On The Stuph File Program radio show, Dennis Palumbo, one of my favorite mystery writers, is also a psychotherapist. He talks about how his profession is depicted in film & television.
“With this writing, I wish to propose a radical shift concerning the great attention that, in the context of the formation of candidates for the priesthood, must be paid to literature.”
“Contact with different literary and grammatical styles will always allow for deepening the polyphony of Revelation without reducing or impoverishing it to one’s historical requirements or mental structures.”
“an assiduous frequentation of literature can make future priests and all pastoral agents even more sensitive to the full humanity of the Lord Jesus, in which His divinity is fully poured out, and to proclaim the Gospel.”
“In reading, we dive into the characters, the concerns, the dramas, the dangers, the fears of the people who have ultimately overcome the challenges of life.”
“Here is a definition of literature that I like very much: listening to someone’s voice. And do not forget how dangerous it is to stop listening to the voice of the other who calls out to us!”
“literature helps us to say our presence in the world, to “digest” and assimilate it, capturing what goes beyond the surface of life; it serves, therefore, to interpret life, discerning its fundamental meanings and tensions.”
“When one reads a story, thanks to the author’s vision, everyone imagines in their own way the tears of an abandoned girl, the elderly woman covering her sleeping grandson’s body, the passion of a small entrepreneur trying to move forward despite difficulties, the humiliation of one who feels criticized by everyone, the boy who dreams as the only way out of the pain of a miserable and violent life.”
“The spiritual power of literature finally recalls the primary task entrusted by God to man: the task of “naming” beings and things (cf. Gn 2:19-20). The mission of guardian of creation assigned by God to Adam passes first and foremost through the recognition of the reality and meaning of the existence of other beings. The priest is also invested with this original task of “naming,” of giving meaning, of becoming an instrument of communion between creation and the Word made flesh and of its power to illuminate every aspect of the human condition.”
Dennis Palumbo, M.A., MFT is a writer and licensed psychotherapist in private practice, specializing in creative issues, primarily in the entertainment industry. His award-winning series of mystery thrillers—Mirror Image, Fever Dream, Night Terrors, Phantom Limb, Head Wounds and the latest, Panic Attack—feature psychologist and trauma expert Daniel Rinaldi. He’s also the author of Writing From the Inside Out, as well as a collection of mystery short stories, From Crime to Crime. Recently he served as Consulting Producer on the Hulu limited series The Patient, and here (in an article first published in the journal Capital Psychiatry) he tells us about how the play out of the television crime drama affected his real-life patients.
After seventeen years as a Hollywood screenwriter (the film My Favorite Year; the sitcom Welcome Back, Kotter, etc.), I retired from show business and have been a licensed psychotherapist in private practice for over thirty years. During this time, my writing has been confined to articles and reviews, as well as a series of mystery novels whose protagonist is a psychologist. My point is, it’s been so long since I was a dues-paying member of the Hollywood industry that I was quite surprised to hear from the team of Joel Fields and Joe Weisberg. Writers of the award-winning TV series The Americans, they’d reached out to me to act as advisor on a new show they were developing. Called The Patient, it was about a serial killer who kidnaps and holds hostage a well-known therapist, in hopes that he can “cure” the killer of his homicidal urges.
Apparently, my former career as a script writer and my current one as a therapist prompted them to see me as a reasonable person to act as consultant on the new series. Essentially, what they wanted was for me to vet each episode’s scripts for clinical accuracy and to “make sure the therapist sounded like a therapist”—or as much like one as possible given the bizarre circumstances of the show’s premise.
Over the coming months, I did my best to keep the narrative within the range of plausibility, including suggesting the occasional line of dialogue or therapeutic interpretation. Just as we were finishing the script for the last episode, it was announced that Steve Carell had been cast as the therapist. A wonderful actor, he’d been given a salt-and-pepper beard and glasses. Whether or not it was conscious on the writers’ part, he looked somewhat like me. Which, at the time, I just found amusing.
My working relationship with Fields and Weisberg was one of the most pleasant professional experiences of my life. Moreover, the two writers were very gracious about my contribution when doing PR interviews leading up to the series premiere. During one such interview, when writing up the story for Newsweek, the reporter off-handedly mentioned that Carell’s character looked like me.
It wasn’t until the series began airing on Hulu that the ramifications of this became apparent in my therapy practice. A number of patients who’d begun watching the show pointed out that Carell’s therapist character looked a lot like me, and on occasion even sounded like me. (No surprise, since I’d suggested some of the therapeutic comments the therapist made.) Naturally, I had to process this with these patients, some of whom were quite upset at seeing the therapist chained to a bed, helpless. More than one half-jokingly worried that the series’ premise would give “some crazy person” the idea of kidnapping me. Did I feel I was in danger? they asked. I answered honestly that I didn’t, while privately wondering why I’d never even entertained that idea when working on the show.
