The Surprising Root of Manic Character Patterns
Kathryn Levison, BA
Imagery by Dan Mohr / yesisaid.design
One of the most life-changing paradigm shifts I’ve experienced in all of my psychological research is Nancy McWilliams’ presentation of the root of hypomania:
Manic character patterns indicate a denial of depression.
With this definition, hypomanic behavior isn’t as much in contrast to a more depressive person as it is a mirror image.
McWilliam’s viewpoint may best be expressed as the old pop psychology chestnut:
“The best way to turn out like someone else is to decide to be exactly the opposite.”
Indian-born psychoanalyst Salman Akhtar agrees with Helene Deutsch’s observation that hypomanic behavior reveals a persistent underlying denial of trauma. Deutsch noted that they depreciate what they have lost, sometimes to the point of either criticizing themselves for being “weak” or for having strong feelings. They may also diminish the positive aspects of who they lost and try to find substitute people and activities as quickly as possible.
Deutsch also observed “a hollowness to their success compared to the energy expended” — that they spend excessive effort without really accomplishing anything. Continuing on the theme, Akhtar adds that those with hypomanic tendencies may develop a strong interest in different ideas or schemes but then don’t follow through because they can’t sustain their enthusiasm over time.
Character patterns vs pathology: hypomanic behavior vs bipolar disorder
As with all psychologies, the differences between a “personal style of operating in the world” and a “disorder” that requires medication can be highly subjective. It all depends on severity.
The National Institute of Mental Health defines bipolar disorder as:
a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.
The keyword here is unusual shifts. Severity also matters. Here are a few examples of a bipolar extreme vs. a hypomanic person having a less intense experience:
- Bipolar: high, elated, irritable, touchy
- Hypomanic: upbeat, excited, anxious to get started/get going, a little impatient if others are moving too slowly
- Bipolar: jumpy or wired from neuron activity
- Hypomanic: hyper from too much coffee, sugar, etc.
- Bipolar: talks very fast about many different things, often disconnected ideas — what psychiatrists call “flight of thought”
- Hypomanic: prolific brainstorming with lots of ideas from lots of different areas or categories
- Bipolar: racing thoughts that come across as “out of control”
- Hypomanic: thinking very quickly to solve a problem when time is short
The problem with prescriptions: personality styles do not need to be “cured”
Today’s issues with ADHD and other focus-related problems are genuine. But the best “treatment” for personality patterns that are causing trouble is excellent psychotherapy.
The perk of prescriptions: troubling behaviors can be worked through more easily
Some people need help regulating their brain chemistry to experience a taste of balance. In the past, some people couldn’t be helped effectively because the rigors of therapy stirred up even more uncomfortable emotions.
Now, though, psychoanalytic psychotherapists can work in tandem with psychiatrists. For example, a referral to get some medicinal help may be invaluable if the person’s struggles to focus in therapy are too challenging.
Those patients who prefer this combined approach (and we leave that decision to each individual) often find that medication can “lay a floor under” depressive emotions and “put a ceiling on” manic or hypomanic feelings. This lets the person operate more in the middle of the emotional spectrum. Of course, they can still feel both poles, but because daily living is easier to manage, the more complex feelings that come up in therapy can also be easier to work through.
Psychotherapy can also be more effective with the person’s newfound ability to find balance.
One note about consultations between psychologists and psychiatrists
No one who goes to a psychoanalytic psychotherapist will ever be referred to a psychiatrist or other professional without express consent. Client-practitioner confidentiality holds across the board. Your psychotherapist will always ask your permission first.
There’s also always the option to decline psychiatric prescription help. Sometimes just the realization that therapy will be “a lot harder than I thought” can free up a person to handle a little more discomfort during the therapeutic process.
A personal note: psychoanalytic psychotherapy can help slow down and focus thinking
What intrigued me most when I started working with my psychoanalyst is that, from the first intake session, I could sense myself “slowing down and focusing” with every question he asked while still making creative connections.
Before psychoanalysis, I could generate countless ideas. However, I often thought of either “too many” things in too many disparate categories, or I couldn’t follow through on the ideas I gathered.
