Tuesday, March 26, 2013

Guest Blogger Dr. Jesse Hellman: Why Can't We Be Friends?

Back when we discussing The Basic Treatment Plan, I asked Jesse if he would write a blog post on Non-compliance.  Jesse, however,  was non-compliant and he wrote a guest blog post on how we dialogue here on Shrink Rap.

Was St. Bernard right? 
Qui me amat, amat et canem meam
 "Who loves me, loves also my dog."  --St. Bernard, 12th century
St. Bernard quoted this Latin saying in a sermon, and it led me to consider whether it applies to much of what we discuss on Shrink Rap. Granting that St. Bernard had a very big, and most likely unwashed and untrained, dog, which would have tried the patience of many homeowners of his time, may we apply his principle beyond retainers, followers, and family to equally speak to our possessions, words, actions, and beliefs?  If you love me, you'll also love all that I think, say, and say.

How often do we see here on Shrink Rap dialogue which is heated rather than restrained, opinions which are held ex cathedra, invectives thrown with careless disregard, and individuals attacked quite casually? Shrink Rap is not unique, but a rather educated example of what we see commonly in the news, on talk shows, in editorials. 

What I am positing is that St. Bernard's adage is often taken in the reverse: if you do not agree with what I say, you do not love me, and I will respond accordingly. There is a failure of empathy, and hurt feelings, the sense of not being loved, leading to an exaggerated response.

Shrink Rap is a psychologically attuned blog with a thoughtful community. Do others see  what I do, or disagree? Do you see that when an opinion is presented a disagreement may lead to a nuclear response rather than to a thoughtful reexamination of whatever argument is present? Do you think that hurt feelings are frequently underneath this?

Lost in history is the housewife who did not want Bernard's big unwashed dog on her couch. How do you imagine the conversation went?  

Moral: if you disagree with an adversary, it is best said in Latin.


jesse said...

Nota bene: my blog was written before Dinah posted the last blog.

Today is the second day of Passover, friday is Good Friday and sunday is Easter. Happy holidays to Shrink Rap bloggers and readers everywhere!

Alison Cummins said...

I think that often people who have been hurt respond here. I don’t necessarily expect them to have subtle, reasoned responses though they often do. I learn things from all of them — among others, who your patients are. They are not always happy or receptive.

I suspect I’d find Dinah annoying if she were my sister (and vice versa) but I really like the way she responds to some of these attacks when she’s at her best. She is able to set a good example. And we aren’t sisters, so that works out for both of us.

Jesse, in your case I kind of think I’d find you less annoying in person than I do on the blog. But we’ll never know.

I’m glad that you commented that this post wasn’t written in response to the comment thread on the previous post because I thought you were talkng about me. Even when I’m cranky (which I freely admit I sometimes am) I try to remain objective, so it would have upset me greatly to think I’d inspired a blog post about personal attacks.

jesse said...

Thank you, Alison. Yes, my blog was not written in response to your comments on the previous blog. I thought, actually, that your points were well thought out and to the point.

There were comments made in in that blog that do fit what I was describing, but rest assured you did not make them.

And Dinah would indeed make a great sister.

Dinah said...

Thank you Alison.

I don't have a sister so I can't ask anyone. I do have some friends who voluntarily subject themselves to my company on a pretty regular basis. They might all agree with you that I'm annoying (but in an endearing way?)

Jesse is not annoying in real life. I would adopt him as any form of relative in a heartbeat.

And Jesse sent me this post before Dr. Frances sent me his, but I held Jesse's because the one on premature diagnoses tied in with Dr. Pies' piece in the New York Times.

Dr. Pies tells me that while he believes diagnosis can be a good think, he did not intend to sound like a proponent of DSM-V.

Sometimes I think we all argue to express the same point of view.

Alison Cummins said...

Dinah, as long as there is one person in your life who you do not annoy then you are not annoying. Me finding you annoying is different from you being annoying. One of my best and oldest friends is objectively extremely annoying — I’m the only person I know who she doesn’t annoy — but she doesn’t annoy me. Annoyingness is very personal and subjective.

It’s like communication: you need both a speaker and a listener for it to happen. For there to be an annoyer there must be an annoyee. (You are free to presume that my annoyance threshold is set very low and that I give lots of false positives.)

Anonymous said...

Well Dinah, I could write a guest blog post on non compliance but I don't think you would like it:) Personally, I despise the term as I feel it is used generally in mainstream medicine to unfairly blame patients when medical therapies don't work.

Back to the topic. I am a little confused about the purpose of Jesse's blog post as I don't recall any recent posts that have been disrespectful. A little perplexed but maybe that it is due to my sleep deprived brain.

jesse said...

@Anonymous: I agree with you. "Disrespect" was not a term I used or considered. What i was getting at, and I admit it is not easy for me to write about it, is that occasionally a statement by someone (blogger, responder) triggers a rather strong reaction which I surmise (no proof, I am asking a question) was precipitated by hurt feelings or some other emotion which is not acknowledged.

