https://youtubetranscript.com/?v=GbYf0b5DfL8
Thank you. Welcome everyone to voices with verveky I’m here with Peter to Plinsky. He’s a psychiatrist, and Peter reached out to me via email, and he was relating a particular case that he wanted to discuss with me because he thought it was pertinent and relevant to my work and this community in this corner of the internet. As severely King calls it, I believe we’ve now even got a hashtag around that on Twitter. And so, I was impressed by what Peter said. And so I’m going to turn things over right now let him introduce himself, give a little bit of his background and then why he’s here and what he thinks we is pertinent for discussion so welcome Peter. Thanks very much john. I’m just thrilled to be here, and really pleased that you accepted my proposal to to talk about a case. I work as a psychiatrist, and I guess to sort of put my story in a nutshell. I feel like psychiatry has trained me to to to do a lot of valuable work, and it’s given me fantastic opportunities to get involved in patients lives in a very deep and meaningful manner. I think that one of the troubles that I’ve had and I’ve resonated with what Greg Henriquez has said to you and some of the conversations you’ve had. He was talking about the psychological institution. And for me I feel something similar in the psychiatric institution here in Canada, which is that there’s this sense of maybe limitation and I don’t want to sound too grandiose when I say it because I owe so much to my colleagues and to, you know, that my training and the whole field that I come from, I owe so much to it. I feel like it’s given me so much opportunity and a fantastic living and livelihood, and the opportunity to help people, but this sort of sense that there’s a scientific paradigm that you need to fit in so that colleagues and so that the scientific community can can treat seriously what goes on, there needs to be evidence. And, and in particular when it comes to the actual kind of clinical work. It’s felt like the boundaries of confidentiality has significantly affected my ability to, you know, take some of what I want some of the value that I’ve gained some of the wisdom some of the pearls of wisdom that I’ve picked up over the years of being a therapist, you know, and I feel somewhat shackled and unable to spread that as much as I would like. So this feels like it could be one of the first kind of opportunities for me to kind of reach that those walls of my office and speaking with you today feels like it’ll be a. Well I’m just so excited for the opportunity to talk about this case and talk about some things that I think psychiatry, or even scientists may struggle to kind of fit into to grapple with conceptually. But what I hope to talk about is something that’s deep and possibly an important route to healing. That sounds excellent. That’s an excellent proposal. And so you’re you’re the format you suggested to me is, you know, you’ll first sort of talk about this case and what happened. And just to foreshadow the one of the things I see here that really intrigued me, I mentioned to you this to you before we turned on the cameras is this case involves like an intersection of the therapeutic with the mystical and the dialogical together, and I’m very intrigued by that sort of that meeting point. And so why don’t we start by you, you know, presenting what was happening in this situation, and why you think it’s important to discuss it. I think it’s really important to to to discuss it for sure. And in a nutshell, what was happening you know we’ll get into detail I think, but just to sort of try to summarize it. This is an individual who I’ve been seeing for 10 years of psychotherapy. It’s person, you know we’ve used some medications she’s she’s been in the hospital in the past, but it’s a person who’s really had some terrible trauma and has some very significant burden of mental illness, if you will. And what one fantastic, you know, magnificent inspirational thing that I that I’ve that I’ve learned is that, you know, even if you are traumatized to your core, which I believe this person is I’ll call her Dora, which is a protector, not her real name. Dora, despite the fact that she has deep trauma to her core. She still maintains this capacity for connection. And I would say that what connection is in this very basic way is, is, is the, the raw materials with which we can engage in a treatment with somebody. You know, and so even though many of my colleagues I think might look at her case and kind of say, she’s kind of too far gone or this is sort of like, this is a, you know, this is somebody who’s kind of, perhaps some people might even think about suggesting she go to made like medical assistance in dying, which is something that legally available to individuals in Canada with a primary mental illness as their underlying medical condition in March of 2023, you know, so that so that feels like that’s part of the urgency of why I bring this case, because maybe tough problems, maybe we need to just sort of find a quick solution and