About Katherine Noordsij

I am a psychoanalyst and a psychotherapist working in New York City and New Jersey. I have always been interested in how people feel and what motivates them. This blog will be another way for me to observe and learn from the feelings, observations, and questions that strike me in my work and in daily life.

Then Again…

Judy Blume has been in the press lately for her first novel for adults, In the Unlikely Event.  The reviews also referred to how important and popular her earlier books for children and adolescents have been.   I decided to sample her work to see what I missed.  Starting with, Are You There, God?  It’s Me, Margaret, I was taken inside the mind and emotions of a pre-adolescent girl.  I thought she nailed Margaret’s emotional changes as her hormones carried her into puberty.  How would she do with boys?

As a psychotherapist and analyst, I hoped I might gain some insight into how my male patients experienced this time of life. I turned to Then Again, Maybe I Won’t,Book cover--Then Again the story of Tony Miglione at 12 through 14. Tony had to deal with a lot of changes along with the physical and emotional impact of puberty. Before the book began, his oldest brother was killed in Vietnam. His grandmother, who lived with them and cooked for them, had had an operation for cancer of the larynx, and lost her ability to talk. In the book, his father sold an invention, electrical cartridges, not ever clearly defined and surely not understood by Tony.  The family became instantly wealthy. They moved from Jersey City, New Jersey, leaving Tony’s friends behind, to Rosemont, Long Island. His father went to work for the company that manufactured his invention. His older brother, who had trained to be a teacher, joined him. They hired a maid, putting his grandmother out of a job.  Deeply offended, his grandmother took to her room and isolated herself from the family.  Tony had to make new friends, one of whom liked to shoplift for fun.

Tony’s biggest problem was his stomach. The stress of his new life and friends expressed itself through his gut, terrible stomach pains that ultimately sent him to the hospital, where Tony met Dr. Fogel, a psychiatrist.  To my surprise, this book is also a case study in how to help an adolescent embrace life and gain confidence in himself through “the talking cure.”

In Tony’s first appointment, he freely talked about the changes in his life.  In classical form, Dr. Fogel nodded, shook his head, smiled, and grunted.  He asked a few short questions related to Tony’s multiple ambivalences.  He loved his mother but hated that in her striving to imitate her wealthy neighbors, she hurt his grandmother. He hated that his friend Joel shoplifts but was afraid to report him and lose his friend. He loved his brother but resented that he was going into the cartridge business. He missed his old life in Jersey City but liked having plenty of money. Dr. Fogel’s longest remark was, “Well, Tony…we’ve had a very good first session.  I’ll see you again next week.”

Tony saw Dr. Fogel regularly, though now the impact of their work was revealed through his thoughts and actions outside the consulation room. He had a crush on the older sister of Joel, his next-door neighbor, and he spied on her with binoculars through his bedroom window. He said, “Last week I told Dr. Fogel about my binoculars….I thought he’d be really surprised. But all he said was, ‘How does that make you feel,’ so I told him…Dr. Fogel didn’t tell me to stop doing it.”

When his brother told him he and his wife were moving to Rosemont, he was conflicted about his brother’s materialistic concerns, having a bigger house, giving up his plan to teach.  Yet Tony realized he could look at his brother without hating him and found that he could accept that he and his brother were different people and that he might even become more like his brother.  But he gave himself latitude: Then again, maybe I won’t.” He realized: “Well, at least I got through thinking about all that without getting pains. I’m learning how to handle myself. Dr. Fogel will be glad when I tell him next week.”

Tony had a positive transference to Dr. Fogel. He expected that Dr. Fogel would be pleased with his progress. He did not feel judged. He was grateful that Dr. Fogel was helping him handle his problems.  Yet he realized Dr. Fogel never told him what to do, which slowly built his confidence in his own judgment and reduced his fear that his decisions would bring on a catastrophe–anger of friends, disapproval, pain, loss.

