Developing Meaning
A podcast about healing trauma and finding meaning.
Have you ever wondered what your therapist has figured out about life's big questions?
Join psychiatrist Dr. Dirk Winter as he speaks with colleagues, therapists, and other healers about what they have learned from their clinical work about how to heal trauma and build more meaning and purpose into our lives.
Developing Meaning is NOT CLINICAL ADVICE and is NOT AFFILIATED WITH ANY INSTITUTIONS. It is intended to play with ideas that are emerging, fringe, and outside of the mainstream in order to discover the meaning of life.
Produced by Dirk Winter and Violet Chernoff
Developing Meaning
#5: Dr. David Merrill - on Psychoanalysis, Writing, and the Value of Exploring Our Unconscious Mind with Honesty, Kindness and Courage.
What would make a successful Columbia Psychiatrist and Psychoanalyst fly across the country to write a story about a one-legged wrestling superstar? What does it mean to be Neurotic, and how can we recognize and change repetitive self-defeating patterns?
In this episode we explore unconscious motivations with my friend, colleague and former supervisor, Dr. David Merrill. Dr. Merrill describes how he made important life decisions that led him to become a psychiatrist and psychoanalyst. We seek to understand and explain the process of psychoanalytic psychotherapy, and how lying on the couch can facilitate introspection. We also discuss what type of problems psychoanalytic therapy is particularly helpful for, and the importance of honesty, kindness, and courage in psychotherapy.
As our world becomes increasingly divided and distracting, we reflect on the need for kindness, self-reflection, and listening, as well as the importance of creativity and connection with Nature in finding balance. Buckle up for a captivating discussion that navigates the complexities of the mind, illuminating how psychoanalysis, literature, and introspective journeys shape our understanding of life's meaning.
Hello, welcome back meeting seekers. I'm excited today to be talking to a friend colleague, supervisor, former supervisor, psychiatrist and psychoanalyst, dr David Merrill. And, as you know, I became a psychiatrist perhaps stupidly, but I think not because of my own existential struggles and I have felt that by getting this deeper insight into people that would help me build meaning and purpose for myself. And I believe that other people had sort of a similar, either conscious or unconscious, path, and I want to learn what they figured out and I want to hear their stories. So I believe there's an enormous amount of really helpful wisdom held in our community of therapists, healers, psychiatrists. I want to unlock and share it with you, really using the medium of story. And I want to start with personal stories, people who are close to me, and so I started recording conversations with classmates and teachers where I get them to tell the story about how did they become, what kind of therapists are they, how did they get to be that kind of a therapist and what did they learn along the way. And one of my favorite supervisors is Dr David Merrill, who graduated a few years ahead of me. He was a supervisor, a beloved supervisor of our class. He was one of our favorites. We voted him as the supervisor to give our graduation speech, so we picked him as a favorite among many amazing supervisors.
Dirk:And so, to frame this conversation a little bit and put it into context, in our past episodes we have talked about felt sense and embodied knowing and sort of the meaning that comes from our body, and we've also had an episode about death and end of life and how that impacts our understanding of meaning. We've also had an episode of psychedelics and the mind expansion and ego dissolution that comes with that, and today we add another really important piece, which is psychoanalytic theory, a huge you know. This is really where the bulk of our understanding of the unconscious comes from, and this is where I come from and this is where my therapeutic models of the mind come from. So in this episode we get to learn from David, who is a great psychoanalyst. And also another theme of today's conversation is literature and storytelling that comes from fiction, and in particular I want to mention Russian literature and George Saunders, who is a writer and professor of creative writing, whom David mentions in this interview as a person who has profound insights into meaning, and when David makes a recommendation to me, I tend to sort of follow up, and so he recommended this book, a Swim in the Pond in the Rain, because it gets at a lot of these same questions of how we approach meaning, how we understand meaning and how do we conceptualize meaning, and this book really gave me a lot of insights that I hadn't had before. So I just want to sort of mention a couple of them and then we'll get into our conversation.
Dirk:So these are some insights about meaning that come from Russian literature great short story writers like Tolstoy, chekhov and so on, as identified by short story writer and Russian literature professor George Saunders in his book A Swim in the Pond in the Rain. Saunders has an enormous amount to say about meaning, how important it is, what it is and how it is essential to great writers and how writers really have a profound insight. And there are just a couple of points that I want to make that come from him before we start the interview. Number one meaning implies relationship and causality. So when we tell a story, each piece that we add especially in a short story by a great writer, where everything is designed to create an impact, to generate energy and create an impact every piece of that story has to have some kind of a relationship and some kind of a causal impact on the reader and on the main point of the story, and that really gets that meaning. And number two Saunders has a comment about how art is a way of expressing preverbal knowing, so, things that are emotionally impactful but we just don't know how to put them into words. Art can express those and that is a major function of art. Another point, and this comes from the writer Tolstoy in his short story man and Master. In this story the ultimate fear, according to Tolstoy, is not death but meaninglessness.
Dirk:So fiction, according to these Russians, is a moral and ethical tool and it is a means to really get at, to really ask the big questions. And here these are sort of some of the big questions, according to George Saunders, that the Russians get at. I'm quoting directly now how are we supposed to be living down here? What were we put here to accomplish? What should we value? What is truth anyway, and how we might we recognize it when we see it? How can we feel any peace when some people have everything and other people have nothing? And how are we supposed to live with joy in a world that seems to want us to love other people, but then roughly separates us from them in the end, no matter what.