made like, you know, ending these people’s lives feels like a solution. At the same time, in my opinion, what it is, it’s also the end of the possibility of connection. And for me, I think a lot of healing can come through, just plain old connection as and as you might call it dialogue. So, yeah, I’m very interested. In fact, I’ve tried to go back to the Greek and call it DL logos in terms of the sense of that, as opposed to just a conversation, like more like connection and communion and conversation than just conversation. So what, what does that mean? You’ve had a lot of experience with this and it’s standing out in your mind. So I you know, this this notion of connection is very important to me. It to well, sorry for this pun, it connects to a lot of the literature about meaning in life for a statistically normal people. So, I you know, this this notion of connection is very important to me. It to well, sorry for this pun, it connects to a lot of the literature about meaning in life for a statistically normal people. Well, you know, that sense of connectedness is very predictive of how meaningful they find their lives. And so what like a little bit of the phenomenology, what does that connectedness mean? What does it feel like to you? And like, what’s happening? How’s it unfolding for you in your experience in your awareness when you sense connectedness as opposed to when you sense it lacking or reduced? But you’ve really helped me with this and a lot of the language that you’ve been using. So there’s sometimes that you’re having a conversation with somebody, you know, and it feels interactional or even transactional or like turn based. There’s times where in my personal life, I mean, I’m going to try to focus on my clinical work. But like, so there’s some patients who I see where trying to have a conversation that’s got a flow to it is like trying to squeeze blood from a stone. You know, there’s some people where there’s a mechanicalness or there’s a, you know, there’s an absence or maybe it’s a withdrawal. I feel like I need to work really hard in order to reach out and try to engage these people. I feel like I’m expending tremendous amounts of effort to empathize, to enter into their world and to think of things to say, like something that would interest them or something that would hook them or something that seems relevant to them, something that they said last week to just keep a conversation going. In contrast, somebody who I feel like I’m connecting to, I feel like there’s something very different. It’s like there’s an effortlessness. Rather than doing something to someone, rather than strategizing, rather than even implementing techniques, it feels more like there’s just a dwelling with. Right, right. To kind of put it in a nutshell, it’s something like being with rather than doing to. Right, right, right. Yeah, and I’m really fascinated by this because so much of what medicine is all about is doing to. Right, right, right. Yeah, if you’re a doctor, you’re a pillar of society, you’re paid well to be an expert, to have a command of knowledge and you utilize this knowledge and you use the healthcare system to implement treatment strategies that are evidence-based, that are compiled by teams of researchers on a national level. It’s like these guidelines are handed down and it’s almost like an algorithm that you enact. Yeah. And through your interaction with the patient, it feels like you’re a cog in a machine of sorts. Right, right. There’s a unilateral sense to it. There’s a doing. There’s a my value to you is in what do I do to you? I’m gonna fix you. And this is a really strange thing to hear as a psychiatrist. Somebody wants to say, fix me. And it’s like, in psychiatry, I think it’s a lot, especially in psychotherapy, in psychodynamic psychotherapy in particular, I would say, nah, it’s not unilateral. It’s not about me fixing you. It’s about us participating in something. Right. Yeah. And when we’re really sort of connecting in this sort of de-logo’s manner, I think that there’s so much healing there that I feel it’s strange to make money from participating in that because I don’t feel like it’s my skills. In fact, here’s sort of how I paradoxically kind of sum this up. I feel like the opportunity that being a psychiatrist and working in the medical system affords me is it’s this sort of structure that I have in order to put me in touch with people who need help. But then we use that scenario to deconstruct the structure. And in a way, instead of the top down doctor patient thing, it feels more like there’s two people in a room, or even the boundaries feel like they blur. And miraculously, it feels like healing kind of results from that. And I feel like I can’t take credit for it almost. I don’t deserve to be paid for it, but it almost is like an honor to participate in it and a wonderfully meaningful experience to participate in. Yeah, yeah, that’s, Christopher, Master Pietro and I have sort of tried to revise the notion of a logos, this dynamic goal self-organizing process that’s much more the agent that