Not Nothing, Not Enough
Leukemia and rewriting a failed analysis
Vijay Masharani
Photograph by David Billet of the bedroom in which I got sick. (Credit: David Billet)
In the five weeks leading up to my leukemia diagnosis, my body and cognitive faculties broke down along with my relationship with my therapist and psychoanalyst of five years. I was in psychodynamic therapy from 2018–2022 and then switched to analysis with the same practitioner after completing my master’s. The combination of school stress, the pandemic, and a rough breakup during finals week caused my mental health to decline and led my analyst to recommend a more rigorous four-times a week treatment. This relationship was like no other in my life. Through the analytic process, my history of difficulties in interpersonal, work, and family relationships took on structure and clarity. I gained gleaming, priceless insights into how I selected experiences and people, both of which would produce “extreme anxiety, profound disorganisation, harrowing depressions, and endless rage,” and became aware of the option to choose otherwise. I felt like I had access to a rare avenue for genuine self-knowledge. I am embarrassed that I idealized the relationship, and yet, how could I not, when the returns were so concrete? Each small breakthrough fed my conviction that a life with less suffering was within my reach.
Before I was a cancer patient, most of the adversity I'd experienced in life was psychic. My sense of self has always been somewhat hazy, but I’ve become adept at shoring it up through creative practice and psychoanalysis. Identifying as an analysand gave me stability and direction in life. When I read The Impossible Profession, Janet Malcolm’s extended endorsement of analysis, I was drawn to passages in which the pseudonymous analyst Dr. Green insists that the magnitude of change induced by treatment is small, remarking, “I don't think basic character structure ever changes. We're not that malleable.” Elsewhere, he states, “analysis leaves the patient with more freedom of choice than he had before—but how much more? This much: instead of going straight down the meridian, he will go five degrees, ten degrees—maybe fifteen degrees if you push very hard—to the left or to the right, but no more than that.” This sentiment is echoed in a 2022 interview with Lacanian analyst Ellie Ragland, who says “it is a problem in psychoanalysis: you can’t cure a person of who they are, structurally.” The temperedness of these claims made me more of a believer. It is psychoanalysis’s lack of guarantees, its reluctance to make outsized claims about the possibility of radical change along with a high frequency of sessions, that together make it realistic, proportional to what it actually takes for someone like me to achieve small but important transformations. As an artist and writer, I was also drawn in by the field’s engagement with art and philosophy. That my analyst had a background in comparative literature strengthened our alliance. She was well-versed in discourses of race and racialization, having completed graduate work on the nexus of Freudian drive theory and Asian American literature. I have South Asian ancestry and returned to graduate school to study race and postcolonialism. I felt like I was able to connect to my analyst not only because we were both people of color, but also because we shared a vocabulary of concepts.
My physical symptoms became pronounced when I returned to New York from my home state of California after Christmas. I was constipated, which my analyst postulated to be a conversion symptom: I was really blocked up with rage at my dad, specifically at his lack of belief in my career, which we had argued about while I was at my parents’ house. With my stomach in pain, I ate less for a few days, which caused a rift in analytic sessions; disordered eating would become a theme of all subsequent sessions, unmoored from the reality of my eating habits, which were more complex. My appetite remained suppressed, but I forced myself to eat, developing impromptu solutions to novel, inexplicable waves of nausea that had rendered my normal diet suddenly unpalatable, like alternating bites of dinner with single frozen blueberries, and frequenting a Lebanese restaurant whose citrusy shish taouk I was somehow able to stomach even when other food made me want to puke. Disordered eating became the prism through which my analyst explained most of the subsequent symptoms I would develop, despite the fact that I was getting a more or less normal amount of calories.