Dirk:So these Russians were writing and making subversive moral arguments in a pretty hostile political environment, where they were progressive reformers in a repressive culture. And I'm quoting George Saunders now, and he says that these Russians were writing under the constant threat of censorship in a time when a writer's politics could lead to exile, imprisonment and execution. The resistance in these stories is quiet at a slant and comes from perhaps the most radical idea of all that every human being is worthy of attention and that the origins of every good and evil capability of the universe may be found by observing a single, even very humble person and the turnings of his or her mind. That really overlaps with psychiatry. Each person that's in front of us contains all of the truths and all of the deepest wisdom, and so it's really amazing to get this additional perspective. I just want to add one more quote for you to ponder before we start this interview. This is from Russian story master Isaac Babel. He writes no iron spike can pierce a human heart as icily as a period in the right place.
Dirk:So after listening to this conversation, you will probably want to pick up George Saunders a swim in the pond in the rain, where he explains how Russian masters use fiction to make things happen inside characters that then matter to us. So how do you make things matter? How do you create meaning? That's what we want to understand. There's a lot of great wisdoms in this book and there's really great wisdoms in this conversation, so I'm going to drop you into this interview, which is already in full stream, with David telling me about how he came to write and publish a story about a one-legged wrestling superstar. He quickly moved into David's own story, how he became a psychiatrist and then an analyst, and how psychoanalysis can be helpful, whom it can be helpful for and key realizations that can come from psychoanalysis. We also talk about how psychoanalysis and fiction writing relate to meaning and the meaning of life. So let's do this. Please enjoy my conversation with Dr David Merrill.
David:So I've been looking for a creative outlet for a while. I was thinking that writing might be a way to do it. Didn't really know how to focus my efforts. And then one year was watching the NCAA wrestling championships as I do every year to reminisce about my high school days as a wrestler I kind of incredibly saw this wrestler who was not just competing but doing very well with one leg and that kind of blew my mind and it felt like that is a story that is kind of begging to be told.
Dirk:And you were a high school wrestler yourself, so you understood what wrestling is and what it means to wrestle with one leg, exactly.
David:Yeah, well, I basically thought that one doesn't wrestle with one leg, and so to see this was remarkable, so I decided, okay, this is going to be the story that I try and write and I'm just going to go for it and I'm going to try and go meet this guy and talk to him and hear his story and find out how this all works. So I was very naive about this process.
David:I spoke to the wife of a friend and colleague who works for a major media publication, so she kind of helped talk me through the process a little bit. But basically I just started making some calls and this wrestler had an agent by the time and he had already kind of blown up by the time that I got to him and an agent I had to go through. But eventually I arranged to meet with him and traveled out to Arizona, where he was from, and learned his story and wrote that story and had initially tried to kind of pitch the idea to certain media outlets, hoping that they would pick it up and pay me to write the story. And because I had no, I guess, what are called clips I had no examples of my prior published work.
Dirk:How old were you at this time? We are in your? This is 10 years ago, I'd say so you were done with your medical school or you were, I was done with your residency, done with residency.
David:You're a? You're a Practicing attending? Oh yeah, exactly.
Dirk:Yeah, oh, wow. So then you picked up on this story and you chased it.
David:Yes, and then you ended up writing the story and chased it and realized that nobody was going to pay me to write it so I just had to write it and then shop it around.
David:So I did that and I kind of set my Naively set my sites high and then kind of got rejection after rejection and it worked my way down the list of publications that I had in mind and ended up getting it published on a website like a sports themed website and, yeah, didn't know if anyone was going to read it. It ended up doing well. It got republished on certain other websites. It got included in one of those Best American Essays collections, so it ended up doing well. But it was a humbling but also very satisfying experience. And I kind of had the writing bug after that and enrolled in a course a more kind of creative so that was a profile piece about that wrestler and then I enrolled in a creative writing course and basically it's been like doing some creative writing on my own since then, and not kind of with a focus on publication, but just kind of for my own pleasure.
Dirk:What was it like meeting this wrestler?
David:It was really inspiring. I mean, you know, when he started wrestling, people in the wrestling community thought what I thought, which is just that this was a non-starter, you know, and he got a lot of critical feedback in the beginning. He got a lot of kind of condescending kudos. It was like hard for him, and what was inspiring was not just that he stuck with it, but that he was resourceful. He had to come up with a way of winning with his body type.
Dirk:How did he do it? What was his move?
David:So he did a couple of things. For one he didn't try, and Initially he tried to stand on one leg, but he was just kind of too easily unbalanced. He'd get shoved and he'd topple over pretty easily, and so he would lower his center of gravity by dropping down into like a tripod position on his knee and on his two hands. And then other wrestlers had to decide, you know, are they going to meet him in that lowered stance, are they going to maintain their usual stance? And then when they would go to put their hands on him.
David:you know, wrestling moves very quickly and so a lot of it's just muscle memory, and they would become almost kind of disoriented because they'd reach for this leg that wasn't there.
Dirk:Oh, wow.
David:And so he you know, instead of you know his being the off balance. When they ended it being the off balance, off balanced ones, and he started to get really good, really really good. So good that people started saying, instead of, oh boy, he's got a real disadvantage, people started saying maybe he's unfairly advantaged, you know, maybe he shouldn't be allowed to do that.
Dirk:He's cheating by getting rid of his leg.
