The patient who provided his own placebo and fully recovered

Lawrence Climo
Lincoln, Massachusetts, United States

 

Photo by Zach Lezniewicz on Unsplash

My elderly patient began his treatment by complaining about how his mother had behaved towards him in his boyhood. She had hurt him with her name-calling and humiliating insults, and these had apparently resulted in a lifetime of a negativism towards her. He wanted my help to end that negativity. His mother had recently died. His resentful memories had not.

By the end of his brief treatment with me, he was still remembering those abuses but was remembering and thinking about them with tolerance. More, he now respected and admired his mother for them. He at last understood where she was coming from, had finally found the roots to her outbursts, and that made all the difference. They had been buried deep, not in his childhood but in hers. Seeing his mother in this new light had brought what he had been seeking, his forgiveness.

Now he knew why his mother did not even remember those roots. She could not have, they were seeded in her first two years of life. What amazed me was not that he had figured it all out in three months’ time, or that he had uncovered those details of his mother’s infancy that she herself could not possibly have known. It was that he made it all up. I knew he made it up because he told me. That was what he had come to me for, he explained when therapy ended. He needed someone to just listen and let him find his own way through this lifelong negativity by going as far back as possible to its sources and doing it his way. He had heard that I listen.

I am a psychiatrist trained in psychotherapy, not a psychoanalyst, but I knew that if anything called for analysis here, it was not this patient or his mother. It was his imagined backstory that, sounding like the real thing, functioned as a placebo, an effective placebo, and had found for him the peace-of-mind he had sought.

Here is the placebo, the dots he connected, that resolved his problem. I will start with what he started with, what he knew of his mother’s past.

She was born of immigrant parents whose life in America was a struggle. Their corner grocery store was in a poor neighborhood, their home was behind that store, and they were always close to bankruptcy. His mother’s mother (his grandmother), who made or prepared several of the foods they sold along with wine, and who looked after sick neighbors, must have had very little time for her daughter, or her other three children for that matter, leaving them unattended as newborns and infants for long periods. His grandmother was respected and loved in that neighborhood for her caring generosity towards them. His grandfather, deeply depressed for long periods of time, rarely spoke. He operated the store and struggled through at least two bankruptcies. His first daughter, my patient’s mother, was an adult when he committed suicide.

My patient’s knowledge of his mother’s background was limited to random bits, like comments by distant cousins about her hounding her father for money to pay for an expensive dress when she was a teen. She had been desperate for acceptance by a clique of girls who had mocked a homemade dress she had once worn, but otherwise ignored her. Her family couldn’t afford that expensive dress and her father only bought it because of her incessant pushing and pleading.

Those cousins had also let slip their view of this teen as forever “wanting what she wanted when she wanted it,” as she grew up. They called her their “crazy” cousin.

As if to verify those roots that he had dug up, my patient explained to me that, in his view, while infants do not have memories of their first two years, it does not mean that memories are not stored. They might not be stored in the infant’s head—the mind is not ready—but could they not be stored somewhere else? Could not memories of bodily feelings be stored in other organs—what others call “muscle memories”—and appear later? His theory was that some of what are called “gut reactions” might actually be triggered by something that resonates with an early experience, a sensation buried deep in tissue, not in the mind as memory.

What follows is his version of his mother’s first two years of life and his backstory for her, his homemade placebo.

He imagines his mother alone in an old-time crib or stroller. He imagines her crying and then screaming. He imagines no one coming to her.

His translation: That deprivation of contact must have been too much for her, her receiving so little. That absence of attention, including being held, of body-to-body contact, must have diluted her foundation for a healthy sense of Self. Her trauma in her first two years was not something that happened. It was something that did not happen.

Here are some of the dots he connected.

Why was she always demanding of her parents? Her instinctive resolve was self-reliance. She would fend for her Self, herself. And she did.

Why was she shunned by that clique? Her need for affirmation by peer acceptance was desperate and it was not met. Her fragile self-confidence must have been obvious and her neediness off-putting. She was not trying to grow as a person here, she was trying to hang on, and was likely dismissed as simply not being ready for their world.

Why was she called “crazy” by her cousins? They were young and did not have the concept, let alone words, that her “wanting what she wants when she wants it” may have been driven not by selfishness about having more, but insecurity and anxiety for not having enough.

Why was she superstitious? The omnipresence of an “other” watching her regarding certain rituals was not her paying homage to her mother’s habits from the old country. It was the security one feels obeying or fulfilling an obligation. The imagined feedback, even if temporary, must have meant something vital. She was being seen. She was someone noticed for that moment.

Why did she call her son hurtful names? Because, in her eyes, he is forgetful and lazy. He is not measuring up. He is not doing what he is supposed to do, his job, and it was that dereliction of duty that triggered something deep inside her, that resonated with a “muscle memory.” Someone was being neglectful, so it was not simply her Self that was venting here. It was her Self PLUS a screaming inner-child. It is as if an inner-child had joined its adult Self in a combined venting/relief eruption. Her son, my patient, was simply an innocent bystander in this drama acted out by an equally innocent actor. And all this he had put together himself.

 


 

LAWRENCE H. CLIMO has practiced in inpatient and outpatient, public and private, and military and civilian settings along with jails and courts over the course of his professional life as a physician, psychiatrist, psychotherapist, and psychopharmacologist. He has taken his turn in teaching and administration as well. His occasional articles have appeared in academic, professional, and popular journals. He is the author of The Patient Was Vietcong: An American Doctor in the Vietnamese Health Service, 1966-1967, Psychiatrist on the Road: Encounters in Healing and Healthcare, and Caregiving: Lives Derailed (under the pseudonym Eli Cannon). He is a Board Certified, Life Member, and Fellow of the American Psychiatric Association.

 

Spring 2021  |   Sections  |  Psychiatry & Psychology