Somehow I knew that my slower, more focused thinking had something to do with my analyst directly, but it was still just a hunch. I’d only known the man for half an hour, so I didn’t say anything. But over time, as I worked with him, I found myself “sticking to the point” more and more. Even my wisecrack witticisms in session with him were related to our work that day.
A brief note about the third depressive-manic personality organization: cyclothymia
The word cyclothymic corresponds to the root of the feelings and behaviors: they’re cyclical. The person can shift back and forth between depression and manic denial.
In contrast to bipolar disorder — a mood pattern with dramatic peaks and valleys, not unlike an ECG (electrocardiogram) readout — cyclothymic coping patterns can be visualized more as shallow waves above and below a “normal” baseline (a straight horizontal line).
Clinicians have observed that the depressive experiences of cyclothymic people are due to episodes when their busy, upbeat denial fails them and the depth of their depression threatens to surface.
How Freud and Jung’s personality variables influence behavior
How someone behaves in different situations is contingent upon more details and input than can be listed almost anywhere. But, interestingly, the two giants in the field, Sigmund Freud and Carl Jung, each contributed one insight that, applied together, can be a good source of comfort to someone concerned that they may be slipping away from a personality style into a personality disorder.
Freud’s presentation is a little more technically complicated, so we’ll start with Jung.
Jung’s short definition of introvert/extrovert behavior patterns
These days, it’s reasonably common knowledge that a person’s behavior in a group — if they’re more outgoing or more reserved — is not an indication of whether they’re an introvert or extrovert. Instead, what matters more is what they do after an outing or event.
Carl Jung introduced introvert and extrovert into psychology to explain why some people are more talkative and outgoing while others are more reserved and thoughtful. He added that the primary distinction between the two is the source and direction of how a person expresses their energy — whether the energy is aimed more inward or more outward.
Jung’s interest in typology — the set of classifications used by psychologists to describe the similarities and distinctions between people — was his way of simplifying theories and finding a balance between the viewpoints of his colleagues, Sigmund Freud and Alfred Adler.
The Myers-Briggs Type Indicator — a fascinating assessment tool best administered by a trained psychologist — is based on Jung’s book Psychological Types or the Psychology of Individuation.
Building on Jung’s theory, psychologist Hans Jürgen Eysenck introduced the idea that the root of these two personality types lies in the concept of “recharging batteries.”
Applying both Jung and Eysenck’s theories results in one question that answers any number of reasons why people do what they do.
Eysenck’s key question: “How do introverts and extroverts recharge their batteries?”
- Introverts “turn inward” and need time to themselves to refill their emotional gas tanks.
- Extroverts “turn outward” and recharge by being with people.
The depression/mania connection to introvert/extrovert styles
- An introvert can feel guilty about not being “more sociable.” Of course, they’ll try their best, but sometimes the only alternative to hiding in a corner is to go a little wild. Add anything disinhibiting to the mix like liquor, and our quiet little wallflower can wind up manic and figuratively — or literally — dancing on the table … and then go home feeling guilty for “making a spectacle of themselves.”
- An extrovert can get depressed if they feel deprived of “not enough socializing.” Their reaction to something like a small, intimate wedding with fewer chances for interactions might be, “Well, that was depressing.” They may even look for a big fat Greek wedding in the adjoining ballroom that they can crash. If there’s nothing more to do, they may feel cheated and either mope around or get angry.
Can a hypomanic person really be an introvert?
While an extrovert often finds it easy to have a great time with other people, an introvert with a hypomanic personality can also be exuberant until their emotional gas tank runs dry.
The extrovert will come away feeling energized. On the other hand, a tapped-out introvert may want nothing more than to race home and hide under the covers.
Both personality types can be the first to arrive at an event and the last to leave. The difference is that an extrovert can’t wait for the next invitation while the introvert hopes the phone doesn’t ring for at least a week.
Sigmund Freud’s key question: “Is this activity or behavior ego-syntonic or ego-dystonic?”