David:Actively cheating by not having a second leg. That's how good he got. But you know, as I wrote about, that kind of logic only works in retrospect. You know in the beginning, you know nobody thought he had a chance.
Dirk:That's a fun story of just sort of picking a different interest. So I would love to hear more about your decision to become a psychiatrist. And at what point did you make that decision? Where were you? What were the things that were going through your mind and alternatives.
David:Yeah, I'm kind of curious to hear what I'll say about deciding to become a psychiatrist, because I don't have like a like a cohesive narrative about that, I think. I mean, I remember being in. So you know, you end up in medical school oftentimes because you like people and you like science and you're not sure what else to do. And it seems like you know that's a way that you can keep doors open, have a respectable career and work with people and work with science. You know, and that's how I ended up there, but you know, without any real knowledge of what it's like to be a med student, let alone what it's like to be a doctor, let alone what it's like to be a psychiatrist. So you kind of, as you're going through this process, you're always making decisions not really knowing what you're deciding to do.
David:So I was in med school. I was happy in some ways. I, you know, met the person who's now my wife and I was really happy with that relationship. But I was unhappy in other ways. I wasn't finding medical school to be as intellectually stimulating as I had found college. And you know, I wasn't sure about what specialty to go into and I could see my peers making that decision and I still didn't know and I remember taking one of these like online questionnaires to kind of figure out like what specialty I was best suited for and I got.
David:I got paired with aerospace medicine which I'd never even heard of before, and I think it's just because I still haven't heard.
Dirk:This is the first time. I think I've heard of it at some point.
David:So I still don't know anything about aerospace medicine, but I think, I think that that's how I got paired, because I basically said, like I don't like the surgery that I've seen, I don't like the internal medicine that I've seen, I don't you know, I basically hadn't loved any of my rotations and so I just got stuck with whatever was was leftover. So I ended up putting off the decision for a year. It took a fifth year of medical school to take some more time, to do some more rotations, to travel, and my then girlfriend, now wife, decided to go into psychiatry and I think in part because of her influence, like respecting her and respecting her decision, and part because I was at a loss and and part because I really did like to talk to patients and found I didn't have much time to do that and some of the other, you know, specialty rotations. I kind of just made a guess at what I thought I might like.
Dirk:Was that, do you remember, sort of being stressed out about this sort of decision?
David:point I was stressed. I was kind of all over the map. I thought like I kind of like, you know, working with my hands like surgery sounds, you know, interesting, seems interesting in some ways. But again, I didn't love my surgical rotation. So, yeah, it felt like it was a big decision and I felt like I was being given a reasonable amount of time to make it in. I mean, you know, people make this decision at a much earlier age in other countries, right, and you know, I was well into my twenties and seemed reasonable to ask this of me.
Dirk:But I didn't know, you know, I really was just, you know, taking, I guess I was like, you know, I guess at it and hoping it would work out and figuring I could always switch if it didn't, yeah, I'm interested in sort of principles and decision making, and I think one concept as a child psychiatrist that I've become interested in is when we treat kids and we think about development, the family situation often ends up being really complicated, yeah, and there's so many factors to look at.
Dirk:And so then I liked Victor Frankl, sort of concept of meaning. There's these symptoms, some of them people will grow out of, sometimes you have to intervene, sometimes you don't, but sort of this idea of well, I don't know where my question is there, but Do you have any sort of thoughts about sort of how to orient or in this kind of a situation where there's you know you're in a great place, you have a lot of different options, but but this is sort of this is like the big existential issue, like there's so many different paths we can go down in life and we can't go down all of them. We have to choose and every door that we pick.
Dirk:there's another one that closes and how do you, how do we think about this?
David:Yeah, I have a couple of thoughts about what you're saying. I mean, one is related to your comment about development. I think for me I was not a mature enough person to be able to make the kind of informed decision that one would like to make. I had the same facts at my disposal in terms of the different, you know, specialties of medicine that my peers had, but I didn't know myself well enough to make the kind of decision that I'd like to you know, and that came later. You know I know myself much better now, but at the time that, I think, is why I felt myself to be at sea with that, with that question.
Dirk:And that's. That's such an interesting and important point of knowing ourselves and that's really a special piece of psychiatry and you really pursued it with the analytic training. But, yeah, maybe I'd love to hear you expound on that a little bit more.
David:Yeah, I mean, I think that I mean I could go on for a long time about reasons that I might not have known myself well, but, like in short, I think there were certain things that were true about me that I didn't want to know and I kept them out of conscious awareness. And so until you're willing to sit with that discomfort and know those parts of yourself, you can't know you know, you can't know yourself, you know it's not just about knowing that the parts of yourself that you're happy with.
David:It's about knowing the parts of yourself that you're not. That that's part of what you need to inform these big decisions.
Dirk:What are the signs that maybe somebody doesn't know themselves, that we don't know ourselves well enough?
David:I mean, for me it was anxiety. You know I felt a lot of anxiety back then and anger, you know, oftentimes anger at other people and systems and, if pressed, I would have to acknowledge that I was angry with myself about certain things but always seemed in the moment that you know, fault late elsewhere and guilt, you know, shame. I think for me those were all like, you know, in retrospect you'd maybe you'd call those red flags. You know, those were all indicators for me. I think for a lot of people those are indicators that like that like they're parts of themselves that they're not comfortable with.