either you or I in, like you said, so it doesn’t even feel right to take credit for it because both people get to a place they couldn’t have gotten to on their own kind of thing. And what’s interesting about that is like this being with versus doing to, because I mean, there’s two, there’s also health and medical anthropology basically saying the Western model has lost the being with through its overemphasis on doing to. And then the existentialists say there are many situations where there’s nothing to do other than to be with somebody. You confront somebody who’s in deep grief, they’ve lost a loved one, trying to do something to them is completely inappropriate. It’s just not responsive to their humanity. And you have to, and this sounds like if all you think of is doing to, being with just sounds like, well, that’s just a lack, an absence, but there’s very much a presence in being with, like when you’re being with somebody who’s in grief, that’s a very active thing to be doing, even though you’re not doing anything to someone. So I think you’ve put your finger, I hope I’m helping you do what you said. You said you wanted to broaden stuff out and make more connections. I think you put your finger on something really, really important. This notion of connection and this mutual indwelling, this flow of relevance, realization, people are, I’m becoming more relevant to you, you’re becoming more relevant to me. All of that is taking on a life of its own. I think, yeah, I think that that is, I think that is more important. Sorry, I’m not trying to diminish what you do, but I think it’s more important than just the therapeutic context. I think this is something that the culture as a whole is hungering for, this kind of connectedness with each other, even with themselves and with the world. So Dora somehow maintained this capacity. And so how did that afford- That’s the deepest part of all of us, you know? Yeah, yeah, well said. I mean, I think it’s a good contender for a modern version of the word soul, our capacity to enter into dialogos in this fashion. So, well, let’s use it that way then. So Dora’s soul was still functioning, even though she has lots of, I’m reminded of Conrad. He does the opposite where he said, you know, he was clear in his mind, but mad in his soul. He was exactly the opposite, right? The great villain of Heart of Darkness. But so although Dora is significantly mentally distressed, if you’ll allow me, her soul is still functioning in this manner. And then I take it that the experience you want to relate to us touched on that in some profound way between the two of you, is that correct? I think so. I mean, I can’t speak for her experience. I just experienced it from my side. And yet there’s this very strange parallel process, which is that though I don’t know, I’ll tell you the story. We were on the phone. And so even though she wasn’t in front of me, I wasn’t able to see what the impact of the session was on her. I found subsequently that it was a profound impact that the feedback she gave me was that my presence, my willingness to be with her was the mechanism of action, if you will, like that was the secret ingredient that was very impactful for her. And she had a stepwise decrease in her suicidality of subsequently. And she’s a chronically suicidal individual. So it’s a- Oh, great. Yeah, so it’s a significant, I don’t wanna say, I don’t wanna say too dramatically because she’s still got challenges. And even at present, she’s struggling as far as I know. So my heart goes out to her, but it does appear that there was a significant therapeutic benefit. Yeah, so as I was mentioning to you before we turn the cameras, I think often judging this in terms of all or nothing, cure or not cure is inappropriate. And I was suggesting to you, we should more adopt the language of amelioration and affordance. Is her loss of agency being ameliorated and is it being restored? And she’s flourishing a little bit more than she was before. And I think that’s a very valuable thing to note. So what actually happened in the conversation that led to this change? Why don’t I start, why don’t I take a few steps back and sort of tell you a bit about her and tell you a little bit about our work and then bring us into the- Please, that’s great context. Please set the context, yes. Oh, forgive me. She’s 40, 45 perhaps, individual, born and raised in Winnipeg. So she’s a victim of incest. Yeah, yeah. And it feels like the way I would describe it is it’s like a massive conspiracy against her spirit. It’s amazing that she sort of survived psychologically or physically for that matter. But from early on, I don’t wanna be too graphic, from six weeks of age in her life as an infant, there’s photographs of her body and it’s sprawled, it’s like pornographic images. And her mother apparently signed and dated the back of these photographs as if they were just regular childhood photographs. And so years later, when she stumbled upon them in a family album basically, or in a box in a closet, there was multiple levels of shock because here’s this