Freud’s terms refer to whether what you’re doing or experiencing either aligns or doesn’t align with how you’re comfortable handling your world. The APA dictionary (American Psychological Association) gets into the concepts of ego and superego, but let’s keep it more straightforward.
- Ego-syntonic defined: Personal behavior and feelings in social situations that feel normal and comfortable regarding your personality.
- Ego-dystonic defined: Personal behavior and feelings in social situations that are so different from your personality that you feel pressured. Sometimes you can even feel guilty for not meeting what feels like the implicit expectations of the group.
How Freud’s ego theory applies to introvert and extrovert social preferences
- Ego-syntonic introverts are often more comfortable in small groups and one-on-one social exchanges. However, they also often function well in “large groups but alone.” For example, introverts may be perfectly comfortable in a standing-room-only theater because they’re not forced into “socializing” except with those in neighboring seats.
- Ego-syntonic extroverts can have an exuberant, “the more, the merrier” mindset. They’ll go home from busy, noisy get-togethers, eager for the next event. After the same theater performance as their introverted counterpart, extroverts might recruit a few fellow theatergoers to go to that great late-night jazz club down the street.
How hypomanic personalities handle depressive experiences like loss
Even though a hypomanic person is fundamentally depressed, instead of “wallowing,” they’ll try to counteract depression with different versions of the defense of denial. The following behaviors fall into that “mirror image of depression” category.
Devalue the loss:
- “It doesn’t really matter.”
- “The person/thing didn’t mean that much to me to begin with.”
Take a defeatist stand:
- “Loss is a natural part of life, so get over it already.”
Refuse to admit to being sad or down:
- “What’s done is done. No sense dwelling on the past.”
- “I can’t fix it, so I’ll just forget about it.”
Call on charming and distracting hypomanic behaviors to get them through:
- Be witty and humorous.
- Be socially engaging.
- Be energetic and throw themselves into a project or two. Or three.
How hypomanic denial of depression might look and feel
When it comes to denial, the idea is to run — as fast and as far as you can — from the emotion you’re trying to push down, hoping you’ll forget it altogether. But the running doesn’t “take you anywhere.”
One of Nancy McWilliams’ patients described herself as feeling like “a spinning top.” My psychoanalyst worked extensively with children early in his career. He noted that his adult hypomanic patients reminded him of a little kid “trapped” somewhere uncomfortable, like a wedding or a worship service that went on too long with no way of escape. They’d squirm in their seat, fidget with their fingers or tap their foot. Sometimes, he felt that the person might abruptly get up and leave the session.
I experienced a taste of this manic “running away” a few years ago. We’d touched on something extremely painful, and it took several minutes for my analyst to help me sit still and look inward. Once I was more settled, an image came to mind:
I saw myself as a small animal, frantically running back and forth and around and around in circles, but not in a cage meant for a pet. Instead, the impression was that I was in a cardboard box with solid sides and “no windows,” as in an air hole or two. The box had an open top which let me see my frantic, racing self, but the sides were too high for me to jump out.
Once I had that image, he was able to help me stick with uncovering the traumatic memory by telling me:
“Don’t run, Katy. Don’t run.”
Humor and creativity as socially acceptable sublimation defense mechanisms
People who manage their world in a hypomanic style can sometimes feel like they need an outlet for their stronger reactions to life experiences. For instance, sometimes, instead of their usual high energy level, they might feel “overcharged” with “energy to burn” or jumpy or distracted. In these situations, instead of “spinning their wheels,” conscious sublimation can be a great way to redirect this excess energy into productive channels.
Psychologists describe sublimation as something a person does to transform socially unacceptable impulses into socially acceptable behaviors — a substitute of sorts. Even Freud, who focused on how people handle their libido (innate sexual drive), considered sublimation a sign of maturity.
Interestingly, although sublimation is considered an unconscious defense against overwhelming feelings, channeling your energies elsewhere can be a positive, conscious choice. This redirection of instincts is also crucial to civilization. Alternative outlets to anger are crucial for the survival of any species. The root of many artistic creations, scientific advancements, and even inventions that serve essential social functions result from conscious sublimation.
