On The Couch

What follows is the first of a series of articles that will explore the psychology and psychopathology of American life in this election year of 2016.


Nobody knows my name, says the man entering my consulting room. I see him, but not clearly enough. I can tell it's a man but it's hard to judge his height, weight, or even age. On closer inspection it's hard to judge his gender - is it a he, or is it a woman beneath all those clothes? And my room is well-lit, but his race was not easy to discern either. So the stage was set already before the first words were spoken.

I had already said, "Please come in." Then I pointed out a chair for him and asked him why he was consulting me. What happened then was unprecedented in my forty years of psychoanalytic practice. He said that passers-by look but never said hello or even acknowledged him. When he went to buy groceries he grew confused about what to purchase - looking at GMO labeled foods, at artificially sweetened cereals, at tired-looking vegetables probably not sprayed with DDT, at hormone-fed chicken legs, at a wide variety of sweets on checkout line, and too many brands of natural spring water to choose from. At checkout the cost was higher than expected and the clerk never even looked up to see who made the purchases.

I sat there, trying to see where this was going. I had had similar experiences in markets from Whole Foods to Safeway.

He then continued, complaining that his bank told him he was overdrawn and his landlord was giving him trouble about paying his rent on time. I suddenly worried that he wouldn't be able to pay my fee, but said nothing. His job was nondescript and low paying. I couldn't tell if he was a she or a he by then, so poorly paid did he seem for all his work.

Finally I asked his name and he suddenly broke into song - right in my consulting room. I was transported to the 1940's of Frank Sinatra and Paul Robeson:

What is America to me
A name, a map, or a flag I see
A certain word, democracy
What is America to me

The house I live in
A plot of earth, a street
The grocer and the butcher
And the people that I meet

The children in the playground
The faces that I see
All races and religions
That's America to me

The place I work in
The worker at my side
The little town, the city
Where my people lived and died

The howdy and the handshake
The air of feeling free
And the right to speak my mind out
That's America to me

The things I see about me
The big things and the small
The little corner newsstand
And the house a mile tall

The wedding and the churchyard
The laughter and the tears
The dream that's been growing
For a hundred and fifty years

The town I live in
The street, the house, the room
The pavement of the city
Or the garden all in bloom

The church the school the clubhouse
The million lights I see
But especially the people
That's America to me.

Beautiful, for sure. But when were we going to get down to business, or were we?

In the consulting room our material world becomes shrunken (after all, psychoanalysts are called shrinks or headshrinkers) and I try to get to know each patient in terms of his own internal world. Ironically, as I've just described, that inner world - while existing inside one person - can be vast, and usually is. I had gotten a taste of the vastness but not of the particular reason this person came to see me.

Unbidden, the patient described a deep discrepancy between the world of "That's America to me" and the world of his actual family. He (or she) never knew what to believe at home - parents said one thing and did another. Parents were preoccupied with themselves and their lives, neglecting to notice that older brothers and sisters had regularly abused my patient. And I soon regarded my inability to determine my patient's gender as evidence of a deep fear of being seen and labeled. Being seen and labeled is a way of being known, but can also be a precursor to being typecast or dismissed.

We scheduled a second meeting. What happened next? Tune in to find out.