David:So yeah, I mean it took me. I, that decision could not wait the years that I needed to know those parts of myself. So, and that gets me to my second thought in response to your question, which is that I made the decision. I mean, there were kind of manifest conscious reasons that I made that decision, but I think I was also guided unconsciously, as we often are, and this kind of gets to psychoanalysis and it also gets to writing in a way.
David:I feel like really good writers are kind of, you know, motivated by their unconscious. They don't question it too much, they let it go and and then only kind of afterwards can say like, oh, that's that's what I, that's where I think that came from, that's what I think that means to me. Or maybe they don't even bother with that, you know. But like, for me, the best writers are people who are, who have some connection with that unconscious. And I think, as much as I was disconnected from certain aspects of my unconscious, I think I was enough in touch with certain aspects to let those aspects guide me in my decision and I think they guided me well, you know, I think the choice to go into psychiatry ended up being an excellent one. I don't know it was the best one, I don't know, but I'm really happy with this career, and so something in me that I I think I was not consciously in touch with you know helped me in that decision.
Dirk:Yeah, in retrospect it seems like great. It sort of makes makes perfect sense and sort of that, that your unconscious would be so, so sensible to sort of put you on this path. That then so did you have like a vision in mind when you like picked it and you started residency. This is where I'm going to end up with in psychiatry. I'm going to be an analyst, or how did that then play out?
David:Right.
David:Well, I mean, I think, because I didn't know myself well I was I was largely concerned with kind of not closing doors, you know, trying to keep opportunities open and case.
David:I later learned something about myself that made me think I needed to pivot in another direction. So so I told myself and, I think, other people, that I was going to be more of like a biological psychiatrist. I was going to take what I learned in medical school about the body and focus on, you know, kind of the intersection of the mind and the body, which you know is a little bit of a hedge against taking such a big jump into a field that I didn't understand and that felt that felt kind of risky. You know what if I didn't, what if I didn't like it, you know, was I wasn't ready to kind of abandon most of what I'd spent the preceding five years investing in. That came later. I eventually, you know, like what I do now has like virtually nothing to do with what I learned in medical school, and that's fine, I'm ready for it and I'm happy with it now, but I wasn't ready for that transition then.
Dirk:So then your process was you took the directorship of one of the inpatient units and did that for a while, and then you, while you were doing your analytic training and yeah, I kind of weaned myself off of biological psychiatry and onto a more analytic psychiatry.
David:So, yeah, I worked on that inpatient unit for a year as an attending and then for four years as the director, and then, you know, my private practice was growing. During that time I was doing psychoanalytic training and getting more comfortable with and more excited about that way of working. And so at some point I felt like, okay, I have enough of a private practice to make a go of this, I don't need to do this other stuff, this biological psychiatry, which is incredibly important for a certain patient population, but not what I was most excited about. And so then I made the switch.
Dirk:And so what is it that you do now Like? What is your work look like?
David:Yeah, so I still have a part time position doing what I would call mostly biological psychiatry where we work together, we work together.
David:Yeah, exactly at that clinic, but then my private practice is much more talk therapy, and specifically a psychoanalytically informed talk therapy. I still prescribe medication in my private practice. I still think about other modalities of treating patients, but the one that I feel most skilled in is and the one that I find is most helpful for at least the patient population that I work with is psychoanalytic, ie psychodynamic psychotherapy, which you know. Should we just say a word about what that?
Dirk:is yeah. Tell us a little bit about psychodynamic.
David:I mean, people could and have, like you know, spent lifetimes writing about exactly what is this, but I think, in short, I think it's fair to say that it's a form of talk therapy that understands certain types of problems that people have in their lives to be rooted in, just as I was saying before, a kind of unawareness of certain parts of themselves, parts that are kept out of conscious awareness, and that by reacquainting them with those parts or maybe maybe it's their first acquaintance with those parts of themselves they can know themselves better and make more informed decisions about what will be satisfying for them in life.
Dirk:That's well said, I'm just thinking. I remember as part of our training we all were very much encouraged to work with analysts and we did some once in a while. I never did the psychoanalytic formal training. I did a little bit working with a training analyst and just the, and also I saw some psychiatrists at other life transition points. I remember just how powerful it is to step into a room with a person who is just sort of an expert, just there for me and know that I can just like say anything and they're probably not going to be shocked and it's sort of an amazing process to be a part of.
David:It is. It is. I think it's incredibly powerful and incredible opportunity, unfortunately one that not a lot of people get, but it is. I mean, how many people do we have in our lives that we could really say anything that crosses our mind to?
David:so often we censor ourselves and you know, oftentimes should censor ourselves because not everything is, you know, fit for public consumption. But but with one's analyst, with one's psychoanalytic psychotherapist, one can and should. That's actually kind of like the one rule of psychodynamic psychotherapy. If you're the patient, one should say whatever comes to mind, as it comes to mind, and it's a really weird and unnerving thing to do at first, but it turns out to be an incredible privilege.
Dirk:So people will lie on on this couch or what? What proportion will do that, and can you say a little bit about the idea behind the couch and lying on the couch?
David:Sure, sure I think other people could could explain this better than than I.
David:But you know the couch is meant to facilitate a kind of state of reverie, a kind of state of free association, and I don't know how much of that is about kind of lying down. You know we lie down when we're dreaming at night and so maybe that facilitates daydreaming. And how much of that is just not having to look at your analysts, not have them look at you. You know the ideas that there's something freeing about that, but you know that that's the kind of position that the patient assumes in a traditional psychoanalysis, by which I mean like a four or five time a week psychoanalytic psychotherapy.