Moreover, had I been unforgivably clueless in not anticipating this reaction from my patients? I reminded myself that Steve Carell hadn’t been cast until the series’ scripts were almost finished, that I had no idea he’d be playing the therapist, and certainly no idea how they were going to make him look. Yet I still felt pangs of remorse for the distress the show’s depiction of the therapist was causing for some of my patients.
As the weeks went on, and episode after episode aired, it became obvious that seeing an avatar of their therapist was upsetting to a number of my patients. Of equal interest during sessions was the reaction of those patients who found the whole thing amusing, or at least presented it as such. They even joked with me about the series’ story-telling: why didn’t the therapist try harder to escape? Why didn’t he just refuse to talk to the serial killer? Is this how you would react in this situation, Dennis?
Of course, the narrative choices displayed on-screen were made by the show’s writers, not me. I was merely the consultant. But this didn’t matter. What did matter, and what ended up being of real clinical interest (and value) was what some patients’ transferential connection to the therapist character and the story revealed about both their own core issues and their relationship with me. As Robert Stolorow has reiterated, there is only subjectivity and context; in this unusual situation, there was a patient’s subjective experience of me in the context of our therapeutic relationship, and then a kind of meta-subjectivity/context experience through the narrative of a TV series.
(SPOILER ALERT: I’m going to discuss the series’ final episode)
For a select few of my patients, as I’d expected, it was the series’ final episode that elicited the strongest reaction. Not only does the therapist fail to escape, he’s strangled to death on-screen by the serial-killer patient. This horrible murder is hardly ameliorated by the killer’s decision to send an anonymous letter to the therapist’s family, telling them where they can find the body so it can have a proper funeral. The last time we see the serial killer, he’s the one chained to the bed, his mother holding the key to the chain’s lock. Since she’s known all along about her son’s activities, we’re left to wonder if/when she’ll release him to potentially kill again.
A couple patients revealed that they’d cried at the end, one of them pointing an accusing finger at me and saying, “You better not fucking die!” Again, said half-jokingly. And yet, not. The few others who’d stayed with the show all the way to the end were angry at both the series’ writers and at me. Their reactions ranged from disbelief (“How could they end a show like that? How come the killer gets away with it?”) to frustration (“That’s not fair to the viewers. We deserved a better ending.”) to simple creative criticism (“I hate ambiguous endings.”).
As difficult as the sessions were with these patients over the course of the series’ run (including my own guilt at having put them through it), some of the clinical work that arose from our discussions was quite beneficial. A greater understanding of the contextual nature of our therapist/patient relationship undoubtably occurred. Moreover, we often reached a deeper understanding of the dependency/resentment dynamic at work in the therapeutic dyad. And, in one or two cases, the discussion regarding the show was a springboard to a more energized, proactive engagement on the patient’s part.
Still, I have somewhat mixed feelings about my participation in the series. It was often an exhilarating experience, due primarily to the talent, receptivity and warmth of both Joel Fields and Joe Weisberg. And while I regret the distress that the lead character’s words and looks evoked in a few of my patients, I also felt this similarity led to real forward progress in our work together. A potential disjunction becoming a fruitful conjunction.
That said, if I’m ever asked to consult on another series, my only hope is that the lead character looks like someone else.
In the inaugural entry in this column, I addressed the issue of creative blocks, specifically focusing on writers' block. And while being blocked is common to most creatives at some point in their work (due to the fact that, frankly, making good art is hard), I posited that it was the self-invalidating meanings that the patient associates with being blocked that amplifies their distress. These meanings can run the gamut from self-recriminating beliefs about oneself as a person or an artist, to lacerating comparisons between oneself and the imagined ease of creative execution available to others.
In this column, I want to address a similar, though distinct, creative difficulty; namely, procrastination. To suggest ways to conceptualize it for both creative patients and, in a similar way, their clinicians.
Two personal associations with procrastination might serve as guideposts; the first is from my work in advertising on the East Coast. A lifetime ago, I was a young copywriter at an ad agency. One night, invited to dinner by one of the firm’s biggest and most successful clients, I excused myself to use the bathroom, which was at the end of a broad upstairs hallway. To my surprise, taking up most of the space on one of the walls was a colorful logo—the familiar image from the current Nike shoes ad. Atop the image were the equally-familiar words: “Just do it!”
Later, when I mentioned this huge wall graphic to our client, he said that he wanted something that he had see every morning and every night to keep him inspired and motivated. Further, he believed that adherence to this simple exhortation had contributed to his business success.
