“On Friday I went out, got drunk and embarrassed myself.” No, not me (or, at least, that’s not relevant here). My patient wept, telling me about The Shame of the morning after as though alone in having this experience, or because she felt so alone. She described scrolling through excruciating texts she didn’t remember sending, the concerned phone calls she received the next day. She was surprised that anybody could express concern over behaviour she had already judged to be abhorrent.
Desperate to know what, exactly, she had done, I listened to five more minutes of hangover remorse before ploughing in. I turned my question into an interpretation to satisfy the imaginary supervisor at my shoulder. “And I think you want me to wonder what exactly you did on Saturday night?” “I didn’t strip or anything!” she said. So, that’s what she assumes others think of her, or what she thinks of herself. “No. Well. I did dance a lot. Then I was flirting. But, the worst thing was—I cried. I was sitting on the pavement crying.”
Though she is a divorced mother of three with a successful career, she looked, at that moment, face streaming with tears, like a four year old in need of a cuddle, a glass of warm milk and a story. The thought of her on the floor with nobody to look after her was heartbreaking and, I thought, an accurate picture of her childhood acted out by her unconscious. It’s something I often think about patients (and not only patients)—they just need a cuddle, or they’ve never really had one. It is a touch simplistic, but I wonder if the containment of the consulting room and the acceptance of the therapist might serve as a virtual cuddle. But Kleinian theory (Melanie Klein was the foremost 20th-century post-Freudian theorist), the basis of my own training, is not very cuddly—all envious, greedy babies punishing their mother for her munificence.
Like so many people, this ashamed patient has a wall chart in mind on which she gets a gold star for concealing distress, for keeping up the pretence of a perfect life, and on which she gets minus points and possibly a beating for displaying the smallest scrap of honesty, for sending out the message that things are not OK. This patient, was, in fact, beaten for childhood misbehaviour and a large part of the brutal system of rules in her home was that the happy family illusion must be upheld at all times.
Patients’ score sheets, the behaviour for which they score themselves highly and that for which they must be punished, reflect an often very complex but always very rigid system. A severe scoring system in which the patient can only fail (plus points are earned only by becoming an impossibly idealised fantasy figure who glides through life achieving universally-acknowledged success while also earning the unmitigated approval of everyone they meet without a moment of difficulty or sadness) is, in Freudian terms, a harsh “super-ego,” our internalised ideals.
But the scoreboard analogy is useful because it helps me to demonstrate how strict these rules are, how incredibly obedient patients are to their hidden system and the fact that these virtual spreadsheets are utterly divorced from present reality.
“So, you get points for not crying in public?” I asked the woman to whom I wanted to read Winnie the Pooh. She laughed through her tears. “It’s ridiculous! There are no medals for pretending!” she said. I wanted to punch the air. So I did the therapist’s equivalent and slightly adjusted my neutral-coloured scarf.