One good example is comics and humorists with hypomanic personalities. They can be great entertainers and storytellers, but that underlying denied depression can express as an “edge” like some of Mark Twain’s writing. Or the person can be very entertaining and funny, but a sad undercurrent runs throughout. The late Robin Williams easily comes to mind as an example of the latter.
Other more personal sublimation behavior outlets for hypomanic energy can include “spring cleaning” the house, going for a run or workout, or finding a creative outlet. Of course, painting, writing, and doing crafts quickly come to mind, but rearranging furniture can be both creative and physically burn off a lot of psychological steam.
The downside of humorous and creative defenses
Some find those with hypomanic tendencies challenging to get close to emotionally. This is because, to survive emotionally, the person may devalue relationships and interactions by making a joke that keeps others at a distance.
I employ a lot of humor in my writing, much of it sarcastic, and I’ll admit it: My primary intention when “making fun of Sigmund Freud” is to let off the steam of five years of difficult emotional work and the intense, unsettling feelings I experienced as part of my relationship with my analyst.
One example is a prose poem I wrote entitled What’s in Your Chart, Doc? It was my way to “take respectful creative retaliation” on whatever my analyst had written in his notes about me, turning it back on him as, “What Freudian interpretations did your analyst put in your file, hmmm?”
I also no longer mind if psychologists and others wiser than myself frame my analytical humor as some version of a “negative diagnosis.” Coming up with thinly disguised sexual wisecracks to entertain my analyst was the most fun I’d had in years. Writing about our relationship now also draws me back in time and makes even the most painful, bittersweet moments with him all the more precious.
Sudden anger may short-circuit humor if experiences are too ego-dystonic
Interestingly, but not unexpectedly, people with hypomanic tendencies often reveal their negative side, not as sadness or disappointment but as anger, especially when they are pushed too far or feel trapped in what is, for them, an ego-dystonic situation. If an experience is too far outside their comfort zone, they can have fits of rage.
This makes “psychological sense,” especially when depression is viewed as anger turned inward:
- A person with a hypomanic personality has an experience where they feel angry.
- They also feel guilty for whatever prompted the anger.
- The guilt drives them to internalize the anger where it lies, unexpressed and is now a root of depression.
- However, because a hypomanic person can’t tolerate feeling depressed, they employ whatever “running away in denial” defense serves them the best at the moment.
- Then something happens that disrupts — maybe even shatters — that “busyness defense” in a way that robs them of the hypomanic outlet.
- Now they’re stopped in their tracks with no way to deny the depression breathing down their neck, so …
- They have what can be viewed as the adult equivalent of a frustrated child’s temper tantrum.
- Once the situation changes and they regain their denial-of-depression outlet, they’re back to their usual busy, entertaining self.
Traumatic root of hypomanic personalities: unmourned losses
Even more so than depressive personalities, the history of a hypomanic person is filled with traumatic losses and separations – especially those in childhood — that occurred in situations that offered no opportunity to process what happened emotionally.
- Death of significant people either weren’t grieved or weren’t grieved sufficiently.
- No one discussed the parents’ divorce or separation.
- There was no preparation for the family moving.
- One too many symbolic losses – loss of a place, loss of an identity, loss of a self-defining ideal (something that represents who or what you want to be).
One of psychoanalyst Nancy McWilliams’ patients moved 26 times by the time he was ten years old. He also said that on more than one occasion, he came home after school to see a moving van parked in front of the house.
The hypomanic solution to the pain of unmourned losses: don’t get attached in the first place
Because a hypomanic person expects the pattern to continue — that no loss will ever be processed thoroughly enough — they’re terrified of attachment. If they lose the other person, the pain will be too much.
A hypomanic person’s self-esteem is also often maintained by avoiding pain and captivating other people while keeping them at a distance. But, interestingly, because hypomanic people are quite often very intelligent and very funny — and because it’s hard to think that someone that intelligent might cause themselves harm — others are often stumped when the person turns out to be worse off psychologically and emotionally than anyone guessed.