As the story wound up, he was able to see his parents as fuller people. He noticed that his father was getting older, that he was now a grandfather, his son killed in Vietnam would be 28. His transference toward his parents changed. He was able to listen to his mother trying to keep up with the neighbors with both amusement and sadness. He realized his father trusted his judgment, that he believed his son could face things.

His dreams also changed.  In a dream, and presumably in his life, his crush on his neighbor began to shift toward a more age-appropriate girlfriend.  His shame about his wet dreams, the last bastion of bad things he was afraid to tell Dr. Fogel, also waned. “I think I’ll ask Dr. Fogel about my dreams. Can too many of them hurt me?”

A More Fearless Tony
A More Fearless Tony

After he had flown down a hill, hands free, on his bicycle, he mused that maybe he was ready to put away his binoculars, but concluded, “Then again, maybe I won’t.”

Tony was a good psychotherapeutic patient.  He knew he needed to talk about what was happening to him, but he recognized, realistically, that most people could not relate to his feelings. Ironically, his grandmother would have been the ideal person, but she was voiceless. He also had a strong super-ego that reflected the positive values of his family. By 14, he became more aware of his feelings and fears, which reduced their power to double him over in pain. I enjoyed reading about how his treatment helped him through this difficult transition.  This book not only captured how it was for Tony to go through early adolescence but also demonstrated how useful my own profession can be.

Anxiety–Those Yearly Mammograms

A recent article in the New York Times (http://nyti.ms/1q4E05U) reported on a new mammogram technology that may be more effective in showing invasive breast cancers. Breast cancer specialists are searching for more precise tools.  Now radiologists, uncertain about what the mammogram shows, call women back for what proves to be an unnecessary second scan, which leads to anxiety.

I felt gratified that the article acknowledged the goal of reducing anxiety from what may prove to be an unnecessary follow-up. My own relationship with mammograms was full of anxiety. My first stun occurred when some calcifications showed up and I was told to return the same afternoon for a second scan. I was in my late 30’s. This was the first time I hadn’t sailed through with an “All clear, see you next year!” It was hard to breathe; I sat in my car in the parking lot of a CVS, unable to imagine anything else to do, waiting until my appointment time. The radiologist who examined the second scan gave me a qualified “wait and see.” Uncomfortable with the uncertainty, I sought out a breast cancer specialist I knew, Frank Gump, MD, to get a second opinion. “Not a problem,” he said. “These calcifications are in the periphery of the breast. You’re fine.” Much relieved, I vowed to get every mammogram examined by Dr. Gump to minimize the possibility of error.

Several years passed. Each year, I checked out the films from the radiologist’s files and took them to Dr. Gump to seek his opinion. The next stunner occurred when he looked at the films, which the initial radiologist had read as negative, and said with concern, that he saw a tumor. “How can that be?” The anxiety became unbearable until he looked at the envelope and saw that I had been given someone’s else’s films. Lucky me, poor other person. The last time I brought the films to him, again they had been read as negative, but this time, he saw a calcification in the center of the breast, behind the nipple. That day he did a biopsy, and a week later, he called to tell me that the biopsy showed very early stage cancer.

Now I am a breast cancer survivor with an additional history of what proved to be needless mammogram anxiety, much alleviated by Dr. Gump, for whom I will always be grateful. Perhaps the generation of women behind me may have less uncertainty, although uncertainty is our lot until there is a cure.

Time Marches On

The proud grandparents watch as their blue-robed grandson, tanned, tall, quietly confident, delivers his valedictory remarks.  Images float up.  Stunned toddler sharing his tired mother’s lap with his newborn brother, brothers playing basketball in the driveway, driving the family car home from dinner out for the first time, size 13 shoes piled in the mudroom.

A friend’s son also graduated. I’m sad, she says. He’ll be 10 hours away next year. I have to keep myself busy. Another friend’s grandmother died.  The funeral was in my home town. Seeing all the people I haven’t seen for so long, she tells me with tears in her eyes, I realized my life is half over.

