B&F 4

Treatment Models

Copied from below:

In fact the dissociation between implicit and explicit mentalization in the course of development may be a defining criterion of psychological disturbance….. The experience of being understood generates an experience of security which in turn facilitates ‘mental exploration’, the exploration of the mind of the other to find oneself therein (bateman/pbpd/142)”

++++

Otto Kernberg borderline personality organization (2002a):

“…at the core of TFP [transference focused therapy]  is the understanding that externalizations in the transference are externalizations of mental representations of self-other relations internalized at moments of peak affect.  Within MBT many such externalizations would not be seen as primarily relational, but rather, as externalizations of parts of the Unmentalized self, particularly the core self or the alien self.  An important technical implication of this is that MBT would not expect the patient to understand much of the discourse that the therapist might verbalize in relational terms.  The self and the therapist are experienced as perceived (unquestioning psychic equivalence), and this is sometimes strikingly without relationship implications.  Third, and related to this, projective identification in TFP is seen as protecting the ego from destruction by aggression.  Within MBT its principal role is ensuring the coherence of the self-organization.  Fourth, affect dysregulation is attributed to constitutional anomalies, temperamental differences, (bateman/pbpd/117) the absence of effortful control in TFP, but is seen in MBT as a consequence of symbolic failure, particularly associated with incongruent mirroring.  (bateman/pbpd/118)”

I think Schore is saying this also – but that as the therapist feels the client’s feelings and gives words to them, the client is assisted in being able to find the symbols and words for their own affective experiences.

“In MBT  the therapists’ occasional enactment is seen as a necessary concomitant of therapeutic alliance.  In MBT is is assumed that the therapist is an essential vehicle for the alien part of the patient’s self, and that this permits the therapist to perceive and reflect on the patient’s constitutional self (that which is left behind following the externalization).  For the patient to tolerate the relationship, the therapist needs to become that which the patient needs her to be.  But both approaches recognize that beyond enactment the therapist, in order to be helpful, must be able to preserve a ‘neutral’ part of their mind that is able accurately to mirror, to reflect the patient’s internal state following successful projective identification.  (bateman/pbpd/118)”

++++

“The dialectical approach is a philosophical position or a world view whereas our position is developmental and informed by attachment research.  As has been said, the absence of mentalizing capacity and of accurate second-order representations of internal states (feelings, beliefs, wishes, ideas) in BPD leads in our view to failure in establishing an agentive sense of self.  Emotional fluctuations, opposing beliefs, proneness to action, all arise from an inability to experience a sense of self as agentive, especially within the context of monitoring and interpreting correctly the relevant mind-state cues that are available in intimate attachment relationships.  The borderline patient needs to rely on rigid structures and schematic beliefs in order to protect and maintain an illusory stable self.  (bateman/pbpd/120)”

“While agreeing that borderline patients have significant problems with emotions, we take an alternative view about the core of the emotional difficulty.  It is not that the child fails to develop the skills to modulate emotions but that she cannot easily identify emotions and distinguish whose they are or give meaning to them.  The deficit is not one of regulation but it is the inaccessibility of the experience of feeling regulated.  The borderline patient both misunderstands and misattributes them and finds them perplexing.  (bateman/pbpd/122)”

“According to our model, adaptive affect-reflective interactions between mother and child result in expressed affect being identified and decoupled from the parent.  The parent first has to ensure that the emotion is accurately perceived and reflected (categorically congruent) and second that the feeling is recognized as either hers or the baby’s through marking the emotion (perceptual marking).  Invalidation is but one example of failure of categorization and/or inappropriate perceptual marking rather than the underlying cause of the difficulty so the emphasis on invalidation in DBT as a causal phenomenon is too narrow and exclusive.  The selective lack of either markedness or category congruence produces deviant mirroring styles that, if dominant in the infant’s experience, are likely to lead to characteristic pathological consequences of emotional identification and expression.  Secondary representation of emotional states, which acts as a buffer between feelings and actions, does not develop and so the patient has no psychological process through which to modulate or soothe feelings.  (bateman/pbpd/122)”

MENTALIZATION AND MINDFULNESS

In DBT, the “…’Wise mind’ which may be nearest to mentalization but, again, it is seen as a skill in DBT rather than a complex developmental psychological process.  (bateman/pbpd/123)”

