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Loses at the Core of the Self and the Merits of “Portable Families” 1

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Loses at the Core of the Self and the Merits of “Portable Families” 1 International Journal of Brief Therapy and Family Science 2011, Vol. 1, No.1, 57-67 <Invited Paper> LOSES AT THE CORE OF THE SELF AND THE MERITS OF “PORTABLE FAMILIES” 1 Carlos E. Sluzki1) 1) Department of Global and Community Health, George Mason University ABSTRACT. The treatment of a patient who was referred due to hallucinations reveals a world of “magic realism” that is far from infrequent in elderly people with a small and dwindling social network –especially if coming from cultures where the boundaries between the inner and the outer world world are fuzzy. Respecting these traits allow for the development of treatment approaches that can evolve satisfactorily without disrupting the patient’s inscription in this dual world. KEY WORDS: self boundaries, family, hallucinations, culture Introduction after his death, reeling with the vacuum of Our beloved talking cat, an agile acrobat his loss, I still quasi-hallucinate him: I have and tender social being who would jump the sense every now and again that I see his onto my desk whenever I was there and shadow outside my studio window wanting to managed to create a space to lie down be allowed into the house after one of his –pushing away whatever paper, pen or escapades; or I experience him rushing by stapler was in his way and purr until falling me in or out when I enter the house. Slowly asleep--, who would climb into the vane of and steadily, however, at his own pace and the window outside my studio and look at me mine, he is erasing himself from the world of while calling imperiously until I would open the present and into the bittersweet world of the door, who would follow my wife and I to the memories of the loved ones. whatever room we would end up in, parking What a fascinating process is that transition, himself there sharing the space in good that road frequented by so many of our objects company, was hit by a car and died a month of love no longer there, inaccessible as they ago, while crossing the street during one of are to our seeing, hearing, smelling, touching his petted, just being there for the sheer joy and being touched by them but lingering just of incursions into the neighborhood. Weeks the same for a while. Far from being a cognitive experience, it is a laborious process CORRESPONDENCE TO: SLUZKI, Dept Global and in which our senses trick us, probably to help 1 Community Health George Mason University Fairfax, VA us learn the painful experience of letting go. 22030, USA. Many friends who lost loved ones describe a e-mail: [email protected] 1 A Pirot version of this article appeared in Transcultural Psychiatry, 45(3): 379-390, 2008. 57 58 SLUZKI similar process: “I sensed that she/he was there, The more skin-bound the construction of the that she/he never left, or had returned”, self favored by our culture, the more it will sometimes as a faint hallucination of their force us to distinguish between whomever we voice, or hearing their characteristic footsteps long and wish to hear, see, touch and embrace in the house, smelling a whiff of their again, and the vacuum of his or her abence; preferred perfume, hearing the tingling of their ultimately, between self and the other. The door keys, “almost” seeing them.2 spartan dictum of a culture that informs us that The passage of time may be also a kind and we are in-dividuals, that the others are “out relentless healer for, as the traumatic loss there” and not part of our self, instructs us also recedes in time, so does the daily imposing to let go of whatever we cannot retain… and presence of the absence. One day we discover continue with our life. This injunction will be that we haven’t been tortured by that feeling of counter-intuitive to, and clash with, the softer distress throughout several hours, or that we injunction emanating from cultures that define laughed with abandonment at something funny our self as enveloping others within its –a discovery that may flood us with guilt, as if perimeter, that give us permission to rebel that moment of joy or of involvement in our against our letting go of the departed by daily living would have affronted or betrayed somehow keeping them with us. the object of our sorrow. But that betrayal The following clinical case will illlustrate this repeats itself until we realize that we may be alternative, culture-supported, approach to loss, able to live a life with at least a modicum of and some consequences of its cross-cultural happiness while carrying within us a permanent clash4. functional split of the self that may give us the authorization to re-engage into our capacity for Clinical presentation joy and creativity3. A few years ago, at an outpatient psychiatric clinic for low income/low-paying 2 The word that comes to my mind when trying to insurance patients that I directed within a identify that feeling in its many nuances is the idiosyncratic and perhaps untranslatable general hospital in California, I was asked to Portuguese word saudade, derived from the Latin see a 70 year old bilingual Hispanic (a solitatem, loneliness, and defined as “a feeling of nostalgic remembrance of people or things, absent broad category encompassing people of or forever lost, accompanied by the desire to see Latin American origin living in the United or possess them once more" (Correia da Cunha, 1982.) States) woman, a well-known patient at the 3 Needless to say, major and prolonged trauma –years in a concentration camp, months of clinic. For the past two years she had been unending terror —may lead to major splits in our identity, creating selves who end up living in without remorse bread from a dying inmate (cf. parallel, unable to fuse or even to have areas in Langer, 1991) common: one moment I am here, with you, a 4 While retaining her persona, traits of the father, a husband, a socially constructive fellow, patient’s description have been distorted in order and at the next moment I am back there, in the to preserve her anonymity, in spite of her having concentration camp, witnessing myself stealing authorized me to write about her. LOSES AT THE CORE OF THE SELF AND THE MERITS OF “PORTABLE FAMILIES” 59 seen by a colleague, who asked me to take Moreau titled “Madonna Guaraní” that I over her treatment arguing that, due to my had at home since childhood6. being bilingual and multicultural, I would be In order to reduce the chances of better able to connect with her and figure out contamination –that is, to allow my own ways to treat her without falling into the biases to develop rather than incorporating frequent confrontations that he himself some colleague’s skews--, I had chosen not experienced with that patient. to read her rather thick clinical file prior to He informed me that this lady –whose the consultation. So, after some introductory improbable first name was Samotracia 5 -- social graces, I started from scratch: “I carried a diagnosis of “atypical chronic haven’t read the previous notes on your schizophrenia”, while her symptoms were chart. I will do it later, but, to begin from a quite impervious to the neuroleptic fresh place, in what way, if any, can I be of medication she had been taking already for help?” the past several months. Samotracia began by listing in detail the I accepted the referral. At the appointed litany of her physical problems and time, in came this rather voluminous symptoms, from a heart condition to her high Mexican-born woman, with marked Aztec blood pressure to a lingering fatigue (the facial features, her long white hair combed latter probably a combined effect of heart into a bun, a strong and coarse voice, insufficiency, heart medications, and the dragging herself into my office with some frequent extra-pyramidal effects of the huffing and puffing and greeting me neuroleptics she had been prescribed.) Her respectfully while maintaining a rather daily life followed a rather tight routine –the symmetrical stance, shifting to Spanish as highlights being her daily walks in her soon as I indicated my fluency in that neighborhood, some social life with language. neighbors, her frequent contact with her For me --and perhaps for both of us-- it daughters, and her visits to her various was, so to speak, empathy at first sight. In health care practitioners. Her diet was fact, she reminded me of the rotund and balanced, she didn’t drink alcohol, and she tender aboriginal woman that is central in a 6 The Guaraní were the natives of Paraguay and mother-and-child engraving by Clement northeast Argentina before the Spanish conquest, and are still a substantial part of that region’s population. To further reveal for the reader 5 How come such an utterly Greek and rather some added roots about my empathic connections unusual insular name was bestowed at birth on with this woman through the association she this Mexican-born woman was a mystery not only triggered with that engraving, I should add that for me but also for her: she didn’t have any my nanny—the lady who care for me as a satisfactory explanation for why or how her mother-extender since birth on-- was a sweet parents, both semi-analphabet peasants, had woman of Guaraní origin. A reproduction of the chosen that name for her. engraving I mention in the text can be found in Moreau/Meffert 1978, p.242.
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