My grandson is not yet one.  He is developing before my eyes. Now he can clap. He can do the raspberry. His father swears he can sing. The next time I see him, he may be walking. A friend says to me, when my little boy leaves the room and comes back, he is already different. Stop, I want to say, don’t change!

I am reminded of a poem by Gerard Manley Hopkins that addresses a young girl, Margaret, who is crying because the beautiful yellow leaves of autumn are falling.  It ends with the lines:

Now no matter, child, the name:
Sórrow’s spríngs áre the same.
Nor mouth had, no nor mind, expressed
What heart heard of, ghost guessed:
It ís the blight man was born for,
It is Margaret you mourn for.

 

It does not matter what you are talking about–leaves, grandchildren, graduation, life half over, the sorrow evoked is from the same source: as “time marches on,” our hearts know that all life, but more to the point, our life is finite.  As we experience these landmarks, we rejoice but sometimes we cry because we are mourning that the milestone marks life moving toward its and our inevitable end.

Witnessing–A Cousin Lost to Breast Cancer

“When I was driving to work, I suddenly felt this terrible sharp pain in my breast.” Thus my cousin Cathy told me how she knew something was wrong.  The pain in her breast was diagnosed as inflamatory breast cancer.

Cathy's Robin

Robin–One of Cathy’s Series of Bird Pictures

Ten years younger than I, Cathy was only in her mid thirties.  A full-faced, smiling young woman, she was an artist and had developed a career designing needlework. She was not only developing a following, she had several patents and had won awards for her designs.

I had called Cathy because her mother, knowing I had also recently been treated for breast cancer, asked me if I would talk to her. Thus I became engaged long-distance (she lived far from me) with her in her struggle.  I was the far luckier person.  Cathy’s kind of cancer is aggressive and very hard to treat successfully. More than 20 years later, I’m still going strong.

Her treatment was harsh, including a bone marrow transplant, but she died within two years of her diagnosis.  She went, when she had to, from her home in the town where she worked to her family home, but she would go back to resume her life when she felt strong enough. She was always creating a cross-stitch project for someone during this time.

A tiny needlepoint picture of mushrooms by Cathy

A tiny needlepoint picture of mushrooms by Cathy

I think of Cathy often because we have displayed some of her paintings in our house. She was talented; we are both sad and enriched when we look at her work. I am also reminded of her mother, my Aunt Gloria. The youngest of three, Cathy’s mother lost her own mother at the age of 4.  Her father quickly remarried to a smiling, warm woman whom we called Mama Clo. My aunt and she got along fine; my aunt grew into a sturdy, matter-of-fact woman with a hearty laugh and a wry sense of humor.  She married and had two children, Cathy and a younger brother.  When they were about the age of Aunt Glora when her own mother died, her husband died of lung cancer. She married again to the local postmaster, outliving him after a long marriage. They were together with her when Cathy died, and together they cleared out her apartment and folded down her life.

The last time I saw Aunt Gloria, she was living alone in the house she had lived in with her late husband.  Her son had built a house next door. She welcomed us with pleasure and we spent lunch together reminiscing, catching up, remembering the family members we had lost.  When we asked if she had any of Cathy’s work, she gave us some of Cathy’s paintings.

Cathy Livingston photo

Cathy about a year before she died

Anxious? There, there…How We Learn to Soothe Ourselves

Charles Schwab, a sponsor for the PBS Newshour, looks out the window of a skyscraper and pronounces, “The one thing people don’t ever want to have to ask themselves is, ‘How did I end up here?’ ”  What a seductive advertising message.  You can plan and execute a desired life (financial), presumably with the help of Schwab.  But wait a moment, Mr. Schwab.  You totally leaves out the unpredictability of life, the definition of which some believe is what happens when you are making other plans.

