Jung At Heart

I'm delighted to see that discussion has already begun on this film. Let me start by saying that I chose the film for the way paranoid schizophrenia is portrayed and in that, I accept that the plot itself is pretty ordinary. But it works reasonably well as a means to show us who Romulus is and how he functions.

This film does not romanticize madness. It does not give us the kind of happily ever after triumph over mental illness that many of us wish for. In the end, Romulus returns to his cave to live, refusing his daughter's offer of shelter. His madness is still what his life is about, as is most often the case with paranoid schizophrenia. It is hard for us to accept that someone like him would refuse help, refuse shelter and instead opt to live out on the margins, lacking stable relationships, housing and even food. But this is where the inner world of Romulus takes him, into the precarious security he is able to forge against the forces of his delusions and hallucinations. We see his moments of lucidity collapse again and again in the face of his persecutory delusions. And we see what is truly lost to his madness when we hear him play the piano.  Even when lucid, he is semi-hallucinatory, living in a dream-world in which his imaginary ex-wife represents his rational thoughts.  He cannot hold on to conversations without drifting into his internal world, and he turns every rumor he hears into fuel for his paranoia. He can barely concentrate enough to complete a sentence or a short piano piece. He destroys his credibility when he tells the police that the murder committed by Stuyvesant with death rays shot from the Chrysler Building. We see that he knows about his own problems, and works to fight them in order to stay on the trail.

Often there is a kernel of truth inside delusions and that is true here. Ledbetter makes strong social commentary but his madness, his paranoia is wound all through it. What might be a grain of paranoia in someone who rails against the system in Ledbetter becomes a persecutory system of death rays and terror directed at him. 

Roger Ebert gave this film one of its more positive reviews. You can read it here.

And now, let's talk about the film!

A commenter to one of the recent posts on termination mentioned dual relationships so it seems a good time to look at this issue.

The APA (American Psychological Association) has this to say in its code of ethics:

A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.

Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

(b) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.

Note that dual relationships are not forbidden, though caution is urged. So those who advocate a very rigid policy prohibiting such relationships are not more ethical, they are just more rigid. For some this seems the best way to go. But such rigidity assumes that patients are capable of functioning only at the lowest level for relatedness and that any dual relationship is necessarily exploitive and harmful. It shouldn't be necessary, but I want to make it clear that I am talking only about non-sexual dual relationships. It certainly makes sense for example not to play tennis with a patient who suffers from borderline traits as such a person’s difficulty making sense sense of multiple roles going to cause problems. And one of our roles as therapists is to  work to understand the context, purpose and meaning of behavior.

There is a trend in our culture toward attempting to codify ethical behavior through an ever more detailed set of rules and guidelines. But this comes at the dangerous expense of ignoring the fundamental component of ethics, that of setting one's own ethical compass by holding to a clear sense of what is right, what is good and what is moral and ethical. This only comes from being challenged to think critically, good clinical supervision, and strong focus on inculcating the ethical values of the profession. The ethical life is not simply the result of rigidly following rules. The ethical life is a matter of trying to determine the kind of person I should be and of attending to the development of character within myself and my community.

So, an acquaintance, someone I know slightly socially, calls and wants to see me in therapy. What do I say? My stance is that I agree to an initial appointment and within that session we look at possible complications arising from our other relationship and new limits and boundaries that therapy will create. And make it clear that these issues may arise again at different points in our work and when they do, we can and will work through them. In a large city, this issue could be handled by referring the acquaintance to another therapist but in rural areas, this is not always possible or desirable.

Aware of the power issues in a therapy relationship, issues which make any request I make inevitably create conflict, however minor, I try to avoid initiating any dual relationships with my patients. Were I working with a patient who is a plumber, I would not call that person if I needed plumbing services. It just gets too complicated. Nor would I ask a patient to edit a paper I wrote or collaborate on a project. Only when the other can feel free to refuse can such requests work. At least that is how I see it.

But what if my landlord wanted to see me in therapy? Is that okay? Or my physician? Is it all right for a student to seek therapy from a therapist who is also her instructor? 

The only way I know to decide such cases is to keep in mind the best interests of the patient and the therapy. Anything which threatens either the patient or the therapy at the very least needs to be thoroughly explored and discussed, if not avoided altogether. What does a request like one of those above mean to the prospective patient? What are the potential complications? How willing is the prospective patient to look at these issues and explore them? What are the possible negative consequences if the therapy is agreed to?