I developed brain fog, fatigue, and night sweats, waking up in the early hours of the morning with my clothes, sheets, comforter, and mattress soaked through. My insurance had just changed and I had lost my prior primary care provider. I found a new one in my neighborhood and made an appointment, but she wasn’t available for a few weeks. I was losing weight. Muscle mass and abdominal fat dissolved. Overnight, I felt like a skeleton. My legs became weak to the point that I had to lift them into bed, and I lost the ability to walk at the normal brusque pace of city life. I shuffled to the grocery store during a cold snap wearing two coats, freezing. The rapid proliferation of lymphoblasts in my marrow caused my tailbone, femurs, and ribs to expand, producing a new genre of pain that kept me up at night. I was unquenchably thirsty. I became too weak to properly get out of bed: each morning, delirious, I would struggle to sit up, wedging myself up with my elbows since my core muscles had stopped firing. Sleep deprivation, combined with the onset of varied and inexplicable symptoms, was disorienting. The symptoms’ rate of advance was fast enough to stun me into a somnambulatory state, but slow enough that it didn’t raise significant alarm bells among my friends or family. This period has become difficult for me to recall, maybe because chemotherapy has addled my memory, or maybe because I’m repressing a nightmarish sequence.
“Hearing that you are the cause of your own debilitating symptoms can come as a relief and can refurbish your sense of agency.”
In an earlier era, these symptoms might have been scrutinized individually: the bone pain would correspond allegorically with one psychical conflict, the weight loss another, and so on. However, as symptoms accumulated, my analyst considered them in aggregate rather than in particular. According to the American Psychoanalytic Association’s Psychoanalytic Terms and Concepts entry on psychosomatic disorders, attempts to close-read individual symptoms in this way have been largely abandoned by analysts today. When I spoke about my health to my analyst, she focused on my disordered eating, while the night sweats were met with a handwave: “maybe your diet is changing your hormones,” she posited. This was only the first part of the interpretation that she offered. The rest went something like this: You were deprived of your dad’s attention at a crucial period in your upbringing, and you are now manifesting symptoms to secure it. Since my dad is a physician, sickness would be the ideal idiom through which to get his attention. I recall one session in which my analyst said, almost verbatim, “you’re perfectly healthy. These symptoms will go away when you accept that you are making yourself ill to get your dad’s attention.” I trusted my analyst and took this insight seriously. She even suggested that talking about my symptoms in our sessions would perpetuate them. It felt like being offered a challenge, a gift, and the enticing possibility of overcoming: to move beyond my symptoms by shutting up about them would be to move beyond a degree of painful attachment to my dad. Situated within a larger goal of my treatment—autonomy and separation from my parents—it was not an altogether strange proposition. Hearing that you are the cause of your own debilitating symptoms can come as a relief and can refurbish your sense of agency. I acceded to her narrative in part because it calmed me down. Despite being too short of breath to properly finish a sentence, I tried in earnest to get over it all.
*
They didn’t go away. A stubborn mystery, my symptoms remained. After weeks of disrupted sleep, I felt like I was cresting unreality. I tried to focus on work both in and outside of treatment. I wrested the conversation in our sessions back towards earlier themes like career anxiety, a love-hate relationship with artmaking, my barren romantic life, grief over the loss of my best friend, and a vexed relationship with my dad, with whom she discouraged me from discussing my symptoms. I took her suggestions: I resisted calling him when a new symptom emerged, because I was convinced this disclosure would actually hold back my psychic progress, and therefore prolong my physical pain. At the time, this logic did strike me as counterintuitive, but that’s also what I loved about analysis: it offered causal alternatives. Almost every prior insight I integrated during my years of therapy was first received as an idiosyncratic, countervailing proposition to my own deep-rooted tendencies.