horrible thing that happened to me so long ago, earlier than I could even remember. And even my mother, but I think her father was the perpetrator, but her mother apparently participated or was unable to protect her from it. And for reasons that she’ll never really understand, it’s like she was selected to be sacrificed to the father, whereas her sister was with her mom, protected, safe. But Dora was sort of chosen to be sacrificed, if you will. And she was sold into child prostitution rings, I think from age three till 16, something like that. So horrendous, you know, like really, like I don’t know if it gets much worse. Yeah, yeah. It’s much worse. So we can kind of, I suppose, you know, take that and we’ll try to move on, but it’s heavy, right? Yes. So the diagnose, if you want, from a diagnostic perspective, she’s somebody who maybe might be diagnosed with borderline personality traits. Of course, yeah. Yeah, difficulty of identity disorder, depression, she’s had eating disorder, she’s sort of had, you know, a laundry list of psychiatric conditions over time, anxiety, panic attacks, you name it. Yeah, yeah, yeah. Yeah. So I took her on in psychotherapy. I was a student, I told my supervisors that I was interested in therapy and my supervisor said, you know, here’s one. You know, he gave me a bit of a warning. This is an individual with dissociative identity disorder. It’s not a small project. This could be a lifelong, you know, like buckle up your seatbelt if you’re gonna take this one on. And I was young, I was keen, and maybe you could say I was ambitious from a psychotherapy standpoint. I felt like that’s kind of my direction. And so we went for it. And it’s been a wild ride for both of us, both she and I. And I’ve made a lot of mistakes over time and she’s seen me grow in my learning, you know, and she’d see the influence of each supervisor that I had as I went on. And it’s so interesting to reflect back because we’ve made a lot of progress and she’s seen me grow. And I feel like there’s a connection and closeness that when we’re talking about boundaries and professionalism, it’s quite a bit closer than what many doctors and patients might have. So, you know, so it’s a bit of an interesting, well, a very interesting relationship. The other thing to mention is that she was in an abusive relationship. Of course, oh my God. Or let’s at least say there were abusive elements to the relationship. So, and this is around the time that COVID hit Canada. She was ready to escape from her husband and she did so. She ended up in a women’s shelter and she found government supported housing in a small town, a couple hundred kilometers away. Because of COVID, the government supported psychiatrists shifting to virtual appointments. Instead of being in person, we were able to actually continue our sessions basically uninterrupted over the phone. And so the case or the session in particular I’m gonna tell you about took place over the phone. Right, right. It was April of last year. It was plus five. I was working from home and I remember the temperature was quite cool. Right. Dora had run out of data. So we were not gonna be able to meet via Zoom as you and I are meeting now for our virtual appointment. Instead, we were gonna have to use the phone. However, I don’t have good reception in my house. So off I go into my unattached garage. And so I remember the temperature quite clearly. I was wrapping up and I could see my black house. I was talking with her on the phone. And this is when this sort of very powerful session. Can I just intervene there? I mean, there’s work I’m doing with a student who he’s just did an independent study project with me. We’re seeking publication. Putting people into colder environments actually makes them more conducive to pile of erection and chills and thrills. And that makes them more open to awe. So the fact that you were in a chilled environment is probably not coincidental. I’ll have a lot to say about awe and chills because I had plenty of them during the session. So that there’s already really relevant to some emerging research. So please continue. Oh, that’s fascinating. So we get on the phone and she had been struggling for quite a while. Cause as I said, she had moved to this small town in the south of the province, a couple hundred kilometers away, but she was not thriving. And so the beginning of the session, she was telling me just about how rough life was. Even though there was a beautiful lake, just sort of a stone’s throw from her front entrance, she hardly got outside at all. She got a stalker, somehow they found her. She was having panic attacks when she’d go to the grocery store. And recently she explained how she was hungry, her cats were hungry. She went to the grocery store, but because her visual image was swimming in front of her eyes due to the effects of panic, she didn’t even know what she was buying. So she came home with random items and the wrong cat food. And I mean, she just, she was to fill out forms for welfare. So really like, it just felt like life, you know, she