David:But you know there are all kinds of hybrid models now. You know psychoanalytic psychotherapies that aren't a kind of full throated four times a week psychoanalysis. You could be with someone once a week or twice a week or three times a week. In there they're sitting up and they're looking at you or they're lying down or they're. You know you're seeing them by zoom. There are all kinds of modifications we've made, but the fundamental idea is still for the patient and the and the analytic therapist to work together to cultivate that process of free association.
Dirk:Yeah, I think I never did it and but I do see the sort of the power of it. I think when we talk to somebody, I'm talking to you now. I see your facial reaction. That's very reassuring I sort of feel like I get where and I feel like lying on the couch. It's sort of there's no feedback. That then turns off the emotion. So, it's like it encourages this sort of feed forward, opening up process.
David:It's only encouraging until what crosses your mind is that I suck and you hate me, and then it's quite inhibiting to be looking at me and it's perhaps yeah, yeah.
Dirk:Could you maybe speak to sort of what kind of patient, sort of a hypothetical patient that's sort of in the middle of your wheelhouse for like this? This would be like the ideal treatment for for X person. Yeah.
David:I mean traditionally we think about for psychoanalytic psychotherapy. There are definitely exceptions to this, but traditionally we think about it as well geared for neurotic people, and I think, like a good kind of working definition of neurosis is that neurosis is when someone gets in their own way. You know Someone keeps running into the same problem in romantic relationships or keeps running into the same problem at work, you know, getting fired again and again. Or they have some sense. Oftentimes they come to me with a story about how it's not their fault but they have enough of a sense that maybe they're contributing to the problem in some way that they think, okay, I'm getting in my own way and I need help with that. In psychoanalytic psychotherapy is usually well suited for that kind of or often well suited for that kind of patient, you know, because the reasons they get in their own way are unconscious typically.
Dirk:So what made those? Some examples of those reasons.
David:I mean there are lots, but I think a common one is a feeling of not having gotten what one wanted or deserved as a young person, as a child, expecting that they won't get it.
David:Now seeing evidence of that pattern in every disappointment and feeling like you know, that they're screwed and they feel envious of others who they see as having it better, and they feel defeated. And yet there's this sense that like, well, maybe there's something I could do to make more of the opportunities that I do have. You know that that would be one variant of a common story.
Dirk:Okay. So let's say I come to you and I say I have one of these patterns and relationships that don't go anywhere. And so then what's your sort of approach? A person shows up in your office and what do you do?
David:Someone shows up in my office, I want to really hear their story, take a complete history, we would say so hear from them over, usually over several sessions. You know kind of what hurts the way any doctor would say, like what hurts when a patient comes to them, and to try and understand their explanatory model of why they're hurting and then see whether they're the kinds of problems that might be treated with some psychoanalytic psychotherapy or maybe are better addressed with some other modality. And also you know whether the patient is reflective. You know, in order to do this work they have to be inclined to look within. Not that it's going to be easy, you know, if we're encountering shame and envy and other uncomfortable emotions, it's not going to be easy. But they have to be curious enough to be able to be willing to push through some of that discomfort. If they are, or if they could be helped to be that way, then this type of work might be good for them.
Dirk:And then you'll sort of ramp up, maybe slowly, and go two days and then see and yeah, you might start with someone you know once a week.
David:Usually less than once a week is not going to be a helpful frequency for psychoanalytic psychotherapy. You might start with once or twice a week, something like that, and see how that goes and sometimes that's sufficient, sometimes that's, you know, all a person needs, and then sometimes you know the problems are run a little deeper and maybe it helps to meet more often.
Dirk:What are sort of the key moments in a psychoanalytic, or what might they be that you sort of notice that there's progress being made?
David:That's a really good question, I think. I think I mean it's different for every patient, right, but I think a powerful moment is when they is, when a patient realizes both, that I do have a hand in the perpetuation of this problem, and it's okay to be able to hold both of those things in one's mind. It doesn't have to be someone else's fault or, to the extent that it is, that's okay too. Like maybe I was wronged as a child, but like maybe that's survivable and maybe that's forgivable.
Dirk:What do you mean by that? That's okay, that it's, there's nothing that I need to do, or I can just sort of accept that this happened. It wasn't fair.
David:Yeah, and it's still my opportunity, and even my responsibility, to make the most of the time that I have on this earth. You know that it's not. It's I'm not serving anybody, including myself, by dwelling there. If I don't have to, I mean, that's a big deal, right, that's not what a decision one can just make. But if one can get to that point of feeling like, okay, that happened, that hurt and that was too bad, I don't have to deny that reality. But it also doesn't need to define my entire future, and not that it won't stay with me in certain ways, Like I think of. You know that Faulkner quote about like the past is never dead, it's not even past. Something like that right, Like that past is going to stay with us. We're still going to be shaped to some degree by what happened to us, but it doesn't have to be quite so defining, so determinative as it was when a patient first comes into therapy.
Dirk:Are there other sort of pearls, that sort of you find yourself, that sort of come up with with each of your patients, that and in sort of? I think so what in child work? I often think about this concept of delight in development and how new abilities constantly come online and how amazing is it to suddenly be able to crawl or to walk or to say no.
Dirk:And when you know, just imagine, you're never able to say no, and now it's, you can do that, and so it kind of makes sense to say, no, I don't want to wear this coat. Or all these things that are sort of frustrating. But I think that's sort of a neat concept. But wonder what are the pearls that you have like that?