Psychoanalysis addresses how psychic conflict can manifest as physical symptomatology, but it seems to have less to say about the inverse: how physical symptoms can scatter cognition, depress mood, and distort perception. It would have been simpler, and better, if the linear progression of my illness corresponded one-to-one with an increased awareness that my analyst was wrong. But over the course of our relationship, an understanding emerged that to some degree I was opaque to myself, and therefore it would be best for me to accept that I may be mistaken about things as immediate as desire, motivation, or pain. This led to a turbulent situation. It made her error not dismissible as such; instead, it was like a line of bad code, sticky in my mind, jamming up my cognition. It had its own centrifugal force, marring and rending my psychology, leading me not towards any new type of self-understanding, but rather, leading me to flail at the incoherence of my predicament. As I’ve mentioned, I have a difficult time recalling this chapter; the memories are gaseous, volatile, partial, hazy, distorted. Retreading this period, balking at how bad things got and how much worse they could have been, my attitude is forensic. I ask myself, “what was I thinking, what was she thinking?” I’ve pored over my browser history, camera roll, social media posts, credit card statements, and phone records for clues with which to gauge my mental state as my illness advanced. I ordered nice socks and towels and posted a sentimental photo with my sister on social media.
Since I couldn’t figure out what was going on, I thought that I might as well get comfortable, and start saying good-bye to my loved ones, just in case. I requested an increased dose of Olanzapine from my psychiatrist, ostensibly to help me sleep and eat, but also, considering its side effects of increased feelings of anhedonia and resignation, as an act of palliative numbing. I rewatched films depicting the sick and dying. I became estranged from my own body, and experienced it as a foreign, brute, failing corporeality. I identified with the splayed corpses in Stan Brakhage’s The Act of Seeing with One’s Own Eyes, as they became formal material through various post-mortem operations, mortuary technician and cameraman collaborating to recast dead bodies as equivalent series of planes, folds, apertures, bagged accessories, and voice records. Watching David Lynch’s Eraserhead for the first time, the ambient score of pipe organ and industrial noise matched my cloudy perception. In a famous scene, it’s revealed that the alien infant has no skin. Its internal organs are held in place by bandages, which Jack Nance cuts with scissors before stabbing the baby’s organs. It hyperventilates and hemorrhages blood while its insides gush a quantity of liquid disproportionate to the baby’s size. It looks like expanding foam or cottage cheese or unrestrained cell division.
I also watched Forugh Farrokhzad’s 1963 non-narrative documentary The House is Black, a portrait of a northern Iranian leper colony, commissioned by the Society for Assistance to Lepers to raise awareness and funds for the organization. The film addresses but does not dwell on the lepers’ ailment; rather, the point of the film is the irrelevance of leprosy to the lepers, who we see praying together, playing music, caring for one another, and participating in classroom activities. When Farrokhzad shows a flaking degenerated foot, or the withering nubs of a hand, it’s to show what the lepers are not. It brings to mind the lesson Alain Badiou takes from Varlam Shalamov’s experience of the gulags: “we are dealing with an animal whose resistance, unlike that of a horse, lies not in his fragile body but in his stubborn determination to remain what he is—that is to say, precisely something other than a victim, other than a being-for-death, and thus: something other than a mortal being.” Cancer, on the other hand, vindicates a vulgar biologism, and claims the last word: “if you thought you were more than your cells, you’re not.” By the end of the workday, I would be too tired to sit up, so I would prop my chin up with my palm. Illness petrifies the body; my head felt more like a skull—statuesque, heavy with the cancer’s indifference to my thoughts and plans.
“Illness petrifies the body; my head felt more like a skull—statuesque, heavy with the cancer’s indifference to my thoughts and plans.”
I also became fixated on songs that expressed resilience and vitality: Byron Messia’s weightless “Talibans,” which had saturated my neighborhood the previous summer; Chino Pacas’s energetic corridos tumbados; Daboor and Shabdjeed’s anthem of resistance, “Inn Ann”. And yet, they too have a gothic valence, as they are all songs in part about killing. It felt like there were competing logics of death and life inside me—the former telling me to accede to the senselessness of my condition, the latter propelling me blindly upward. When all is said and done, I am not sure to which side analysis falls. Since my symptoms were not in fact psychosomatic but physical, they felt insurmountable, and any initial feelings of agency gave way to helplessness. Paul Verhaeghe writes that oftentimes “the patient is guilty for what is inexplicable,” and I did experience shame at the insinuation that I was getting off on getting sick, the persistence of my symptoms confirming an indulgence in self-sabotage.