“In relation to MBT it is worth pointing out that mentalization is not seen by us as a skill which is learned but a high-level mental function that mostly takes place outside consciousness and it is this developmental approach to its evolution which informs our therapy.  It develops through a presentation to an individual of a view of their internal world which is stable, coherent, and can be clearly perceived by them and may be adopted as the reflective part of their self (the self-image of the patient’s mind).  It is intimately related to the development of both the purposeful and the representational aspects of the self:  both the ‘I’ and ‘Me’ and therefore involves not just a self-reflective element but also an interpersonal component.  In combination, these provide the individual with a capacity to distinguish inner from outer reality, intrapersonal mental and emotional processes from interpersonal communications, and what is self from what is not.  These functions are not part of mindfulness.  The development of mentalization critically depends upon interaction with more mature minds, which are both benign and reflective in their turn; hence our requirement for therapists themselves to show a capacity to take a mentalizing position … as a basic therapeutic stance and for the programme to be arranged in a way that encourages self-reflection within an interpersonal milieu.  (bateman/pbpd/123)”

“The development of a capacity to modulate affect states, which is one purpose of mindfulness skills, is closely related to mentalization.  Affect regulation is a prelude to mentalization and yet we also believe that once mentalization occurs, the nature of affect regulation is transformed.  It is no longer simply modulated.  ‘Mentalized affectivity’ allows the individual to discover the subjective meanings of his own affect states and this recognition of meaning as a fundamental aspect of mentalization distinguishes it from mindfulness.  Mentalized affectivity represents the experiential understanding of one’s feelings in a way that extends beyond intellectual awareness.  It requires not only an internal recognition but also an appreciation that feeling has an interpersonal context and full understanding necessitates a grasp of one’s own mind as represented within the mind of another.  Not surprisingly such a complex mental function, not part of mindfulness, becomes subject to resistances and defences.  We can misunderstand what we feel and what others think of us or think that we feel one thing while truly feeling another emotion.  So, in this respect one task of therapy is not to teach mentalization but to identify how defensive processes interfere with its functions.  (bateman/pbpd/123)”

“…consider their understanding of the reasons for others’ behaviour as well as questioning their own.  (bateman/pbpd/124)”

“The concept of the schema is the cornerstone of cognitive formulations of BPD.  Patients with BPD show characteristic assumptions and dichotomous thinking.  Basic assumptions in the borderline commonly include ‘the world is a dangerous place’, ‘people cannot be trusted’, ‘I am inherently unacceptable’.  Dichotomous thinking is the tendency to evaluate experiences in terms of mutually exclusive categories such as good and bad, love and hate.  Extreme evaluations such as these require extreme reactions and emotions, leading to abrupt changes in mood and immoderate behaviour.  The assumptions, dichotomous thinking, and weak sense of identity are considered to form a mutually reinforcing and self-perpetuating system that governs relationships.  Schemas that were adaptive during childhood persiste even after they have become seriously dysfunctional.  They are maintained in the face of contradictory evidence because of distortion, discounting, and seeing the evidence as an exception to the rule and extinction of the maladaptive systems does not take place as a result of negative reinforcement.  In fact new experiences support existing dysfunctional beliefs and behaviour patterns.  Young (1999) has argued vociferously for a ‘fourth level of cognitionn’ to be added to Beck’s cognitive model, namely Early Maladaptive Schemas (EMS).  These are stable and enduring patterns of thinking and perception that begin early in life and are continually elaborated.  EMS are unconditional beliefs linked together to form a core of an individual’s self-image.  Challenge threatens the core identity, which is defended with alacrity, guile, and yet desperation since activation of the schemas may evoke aversive emotions.  [How could they not?] The EMS gives rise to ‘schema coping behaviour’, which is the best adaptation to living that the borderline has found.  These schemas are different conceptually (bateman/pbpd/127) from some of those discussed by Beck, which are not unconditional beliefs about the self.  Beck refers to core beliefs and conditional beliefs, both of which are labeled schemas.  Core beliefs are more like EMS but conditional beliefs require an additional context to become active – ‘if he gets close to me he will find out how awful I am and then reject me.’ (bateman/pbpd/128)”

“Safran and Segal (1990) have integrated schemas within an interpersonal context, arguing that the impact of an individual’s beliefs and schemas is not purely cognitive but interacts with interpersonal behaviour which in turn has a reciprocal effect on beliefs.  Thus the person is seen as being in a state of dynamic balance to the extent of provoking responses from others that perpetuate underlying assumptions.  The borderline patient holds poorly integrated views of relationships with early caregivers and has extreme and unrealistic expectations that determine both behaviour and emotional response.  This is exacerbated by problems of identity and a fragile identity leads to a lack of clear and consistent goals and results in poorly co-ordinated actions, badly controlled impulses, and unsustained achievement.  Relationships become an attempt to establish a stable identity through dependency, assertiveness, and control.  From this viewpoint, cognitive therapy is more than just changing assumptions.  It becomes much more complex, lasts longer, and requires new techniques.  (bateman/pbpd/128)”

They don’t argue any of this information with their own beliefs or approaches, nor are they contradicting it…not sure why.