Fortunately, psychoanalytic psychotherapists are particularly sensitive and are trained to pick up nuances others might miss. They also won’t underestimate the degree of suffering hiding under what appears to be an otherwise open, interesting, engaging person.
The psychoanalytic psychotherapist’s number one challenge with hypomanic personalities: flight prevention
One of the saddest aspects of a hypomanic person’s history is that far too often, they’ve never experienced an appropriate ending with another person. The rending of friendships and relationships with little or no warning — and even less explanation — only confirms the survival mindset:
“Next time, I’ll know better. Next time I won’t care about the person at all.”
For an adult, losing a relationship due to death is one thing. It will still be traumatic, and dealing with family relationships can stir up old issues. But at least the concept can be understood psychologically.
When someone precious to a child dies, and if the loss isn’t explained — or if the child is too young to understand any attempt at the truth as to why someone has gone and is never coming back — and if no one steps in to fill the void, such as an adult relative or family friend, then it will become far easier in the future for the child to once again refuse to get attached.
Clearly established guidelines in therapy provide stability and reassurance
Once in a while, the hypomanic person seeking help will volunteer, “I’m committed to therapy even when it gets uncomfortable.” That person may have had at least one “positive” loss that was sufficiently explained and thoroughly mourned. Or, over time, they may have had a few reliable experiences with others. A positive long-term relationship with a family physician or other medical professional can also go a long way toward helping a person trust their psychoanalytic psychotherapist a little sooner.
Much of the time, though, once therapy is underway, even the most skilled and compassionate clinician may make a minor misstep that triggers the flight response in the person they’re helping. Therefore, one of the most crucial steps to take to offset a person’s urge to flee is for the clinician to establish boundaries right from the start.
There are as many ways to phrase this kind of contract as there are therapists. However, Nancy McWilliams offers a comprehensive plan of action that begins with the therapist establishing the boundaries:
“I notice that every important relationship in your life has been disrupted abruptly, usually at your initiative. There’s no reason why that won’t also happen in this relationship — especially because in therapy, so many painful things get stirred up. When life gets painful, your pattern is to flee. I want you to make a deal with me, up front, that no matter how reasonable it seems, if you suddenly decide to break off your therapy at any point, you’ll come back for at least x-number of sessions so that we can understand in depth your decision to go and have a chance to process the ending in an emotionally appropriate way.”
Keyword: emotionally appropriate
The best therapy anyone can receive is to have at least one relationship in their life come to a close in the least traumatic way possible. It may feel unnatural or artificial for that relationship to be with a professional psychologist. But therapy — especially psychoanalytic psychotherapy — is all about learning.
- Learning about yourself.
- Learning to think about yourself in realistic but positive ways.
- Learning that another person will always be there when they say they will.
- Learning that not everyone you love or sincerely care for will abandon you without warning.
Addressing the potential “what if?”
- “What if my therapist quits practicing and I can’t come anymore?”
- “What if they move out of town?”
- “What if they … die?”*
- “What happens to me then?”
This is the beauty of depth psychology. Every psychoanalyst and psychoanalytic psychotherapist is part of a network that is, for all intents and purposes, a near-perfect extended family. No one flies solo. If they aren’t part of a formal practice group, they create their own network.
When I first started therapy with my analyst, we met on Monday and Thursday afternoons. He worked alone but shared an office with a psychiatrist whose assistant answered the phone during business hours. I also had my analyst’s cell phone number from the beginning. Then one Thursday, after I’d been with him about four months, he handed me a slip of paper with a woman’s name and phone number.
“If you need me over the weekend, call her. She’s very good.”
He wouldn’t tell me where he was going, but I found out later he’d gone to a weekend conference with his psychoanalytical “family.”
By the time he passed away, he’d given me access to his closest circle of professional friends and colleagues so that, if anything happened, I wouldn’t be alone — and I’m not. I can call or email if I really need someone to talk to.
Your psychoanalytic psychotherapist won’t leave you alone, either. They’re “in it for the long haul” from the moment you step foot in their door.