had escaped her husband. She had gotten through this horrific childhood and here she ends up in this place, possibly into freedom. But unfortunately it seems that her symptoms followed her and she was continuing to really, her life force continued to be kind of withered, if you will. And she was just feeling hopeless and unable to find her way to healing. And so, yeah, this is this opening scenario of my phone call. And I’m charged, as a psychiatrist, as a therapist, I’m charged with the task of fixing people, you know, if I could put it that way. And so this felt like a real tough one, because I’m like, how on earth, what do I do? I’m hundreds of miles away. And I was just to kind of support my own, just to support myself, I was reminding myself of what my strategies are, what my training is. And I’m always going to remember that if push comes to shove, if the person’s really suicidal, if they’re at the end of their rope, you got to do what you got to do in order to get them into hospital, by hook or by crook. You know, I just reminded myself of, I’ll call the police if this goes south, you know, I’ll do what I got to do. But, you know, this is me now talking about techniques and doing too. And so the story though is how I started to connect more with her. And so, yeah, so basically she was saying that she’d been thinking a lot about dying, about death. So it was very heavy, very dark material in the session and talking about death. And she was actually talking about death in this way where she seemed to rather comforted by it. And this is an alarm bell for me, because it made me seem like, yeah. So she was saying things like, death has been a lifelong friend. I’ve walked hand in hand with death throughout my whole life because she’s had multiple suicide attempts throughout her life. Oh, right, right. Yeah, self-mutilation, you know, this has been a common thing throughout her life. And so she had had a lot of experience being on the brink between life and death. And as I was kind of thinking about, you know, how do I make her feel better, you know, I kind of released away from that need for control and tried to join with her a little bit more, made an empathic statement. So one of the things that I said is, gosh, it really seems like you’re talking a lot about death today. And, you know, I have to say that it’s hard for me to accept. It’s hard for me as your therapist to listen to this, to like really let it sink in, because, you know, I guess I’ve just been trained to resist death, you know? Everything that I’ve been taught tells me to control it or to help people or to move them towards feeling better. Right. But she, you know, and so she was aware that she was putting me through some stress. Right. I was kind of sighing. I was kind of trying to show her and like let myself reveal the stress that I was feeling, because, you know, not to kind of guilt trip her, that you’re stressing your therapist kind of thing, but more like, hey, you’re really, you’re actually affecting me. Like I’m hearing this. Right, right. I’m trying to grapple with it and I’m finding it hard. I’m finding it heavy. Best case scenario, I was kind of hoping against hope that she would feel that I’m sharing in that burden with her. But basically the session felt like it kept moving towards more and more darkness. Like she was not going to get, she was not gonna snap out of it. I was not gonna convince her, hey, your life of suffering can be worth it. Hey, don’t worry. You’re all, it’s okay, you know? There was no words of consolation that I could find that we’re gonna do the trick today. For whatever reason, it really seemed like she was just at death’s doorstep and that was it. And then the sense of calmness was quite worrisome. Wow. Yeah, yeah. So any thoughts or questions at this point? So first of all, I’m wondering, so I don’t want you to lose too much your recollective empathy. So, but I’m stepping out a little bit. Like I guess what’s one of the things that’s being impressed upon me is this is, again, this is like what I was talking about earlier about these limit situations within existentialism. Like you’re coming to this place where you’ve gotta move towards like trying to somehow consider, is life worth living? What makes a life of suffering like that worth living? And that it sounds, and I don’t mean, I’m not trying to besmirch anything, but it sounds like the scientific training just sort of falls away. I’m a scientist too, so there’s no anti-scientism in me here. But the point that like the framework just doesn’t have anything for you to offer at this point. Like, did it feel that way to you? Precisely. I mean, it felt like it was all just, it was all thin. Yeah, I felt like any sort of technique that I could use, even if I was successful, get this, even if I knew that there was a technique I could use to like make her feel better, I felt like that would be manipulative. Inauthentic, yes, yes, I get that. I get that, I really resonate with that. So you’ve got this place where you’re resisting any inauthentic response. You’re finding the