Talking about cognitive analytic therapy (CAT)

“Three levels of abnormality of the internalized reciprocal role structure are described.  The first is the relative scarcity of roles that borderline patients have I their repertoire which is in contrast to the large number that other people can deploy.  This relates to our own suggestion that borderline patients, when faced with complex interpersonal situations, default to repetitive and schematic representations of relationships.  The second level of difficulty is the problem of switching gracefully and appropriately between roles.  Borderline patients may switch suddenly leaving the reciprocator rather bewildered, uncertain, and unclear why things have changed.  Finally there is incapacity to self-reflect and to exert self-control within the reciprocal roles.  (bateman/pbpd/129)”

“…we are, to some extent, in agreement with this sort of formulation which is clearly developed within a psychoanalytic frame.  Ryle suggests that the concept of reciprocal roles is a less-mystifying version of projective identification and countertransference but in fact it is less specific rather than less mystifying and has more in common with the dynamic formulation of role responsiveness put forward b Sandler (1976), that of evocative projective identification suggested by Spillius (1994), or even that of complementary and concordant countertransferences suggested by Racker (1968).  But the main problem with regard to the CAT formulation of reciprocal roles is that there appears to be little concern for the underlying (bateman/pbpd/129) reasons in borderline patients for the limited repertoire of roles, the difficulty in switching between them smoothly and appropriately, and the paucity of self-reflection.  (bateman/pbpd/130)”

“We have already discussed our views about why the borderline patient experiences problems in self-reflection and the relationship this has with an unstable sense of self, which in turn leads to affects remaining unlabelled and confused (see p. 64ff). During development, the absence of a stable reflective self creates a gap within the self-structure which is filled by internalizing a version of the other’s state rather than by a metabolized or an appropriately reflected version of the child’s state.  This creates an alien self (see p. 89) which once internalized undermines self-cohesion and leads to confusion between inner and outer, between thoughts and feelings, between self and other.  Feelings that are experienced within do not seem to belong to the self,.  Stability can only be maintained if the alien self is forcibly projected and it is this that leads to the distorted and limited reciprocal roles described in CAT.  Interventions are likely to be ineffective unless the underlying purpose of the sudden switches and the reasons for the rigidity of roles, namely the stabilization of the self and the need to establish a basic continuity of self-experience, is understood by the therapist.  In addition, there must be recognition that enacting such roles is at a considerable personal cost for both patient and partner.  The enforced nature of the roles is resented by partners who may refuse to enact the assigned role.  [I do not understand why he does not talk about these kinds of effects when they happen with BPD children, not just with their partners!] This not only leads to potential abandonment but also to a return of the alien self which further destabilizes the self-structure.  (bateman/pbpd/130)”

“Borderline patients are desperate for meaning….  (bateman/pbpd/130)”

“Interpretations are used in MBT.  Their primary purpose is to increase the level of mentalization within therapy and to provide an alternative perspective.  It is implicit and explicit during treatment that at times the therapist understands more than the patient and yet at other moments the reverse is true.  However, interpretation is not enforced in some dictatorial way but offered as the start of trying to make sense of what otherwise may be an apparently meaningless event or feeling.  It becomes a way in which a therapist can demonstrate that they are thinking in their own mind about the patient’s mind….  (bateman/pbpd/131)”