*I lost two psychotherapists, both to cancer. It’s not easy, but it is survivable. The first, a gifted LCSW I worked with in my mid-thirties, was difficult to process since her family’s lack of communication resulted in poor follow-through by her office.
My analyst’s passing “hit closer to home,” but his family — both blood relatives and his family of colleagues and friends — were lovingly supportive.
Psychoanalytic psychotherapy is “the best medicine” for almost every personality concern
There’s “something about the process” of depth psychology that can genuinely change how a person thinks. Of course, digging up and healing the root of the issues that results in unpleasant interpersonal encounters doesn’t erase the past. However, it does help a person start to loosen the shackles of coping mechanisms that helped the person survive childhood but are now crippling their ability to move forward in life.
The key is hanging onto the courage learned in therapy to recognize when something is amiss and then using every tool in the therapeutic psychology book to sort things out on your own.
For me, it’s a lot like learning to take a break from work projects without “falling down the ‘Tubes.” Jumping from video to video on YouTube can be fun. But for me personally, if I get the urge during the day — especially if I’m working on something and just need a short break — clicking around on YouTube is avoidance. I’m avoiding acknowledging some uncomfortable thought, memory, or feeling.
Fortunately, my psychoanalyst taught me early on exactly how to self-introspect as deeply as possible in this situation:
- Sit still. (Don’t run, Katy. Don’t run.)
- Do my best to “feel and name the feeling” that’s causing a problem.
- Employ my analyst’s prompt to try to remember, “When have you felt this way before?”
I don’t worry about getting to the traumatic root of the issue because we dealt with and resolved so much over five years. Today it’s more about me working through a “variation on a traumatic theme from childhood” — feeling abandoned, abused, deprived, helpless, and hopeless.
The worst of these negative thoughts is my old nemesis, my mother’s negative introject — the unconscious tape she installed when I was too small to fight back. When I’m stressed, her insistence, “You’ll never survive on your own,” can still click on in my head.
Well, my mom was wrong. I already had the capacity to survive and sometimes thrive, even during seriously tough financial and emotionally stressful times like the current Covid-19 pandemic. I just needed someone to be a consistent, positive introject to help reshape my thinking. My analyst’s goal was not so much to undo my mother’s damage as it was to override it. He replaced her malevolently negative “You can’t, you won’t, you’ll never get anything you need or want” with his benevolently positive “You can, you will, and your mother can’t stop you anymore, Kate.”
Mostly, I’m no longer all alone. Even though he’s gone physically, now it’s my analyst’s tape I hear in my head. His repeated insistence, “I’ll be with you every step of the way,” is a promise he’s keeping in my retrained unconscious.
Your psychoanalytic psychotherapist won’t leave you alone, either. They also won’t slap you with a “personality disorder.” Instead, they’ll help you dig deep and make the mindset changes to make the most of your personality.
An encouraging word: emotionally appropriate endings are not always easy
In psychology, when a therapeutic relationship comes to an unexpected close due to life changes, either on the part of the therapist or the patient, ending the relationship is sometimes called “forced termination.” But forced terminations aren’t limited to psychotherapy, and I’ve experienced both sides of the coin. I once had to close a practice and say goodbye to too many people who’d become an integral part of my life.
Now I find myself on the just as painful “other side.”
Saying goodbye to “my kids” (private music students)
When I landed the position at the Michigan music studio, I thought for sure I’d be there for life. Since I taught all woodwinds – flute, clarinet, saxophone – and beginner piano, my schedule was packed. I also had students outside of the studio, was in training to teach Suzuki piano, and had landed a sweet gig playing piano for brunch twice a month at a classy bed and breakfast.
It was perfect for many years … until my husband received an offer he couldn’t refuse: teach Hebrew at a seminary two hours south in northern Indiana. The position also came with a steady schedule of guest speaking engagements at worship services and events around the state, all reasonable expenses paid. Since I was already his worship leader, they plugged me into his schedule. They even found us a lovely apartment a short distance from the seminary with reduced student-rate rent.