At those times, faced with unpredictability or disaster, it helps to believe that everything will work out somehow. This hope can soothe us.  How do we learn to soothe ourselves?For babies, after mommy or daddy,  some use what is called a “transitional object.”  This is the blanket that becomes worn to threads, the stuffed animal, a substitute for the mother as the baby realizes he and mother are two separate people.  Over time, the growing child internalizes this separate mother, and one day, the beloved blanket is no longer necessary.  My grandson has for now his own soothing method.  He looks somber, uncertain, and then he puts two fingers in his mouth, always two.  Sometimes, he brings the wrist of his other hand to his upper lip, and lightly brushes the fabric of his sleeve back and forth.  Then, suddenly, the hands fall away, his face brightens, and he engages again.

Later in childhood, for some it is a parent or other adult who can communicate with confidence that you will be fine. This belief, like the soothing mother, can be internalized. A colleague of mine, nearing the end of her long career, was musing about escaping from Europe as a girl during WWII.  She remembered one lonely and scary moment, as she was looking across the North Sea, waiting to board the ship that would take her to America. The beauty of the light in the morning sky transcended her anxiety and soothed her. The capacity to soothe herself, she continued, has helped her throughout her satisfying yet complex life.  Sometimes it is the light or even the memory of light. Even now, through a window in her apartment that overlooks the tree-tops in Brooklyn, at certain times of the day, she sees a light in the sky that holds her.  But also, she says the memory of having passed through crises, having come out all right before, also soothes.

Charles Schwab is right that we need to plan, but we also need to develop the capacity to accept and endure what disrupts our plans, to soothe ourselves.

 

Associations

One of the ways people get to know themselves better is to follow their associations. One thought leads to another, and if a person is alert to where the mind wanders and is curious about why this thought followed the one before, self-understanding may deepen. Visiting with my 10 month old grandchild reminds me of my own son when he was new, which reminds me of how upsetting it was to hear his cries of distress. This then reminds me of how my father, when visiting our new family, noticed my anxious race to my wailing baby, who had just woken from his nap.  He looked surprised.  He asked me why I was in such a hurry. “Slow down,” he said.  “You don’t need to rush; he’s ok.” Then my mind goes to a photograph I keep of my father, smiling at me as he stood with my then much older son, and I realize how much I miss my father, gone for nearly 15 years. Three generations were with my grandson this weekend.

As a lifelong reader of fiction and poetry, many of my associations are to what I have read. I love these parallel rich lives. Often when I listen to patients, I will be reminded of something I have read. For example, a young woman complained to me about her new husband’s annoying habits, and how she had never anticipated having to deal with such thoughtlessness. Her distress reminded me of a well-known marriage, that of David Copperfield and Dora. After their much opposed engagement and marriage,  he mused, “Sometimes of an evening, when I looked up from my writing, and saw her seated opposite, I would lean back in my chair, and think how queer it was that there we were, alone together as a matter of course – nobody’s business any more – all the romance of our engagement put away upon a shelf, to rust – no one to please but one another – one another to please, for life.” (Dickens, Charles.  David Copperfield, Chapter 42.)

Alone together, they have to get to know each other. Ultimately, neither David nor Dora could truly please the other. David had fallen headlong into love with a young woman who reminded him, probably unconsciously, of his doting yet hopelessly dependent mother.  I shift my attention, now reminded of this other marriage, back to my patient’s distress. Are the marriages similar? No. Are my patient’s hopes and disappointments similar? Perhaps.

What’s on my mind today?

Psychoanalysis has made me much more aware of my own thoughts and feelings. This awareness helps, is essential to, my work with patients, though the reasons why are far too complex to explain in a blog.

On the other hand, learning to pay attention to what I feel and where my mind roams is a skill that I want to keep developing.  Having had the experience of analysis, I know that a listener is also crucial to developing this skill. The blog serves both requirements. It will help me think about what seizes my attention, and it provides a listener, the presumed reader. Perhaps such a blog might be of interest to others and there will be real readers. We’ll see!