Placebos I Have Known
Modes of therapy that have and haven't worked for me, who knows why.
It’s been a long time since I purchased a print edition of the New York Times. I have a digital subscription, and usually only pick up a hard copy when I have a piece in the paper, which I haven’t in years.
But last Sunday I took a half-mile walk to RiteAid, one of few places in Kingston that carries it, because I wanted to pore over that week’s psychotherapy-themed edition of the magazine section without the many distractions that often keep me from engaging with longform uninterrupted on my laptop or other digital devices.
Most of all I was interested in Susan Dominus’s piece, “Does Therapy Work?” because I’ve long been engaged in an internal debate about that and have been wondering if I’m up for more of it, and Daniel Bergner’s, “Let the Body Do the Talking,” examining the efficacy of Somatic Experiencing, or S.E., which I’d tried, to disappointing results.
The week before “The Therapy Issue” was published, I’d considering re-entering talk therapy after feeling thwarted in the pursuit of that last year.
I was also curious about therapist Orna Guralnik’s article, “Domestic Disturbance,” about a new awareness of systemic inequality and outdated gender power dynamics that seems to be positively affecting couples in therapy together—mostly because I think the best shrink I ever had, from 2000-2004, a slightly macho maverick I saw when I still lived in the city, would have been an even better therapist if he’d been more aware of those things, and more willing to entertain my contention that some of what was impacting me, emotionally, was societal.
The week before “The Therapy Issue” was published, I’d considering re-entering talk therapy after feeling thwarted in the pursuit of that last year. To recap: in the fall I had three sessions with my most recent therapist (a woman in the Hudson Valley, not the maverick in Manhattan), who’d closed her practice a few years before to become an academic. She was now seeing a few patients in the evenings, over Zoom. At the end of the third session, she said she feared talk therapy was only re-traumatizing me, and suggested I try one of the new body-oriented types of treatment.
She referred me to a therapist who practices Somatic Experiencing, or S.E. I gave it a shot—a full seven sessions that ran me roughly $1000 out of pocket. (Pychotherapy is partially “covered” by my “affordable” marketplace insurance, but only after I’ve reached my $4700 annual deductible. 🙃) But the whole thing left me cold, and honestly more depressed than when I’d started. After that, I took a friend’s suggestion that I try acupuncture, and that surprisingly to me, has had positive results.
In my prior posts about this I chose not to name the modality of therapy that didn’t work for me because I didn’t want to disparage a kind of treatment that was helpful to some, including friends of mine. Also, on some level, I thought my skepticism was part of the problem; one of the things that kept coming up in my S.E. sessions was that I felt I was failing as a patient.
I couldn’t get on board with being interrupted as I talked about what was going on with me emotionally so that the therapist could say things like, “Okay, but can you feel the earth coming up to support your body? Feel how powerful that support is…” or ask me, “Where in your body are you feeling this?” to which I would reply, a bit impatiently, “Everywhere…? Like, I assure you it’s not in my elbow.” Or to have her respond to my crying with the suggestion that I cross my arms over my chest and tap myself with my fingers, near my shoulders.
But now that the Times has published a piece on S.E.—one that acknowledges the leaps of faith and gaps in scientific rigor behind the movement that I’d also encountered in my limited research—I feel okay about naming it.
S.E. is predicated on the idea that the way to heal trauma, which certainly affects our nervous systems, is through the body, not the mind. That, per Bergner’s article, “the content of emotional states ranging from common anxiety and depression to the onslaught of full-blown post-traumatic stress disorder arrives in our brains from the neural circuitry running throughout our bodies. S.E. upends beliefs about the mind as the origin and essential locus of our feelings.”