The shame in turn strengthened my resolve to get past my symptoms. I ate heavier portions and logged my meals. Every time I walked past a smoothie place, I got the most high-calorie whey protein shake they had. Since I felt weak, I went to the gym. I, a nominally healthy and relatively fit 28-year-old man, could suddenly only leg-press the second-lightest weight. Five minutes on the Stairmaster left me gasping, and I could no longer do a single pull-up because hanging from the bar triggered shooting pain in my breastbone, ribcage, and spine, as did the bumpy Uber rides I increasingly relied on as the MTA became too exhausting to navigate. It was qualitatively different from ordinary exhaustion. The best way I can describe it is a sense of inexplicable frailty and buzzing anticipatory grief punctuated with sudden jolts of urgency: I need to drink juice. I need to be in bed. I counted down the minutes as the driver would close the distance to home. I rationalized that the respiratory virus I had the previous November had actually been COVID despite the negative tests—an illness perfect for such rationalizations due to it being both ubiquitous and unpredictable in its expression. As for the bone pain, I decided it was costochondritis, inflammation in the cartilage of the rib cage that has also emerged as a post-respiratory virus symptom. When I allowed myself to disclose this pain in analysis, my analyst said “everyone has pain. They live with it. It will go away eventually.” I changed my lock screen to the phrase “it will all pass.”
*
On January 26th, my roommate, Coco, and I were scheduled to perform songs from our collaborative album. I now refer to that night as “the cancer show.” My role was easy, all I had to do was press play on a laptop while she sang. I ate two large bowls of a sweet potato dhal to prepare myself for the journey from our apartment in Crown Heights to the venue on the Lower East Side. My friend Ben and I transferred at Jay Street and took the F to East Broadway. Because of the many staircases, it was a more tiring train commute than I had taken in a while. I wasn’t able to hold a conversation on the train, and when we arrived, I was heaving big belly gasps. Foregoing pleasantries, I asked the host where I could get water. After our set, I had breathless conversations with friends that I hadn’t seen for a while. They asked me how I’d been; I was honest that I had been under the weather, but framed my fatigue as an expression of catatonic seasonal depression. This night is shrouded in darkness. I’m surprised nobody told me that I looked and sounded like shit. I was dying—pale, skinny, running out of breath in the middle of confused sentences. Framing my state in terms of mental health induced my friends to respond, “you can call me anytime,” before going to the bar.
It is apt, then, that nobody at the show compelled me to take action. I had worked with Wei, an architecture student, on a weekly basis the previous semester, but hadn’t seen him since. A few days after the concert he came into the Writing Center and acted like he had seen a ghost. His frank reaction jolted me out of my fugue state and prompted me to take initiative, and for this, I owe him my life. After our staff meeting that day, I decided I would go to urgent care for weight loss, thinking “maybe something’s up with my thyroid, and besides, CityMD is around the corner.”
The leukemia subreddit features many accounts of how people came to be diagnosed, and although the analytic relationship distinguishes my experience, similar themes of denial, close calls, misrecognition, and self-doubt recur in these comments. Although there are certain signature symptom combinations, the presentation of this disease is varied, and can consequently be mistaken, at first, for other conditions. I’ve read dozens of these “diagnosis stories.” They share a funnel shape. They have all sorts of different starting points. Slow developing, benign, minor, disaggregated symptoms suddenly become debilitating and people find their way to a blood test, then to a bone marrow biopsy, and eventually hospitalization. People conclude with their current status—how long they’ve been in remission, if they’ve relapsed, how many days since their transplant. Other users comment asking for updates on how the original posters are doing now, presumably because they’re wondering about themselves or a loved one. I’ve developed a habit of looking at the profiles of other acute lymphoblastic leukemia (ALL) patients to see if they’re still alive.