The second association I have with the concept of procrastination derives from the fact that, despite being a full-time therapist in private practice, I have moonlighted over the years as a mystery author. The very first line of my debut mystery novel, Mirror Image, is "Shame is a deep well."
Why these 2 distinct (and distinctly different) associations? In the first case, it is because “Just do it!” is what many artists struggling with procrastination routinely tell themselves; or, just as often, are told by others, from spouses to colleagues to seemingly more motivated friends. This despite the fact that telling a procrastinator to "just do it" is as helpful as telling a depressed person to "cheer up," and a distraught or grieving person to "get over it."
Admonitions to merely "stop procrastinating and get on with it," whether in answer to the hectoring voice in one's own head or the barely-concealed frustration of intimates, rarely addresses the issue. In fact, if anything, it reaffirms that which, in my view, underlies most instances of procrastination: shame.
Or, to put it more clearly, fear of shameful self-exposure. As I have seen in over 30 years treating creative patients of all stripes struggling with procrastination, such shame is indeed a deep well.
In my studies on the subject, I have read various explanations as to the root causes of procrastination, from simple anxiety to low self-confidence, from a lack of motivation to do unpleasant tasks to merely a tendency to ruminate. In my view, and in both my personal and clinical experience, these concepts woefully miss the mark. They rely on a conventional and unconvincing set of assumptions about the procrastinator, and, frankly, seem to be a “blame the victim” response to the issue. (Not to mention the fact that many individuals are willing to do any number of unpleasant tasks to avoid confronting their reluctance to start or continue their creative project.)
If, as I will try to argue, procrastination is primarily a function of the fear of shameful self-exposure, what makes it so insidious and how many forms does this fear take? What makes treating the creative patient grappling with procrastination so difficult is that the underlying shame has myriad origins. As H.L. Mencken noted, “There is always an easy solution to every human problem—neat, plausible and wrong.” Just as there is no one-size-fits-all approach to creative blocks, there is no uniform approach to dealing with procrastination. Not without narrowing in on the shame, and the possible meanings that birthed that shame.
Which is not to say that there are not a range of similar issues behind procrastination. Over the years, I have treated many PhD candidates from a variety of fields as they struggle to finish their dissertations and defend their paper before their committee. It is a common joke among academics that often these candidates take many years to complete their work, always seeking new sources to support their thesis, always revising it whenever a new book or study appears that might provide additional ammunition for their argument.
Even the terminology invites suspicion. These candidates do not present their work to the committee; they defend it, a position that practically invites the possibility of shameful self-exposure.
In fact, one such patient, a PhD candidate who had spent years researching and writing her thesis in anthropology (ie, procrastinating), explained it with wry self-awareness.
“Did you ever see that movie, Defending Your Life, with Albert Brooks?” she asked. “That’s what I feel like I’m doing. I have to defend my life choices, my ambitions. If I don’t get my PhD, I’ve failed. After all these years, I’m…”
“Exposed?” I offered.
“Exposed, revealed. Whatever you want to call it.”
And no wonder. Between submitting a dissertation and then having to defend it before the empaneled committee, many candidates experience an understandable parental transference with those judging them. That is why the treatment for these patients involves a thorough exploration of how their particular families of origin invoked and embedded iron-clad ideas around success and failure, self-worth and self-recrimination. And how these conceptual myths affect the patient’s belief in their intrinsic lovability.
In cases with such patients, it is necessary to unearth and examine these core beliefs around one’s worth, and then help them challenge their veracity, their very legitimacy. Letting some much-needed air into their shame.
But not every procrastinating creative patient’s issues are so easily uncovered. For example, I once had a novelist patient whose first book was roundly praised by critics, though its sales were poor. Now, midway through his second novel, he found himself procrastinating. He was constantly doing research online, writing reviews of other books, engaging in lengthy email arguments with friends and colleagues. Early in our work together, he assured me that though he had stopped work on the new book, at least he was pounding the keyboard every day, churning out these other written pieces.
“Maybe I’m priming the pump,” he explained. “Getting myself up to start work again.”
When I asked if, given the first novel’s poor reception by the reading public, he was worried this new book might suffer a similar fate, he smiled sardonically.
“I wish.”
A surprising answer. “What does that mean?” I asked.
“Look, I haven’t mentioned it, but my editor loved the early chapters of the new book. Then he got the publisher excited, and their PR people, and well…” At this point, he looked practically embarrassed. “Everybody says this new book is a potential best-seller. There’re already rumblings in the publishing world about what a splash the book will make. They’re talking magazine covers, movie deals. Hell, I just heard that Oprah might have me on her show to talk about the book.”
“And this is bad…how?”