It was a no-brainer. We couldn’t turn down this once-in-a-lifetime opportunity for him, but I couldn’t slam the door and walk away from “my kids” on short notice. So we came up with a plan to commute the two hours to Michigan and back every other weekend. I could continue to teach my most dedicated students, keep the very lucrative piano gig, and we could still offer the small Saturday service we’d established just outside of Detroit. It all went swimmingly from September until early spring.
Then in March, the B&B brunch folded unexpectedly. In April, the Saturday services ended due to a lack of interest. Then, in May, it finally hit home how many of my students were graduating high school. Only four planned to be music majors in college and study with the university’s professors. The rest chose to end lessons after graduation. By the end of June, it was no longer financially feasible to drive two hours each way. The tremendous task of closing my teaching practice had finally arrived.
In July, I spent the two remaining weekends telling each of my precious students goodbye. A few of my youngest – primarily those in fifth grade and middle school – were openly devastated, some crying, some physically clinging to me, a few begging me to keep coming back to teach them.
In the end, I had to let all of them go. But in the interim, I offered as much support as I could. I didn’t know anything about “emotionally appropriate endings” from a psychological point of view. But I did know that I needed to give each of these precious young people as much time as possible and offer them as much closure as their physical and psychological age allowed.
As of April this year, the tables have turned, and now I’m the one struggling to come to grips with the unexpected ending to a most unique professional relationship.
Saying goodbye to my colleague and friend (my favorite physician)
Six weeks ago, I showed up for what I thought was a routine visit to my physiatrist (a specialist in physical medicine and rehabilitation). Instead, he told me that he’d be retiring by the end of June. Despite closing the office on Fridays and limiting in-office appointments to afternoons only, the stress of twelve-hour days — two-thirds of that time spent at the hospital with constant exposure to Covid-19 — was too much. His body finally rebelled, and while examining a patient, he suffered “an event.” (In allopathic medicine, “events” are usually cardiac or cerebral. Think heart attack or stroke.)
His cardiologist told him that he could either continue to work until he literally died on the job — or suffered a more serious event that could end up disabling him — or he could finally admit that it’s time to retire.
Considering that he’s a year or two into his seventies, this shouldn’t come as a surprise, but for the fact that several times in the past, he and I talked about how much he enjoyed his work and his patients. Like my analyst, he planned to stay in practice until he was closer to eighty. But that is no longer meant to be.
I spent an entire week feeling devastated, and I’m not done adjusting. Even though I’ve never seen him more than three or four times a year, this man has been the one constant in my life for sixteen years. He was there for both of my cancer surgeries, my husband’s death, my psychoanalyst’s death, and several other minor personal crises. He’s been my biggest cheerleader when it comes to writing. And just like my analyst, this esteemed physician, voted Doctor of the Year on more than one occasion, has always treated me less like a patient and more like “a colleague without a formal credential.”
After a few days, though, I realized that my attachment to him is stronger because he’s as consistent as a psychotherapist. He’s never changed location or rearranged his office. He’s always worn his doctor’s coat over very nice street clothes. His personal mannerisms and office visit bedside manner are consistent. He stepped in after each of my losses, taking extra time to ask how I was doing personally and offering encouragement as I struggled to survive alone.
The bottom line is that the root of my discouragement over losing him is very much like losing my analyst. I’m also now in my students’ shoes, forced to end the relationship with a person as dear to me as any friend or relation.
My advantage over my students’ struggles is that what I learned in psychoanalysis is helping me to work through and find that “emotionally appropriate ending” that’s so crucial for psychological growth.
I’ll mourn my doctor’s absence as I have all other losses, but he’ll be safer away from medicine. His health and well-being are far more important to me than having him to talk to a few times a year. He also now has the opportunity to enjoy another decade or two with his family.
Because he’s been so consistent, I have photographs in my head of him as vivid as those of my analyst that let me adopt the lyric in Helen Reddy’s hit song, “You and Me Against the World,” as a coping tool. “Remembering [him] will have to do.” Like my psychoanalyst and the others I’ve loved and lost — including my sweet students — “memories alone will [have to] get me through.”