PSYCHODYNAMIC-INTERPERSONAL

“Russell Meares and his co-workers have made considerable efforts to develop a coherent and identifiable treatment approach based on Kohut’s self-psychology, Winnicott’s developmental approach, and the work of Robert Hobson.  They have provided data on its effectiveness (Stevenson and Meares 1992, 1999).  Treatment is based on the notion that BPD arises in the context of a disruption in the development of the self.  Whilst this conception is, to some extent, in line with our own view about maintaining a focus on the self and its development, their underlying theoretical stance is different.  Their principal assumptions are that a certain kind of associative, affect laden mental activity (not conceptualized as mentalization) develops through reverie, that symbolic play is necessary for the generation of the self and that this psychological process is disrupted through repeated ‘impingements’ of the social environment such as sexual and physical abuse.  According to mainstream self-psychology, there is a persistent split of an archaic grandiose and idealizing self-configuration in BPD, which leads to fluctuating and highly conflicting and contradictory self-states as well as corresponding intense and contradictory selfobject needs.  The term selfobject refers to the self-regulatory function of other people (or animals, or valued objects).  Lacking adequate regulatory functions of the self, the BPD patient is all the more dependent on others.  The hallmark of BPD, the intense and unstable relationships to other people, is the behavioural manifestation of these intense self-object yearnings.  An available other is desperately needed in order to feel worthy and vital.  The BPD tragedy is that the tolerance for the inevitable self-object failures is limited, leading to affective storms and frequent rejection of the very source of vitality on which they depend.  This paradox, e.g. the pervasive dependency and the rejection of the other, may be perceived as unbearable and may result in confusion and self-destructive acts.  (bateman/pbpd/132)”

“Metaphor concentrates and enriches emotional understanding through the use of representation and symbolization and may be an effective aspect of psychotherapy, particularly in the treatment of patients with neurotic disorders.  However, as we have already discussed, borderline patients demonstrate an enfeeblement of secondary representation of primary emotional states leading to a deficit in symbolic binding of affective states which is necessary to give meaning and context to feelings.  The result is over-arousal, bewilderment about emotions, and affective volatibility.  In addition, the persistence of psychic equivalence, in which internal and external correspond, results in emotions being experienced as ‘out there’ and ‘happening’.  This makes the use of metaphor in therapy problematic.  It confuses the patient who cannot distinguish reality from representation and may heighten emotion rather than bind it.  It is, for these reasons that simple ‘here and now’ interpretation is used in MBT and use of metaphor or focus on conflict is rarely applied, at least at the beginning of therapy.  If psychological progress occurs, the use of more complex interpretation involving expression through metaphor may be used towards the end of treatment.  (bateman/pbpd/134)”

OTHER THERAPIES

“abnormal attachment styles in PD” – I would say that if 45 to 50% of our population suffer insecure attachment, defining “normal” means that we have a serious problem amongst the other half!!

“Their acute sense of loneliness and abandonment destabilizes them and more frequent contact with a treatment team or therapist is required.  We conceive of this as a failure of patients to keep a mindful therapist in their mind, resulting in loss of internal stability and an experience of abandonment, rather than as a simple repetition of an anxious/ambivalent attachment pattern.  (bateman/pbpd/136)”

MENTALIZATION:  THE COMMON THEME INPSYCHOTHERAPEUTIC APPROACHES TO BORDERLINE PERSONALITY DISORDER

“…group of individuals characterized by the remarkable turbulence of their interpersonal relationships….we believe that it is desirable and possible to be far more precise about the specific aspects of relationship processes that are therapeutic for individuals with BPD.  It is the guiding construct of our therapeutic approach that psychotherapy with borderline patients should focus on the capacity for mentalization, by which we mean the implicit or explicit perception or interpretation of the actions of others or oneself as intentional, that is, mediated by mental states or mental processes.  We believe that….the crux of the value of psychotherapy with BPD is the experience of other human minds having the patient’s mind in mind…..we consider the process of interpretation to be at the heart of the therapy, rather than the content of the interpretations or the nonspecific supportive aspects of therapy. The explicit content of interpreting or educating is merely the vehicle for the implicit process that has therapeutic value. (bateman/pbpd/141)”

“The concept of mentalization, in our view, crystallizes the biological and relational processes that underpin the phenomena….It is important to remind ourselves that mentalization is not the same as introspection.  Mentalization can be both implicit and explicit.  Implicit mentalization is a non-conscious, unreflective, procedural function.  As Simon Baron-Cohen put it, ‘We mind-read all the time, effortlessly, automatically, (bateman/pbpd/141) and mostly unconsciously.’ (Baron-Cohen 1995)  Explicit mentalization is only likely to happen when we hit an interactive snag (Allen 2003).  Explicit mentalization, particularly when it is of a higher order, can be the apparent substance of psychological therapy, for example Person A can reflect upon his awareness of what Person B thinks about Person A’s feelings or thoughts.  Elsewhere we have pointed out that such explicit mentalization (metacognition) can only be considered genuine and productive when the link between these cognitions and emotional experience are strong.  We have referred to this as mentalized affectivity (Fonagy et al. 2002).  Others have approached this metaphorically in talking about ‘making a feeling felt’ (Siegel 1999, p. 149).  In fact the dissociation between implicit and explicit mentalization in the course of development may be a defining criterion of psychological disturbance.  (bateman/pbpd/142)”