David:I mean I'm sure there are none are coming to mind at the moment. I think sometimes I'm influenced by what has happened in my own life and this can be potentially helpful or this can potentially be a pitfall. You know, like if I'm projecting onto the patient what I've experienced and think they're going to be like me and benefit from something that I benefited from or or not benefit from something that I haven't found helpful, then I can miss an opportunity with a patient. But sometimes there are pearls that I come across, like I think it's probably worth saying for this interview that you know I'm in my own analysis right now. I was in a different analysis during psychoanalytic training, so I'm in my second analysis right now and sometimes what I'm learning in that analysis from my analyst can be helpful for me. You know, I think I get pearls from that.
Dirk:So yeah, that's amazing and I know I have a child supervisor that we both know who's had three analyses, and can you say sort of one analysis and then another, like what would be the idea behind sort of a second analysis, and how much better can you know yourself? Always more layers, I mean.
David:I had a fair amount of work to do, and, as you know, the first analysis was I mean it was like a 10 year treatment, probably seven years of which were were psychoanalysis. Before that it was a couple of times a week psychotherapy. So it was a lot of work and that's probably daunting for someone hearing this. I had a lot of work to be done and I think I really did benefit from it. But there were, I think, ways that I went on feeling, as I was saying before, anxious, ashamed, guilty, angry, unsatisfied, bored at times, that I felt like were probably within my power to at least improve, if not totally remedy, and so I kind of did what I could with what I had learned from that first analysis, but felt like I needed to do more work, and so that's what made me feel like it was time for another treatment.
Dirk:And can you speak to the difference between analysis and sort of a more directive approach where I sort of always wonder sort of well, what in psychiatry in general?
David:and.
Dirk:I think, for example, with ADD, which is a real disorder and you can image it and you can treat it. On the other hand, evolutionarily there was a time when it made sense for people to run around and notice a lot of different things, and it probably is sort of a context dependent disorder. And so the idea of what is a disorder? Where is sort of the line between mental health and just sort of a more directive approach of we need to make some changes in our life?
David:Yeah, yeah, I mean I think sometimes a patient will come to me and I will offer advice or support something more kind of directive like you're talking about, and some of them can make good use of that.
David:And that's a short treatment and ends happily, hopefully. But by the time someone is ready or appropriate for psychoanalytic psychotherapy, they've heard from their friend, from their spouse, they've heard good advice and they just can't avail themselves of it. They don't know why. It's not usually for lack of good advice, and so there's something in them again, that kind of self-sabotaging that undermines them, and so that's a person who, I would say, gets in their own way, is neurotic and maybe is appropriate for an analytic.
Dirk:That's a nice explanation for who would really benefit from the analytic work. Within analysis, is there a particular orientation that you find most appealing?
David:I feel I'm pretty eclectic in my approach. I draw from different schools of psychoanalytic thinking and yeah, I think that's in part because I don't actually know any individual school well enough. When I did pursue some of these schools to a greater depth, I felt like it kind of for me personally, I felt that it lost connection with clinical relevance sometimes, and so yeah, I think.
David:I kind of draw from different schools. I draw, as I mentioned, from my own analytic experience as a patient and my own lived experience and ultimately, I think a lot of it what you do in practice, regardless of what school of thought you subscribe to, what you do in practice can look pretty similar. Actually, not always Different people practice differently, but a lot of it comes down to being honest and kind and brave with your patients, and if you can do those things, I think that's a good foundation.
Dirk:Can you think of an example, or make up an example, of being brave, what that means?
David:I think, as I was saying, ultimately patients are going to get to some pretty uncomfortable understandings about themselves and I think what many of us at least those of us who are kind of like adept in social settings have been taught to do is to direct away from that, to reassure a person that they're not as troubled as they feel they are, that it's not their fault or that it's better than they think it is, and, I think, to be able to be honest and face with them the reality. If it is the reality that, yeah, things are pretty bad or yeah, you've screwed things up pretty badly, I think that is counterintuitive. At least it goes against what I was taught to do like company, but it's what some people need to hear sometimes.
Dirk:And.
David:I rarely feel hopeless. I rarely feel that in saying it's pretty bad and you screwed it up pretty badly, that it's hopeless, but that honesty could be an important starting point for okay, if it was within your power to screw it up and it's probably within your power to at least improve it, how are we going to do that?
Dirk:That's a really nice empathic example the way you're sort of describing it of being kind and honest and, at the same time, telling the person the thing that they don't want to hear, probably, maybe have heard but haven't been able to hear from other people.
David:Yeah, and this is where I think my own analysis has been so valuable. I think now that I'm less concerned with myself, how I'm coming across, whether I'm impressive, if I'm less concerned with those things, I can just be more available to my patients to be loving and attentive, and then if you can do that, then it's easier to be kind and honest and brave and all that stuff.
Dirk:So it sounds like you're at a very good place in your journey, professionally and personally. Do you have a vision of what your professional life is going to look like? Now for the next?
David:No, I mean, as I said, I didn't know what med school is going to be like and what being a doctor was going to be like, and I still am bad at looking ahead and knowing what it's going to be like and maybe it's not so important. It'll be what it'll be and I'll accept it or I'll change it as I am able and need to. But yeah, I could see myself kind of doing what I'm doing now for a while. I feel like I'm definitely still getting better at knowing myself and getting better at the clinical work. It's been like a very shallow learning curve for me. I think it took like a good 10 years of this work for me to feel like, okay, I kind of know what I'm doing here.