impotence of sort of your, your scientific technological training. And now you’re at this place with her, and then she’s continues to go deeper and deeper into it. Yeah, exactly, exactly. And so it was interesting because there was a part of me that was terrified. I wanna talk a bit about, I want you to empathize with me a bit, because I was kind of resistant to this process. I was thinking to myself, my God, what if she dies? What if she committed suicide after this phone call? And then what? Is it possible that my colleagues are going to find out or someone’s gonna do a audit? This suicide will be reported and somebody will look, did Dr. Tchaiklinsky do his due diligence? So was he doing an evidence-based treatment? Would his colleagues have done something similar? Could he have done more? And my professional life was kind of flashing before my eyes. Of course, of course. But that was a strange experience because I was thinking to myself, why am I so worried about my professional life? Her actual life is on the line. Yes, yeah, right. So a moral dimension takes over as well, right? But I was struggling with it. And I felt like there was an oscillation that started going. And maybe I’ll refer more to this oscillation, but it’s like I was, there was this protected doctor with the clinical coat who’s protected and who does good. And if the patient doesn’t get the help, then they’ll survive. But then there was another part of me that was really involved and really there with her and really connected with her and feeling that pain with her or feeling bad that I would put my own pain above hers. So that was a strange experience because I was thinking, boy, I feel kind of petty. I feel some pillar of society. Here I am thinking more about my job and the money that comes along with that. Again, not to dismiss that too much, but when it comes down to it, she was actually hanging on the brink of life and death. And so, yeah, this is what I was struggling with. And the self-awareness kept kind of jostling me. It was like, yeah, like the moral dimension, I think. Is there a possibility that, I mean, she’s sort of getting you to confront in this deep empathetic bond, the phenomenological mystery of death. And maybe you were also reaching for anything analogous, what would be analogous in your own life, which would be like, you even use the phrase, the death of your professional life. And so, it could be that, because we do that, right? One of our, I guess, cognitive issues defense responses or something like that is, we try to convert confronting a mystery into, that provokes existential, not pathological, but existential anxiety into a more target-focused fear that we can then do something about, that we can problem we can solve. And what I find interesting is, you’re sort of vacillating between those two in a really profound way. I’m sorry, I mean, this is a compliment. You’re almost like a character in an existentialist novel, right at this point where you’re wrestling with these two things. That there’s a part of you that wants to say, oh, what really matters is this problem I’m facing. And then another part of you goes, no, no, no, you’ve got to go back to her, and she’s confronting something way more profound. I think that’s really, really, it’s exemplary. It brings into a kind of clarity, an issue we, and this is not to trivialize it, but it brings into clarity kind of an issue we all can, or if Kierkegaard’s right, we should be facing throughout our lives, right? So I think there was something deeply human, I guess I’m saying about you wrestling with it in this way. Beautiful, I’m loving how you’re resonating with this. I feel like you’re drawing out really true elements, and some elements that not even my colleagues kind of grabbed onto. So I’m really appreciating this, this dialogo at this point. And yeah, so you’re reminding me about, yeah, another angle that kind of was revealed to me in all this was admiration. I felt like I was looking up to her at some point. Right, right. Because here she is with this calmness facing death and facing the prospect of her own annihilation. And here I was quivering with fear for possibly making her a stake in my job. And so I’m like, wait a minute, I actually have something to learn from her. That, that’s a moment, right? That’s a genuine moment of dialogos when you get the realization, the insight that there is something really to be learned from the other. That’s profound. That’s a profound moment there. Absolutely, absolutely. You know, if you think of the stereotypical psych patient, it’s easy for a stigma to kick in, and many people can kind of think of an example of somebody who’s got a psych condition and a homeless person or whatever. It’s easy to kind of dismiss this whole group of people or to see that there’s not a lot of value there. And what was so interesting for me in this moment and in so much of my work with Dora is that it’s like, oh my God, she’s got so much value to give to me. Right, right, right, right, right. I actually felt like she was my spiritual teacher in