The next morning, I received a call from a technician at the lab CityMD contracts to process its blood samples. In an unprofessional manner, she told me that I was at imminent risk of dying. My hemoglobin was 4.7, and I needed an emergency blood transfusion. The first thing I said to Coco after I hung up was “my analyst has been a massive liability.” I called an ambulance to the emergency room at a local community hospital a few blocks away, where I was placed next to a psychotic patient demanding to be sent home. I listened to his unrelenting, detail-filled syntax as the attending physician fingered my rectum for a GI bleed, tested me for HIV, drew blood, and noted my slightly-jaundiced eye whites. I sent my blood counts to my dad and my sister, who forwarded them along to my cousin, a physician who lives in London. I was moved to the ICU and received three units of blood overnight. The next day, I underwent a CT-guided bone marrow biopsy in a temporary lab reminiscent of a portable classroom, since the hospital was undergoing construction. It was a dry-tap, meaning they couldn’t yield liquid marrow, since my bones were so flush with cancer. Once I was sufficiently stable, my parents booked me a flight to California to continue the diagnostic process at University of California San Francisco, where my dad is faculty; his connections would make it easier to get treated more quickly for whatever I might have. I wouldn’t have to wait long to learn.
As the plane descended, I received an automated email containing flow cytometry results that indicated b-cell ALL. I freaked out, cried for a few minutes, and then went mute with shock. I told my sister about the result in the car ride home—her partner came to get her since she didn’t feel like she could drive. I spent the next couple days in bed while she solicited the help of her friend who works for Covered California to switch my health insurance, and my dad sought a referral for a hematologist. A second dry-tap bone marrow biopsy confirmed the ALL diagnosis and identified that it was the Philadelphia-positive variant, named for the city where this mutation was discovered. The variant at one point offered a poorer prognosis, but is now comparable to the Ph- variant, with some regarding it as a slightly better diagnosis given recent advances in treatment options. All my physical symptoms had been real, consistent with rapidly-advancing ALL. I informed my analyst of the diagnosis in the same text in which I terminated our relationship, our alliance shattered. Other than to pay one final bill, we have not spoken since. I have never been both an analytic patient and a cancer patient.
There is an analytic interpretation of me choosing to end the relationship, already offered by my analyst in a prior session in response to how stubbornly symptomatic I remained: By manifesting symptoms, I was resisting progressing in analysis, resisting growing out of a protracted adolescence. This was not baseless, as my symptoms did develop at a time when I was growing frustrated with aspects of analysis. I grew tired with the increasing frequency, and therefore cost, of treatment, and at times I felt grifted, like when she charged me for timeslots when I was home for the holidays, something I didn’t think she did earlier in our relationship, when I recalled her waiving fees for sessions I missed due to time-intensive exhibition installs or traveling for shows. We had begun to fight about my studio practice.
“I informed my analyst of the diagnosis in the same text in which I terminated our relationship, our alliance shattered.”
I didn’t like how she pressured me to narrow down and focus on a single medium, when I’ve always been drawn to interdisciplinary, conceptual practices; I still feel like I’m exploring, and I’ve generally received positive feedback about the breadth of my work. I felt misrecognized when she suggested I try to emulate the career trajectory of writers and artists whose work I regard as abysmal, like Ocean Vuong and Kehinde Wiley, just because they're financially successful. I found her arrogant when she said she was qualified to offer specialized career advice because she had other patients who were artists, especially when she recommended that I try to market my ethnic background to white curators—behavior that would entail a sort of self-debasement, and also simply would not work. She seemed frustrated when I finally told her that I had other mentor figures in my life who understood me better as an artist, and that she should stick to helping me in other areas to which she was better suited. I felt she was overstepping, her presence ballooning like my bones. I wanted to shout, “get your fingers out of my studio and my wallet!” I did think about leaving, but never for very long. I had a lot riding on analysis, because I had been led to believe that I was a serious patient in need of serious help, and that this was the only way out of my serious predicament. I felt attached to her because I had disclosed dark thoughts and shameful memories that I had never shared before. It had taken months and years to trust her enough to do so. Part of my serious condition was a propensity to self-destruct—fantasies of quitting were clearly a manifestation of that.