I couldn’t get on board with being interrupted as I talked about what was going on with me emotionally so that the therapist could say things like, “Okay, but can you feel the earth coming up to support your body? Feel how powerful that support is…”
I don’t at all dispute the idea that our emotions affect our bodies, and that some degree of relief can be found in moving around in certain ways, especially to get out our frustrations. I think often about “Mucho, Macho,” an episode of Rhoda in which Brenda Morgenstern, Rhoda’s younger sister, gives Rhoda and her husband Joe a gag anniversary gift of cylindrical soft pillows with handles like you’d find on fencing swords, for them to fight with. Brenda doesn’t yet know that her sister and brother-in-law have been fighting; the next season they’ll separate and divorce. But at the end of “Mucho, Macho,” they wind up using these soft “weapons” after an argument, bopping one another until they laugh, and both admit it helped them feel better.
On more than one occasion when I was filled with rage, I have wrapped my glass recycling in several thick plastic bags, then taken it out back to slam it repeatedly with a large gardening shovel. Often when I find myself in this state, I think, “I need to break something!” and then I start raiding the recycling bin. (When I’m not in the throes of unmitigated rage, the mental image of me doing this is pure comedy.)
I derived similar satisfaction once, during a building renovation, by demolishing a wall with a sledge hammer. After I get the anger “out of my body,” I’m somewhat transformed. I can function again. But that doesn’t mean that I don’t also want to make sense of what I’m feeling and experiencing, to learn and theoretically “grow” from it; to learn a new way to handle things next time. Maybe I’m old and old-fashioned, but I still want to talk it out.
During a few of my S.E. sessions, when I started to talk about my feelings, the therapist interrupted to say, also somewhat impatiently, “Um, we’re not doing that anymore. Now we talk about how we feel in our bodies, and heal through that.” I felt like I’d landed in a foreign country where I didn’t speak the language, and there were no translators, and as if my therapist was disappointed in me.
After talking with a few friends who are benefitting from S.E. in their treatment, it occurred to me that maybe I wasn’t the problem, or at least not the only problem. Maybe it was at least partly the practitioner—who, by the way, had made the fatal error of opening our first session by telling me she’d cured her own post-menopausal depression by getting a prescription for Synthroid, and later let me know she was impressed with my work, thought I was “cool,” and would want to be friends with me if she weren’t my therapist. These admissions made me feel uncomfortable, and not trust her.
This touches on my skepticism about therapy in general, and my frustration with how subjective everything about it can be—how certain modalities and therapists can, seemingly randomly, work for some people but not others, and how you can’t know until you invest a fair amount of time and money, sometimes in treatment that doesn’t work for you—or actually hurts you.
On more than one occasion when I was filled with rage, I have wrapped my glass recycling in several thick plastic bags, then taken it out back to slam it repeatedly with a large gardening shovel. Often when I find myself in this state, I think, “I need to break something!” then I start raiding the recycling bin.
The three sessions with my old therapist plus seven with the S.E. practitioner were not only a waste of my time and money, even at sliding-scale rates; they left me feeling more depressed and hopeless than I’d felt before. It left me gun shy about seeking new treatment—although I’m pretty sure I know what kind I’d want, innovations be damned: good, old-fashioned talk therapy.
Dominus’s article on the relatively established efficacy of talk therapy—even if we don’t fully understand why or how it works—and Bergner’s article interrogating S.E., both further validated this preference of mine.
Over the course of my short S.E. treatment, I did a fair amount of reading about it, and also watched some videos produced by Somatic Experiencing International starring the movement’s founder, Peter Levine. I thought that if I understood the mechanics of it better, maybe it would work for me. More than once I watched the video that Bergner mentions in his article, in which Levine interviews an Iraq war veteran about the ways S.E. had allegedly cured him of PTSD. I kept looking for something that would clearly explain how the Iraq war veteran and other patients had gotten from point A, at which they were traumatized, anxious, and depressed, to point B, at which they weren’t, but I couldn’t find it. It was like trying to dissect a magic trick, one that had failed to work.
I kept coming upon an analogy having to do with traumatized animals and how they shake involuntarily once whatever force was threatening them is removed; once they shake their trauma off, they’re (allegedly) fine. But I was unpersuaded. It felt like something big was missing from the equation, or that I wasn’t quite getting whatever was there.