“So what are the strong arguments in favour of mentalization as a key aspect of effective psychotherapeutic process?  Firstly, the foundation of any therapeutic work must by definition be implicit mentalization.  Without social engagement there can be no psychological therapy, and without mentalization there can be no social engagement.  Secondly, since the work of John Bowlby (1988) it has generally been agreed that psychotherapy invariably activates the attachment system and as a component generates secure base experience.  In our view this is important because the attachment context of psychotherapy is essential to establishing the virtuous cycle of synergy between the recovery of mentalization and secure base experience. [They must assume, then, that this is a biological possibility, even though there has been no mentalization possible due to damage prior to actual therapy.] The experience of being understood generates an experience of security which in turn facilitates ‘mental exploration’, the exploration of the mind of the other to find oneself therein.  Thirdly, the therapist of all patients, but particularly those whose experience of their mental world s diffused and confusing, will continually construct and reconstruct in their own mind an image of the patient’s mind.  They label feelings, they explain cognitions, they spell out implicit beliefs.  Importantly they engage in this mirroring process, highlighting the marked character of their verbal or non-verval mirroring display.  Their training and experience (e.g. striving towards therapeutic neutrality) further hones their capacity to show that their reaction is related to the patient’s state of mind rather than their own.  It is this often rapid non-conscious implicit process that enables the patient with BPD to apprehend what he feels.  Fourthly, mentalizing in psychological therapies is prototypically a process of shared, joint attention, where the interests of patient and therapist intersect in the mental state of the patient.  The shared attentional processes entailed by all psychological therapies in our view serve to strengthen the interpersonal integrative function (Fonagy 2003).  It is not simply what is focused on that we consider therapeutic from this point of view, but the fact that the patient and therapist can jointly focus on a shared content of subjectivity.  Fifthly, the explicit content of the therapist’s intervention will be mentalistic regardless of orientation….(bateman/pbpd/142)…These approaches all entail explicit mentalization in so far as they succeed in enhancing coherent representations of desires and beliefs.  …One may view psychotherapy for borderline individuals as an integrative process where implicit and explicit mentalization are brought together in an act of ‘representational redescription’, the term Annette Karmiloff-Smith (1992) used to refer to the process by which ‘implicit information in the mind subsequently becomes explicit knowledge to the mind’. (p. 18).  [he is not saying that unconscious becomes conscious – is that what he means?] Sixthly, the dyadic nature of therapy inherently fosters the patient’s capacity to generate multiple perspectives…..freeing the patient from being restricted to the reality of ‘one view’, experiencing the internal world in a mode of psych equivalence…..mental states are perforce represented at the secondary level and are therefore more likely to be recognized as such, as mental representations.  It should be remembered that this will only be helpful if implicit and explicit mentalization have not been dissociated and feelings are genuinely felt rather than just talked about. (bateman/pbpd/143)”

“…it is our belief that the relatively safe (secure base) attachment relationship with the therapist provides a relational context in which it is safe to explore the mind of the other in order to find one’s own mind represented with in it.  While it is quite likely that this is an adaptation of a mechanism provided to us probably by evolution to ‘recalibrate’ our experience of our own subjectivity through social interaction, it is a unique experience for individuals with BPD, because their pathology serves to distort the subjective experience of the other to a point where they have little hope of finding their constitutional self therein.  The maladaptive interpersonal processes, whether we label these projective identification or pathological reciprocal roles, in most ordinary social contexts only enable these patients to find in their social partner parts of themselves that they desperately needed to discard in the first place, be that terror, contempt, excitement, or pain. [I wonder if we don’t see in them also the good things about ourselves that we don’t own – Jung’s whole shadow contained both our alienated good and bad stuff…] ….The therapist, in holding on to their view of the patient, and overcoming the patient’s need to externalize and distort the therapist’s subjectivity, simultaneously fosters mentalizing and secure attachment experience.  Feeling recognized creates a secure base feeling that in turn promotes the patient’s freedom to explore herself or himself in the mind of the therapist. Increased sense of security in the attachment relationship with the therapist as well as other attachment relationships….reinforces a secure internal working model and through (bateman/pbpd/143) this, as Bowlby pointed out, a coherent sense of the self.  Simultaneously the patient is increasingly able to allocate mental space [great, let’s use vague metaphors here!] to the process of scrutinizing the feelings and thoughts of others, perhaps bringing about improvements in fundamental competence of the patient’s mind interpreting functions, which in turn may generate a far more benign interpersonal environment. A limitation of therapy lies in the therapist’s capacity to mentalize, constricted by his own attachment history, his current interpersonal circumstances and his constitutional capacities.  ….Our capacity to mentalize freely is readily compromised by the patient’s teleological stance and their insistent use of psychic equivalence and pretend modes of representing subjectivity.  These, and the experience of our minds being taken over by the alien parts of the patient’s self, may dramatically curtail our value to these patients when we feel unsafe, threatened, depressed, or just empty of mind in their presence.  (bateman/pbpd/144)”