Once, when I complained about my leg weakness, demonstrating how I had to use my hands to cross and uncross them, my analyst snapped at what I assume she perceived as theatrics: “you want to stay sick because if you get sick enough you can go home and not work and play video games.” This is exactly what has happened since getting sick. It seems my cancer has freed me back into a cage of Oedipal arrest. The conditions of sickness are not dissimilar to the vulnerability of childhood. I stopped working and have mostly stopped making art. During my first hospital admission, my sister gifted me a Nintendo Switch, and I have since logged dozens of hours on The Legend of Zelda: Breath of the Wild. Almost able to forget my condition, I dissolve into the game’s vast, endlessly traversable terrain. I moved back into my childhood home in the Bay Area, pregnant with memories of family conflict—on most days I compulsively escape into a screen. I’ve returned to vices that I thought I had bracketed and outgrown in therapy. These regressions signal that leaving analysis has not been exclusively positive for me. Chemotherapy uniquely tests and literally corrodes the mind. It may have been smarter to enter with a copilot. I’ve looked into treatment in the Bay Area, but the thought of starting over with a stranger feels somehow worse than going at it alone.
*
As I’ve migrated from the analytic chair to the clinic bed, the vocabulary of the former has been eclipsed by the latter. As an analysand, I thought about myself in relational terms. The idea was that Oedipal entanglements overdetermined repetitive scripts that would play out in new, fractal forms later in life. The treatment was literary: a talking cure produced by a collaborative interpretive overcoming. Blood cancer treatment, on the other hand, eschews language. Instead, the count is supreme; the doctors overseeing my treatment mostly encounter me as a series of numbers. The most important number is the number of leukemic blasts in the bone marrow samples they suck out through a drilled hole in my tailbone every few months, and the presence or absence of blasts in my cerebro-spinal fluid, which will be collected across a total of twelve lumbar punctures, during the collection of which they will also administer chemotherapy intrathecally, as leukemia likes to hide in the spine and lurk the blood brain barrier. I get blood tests two or three times a week while outpatient and nightly while inpatient. They look at a variety of factors, but we mostly discuss the number of white blood cells in my blood, and the percentage of them that are neutrophils, which tells us whether or not I’m neutropenic and therefore at risk of infection. When my hemoglobin and platelets drop below eight and twenty respectively, I get a transfusion. There are also numbers that tell them about my liver and kidney function. And of course, they look for residual cancer, which unfortunately is still present, albeit at trace levels. When my potassium drops, they give me big yellow supplements. Chemo side effects are managed by a combination of acid-reducers, adjuvants, anti-anxiety meds, antibiotics, antifungals, antipsychotics, antiemetics, antihistamines, antivirals, laxatives, painkillers, steroids, and supplements. I do not feel like a narrative subject at all anymore, but an unstable bundle of cells, some of which are deviant and trying to kill me.
“I do not feel like a narrative subject at all anymore, but an unstable bundle of cells, some of which are deviant and trying to kill me.”