this moment, because here she is kind of fearlessly looking at death. And I’m like, man, I could learn something from that. One thing she said amidst her talking about death was also this idea, okay, so we need to embrace death. It’s inevitable. It’s like, wait, there’s something very true and wise. Yeah, yeah, yeah. I’ll take that. I actually took that. But the other thing that she was also saying is that I realized that I am life. Coming from Dora, this is an amazing thing to hear. It’s almost like hearing, it’s almost like when the Hubble Space Telescope was pointed towards the darkest patch of sky, and then lo and behold, there’s all these galaxies that are amidst light from the darkest part of the cosmos. What a beautiful image. Yeah, and so I feel like this is what I saw her do. This is a person who’s been through the darkest that life can possibly offer, and it’s understandable she’d want to end her suffering and die, but at the same time, for her to say that I am life, there was something so inspirational about that. So I felt like I was, these are all the things that I was grappling with on the phone in this cold garage. Yeah, wow. Wow. Yeah, and maybe I’ll enhance the imagery of this a little bit because I was also kind of pacing. I was pacing out in the garage. Yep, yep. Because the garage was dark and dingy, and it started to feel like a tomb. Oh, yeah. And so the symbolism was, it’s like the light was starting to interpret my surroundings on a symbolic level, and emerging from the garage to go outside into this sort of more kind of, like it was a more colorful, vibrant place where I could feel the humidity against my skin. It felt like I was emerging from a tomb into life. And here I was, back and forth, in and out of the garage. Perhaps the key was teetering on the brink of her own kind of decision. Yeah. And it’s good. You’ve got some inactive symbolism going on. So there was almost an element of, I mean, you weren’t deliberately doing it, but you’re sort of almost enacting a ritual because you’re enacting this symbolism of transformation between different states. That’s really interesting. I’m so glad I’m talking to you. This is so interesting. Yeah. And I think psychodynamic theorists would have something to say about that, because whether I was enacting that or whatever, was I doing that intentionally? That didn’t feel like it, but it’s like I was resonating with her on that level, and then that became that level of reality, or like the symbolism of that, we did that equivalence there. Yeah, yeah, yeah, yeah. So I was resonating with her on a mental level, on a conversational level, on a physical level, it seems, and probably on a spiritual level too, right? Yeah, yeah, very embodied. Yeah, yeah. And it was so interesting to watch myself. I was like watching myself, like trying to use techniques to talk her off the ledge, so to speak, but then realizing that that’s not the way. That’s not the way. And so I started actually letting go. How did I start transitioning into that? Yeah, I started to feel like if I’m going to use techniques to keep her in this life, why do I have the right to do that? Why is that my role to do that? Exactly, exactly, exactly. I started to feel like my keeping her alive was an instrument of medieval torture. If her life is completely overwhelming and it’s suffering, like I let myself have the thought, maybe she’s going to die. And I don’t think that was me giving up on her though, but that was me really allowing myself to consider the possibility that that just might be the outcome here. And you know what? That is just what might happen. And what the hell am I gonna do about it? So you’re moving into more of a, and I mean this in the ancient sense of the word, you’re moving into more of a philosophical frame now, right? Instead of just like, how do I do the, what’s the right technique? And it’s like, no, no, what’s actually going on here? What’s my, like, do I have the right to intervene? What’s going on? I like the situation is larger than these techniques in some important way. And so you move into that. And so like, what happens with you when you move into that? Like, did you feel a physical change? Like, you know, that felt sense of sort of a shift in your fundamental sort of framing of the situation? Did you, could you, was there a phenomenological feel to it when that shift occurred? Let’s get into the phenomenology. So I had a, I would describe it as a mystical experience. Oh. Yeah, like the way we got there was sort of this oscillation. You know, I was kind of protecting myself, resonating with her, looking up to her. It felt like my perspective almost was shifting rapidly. And I was kind of going back and forth. Yes, yes, yes. And it’s hard to put this into words. Of course, but you know, I’ll try my best to resonate and help you. I appreciate it. And you know, frankly, when I really let myself kind of get into it, I find myself nearing the brink of tears. And in fact, I did break into tears at this point. So it feels like there’s three things that came over me. A visual