This column originally appeared in the Orange County Register.

“He’s gotten completely paranoid and is speaking in vernacular I don’t recognize,” my friend explained slowly and evenly, though clearly in an anxious state.  “The psychiatrist put him on medication, and I don’t know why.  I think he’s having a bad reaction.”

The father in question is elderly and lives in Florida.  A widower no longer able to care for himself, he has recently been removed from his home and installed in a residential facility.  He thinks he is going home again.

Always a belligerent and combative man, age has sharpened his astringency.  My friend, his only living child, is now completely responsible for his care.  Self-employed and living three thousand miles away in Laguna Beach, California, she is trying to honor this parent who injected nothing but harshness and discord into her life.  Fleeing home as a teenager, she has lived independently and successfully ever since.

Loss of independence

My friend speaks with staff members of her father’s facility several times daily in an attempt to buffer his jarring adjustment.  He will never be independent again.  “I tell them that he has to have his wallet or he panics.  He has to have change in his pocket and money.  But he’s changing his clothes several times a day – nobody knows why – and leaves his wallet in the pants he’s removed.  He keeps telling me he’s going outside to get a cab to go home.”  Her enduring empathy and compassion, in spite of a lifelong mordant relationship, are admirable and poignant.  And so I listen carefully and interpret what I hear.

She thought she was phoning a client this morning, but accidentally rang me instead, admitting that I had been on her mind.  Having spoken a few days earlier, she’d asked whether I’d be willing to write something about aging.

Painful vignettes like this are so common, and much has been written about age-related changes and their ramifications.  I wondered what psychoanalytic insights might further illuminate this topic.

Witnessing your parent’s nakedness

As our conversation continued, I realized that embedded in what seemed like loose ramblings were the very meaningful, thematic codas to one man’s long life, the personal themes linking his infancy with old age.

These very “ramblings” exposing anxious vulnerability represented an admixture of cognitive decline and emotional upset that punctuated the loss of a cohesive, independent adulthood.  My friend’s father was struggling to sustain his identity, the “I” that he’d come to know over the course of his life.  No longer living within a familiar and secure environment, his paranoia had a basis in reality.

Perhaps the exposure of such intimately personal traits is what the biblical injunction about seeing one’s parent’s nakedness really prohibits.  Everyone has genitals.  This is about witnessing the most private elements of your parent’s personal life, and the experience can be devastating.  With my friend’s permission, I will share some thoughts about her family scenario.

“He’s telling stories that aren’t true,” She said.  “He had a pretty bad fall.  He ran his walker into a wheel chair.”  I couldn’t help but smile.  A darkly tanned, sinewy guy, her father was an aggressive driver, frequently implicated in car accidents, the most recent occurring about six weeks earlier when his car keys were finally removed.

“Oh, he walks just like he drives,” I remarked.

“Yes,” she laughed wryly and continued.  “Well, he said someone took him to the doctor’s office and that he fell, and that the doctor left him lying on the floor for three hours.  This didn’t happen.  It wasn’t true.”  My friend was exasperated and bewildered by what seemed a preposterous tale.

Understanding emotional truths

I asked her to consider for a moment the very concept of truth.  Of course her dad’s narrative was not historically accurate.  He did not fall in a physician’s office and was not left lying anywhere on a hard floor.  But his story spoke a deeply emotional truth.

I suggested we might deconstruct it like a dream by considering her father’s personal response to the shock of being removed from his home, his loss of independence and lack of control.  The frequent loss of bowel or bladder control that manifests so often among the elderly might be construed as metaphors for the general loss of control they experience.  Very early dependency issues are reactivated just as cognitive capacities loosen.

These are striking experiences for any person, particularly one who was  habitually accustomed to using angrily controlling behaviors to manage basic insecurities.  For a rigid individual like my friend’s dad, these experiences were especially traumatic.

Behavior enacts what words can no longer convey

He was telling her a most meaningful and important narrative.  Leaving his wallet in the pants he’d removed communicated that his financial independence had become irrelevant.  He was showing her what his life had come to feel like.  Having no words to convey his feelings, he could only act them out.  In this altered environment, he could no longer track himself.

In his dream-narrative, someone took him to the doctor.  He had not driven himself.  This was his first revealed trauma, and he was saying, “I cannot care for myself; I must rely on someone.”  His need for a doctor suggested that he felt unwell and required help.

The doctor was a symbolic stand-in for his daughter, the person toward whom he now must turn for assistance.  Their roles have been reversed.  She lives three thousand miles away, and now he must wait for her attention like a child waiting to be picked up after school.