I felt validated in my doubtfulness by some of what Bergner wrote, like this quote: “Levine’s foundational logic contains a major leap. He assumes that the animal shakes off mortal trouble and hurries away in good health. But for all we know, it has terrible PTSD and its health is merely our wishful projection.”
Bergner points to multiple other leaps of faith, weak arguments, and magical thinking behind Levine’s modality, including a reliance on “polyvagal theory”—suggesting a direct connection between the vagus and the unconscious mind—which is so far unproven, and Levine’s delusional conversations with Albert Einstein, including one instance in which he made a server in a restaurant bring a bowl of soup for his long dead, obviously absent, lunch companion.
It all chipped away at what little faith I’d had in S.E. to begin with—not to mention the weird syntax of “Somatic Experiencing,” the kind of awkwardly phrased terminology I associate with cultish “human potential movement” organizations like the Landmark Forum.
Still, people I know report positive results with S.E. Could the placebo effect account for this? Placebos can be powerful, because the mind is powerful. Back when I was doing health reporting, I remember reading a study on a hair replacement medication for men that was only slightly more effective than the placebo it had been tested against. That meant there were men in the study who’d grown new hair on their bald heads just because they believed they were taking medication that could help them achieve that when actually they weren’t.
Despite my skeptical nature, I’m not 100% immune to the placebo effect. For instance, more than once when I’ve had strep throat, I’ve begun feeling relief in my inflamed tonsils the instant I’ve had a bottle of antibiotics in hand—despite not having yet ingested a single pill. Why couldn’t the placebo effect worked for me with S.E., then?
There are some in the scientific fields and western medicine who might suggest I owe my positive experience with acupuncture to the placebo effect. I mean, Wikipedia labels it pseudoscience and quackery. But according to my acupuncturist and others I know, it’s science-science, a legitimate, ancient mode of medicine that involves stimulating meridian points for specific results in the body and mind. I don’t fully understand it, but it seems to have really helped my mood and outlook, especially this past fall and winter, a really difficult time for me.
One friend who works in mental health suggested that the act of seeking help alone might have had a salutary effect on me; that when you take concrete steps to address your depression, it can help to alleviate the depression.
Back when I was doing health reporting, I remember reading a study on a hair replacement medication for men that was only slightly more effective than the placebo it had been tested against. That meant there were men in the study who’d grown new hair on their bald heads just because they believed they were taking medication that could help them achieve that when actually they weren’t.
Maybe the talk component to my acupuncture sessions is a factor; it’s not all needling. After I arrive, for 10 or 15 minutes we talk about where I’m at emotionally. Often my acupuncturist gives me very useful feedback. After that she listens to my pulse, and sometimes looks at my tongue. Based on what I’ve told her and the conditions she’s observed, she devises that day’s course of treatment, deciding where it would be best to insert the tiny pins. Then, with the needles in, I rest on her table for 20 or 30 minutes, an experience that relaxes me tremendously. I leave there in much better shape than I arrived in.
Still, I’m not sure acupuncture is doing quite enough for me, emotionally. It helped lift me out of a deep depression to a somewhat less depressed state, but which is still a bit darker than my resting state—which is…mildly depressed.
I think I really do need to find a good talk therapy practitioner, if not right now, definitely in time for fall, when less light will surely, like clockwork, add to my internal darkness. I’m not thrilled by the prospect of auditioning candidates—ugh, not more trial and error—and the unspooling of my backstory for one therapist then another if I don’t click with the first one or two I meet. But I’m determined to jump back in and give it a try.
In other news…
A number of interviews I did a while ago, in print and on podcasts, somehow all came out the same week or so:
I was on a podcast called We Are Childfree. (Not sure I qualify as a “Gen X icon,” but I’m flattered.) I talked about my need for a hysterectomy in my early 40s gave me the out I was afraid to give myself. They also reprinted, with permission, my second Modern Love essay.