Dirk:How come? What do you think makes it such a shallow learning curve?
David:Well, I mean, again, I think I had to learn a lot about myself. I just wasn't available to do this work for other people as well as I'd like to early on, so that was part of it. And then, yeah, it's just not like doing an app and deck to me. I mean, you can learn the anatomy like pretty quickly and you can learn the procedure pretty quickly and probably within a couple of days of being trained you could more or less know how to do an app and deck to me and ensure you could get better at it. But this is it's subtle. The interventions that the interventions that we make are subtle and I think you have to be quite present emotionally. I guess it's worth saying something here about counter-transference, so if that's a term that people aren't familiar, with Sure.
Dirk:Yeah, Maybe explain that a little bit.
David:Counter-transference could be defined as the thoughts and feelings that the therapist brings to the clinical encounter and specifically those that are provoked by the clinical. So if I'm, because of early life experiences or just for whatever reason, I'm prone to feeling competitive with people, then it's not unlikely that's going to crop up in a clinical situation where someone's being honest with me, including perhaps about their competitive impulses, and I have to be aware of that in order to at least not let it interfere too much and hopefully make use of it in some way. If I'm feeling competitive, maybe more than usual, then maybe there's something going on between the patient and me that I should know about. That's that's in generating that feeling. If it's just my usual competitive impulse, okay, that's just me and that's worth knowing too. But I think until you like know yourself well enough to know what your typical counter-transferences are and what they're not, it's hard to do this work.
Dirk:Being competitive with a patient might mean sort of making clever points.
David:Yeah, yes, I mean straying from what is kind of most helpful for them in order to serve my own narcissistic need to be impressive.
Dirk:So the work that we do is, you know, we listen a lot and we have a lot of ideas in our head and we don't necessarily, you know, we have to be very judicious in what we say, what we don't say.
Dirk:So I guess you have your analysis to say whatever you want to say. Are there other ways that you sort of I guess the creative writing is a way basically, how do we find, how do you find balance? What do you do to create balance beyond that might complement this kind of work, or do you feel like that's not really?
David:I find balance is hard, like I think about that wrestler who found a way to gain a sense of balance by dropping into that stance that he developed, and I think it helps to be creative and that's something that I'm definitely still working on, you know, trying to spend time with friends and to exercise and be with my family. But, like everyone else, I feel absolutely overwhelmed by the amount of news and the nature of news coming my way all the time and I feel always a step or two or three behind. I feel off balance frequently. But, yeah, writing can be helpful. I haven't done a lot of that recently and being out in the natural world probably as much as anything has been helpful. Being able to be in the woods to garden that is something I kind of discovered during the pandemic and has been helpful Like almost nothing else, I would say.
Dirk:Yeah, I love being able to be in nature and garden and unfortunately I don't have. I had access to the pandemic no I don't.
Dirk:And yeah, I think for me, having a creative sort of compliment to sort of I feel like, in what you're talking about, the news too, I sort of lost my train of thought for a second. But the news is so disorienting and so polarizing and so inflammatory, and I do think that's longer form conversations, and I do think that all of us humans sort of go through the same challenges of life transitions and losing loved ones, and frustrations, and there's so much we have in common. It's crazy how polarized everything is. And so I do sort of feel like there's room to maybe in like a Joseph Campbell way, you know, bridge across cultures and find metaphorical commonalities. Yeah, I long for that, and so I don't know, I wonder if there's more room for us as a mental health community to move people in a sort of in a bigger social way versus versus just a, you know the person, the individual on the couch, who that's?
Dirk:great, we can help them, but I think there's sort of a bigger, bigger need.
David:Yeah no, I, yeah. I mean I think that you're good at thinking on that scale and that does not come so easily to me. I'm much more comfortable thinking about kind of one to one interactions. I would love to make some changes on a larger scale. I would love to throw everybody's phone away and help everyone to slow down and reflect a little bit more. But I do think that ship is sailed and, yeah, I guess I can feel more effective, I guess, and more hopeful working on an individual scale. That's harder for me thinking about kind of societal level changes.
Dirk:That makes sense, I think, focusing on the, the moment, and and the person who are your biggest heroes are there had a question about if you could sort of have a hypothetical group of advisors. That could be anyone from from history is there sort of a group of three people you you might want to have on speed dial oh well, think of yeah.
David:I don't know. I mean I think lately George Saunders is someone that I've been. I mean I've always.
David:I don't know who that is okay he's a he's a fiction writer or he's a creative writer and he teaches I want to say, at Syracuse he teaches and I think, their MFA program and I've been reading his short stories for a long time.
David:But I recently read a book of his which is basically a collection of short stories by great Russian writers of the 19th century, and he'll, he'll share, he'll, he'll share one of these stories.
David:Saunders will, and then provide kind of a running commentary about his reaction to it, reaction both in terms of like what makes it great writing, but also his ethical reactions, his psychological reactions, his emotional reactions, and I heard a podcast that he did with someone recently and I think he gets to the same. I mean, I think he's more influenced by, like certain Eastern spiritual traditions and I haven't heard him talk about psychoanalysis, but he gets to, I think, some of the same places that I'm aiming for and I find him to be very wise and very kind and we haven't talked about humility, but he's someone who's who's striving for humility, who's someone who always feels himself, I think, to be kind of up against certain narcissistic impulses in a way that I can relate to and, yeah, I think I just really admire the way he's trying to tackle these problems in the, in the solutions that he's coming up with for doing so.