Reactivation of childhood themes

The trace of a frightening childhood experience may also have been reactivated, and we might consider that the doctor also symbolized his mother, his father, an actual doctor or any authority figure from his remote past.  Perhaps he was left lying in a crib for what seemed like three hours alone before he had developed the capacity to pull himself up.  Perhaps nobody heard him crying.

My friend’s father was unconsciously exposing the very core elements of his character, the feelings of vulnerability and insufficiency he had been striving to master via compensatory aggressiveness all his life.  The erosion of defensive stratagems exposed unresolved childhood issues.

Mother and Child

Mother and Child

Dependency, vulnerability and weakness.  All children are small, dependent and weak.  If the parental and environmental surround amplifies instead of soothes these anxieties, they become permanently fixed character traits, indelibly imprinted on the child’s and then the adult’s identity.  These features define the mythic themes that subsequently inform that person’s entire life.

In this narrative of emotional truth, my friend’s father was revealing that the very persons toward whom he should have turned for safety and protection – mother, father, doctor, daughter – left him feeling very alone and very small.  He was “lying” on the floor.  This double meaning suggests that in his “lie” was the kernel of his personal truth.

This man was an immigrant who confronted many obstacles and difficulties making his way in this country.  Harshness and brutality were linked with survival.  He incorporated this environmental harshness into his emotional and behavioral repertoire and beliefs about life.  In essence, he has had to lie about himself, feigning competency when he felt fragile.  Genuinely confident people are not controlling bullies.

Mastering difficult themes

My friend’s father has spent his entire life living from the position of a frightened child, trying to suppress and overcome his feelings, each aggressive encounter another attempt to slay the dragons of early childhood.

In a way, he’s done nothing but hit the replay button all his life in an endless sequence of reenactments.  This is what Freud called a “repetition compulsion.”  Ironically, it’s an attempt to repair an original emotional trauma or wound by endlessly acting it out in an attempt to obtain a better outcome.  This rarely occurs.  Lacking conscious awareness, difficult psychological themes replay themselves from cradle to grave.

Contemporary psychoanalytic therapy helps people find better ways to resolve personal difficulties by linking current emotional experiences with those from the past.  To accomplish this, my friend’s dad would have had to think consciously about his feelings instead of acting them out.  Sadly, they chase him like a haunt.

When defenses fail to protect the psyche from pain

In his current situation, aggressive behavior is futile.  These defensive tactics no longer work.  This elderly man cannot bully his way back into liberty or emancipation from dependency, decline and eventually death.

He is banging into his own inner world, crashing his walker as he used to crash his cars.  While prescribed medications may manage his behavior or overt symptoms, they cannot assuage the reactivated terrors of dependency that mirror those of infancy.  His inner landscape remains as it has always been.  The facility staff may find him more cooperative, but his feelings will remain unacknowledged and unchanged.   His mythic themes will not be integrated or mastered.

In reality, he’s reacting badly to the loss of his independence, of life as he knew it.  Medication reactivity simply muddies the field.  Cheered on to facilitate a necessarily expedient adjustment to new surroundings with no one to acknowledge the depth of his emotions, he will feel again like a child left alone in the crib.

We are all travelers from here to there

Young man with a skull

Young man with a skull

What is salient about this painful narrative is its universality.  We are all travelers from here to there, and each of us will shoulder demanding adjustments as we cross the threshold of advanced age.

When my father was diagnosed with brain cancer, he was more distressed by the loss of his car keys than the imminent loss of his life.  These irreversible losses reactivate our very primitive experiences of vulnerability and sometimes terror.

Aging is an opportunity to sum up a long life

It is never too late to begin to reflect upon one’s life.  While psychoanalysis in childhood or young adulthood may preclude decades of needless suffering, analytic work begun later in life often helps a mature individual sum up a long life in a meaningful way.

Eric Erikson, a 20th c. analyst, identified the developmental tasks associated with this latter stage of life as “integrity v. despair.”  We either integrate the elements of our life or we experience despair.

All of life’s losses prepare us for the very loss of ourselves.  Failure to achieve a sense of personal integrity at the end of life denudes its vitality, like grain stripped of its nourishing husk to make it more convenient.

In an ideal world, we might consider aging an opportunity to make full use of all we’ve become rather than a terrible inconvenience.  Either way, as my grandmother used to say, “If you’re not here getting older, you’re not here.”

Relationships matter

The willingness to embrace someone else’s personal experience is a gift we give each other.  It begins in infancy when our parents accommodate our sometimes ferocious needs, and later in life we reciprocate.

The method we employ to accomplish these tasks is called empathy.  Analyst Heinz Kohut described empathy as “vicarious introspection,” and it’s a capacity we only acquire experientially from within a relational context.  I’ll discuss empathy more fully in a future column.

This column originally appeared in the Orange County Register.

Contact Dr. Heller at www.mlheller.net or 714/662-7975

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