warmly-glowing television set my mother insisted would make me blind. (She also warned I would poke my eye out with an umbrella. It's a miracle I became a psychoanalyst rather than an optometrist.)

TV gave me hope. If Mary Tyler Moore could make it after all every Saturday night, then maybe so could I.

And so I think it is wonderful that one of the hottest actresses in Hollywood these days is Mary's former costar, Betty White -- an octogenarian with a zest for life and a delicious ability to poke fun of herself. So many people have lost that sense of joy and playfulness. I'm amazed by how many 20- and 30-somethings are already having midlife crises, terrified of growing older.

Over the years, I've worked with a surprising number of healthy people of all ages gripped by a fear of dying. As we explore this together in therapy, we often find that what they are really afraid of is living. They have experienced so much disappointment whenever they have gotten their hopes up, they are wary to embrace life more passionately. So they procrastinate, avoid and worry. The misery they know is safer than the uncertainty they don't. Ironically, they are petrified of a death they are already living.

That's where psychoanalysis comes in. Finding meaning and richer ways of living by understanding oneself from the inside out is the goal of psychodynamic psychotherapy.
Psychoanalysis is unique among therapeutic approaches in that it does more than simply alleviate symptoms and teach coping skills. (Although it does that too.) It helps get to the deep-seeded patterns that cause suffering by helping people understand how, unconsciously, they contribute to the very unhappiness they are trying to avoid. Psychoanalysis gives a sense that one could be a more active contributor to one's life. It generates a precious ability to be curious, creative, open to new possibilities -- to embrace the very uncertainties that so many people feel overwhelmed by.

In short, psychoanalysis creates laughing, loving, teasing Betty Whites, eager to live life with relish.

You'd have to be blind not to see that.

-- Eric Sherman, LCSW

The Dis-Connect: “I’m sobbing right now, can I call you back in 10?"

Time was once when my office was a quiet private sanctuary where the patient and I could delve, without intrusion, into solving the difficulties in the patient’s life. Lately, the therapy room is abuzz with the chimes and digitized melodies of cell phones. Text message alerts and phone calls from patients’ circle of family, friends, and colleagues arrive with regularity during therapy sessions.

And when they do, there is a moment of decision-making for the patient as he or she feels the familiar tug to look and respond to the insistent vibration of the phone. Do I allow this interruption during my time of self-reflection? For just this one hour, can I hold the external world at bay while I explore my internal experience? Are the demands of the texter/caller more urgent than what I am doing right now?

There may be legitimate reasons to take the call immediately, whether the patient is a parent worried that the school is calling about a sick child, a business person waiting for a piece of information from a boss who expects 24/7 availability, or a teenager concerned about not being left out of the social network. However, there is a pause as they consider what to do when the outside world calls.

Psychoanalysts strive to maintain the boundaries of the therapy frame. We attempt to help patients put difficult feelings into words not action. Most analysts would ask their patients not to eat or do jumping jacks, say, during a session but attend instead to feelings and thoughts.

Somehow, perhaps because technology has become such a part of my own life, I have let the distracting chirps and ring-tones enter my office unanalyzed. My phone is always off during the therapy hour so I can focus exclusively on my patients’ struggles. It’s time I ask them to focus with me. I’ve decided to take a page from theaters everywhere: “Ladies and Gentlemen, Please turn off your cell phones!”

Sally Rudoy

Welcome to our Blog

Dear Readers,

Welcome to our Blog. We are very excited to launch this new interactive component to our website. We hope you will join us in our discussion of Psychoanalysis and Psychoanalytic therapy, what it is and how it has evolved from the time of Freud.

Psychoanalysis has gone through a revolution in the last several decades into an approach that is alive, active, integrative, and very different from some of the old stereotypes of the past. On this site we will be blogging about Psychoanalysis, Psychoanalytic therapy and a Psychoanalytic sensibility based on contemporary practice and theory. There are a number of ways in which we talk, think and feel about the world that are influenced by unconscious processes within ourselves and in relationship with others. These processes manifest in a variety of thoughts and behaviors, some in sync with what we want and some conflicted. In all cases, the Psychoanalytic sensibility provides us with vital information to process our experiences and as a result learn new and important things about ourselves and those closest to us, enhancing our experiences and relationships.

We will be writing about various aspects of life, art and therapy in an effort to put voice to what we believe is an essential and powerful life tool. Please feel free to share your point of view, ask questions or simply comment. We look forward to the dialogue, sharing with you and hearing from you about what gives life meaning. The unexamined life may still be worth living, but may not be as lively as when explored.

- Sandra Sinicropi