His answer was one I would never have guessed. Though I knew he had grown up in a poor household in the early 60s in Brooklyn, and that his late father, a factory janitor, was a rabid socialist, constantly deriding American wealth and class inequality, my patient had never described specifically what his childhood with his father had been like. As a small boy, he had trudged to various rallies, in parks and meeting halls all over the city, listening to his father railing passionately against “the big shots,” the ones with the power, the wealthy and entitled men who ruled under capitalism.
“He was crazy, my old man,” my patient said quietly. “But I loved him…and respected him. And believed in what he preached. That’s why, when my first novel flew under the radar, when nobody but the critics liked it, I felt…I don’t know…comfortable. A working stiff. Poor, struggling. Noble, even.”
By then, I’d gotten it.
“So if this new book becomes a huge success, if you make a lot of money and gain recognition…”
He nodded, miserable. “Don’t you see? Magazine covers, real money? In my father’s eyes, it’d mean I’d become a big shot. Some privileged asshole, riding in limos, giving interviews. I mean, it makes me sick. Just the thought of it…”
That is what had birthed his shame. His fear of being exposed as someone striving to attain status, money, influence—the kind of man his beloved father despised. And as painful as this revelation was, it gave us something to work with.
As mentioned, most creative patients’ procrastination comes from more easily recognized origins. However, over my 30-some years treating artists (and would-be artists) from a variety of fields, I have learned that until the meanings underlying the reluctance to start or continue with a project are explored in reference to each patient’s particular personal history, the source of the shame is elusive.
But what is an artist but someone willing to expose what is in their mind and heart? What is creativity delivered to the general marketplace but a desire (or even compulsion) to communicate these things to others?
I once had a classical musician patient who procrastinated on a piece he was commissioned to compose. His procrastination was particularly painful, since he feared (and was convinced) that his lack of musical talent would be exposed, not only to the world but to himself. Meanwhile, at the same time, he was trying (as he had for years) to disavow his love of music. To refute his desire to make music. In a constant war with himself.
“Believe me, I get Jesus in the garden that night,” he’d said once. “I mean, let this fucking cup pass away from me.”
Afraid to start the work, and furious with himself that the work was his calling.
I had another case in which my patient, a journeyman screenwriter, routinely procrastinated with each writing assignment due to his shame at being exposed as a mediocre, though financially successful, artist.
“Let’s face it, I’m no Billy Wilder or Robert Towne,” he’d complain, mentioning 2 noted, award-winning screenwriters.
“Because those jobs are taken,” I replied. “By those people. As an artist, comparing yourself to others is a fool’s game. I think it was Hemingway who said to his fellow writers, ‘Forget it, Shakespeare got there first and better, so just get on with it.’”
He smirked. “Boy, you know a lot of quotes.”
I had to agree. There is some kind of megabyte file full of quotes by well-known creatives in my head. It is not always useful.
“Here’s the thing,” he said after a pause. “And it’s so simple even you’ll get it, though there’s nothing you can do about it. I’m Salieri and I want to be Mozart. End of story.”
(An interesting side note: I’ve had many artists from different fields use the “Salieri and Mozart” analogy in terms of assessing their work, except for musicians, like in the previous example. Curious.)
Anyway, as it turned out, it was not the end of the story for this patient. That did not come until we explored his relationship with his mother, whose ambitions for her son were the background noise of his childhood. Her stated goal for him: to win an Oscar and for her to be especially thanked during his acceptance speech, an example of which she actually wrote out for him as a template when he was still in middle school.
“Seriously?” I stared at him.
“True story. I’d wanted to write movies since I was a kid, and she’d loved the movies since she was a kid, so my ambition became hers. It was all she dreamed about. She calls me every year, after the Oscars are on TV, and we share her disappointment.” A rueful laugh. “Kind of a bonding thing.”
The pain in his eyes, despite the familiar screenwriter’s ironic bitterness, showed me how deeply his anticipatory shame was. How it infused every new writing assignment. No wonder he procrastinated. Who would want to launch on another project whose result would invariably fall short of the stated goal? So our work going forward was about reframing that goal, plotting out a journey toward loving the work for its own sake. Even in the brutal machinery of the entertainment business. Because, as I have written elsewhere, many people come to Hollywood in search of an approving parent. And it is the worst place to find one.
In my experience, when treating a creative person struggling with procrastination, it is particularly valuable to look at the issue through the prism of shame. What does the artistic person fear to expose, to others or even to themself? No matter the actual outcome. No matter how successful the person may be in their career.
I am reminded of another patient, a costume designer with years of experience and accolades behind her, still burdened by procrastination. When I asked her about it, she said, “Because even if they love my work, they never love it enough.”
A sheet of shame reddened her face. Clues to her self-concept, and its possible origins, began to present themselves. A deep well, indeed.
Mr Palumbo is a licensed psychotherapist and author in Los Angeles. His email address for correspondence is dpalumbo181@aol.com.