++++++++++++++

1-22-07 Monday

I would not be surprised to find that there are, beyond this, what we could call tertiary representations, and those are the deepest things that we learn and come to understand about ourselves in intimate relationships with those that we love.

Just as Siegel says that the mind lies at the interface of where the brain meets the external environment and our experiences of it, there must be a place where our “soul,” for lack of another word, interfaces with our mind.  Sits there somewhere and somehow connected to our body and all of its senses, all of its reactions to our environment.  These deeper learnings, this deeper awarenesses must be close to the soul – closer to the soul where our internal subjectivity, reaching always inwardly, comes full circle to inform our beliefs.

These are our understandings.  As Anne Willson Schaef said in her book, “Women’s Reality, our understandings are what position us in our lives.  They are the things we “stand under.”  And the pathway to these understandings must come from a mix of our psychology with everything biological about us.  Psychology, rooted in the word “psyche,” the very breath of our lives.  Just like we live where the breath we breath in and out touches and in-forms our body so that we can live, our psychological stances, most of them coming from deep within our bodies, deep within our brains, from memories of things that happened to us so long ago when we were so very tiny, so very helpless.  They form the procedures we operate from the rest of our lives.  And we don’t even know it.

If we were so wounded early on in our lives, we reenact the early traumas, trying to protect that part of our self that was so wounded—so neglected, starved, scared, terrified, abandoned – without our conscious awareness, we protect ourselves, for the rest of our lives.

I keep asking what is the gem that is so precious in this very painful relationship I am in that I had to experience this situation in order to learn it?  It has to be important, and important for the writing of this book.  Why should I care so much, be so tied to, be so in love with a man who cannot or will not love me back?  What are all the levels of understandings available to me here?  What can I not only learn, but KNOW I KNOW from all of this?

Today is a rare day down here in southeastern Arizona.  The trees and the ground is burdened with snow.  The mountains that surround this place are obliterated within the thick heavy clouds.  It does not look like the world I know here.  It is quiet, nearly silent, as if all of our fighting and all of our running are at this moment frozen at this moment in time.

And at this moment in time the man I love is somewhere I cannot reach him.  I cannot phone him.  He asked me not to.  He is barricaded behind the walls of his past that have constructed his present, and determine his future.  If he lets them.  Which only a miracle would prevent at his age of 69.   And I am somewhere in this thick white world of snow, waiting.  That is all that has been given to me to do.  Wait.  And worry.  And fight this sadness that threatens to envelop me as surely as this world of whiteness has enveloped the desert of winter brown.

Because this man I love, as I seek to understand his priorities and his actions, does not need me.  He might want me, more than he will ever even allowhimself to know.  But he does not need me.  Because I am a siren that calls him to be true to himself.  To be true to the possibilities of freedom in his life.  Freedom from the past, from the wounds ofhis childhood.  Freedom to choose based on the present rather than on the past. As I write I notice a single bird sitting there on the wire, and a pack of seven dogs, no eight, walking through the mud as the road in front of my house begins to thaw.  These creatures of the natural world livein the present.  The rest of us are motivated almost entirely by our past.  And we don’t even know it.

This man I love is diabetic, and suffered some kind of a bite on his left foot over a week ago.  He ignored it for a few days, and then went to the doctor who gave him antibiotics and did not tell him what to look for if in several days there was no improvement and the redness and pain and swelling continued.  This man did not, on his own, seek contact with his doctor until the prescribed five days had expired, and last I heard this man was at his appointment, and he called me to tell me the doctor was “very concerned” and was sending him to the emergency room.  And this man asked me not to call him, that he would call me.  That was 48 hours ago, and they were long excruciating hours.  I know nothing.  I do not know if this man’s foot is healing or if they are going to amputate, or if he is dead or alive.