Dirk:Is there a specific story or book that you sort of recommend for somebody who might be interested in?
David:this this book with the Russian short stories it's called A Swimming a Pond in the Rain or Swimming the Pond in the Rain. I'd really recommend that. I think it. I mean, first of all, it's just like awesome writing and and secondly, I think, although he's not a therapist, I think it's kind of a nice introduction to thinking about one's unconscious.
Dirk:Neat. Are there any other sort of book recommendations or things that are sort of striking your? This is hard.
David:I haven't read a ton about psychotherapy for for like a lay audience, so but what I have read has not been great and I imagine it's out there, but I haven't come across kind of good introductory books for people who are kind of thinking about a psychodynamic type of psychotherapy. Do you know?
Dirk:I don't know. I'm sort of thinking of the Yalom books that are sort of fiction. I don't know if he's sort of an official analyst yeah, sort of existential yeah yeah, a nice writer yeah, kind-hearted yeah. I do like thinking about sort of the, the what's next to psychiatry and psychoanalysis, and the writers who just have an insight into the human condition, so that personal we need to check out. Yeah, so have you figured out the meaning of life? Or?
David:do you?
Dirk:think about this, or is this not something?
David:you, it's not a question that I really think about. I mean, I guess the way that I would frame the question for myself would be like what's the best use of the time that I have ahead of me? We all have, you know, a finite amount of time and we have to decide what to do with it. And I think for me, increasingly, I'm less concerned with, you know, leaving some kind of mark or doing something great. I think when, at a time in my life when I felt that other parts of me needed to be compensated for, I was more concerned with doing something grand like that. And and now I'm much more concerned with being good to the people that I love, and that would include my, my family and my friends and my patients and my colleagues and myself that's nice, yeah, yeah.
Dirk:So being good to the people that you love is kind of the way to it feels like time well said yeah, sent the sort of guiding principle towards meaning yeah, any other thoughts, or I don't. I don't know where, how we're doing in time. I think we've spent an hour, so I want to maybe wrap up. Is there? Are there any sort of final thoughts, or I just have a question. If you know if you could get some big message out to the world, is there something that you would want to communicate?
David:yeah, that's it. That's a tough one. It feels like you know. I mean I would love for people to slow down and to reflect and to be kinder to one another and to themselves. I think a lot of the polarization is driven, you know, that we see in society today is driven by the pace of things and is driven by some of the feelings that I talked about before, like shame and guilt and the need to kind of rid oneself of those quickly and maybe to pin the problem on someone else. And I would love for people to kind of reconsider the way they're going about that stuff. But but that's not only a big ask, but it's.
David:It's very hard to for a, I think, for a person. This out of the sounds kind of maybe condescending or simply thought, but it's hard for a person maybe to even know about how to go about that if they don't have someone to do it with, a kind of structured place to do it in. It's hard to do that on your own. I think it's hard to to confront one's shame and guilt and anger and projections, because I think, you know, frequently one ends up just sitting without those emotions and not knowing where to go next and so. So I don't know, maybe I'm just kind of thinking off the top of my head what, what might help with that.
David:Maybe just keep talking with one another. I don't mean talking at one another and tweeting at one another, but like, I keep talking to people. You know it maybe don't have access to a psychoanalytic psychotherapy, but like, maybe you can keep talking like face to face, and that would include listening, you know, that would include being honest about what you believe and to find people you can. You can do that with, hopefully not just in an echo chamber, but like with other people who may have views that are different from your own, and to really try and talk and listen yeah I totally agree and talk, listen, slow down, and a.
Dirk:It's hard to sort of imagine that that just we put it on a billboard or something and people are just able to do it. But I do think sort of having these sort of key principles to sort of get back to then ourselves is helpful. And we are battling, you know, this world around us where all the blogs and clickbait and so forth is just, you know, triggering our reactivity and amplifying that. So I think it's a really important question how do, how do we as individuals step out of that? And and then, is there a way to do that sort of on a bigger scale?
David:I don't know yeah, that's a really important question, yeah all right.
Dirk:Well, thank you so much for doing this. Thanks. So I hope you enjoyed getting an inside look into the mind of a really smart and kind psychoanalyst. I am extremely interested in how we as therapists find our way into our own particular niches, and this conversation and David's path reminded me of Boyd Vardy, who has a really amazing story that he describes in a podcast Tim Ferriss podcast interview called the lion trackers guide to life. I linked to it on the my developing meaning website and Boyd Vardy says I don't know where I'm going, but I know how to get there and if you listen to the episode, you will understand how that might. Maybe pertains relates to David's path into psychiatry and psychoanalysis.
Dirk:I intend going forward to bring you perspective and journeys from various types of therapists. Stay tuned. We will be getting into hypnosis, emdr, internal family systems, therapists. I hope to see you again next month when I bring you a different kind of episode, which will be an audio diary of my ketamine experiences during a week-long training at the Menla retreat center. Until then, I hope you have a meaningful, meaning filled month. Thank you for listening and if you figure out the meaning of life, let me know hm.
David:DID YOU NOT KNOW? Aldi orders a Christmas on tSpeakutu. If we can't pipes, our health will disur lodge. Something is what event he is. There's a broken madness reflected on the wall. He's shoving his ears and eyes out with desing-vibedness. He could have some more.