I sincerely love and care for this man. While it’s unexpected and relatively short notice, just as I did for my “kids,” he’s not abandoning me without warning, either. When we part for the last time in another week or so, he’ll make it as easy as possible for me. During our last visit, I did not take the news well. I literally cried and clung to him, but he didn’t pull away or give me a patronizing pat-pat on the back. Instead, he patiently waited for me to come to grips with his decision and didn’t end our appointment prematurely.
My doctor never tried to fill my analyst’s shoes, and no one will ever fill his. But I think I’m finally learning that somehow, when I lose one significant relationship, eventually another appears.
And maybe — just maybe — that someone new will come along a little sooner than later and prove once more that no matter how lonely life can be, I never have and never will truly walk alone.
About the Author
Having enjoyed a successful career as a musician in the Chicago suburbs, Kathryn Levison shifted gears after experiencing first-hand the power of quality psychological counseling. However, life had other plans, and her goal of pursuing the advanced credential required to offer that same hope to others was put on hold. Many years and two cancer surgeries later, she again sought help, this time from esteemed psychoanalyst Norman Ellman. Seeing in her what his mentor, Theodor Reik, saw in him, Dr. Ellman first unleashed Kathryn’s latent gift for creative writing and then incorporated informal training into her analysis with an eye toward her own analytical practice. After his death, life intervened once more, so today, instead of a couch, Kathryn uses a pen to both entertain and encourage. While she loves nothing more than spoofing Sigmund Freud and all things analytical, Kathryn has also written award-winning biographical prose. Her most rewarding — and challenging — project to date is a co-authored memoir of paternal incest and maternal psychological abuse, published one gut-wrenching, soul-mending chapter at a time.
Baby, Can I Bum a Cigarette?
Ashes: a Holocaust Haggadah for Passover
Houses: Chapter 1 (Lucy: Based on a True Story)
Friday the 13th with Freud: Spoofing Sigmund on Triskaidekaphobia Day
McWilliams, N. (2011). Psychoanalytic diagnosis. Depressive and Manic Personalities. Guilford.
Extraversion and introversion. Retrieved March 2, 2022, from https://en.wikipedia.org/wiki/Extraversion_and_introversion
Hans Eysenck. Retrieved May 9, 2022, from https://en.wikipedia.org/wiki/Hans Eysenck
Houston, E. (2022). Introvert vs extrovert: a look at the spectrum and psychology. Retrieved May 5, 2022, from https://positivepsychology.com/introversion-extroversion-spectrum/#:~:text=In%20social%20situations%2C%20extrovert%20and,to%20avoid%20social%20situations%20altogether
Theodore. (2020, November). Ego syntonic vs ego dystonic (definition + examples). Retrieved March 4, 2022, from https://practicalpie.com/ego-syntonic-vs-ego-dystonic/.
Akhtar, S. (2009). Comprehensive dictionary of psychoanalysis. Hypomanic character. Routledge.
Akhtar, S. (2000). Broken structures: severe personality disorders and their treatment. Hypomanic Personality Disorder. Jason Aronson. Inc.
N. Ellman (personal communication, May 2012)
Sublimation (psychology). Retrieved March 2, 2022, from https://en.wikipedia.org/wiki/Sublimation_(psychology)#:~:text=Psychoanalytic%20theory,-In%20Freud’s%20psychoanalytical&text=Sublimation%20(German%3A%20Sublimierung)%20is,%2C%20cultural%2C%20and%20intellectual%20pursuits.
Freud, S. & Brill, A.A. (2011). Wit and Its Relation to the Unconscious. Andesite Press.
Levison, K. (2020). Friday the 13th with Freud: Spoofing Sigmund on Triskaidekaphobia Day. Published! A Village Voices Affiliate.
Barry, E. (2022). How long should it take to grieve? Psychiatry has come up with an answer. Retrieved March 12, 2022, from https://news.yahoo.com/long-grieve-psychiatry-come-answer-141026333.html