I watch a video in which Robin Foá, head of the hematology department at Sapienza University of Rome, says that Ph+ ALL used to be the worst leukemia, and one of the worst cancers one could get: “it was a dismal prognosis, and the only chance at cure was, in the old days, a transplant. Many patients did not respond to treatment.” A landmark change came in the form of a series of drugs called tyrosine kinase inhibitors (TKIs) that have turned some of the most deadly blood cancers into among the more treatable—they are often described as revolutionary or miraculous. Tyrosine kinases are enzymes involved in the regular communication and replication of cells, but the Philadelphia mutation is an “always on” switch, causing cells to divide uncontrollably, resulting in the buildup of non-functional but proliferous immature lymphocytes that crowd out healthy cells and inhibit normal hematological functioning, producing all kinds of symptoms before killing the patient in weeks or months. Ponatinib, one of the newest TKIs, is the centerpiece of R-Hyper-CVAD + ponatinib, the chemo protocol I am on, developed at Houston’s MD Anderson Center under the direction of their department chair, Hagop Kantarjian. “R-CVAD” refers to a cocktail used for a variety of blood and other cancers, containing five types of chemotherapy: cyclophosphamide, cytarabine, vincristine sulfate, adriamycin, and methotrexate; a monoclonal antibody, rituximab; and a steroid, dexamethasone. Hyper- is short for hyperfractionated, meaning I receive smaller doses of chemo over a longer period of time in order to better tolerate it. There are downsides: ponatinib has a black box warning for cardiotoxicity, so as long as I’m on it I’ll be at increased risk for arterial occlusive events like strokes, venous thromboembolic events like blood clots, and heart failure. Ponatinib is also expensive—in 2016, Bernie Sanders called out its old manufacturer for price hikes that put its annual cost at nearly $200,000/yr. At first, my fancy platinum insurance plan doesn’t want to cover it, saying that an earlier generation TKI, imatinib, will be adequate for my treatment. They are wrong—studies show ponatinib is much more effective at preventing relapses. Out of pocket, it will cost about $550 daily for five years. The doctors appeal the decision and my insurer agrees to cover it through 2029. I no longer feel like a narrative subject, but like a dependent of a vast multinational pharmaceutical supply chain and byzantine insurance infrastructure. I depend on these behemoths to deliver to me a precise molecular compound that slots onto the Philadelphia chromosome like a sheath, stopping the cancer from detonating inside of me, lest I end up like the Eraserhead baby.
The analytic community might say that my analyst's conclusions and interpretations would be true for most cases, and that I was the rare exception no analyst could be expected to catch. I think many would also say I was failing to grasp nuance in her interpretations. Others might say I afforded her too much authority. Nevertheless, the facticity of my existence, sitting in front of her four times a week, hemoglobin in the single digits, in a state that my student apprehended as shocking, is to me, damning. I am not writing only out of spite, or rage at her wrongness. In the literature I’ve reviewed, organic illness must be ruled out before a symptom is declared psychosomatic, and this step of initial credulity seems to have been skipped. In retrospect, my analyst seems to have afforded somatization a primacy that is idiosyncratic to her clinical purview. I recall that when pressed, she said studies show autoimmune conditions derive from rifts in maternal attachment, which strikes me as fanciful. Though now few and far between—they crested in postwar Germany— psychosomatic explanations for cancer have never gone away. Sontag wrote about notions of a “cancer personality” that persisted into the 1970s, Australian psychiatrist Ainslie Meares hypothesized that psychosomatic reactions “operate in conjunction with the known chemical, viral, and radiational causes of cancer,” and a study published in 2007 in an analytic journal posited cancer as a “defence against depressive pain.” I scoff at these too. Cancer is to me a quintessentially organic illness. But I don't even know if I would have sought medical attention any sooner had my analyst not steered me towards psychosomatic explanations. Maybe I sounded like a liar, because some symptoms would flare up and die down intermittently. My friends assure me I have the right to be furious.