Because, you see, I am only the third woman in his life, the daytime woman.  He has one woman in his life has lived with primarily for the past 30 years in his apartment in the back corner of his automotive shop.  Then there is another woman he has ensconced in his mobile home about 3 blocks away that he lives with on the weekends.  The mobile home sits next to a mansion he has been building for over a decade.  It sits there as a testament to his wealth and power, a cold place, fully furnished yet completely empty.

I have been in love with this man since the moment I first saw him over 7 years ago.  For most of the past 6 years I have visited him at his shop during the days, gone out with him on the road as he answers tow calls.  We have spent thousands of hours together, talking about everything we can think of.  I have always missed him dearly, if not desperately, in between my chosen appointed hours of contact.  I even left for nearly a year, but I could not be far from him because he is entrenched within my heart, my soul, my mind.  I love him.  I am in love with him.  And yes this is a “hopeless” relationship, if not “destructive.”  But I cannot let go.  I cannot, as that bird on the wire just did, spread my wings and fly away.  I am here, waiting and scared to death.  I NEED him to call me!

I am sure that no “treatment” can save me.  There is no way past this situation except by going directly through it to the end – bitter or not.  Because the very nature of my love is that I cannot abandon it.  And my love will not allow me to abandon this man.

This man was born in 1937 to a rural poor family without much education.  His mother was from Mexico.  His father was German, having come to this area first via a birth in Canada.  This man has two older sisters.  But when he was born, evidently at some point his father decided he looked too Mexican and not enough German, so his father decided that his wife must have cheated on him.  I did not learn this early in my time with this man.  I did not learn a lot early.  My disabilities from infancy on prevented me from developing in the part of my brain called the right cortex the crucial skills at reading social cues that I need to get along with people of my species, and certainly this man was an absolute master at disguise and deceit, and knew from the start how to hook me and keep me hooked.  I went along for the ride because in my soul of souls, I loved him.

It was months after I had been told that this man’s father was the sweetest, kindest man that ever lived that I learned the deeper levels of the story.  By the time this man was 10 years old, he had been thrown out of the house and went to live with is maternal grandmother, who saved him.  But things had to have been very wrong long before that time, and this man, when he was a boy, must have suffered deeply, for he is a deep deep man.  We can all imagine the feelings this little boy grew up with.  And believe me, they may be unconscious and unrecognized to this man today, but they are not only there, they have been growing stronger his entire life.

Because what we know of life is that if we live to an old age, we will return again to the state of a child.  Helpless.  And this man, having a brilliant mind, is a businessman first and foremost, and learned to look after his own needs because he had also learned he could not trust in anybody else to do it for him.  He has always had multiple women in his life, and claims it is expected of a Mexican man to do so.  The wife must remain pristine and faithful, but he can do whatever he wants.  Now I kow the whole setup is an enactment from his past.  This man has always had two houses, with a woman in each, while he cats around with a third.  I believe the two women represent his mother and his grandmother, while the third – the one “out there” as I am, represents his bid for freedom from his past, a freedom he has never been able to obtain more than fleeting moments with.

He has carefully created a safety net for himself, a business plan for his old age and potential feebleness, that guarantees him he will never be alone or uncared for.  These women are his insurance policy, and there is no rider on the policy for me.  That’s it in a nutshell.  Except for this little part.

Evidently once he left his home in the country and moved into his grandmother’s house in town, the group of boys he played with an himself used to catch cats in the neighborhood, and tie a strong string to their tails and hand them over a bridge.  One cat alone just hung there akimbo frozen silently in space, dangling terrified at the end of his string.  But the boys learned that if they hung two cats this way next to one another, they hissed and scratched and fought voraciously.  I would add, as if for their lives.  I can’t ask this man now, but I don’t think they ever hung up three cats.

So there’s more action when there are two women close to one another on their individual strings.  At least I am apart and separate from the main drama as he now has to balance time with both of those women, who are taking care of him == while he leaves me waiting and wondering and scared for a phone call.