For instance (totally fabricated example follows) if you wrote "yesterday I was walking to work and I was attacked by an untrained beagle" and then I responded with "Anon, you hate dogs, we all know that, and you think all beagles are untrained," I would hear an instance of going from the particular to the general. But then if you responded to Anon by pointing this out you might be met with some escalated rebuttal.

So I posited that one underlying mechanism might be that comments are taken at times very personally, and some of the responses indicate hurt feelings. In the previous blog it seemed to me that it was Alison who was trying to be very measured and reasonable and was in fact pointing out the very thing I was blogging about here.

So my blog did not truly express well what I was trying to say, and perhaps I am still not being clear. It is not an easy subject to blog about. Noncompliance might have been easier.

Dinah said...

Perhaps the beagle was trained to attack? Those trained attack beagles will get you all the time.

Anonymous said...

Thanks Jesse for clarifying. What you say makes alot of sense.

Oh, please do write that blog entry on non compliance. That is if you want to see some emotional reactions from at least this person:)


PS - I was the one who wrote the previous post and forgot to sign my screen name.

jesse said...

Exactly, Dinah! Your response here is a thoughtful exploration of possibilities. Trained attack kamikaze beagles are as deadly as they come. They are trained to appear untrained, and there's the rub.

jesse said...

AA, I'm thinking on what to say. Stay tuned.

marion said...

I thought Dr. Frances brought it on himself. He should have used a confabulated example if he didn't want people talking about Suzanne and critiquing her story.

Anonymous said...

Who got their feelings hurt? I'm confused as to which blog post we're even talking about.

My opinion, but I think sometimes passion about a topic can be mistaken as someone feeling hurt or even angry, or whatever. I don't know what I'm saying, really, I'm just confused about who got hurt and why they're hurting.

jesse said...

@Anon, my blog was written without any specific person or response in mind. Something I've been mulling over for a while. Just coincidence that that there were elements and responses in Dr. F's previous blog that fit some of wht I was saying.

Now I'm working on a blog on non-compliance.

Alison Cummins said...

Some of the folks here might be interested in this article:

Steven Reidbord MD said...

The subject of exaggerated emotional responses online is something I've pondered for decades. Why did cyber-romance flourish over the text-only internet in the 1980s? There was certainly no in-person chemistry for guidance. Why "flaming" — over-the-top denigration of complete strangers who voiced opposing opinions? The internet has changed a lot in the past 30 years, but it remains a rough and tumble place where tempers run high and feelings are easily hurt. Why?

I believe it's transference. We make assumptions about people we're engaged with but don't know well, filling in the blanks with our imaginations. In effect we shadow-box with ourselves. Our posts and comments are extensions of ourselves, and thus make us vulnerable to narcissistic injury when painfully mistreated by others. (This mistreatment in turn being a product of emotional self-defense by others.) When we rise in defense and rebuttal we are defending ourSELVES, not merely our words or rational arguments.

In my experience, ironically it's the most psychologically sophisticated lists where this happens the most. Intellectualized arguments better hide the underlying emotionality, in contrast to the straightforward "buzz off!" or "you're full of it!" seen in more pedestrian forums. No matter how smart and thoughtful we are, we still snarl if someone pulls our tail.

Anonymous said...

Jesse, thanks for clarifying. As someone who has been non-compliant (I would imagine we all have been at times if we're honest), I am looking forward to the discussion about non-compliance.

Dr. Reidbord, what you write is interesting. Sometimes I have scratched my head in surprise that I reacted strongly to something someone wrote, someone I don't know, and likely never will know. It is kind of odd. Anyway, I like to think I've mellowed somewhat on the internet over the years. In addition to what you wrote, I think at times things people write get lost in translation. You read a post, it spurs a thought about another event or something else you might have read, and you write a response with all of those things in your mind, then the response is misinterpreted. I guess it also doesn't help that we don't have the advantage of seeing body language and facial expressions. I think that leads to misunderstandings, too.

jesse said...
This comment has been removed by the author.
jesse said...

@Dr. Reidbord, thank you for your response. It is actually a joy today to see words like transference used, and correctly used. Could I add that the over-the-top reactions are also fueled by anonymity. It makes it much easier to go overboard when no one knows who you are, and it is easy to choose a pseudonym for Shrink Rap.

jesse said...

And to the last Anon above, "bravo" for what you just said.

Steven Reidbord MD said...

@Anon & @jesse, Yes, we often react to what someone triggers in us, not what they actually said. The lack of facial expressions and the anonymity of the internet both contribute to this, in much the same way the anonymity of the analyst and lack of facial expressions (the analyst being invisible to the patient on the couch) contribute to transference and regression in psychoanalysis.

The problem on the internet is the lack of "treatment frame" or "holding environment" to contain these primitive feelings. It's a challenge for all of us using this medium (and of course there are advantages to the anonymity etc as well).

Anonymous said...

It's easy to critique and judge others until you ponder the symbolism of ducks swimming in a pond. From the outside, only gliding motion is visible. Underneath, each duck is kicking up a storm to make forward progress. Everyone has private struggles and does their level best.