My wager is that there is a failure of analytic practice to be accounted for—a phrase whose meaning remains imprecise from my standpoint as an analysand—but where I am unable to explain, I’ll settle to implicate. In doing so, I can start to develop a grammar for the aporias and gaps between the reality of my cancer and the rationality that rendered each analytic hour a gaslighting session. That said, at no point was I ever hypnotized. Ultimately, I am trying to delimit my culpability from hers, and coming up short. These are my aporias, distinct to my situation. But they reveal issues in the field that may have consequences for when sick people seek mental health treatment. There is something wrong about how my analysis proceeded during January, even if I lack the syntax to express its wrongness in expert terms. Everything became inverted—the illuminative dimension of analysis became occluding, obfuscatory. As the lights dimmed, I remained vulnerable and trusting, holding my analyst’s judgment in high esteem. I afforded her too much authority, but to an extent, an asymmetrical power dynamic is necessary for the analytic relationship to function, and this remains one controversial aspect of the field: the analyst has access to a master discourse, their entire presence justified by the patients’ opacity to themselves. As I understand it, that’s what you pay for. More often than not, I afforded her the last word in our sessions. The consequences almost cost me my life. The result is a newfound deep suspicion of the analytic frame as limited, risky, and an impediment to my health—in short, a producer of suffering.
There’s no shortage of “bad therapy” content online, in which people recount disillusioning experiences with practitioners who come across as irresponsible and at times actively harmful. There is a subreddit for “therapy abuse,” a “Very Bad Therapy” podcast, and recently a scathing article by a former child patient of a famous Kleinian analyst circulated on social media. A friend pursuing an MA in Psychoanalytic Studies read a draft of this essay and reminded me that the scandal of therapy that hurts rather than helps goes back to the minor but enduring posthumous scrutiny to which Freud himself was subjected: Jeffrey Masson’s infamous accusation that the founding tenets of psychoanalysis contributed to the obfuscation of widespread child sexual abuse in 19th century Viennese society. No matter, these histories remain marginal because the field continued to develop, outgrow, and consolidate beyond its controversial origins, and its fundamental insights remain ironclad. Today, analysis is enjoying a resurgence because it simply works. Many of the disappointed customer testimonials online read as unconvincing, the result of outsized expectations, impatience, people unwilling to work, or deep-seated personality pathologies that just seem difficult to treat, particularly when you factor in the broken social structures that constrain and overdetermine patient outcomes.
“In retrospect, my analyst seems to have afforded somatization a primacy that is idiosyncratic to her clinical purview.”
As I recount my own story, I am wary that the roles of victim and victimizer are too stable, incongruent with a dynamic that was relational. But when I try to push the thought further, my mind draws a blank, the analytic relationship remains elusive and unthinkable. Where I used to attend analysis to ask “what happened at home?” I now sit at home wondering “what happened in that office?” I can tend to think in black-and-white terms and am prone to devaluing relationships after they’ve ended. Some parts of this essay, which has been written over the course of months in the brief windows of time when I’m cognitively sharp enough to write, read like an exercise in devaluation of my analyst. I think it’s inarguable she showed poor judgment, but there’s a way to read her as vindicated, and even virtuosic: maybe I delayed going to the doctor because, although analysis couldn’t stop the blasts from proliferating, it actually was treating the pain—that’s not nothing and not enough, and returns me to a conception of analysis as something that can turn, ominously, into palliative care, unbeknownst to both the patient and the analyst.
But we can't both have been asleep at the wheel. My compulsion to pack my account with evidence betrays how a part of me still finds this whole sequence unbelievable. My constant hedging, and my adoption of a somewhat forced posture of credulous ambivalence betrays how I anticipate disbelief from others. Analysands are, almost axiomatically, unreliable narrators. Gender and race further distort interpersonal perceptions that are already constituted through degrees of misapprehension and projection. Cards on the table, I hate my former analyst. I think the particular modality of this therapeutic relationship bears some responsibility for my delay in seeking treatment—how much is impossible to know, but I think there should be avenues of recourse through which this could be adjudicated and through which she would face consequences. That malpractice even exists as a concept endorses the notion that iatrogenesis—defined as “the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence”—is something that can and should be subject to an ethical-legal rubric. Maybe these structures already exist. I’m not going to pursue any of them, because I’ve got a plate full of new problems. But if I did, and others did, what would it look like in aggregate? A single bad apple? A minor body problem in psychoanalysis? A total legitimation crisis?