So I think that I am the “freedom” woman of the present/future in the hopeless situation.  While he is stuck in the past.  I have no portal to him.  I can’t be a part of his security need driven past that is his present.  I am the one that is hurting, for me and for him, powerless and trying to learn the deeper levels to all of this so that I can endure without so much suffering.  I miss him terribly.  I would give my own limbs if they could save his.  I love him as much as I love my own children.  Does he know this?  Can he care?

And while he is back there in the past present surrounded by the attentions of these two women, I am here in my present alone and suffering.  He, no doubt, is on survival mode doing the best that he can.  And I cannot remove myself from the flames.

Can this man escape the past so that he can call me in the present?  I have no way, as I have said, to find out how he is or what is going on.  I am shut out.  It is terrifying, and it hurts like hell.  And I feel guilty worrying about myself when I think about what might be going on for him.  Only he KNOWS and I DON’T!  All the important people in his life know, and I DON’T!  How can I not feel like NOTHING?  This is one of the hardest times in my life.  I can’t imagine his.

I might as well be crying these silent frozen tear drops floating out of the sky so silently.  They make no sound when they land on the ground.  They make no mark of distinction.  I am probably the only person in the world who cannot call and has no one to ask about the condition of this man I love so much.  To me, this whole situation is so truly tragic – except for the fact that as he wants it, this man is not alone.  He has thousands of people who love him.  A large family to attend to him besides these 2 women.  It is just I that is so alone with my end of this.  The not knowing except to know that if he has an amputation there is no way that we can see one another.  His life in the shop will probably be over.  I am absolutely stranded, and it hurts so much.  I cannot tell you how much.  Those of you who can imagine already know.  And to the rest, I cannot explain it.  There are no words and no logic to any of this.  And just as I cannot see that mountain out my window that has been swallowed by a cloud, I cannot tell the future.  I cannot, therefore, even hope to hope.  My heart breaks in worry, and in missing him.

I could not run far enough away or run fast enough to have avoided or have prevented this inevitable crisis in my life as a result of my affections for this man.  It’s been like waiting for a deadly head-on collision to happen.  I could find nothing to do to avoid it.

++++

I have had the sweetest, purist moments of affection with this man second only to holding my newly born babies.  Yet maybe more precious, for meeting him was a different sort of destiny.

What do I love about him?  The feel of his skin, what few time I have been allowed to touch him.  The smell of him, what few times I have been close enough to smell him.  Always the sight of him, those more frequent times when I have been able to be with him.  Every one of his stances.  I can tell them apart.  The ones when he is bored and restless, the ones where he is thinking of something else not present.  His intelligence.  The look in his eyes when I tell him something new he has never thought of before.  The look in his eyes when he has a response.  The look when he has a question, and the look when he feels threatened.  His look of wonder, his look of humor, his look of innocence and vulnerability of being very small.  I love his determination, those days when he feels well enough and work is challenging.  Those days when he feels pressured, those days when he feels like giving up.  I love the sound of his voice without question or qualification.  The timbre of it, the resonance, as if he has the voice that speaks straight to my soul.  I love it when he touches me, how one tiny touch from the tip of his finger as he walks behind me as I sit in the shop – he touched one spot on my neck and I felt warm throughout my entire body, my entire being.  It’s like the after taste of what I would imagine a very fine wine would hold, though I’ve never had one.

He has a bearing and a power in him that spreads out from his body like ripples in a still pond.  He is always at his center.  I love it when he tells me things about himself and about his life.  Like perhaps he might be able to do with me yet after this is all done and finished.  If he can get away from these two women.  If he survives.  If his heart and his sprit and his will are not broken.

For he is not a god even though he is to me.  Pure and perfect.  He is not a young man, and his body is not going to carry him much longer.  How hard it is to have a perfect love that is not meant for this world.  I cannot bring back every single perfect moment with him, for every moment with him was a perfect one.  Does he know how hard this is for me?  Where is he?  What is happening?  I want to see him strong and smiling, a twinkle in his eye.  Some mischief toying with the creases around his eyes.  I want to see him surprised at something.  But not about anything bad or scary.

Never has a man made me feel so sexy, so beautiful, so desired, so provocative.  Never has a man truly stood up to me, or equaled my intelligence and drive.  Yet my drive is internal, his is toward the without.  I have been so at peace, so calm, so balanced, so safe in his presence.  Feelings I never knew existed in me, ones that I had never known.  And he has a dancer’s grace about him, an air of mystery.  He is obtuse and opaque and rarely gives himself away.  So he keeps me guessing.  But he also keep