image, an emotion, and a physical sensation. Right, okay. The package. Yeah, yeah, yeah. The visual image was this tiny light shining from the deepest dark. Okay, can I ask you something right now? Right, sorry. This is really important. Because I mean, there’s a distinction, right, between the imaginary and the imaginal. And the image is, the imaginary is an image you have in your head, and it’s taking you away from the situation, and you’re playing, and you’re doing that. And then there’s the imaginal, which is imagination for the sake of perception. It’s where the image is taking you into the depths. It’s opening you up so you can see what you otherwise couldn’t see. It’s augmenting your connectedness. Was the image more like the first or the second? The second, absolutely. Yeah, so it’s imaginal, right. The imaginary, you’re making it almost sound, the word that comes to mind for me is like a hallucination. That would be interfering with my experience. Exactly, exactly. This felt like it was my lens into the situation. Right, right, right, exactly, exactly. Yeah, completely. So it’s like the visual image was like, almost like a symbol. It’s almost wrong to call it a visual image, but it’s the best words that I can use. It feels like it’s a way of wrapping up what this was. Yeah, yeah. And I kind of explained it a few minutes ago, this idea of the darkness emanating, or the light emanating from the darkness. And so it feels like a visual image, that here I am, and I’m going to not do it justice if I try to unpack it with language. So maybe I’ll just leave it at that. And then there was an emotion, and it was tearfulness. Now I can’t actually say whether it was joy or grief. And I’ve read about mystical experiences where saints have this joy, these tears of joy and tears of grief, and they live with that. I felt like I tapped into that, because I was just so thrilled at being alive. And everything was just so beautiful to me in this moment. And I felt so overwhelmingly joyful that I was appreciating it so deeply that there were tears coming to my eyes for it. But grief also was appropriate because it’s like this will end. And there’s people in the world who will never have access to such a beautiful, profound experience like what I’m having. Right, right, right. So are there elements of wonder, and awe, where there are like… So obviously there’s the joy, and there’s beauty. There’s a lot of beauty you said here. Is it like the beauty of a great passage from Breithoven, and it’s calling up that sort of sense in you? Is it like that? Is it that kind of beauty? Yeah, when I listen to great pieces of music, I feel I’m the kind of guy who gets shivers up and down. Yeah, the chills, yes, yeah, yeah, yeah, yeah. I have a friend who gets that from food. I find that very interesting. Never got it from food, but definitely a beautiful passage of music will do that. I’m not remembering it quite the same way there, but I will definitely say that I felt a sense of awe. Yeah, it wasn’t like listening to Beethoven, but definitely awe. Good. It’s breathtaking. Like my breath was taking away. I felt like maybe a better description would be being on a mountain top. Yeah, yeah, I was gonna ask you. Is it the… It was taken away by the vista that unfolded before me. It’s called the overview effect, right? So yeah, right, if you get the over… I was gonna say, that’s why I was gonna… That was exactly the next question I was gonna ask. Was it like being on a mountain and getting the overview effect? So yeah. This expansive feeling. Yeah, yeah. It was so strange, because I knew I was just in my garage, but I’m kind of like, everything is amazing. Everything is beautiful. Everything matters. Was there a sense of unity? Because you keep saying everything and then drawing your hands out like this. Was it a sense of everything was all sort of fitting together? Everything matters? Was there… People often describe this as a kind of oneness. Instead of things all being… Everything was connected. Did it feel that way? Yeah, okay, yeah. Really it did. And I felt firstly connected with Dora. When we were on the phone, but I just felt like I was so with her. Like I had let go of so much and I was just being present with her. All this phenomenology I’m telling you about, it sounds distracting, but it’s almost besides the point. It’s the strange thing to say about it. Yeah, no, no, that’s exactly the perfect thing to say about it. Because we ran an experiment in my lab where we were talking about that, right? And all the phenomenology that people usually center all of their attention on, it’s not doing most of the heavy work in how mystical experiences contribute to meaning in life. It’s much more the insight, machinery, the sense of seeing into things and understanding and connecting in a way you did before. And the phenomenology, like you said, we get too focused on sort of the weird phenomenology and not enough on the functioning that’s actually happening there. So I think that’s what you just said is deeply astute. It reminds me, if you don’t mind a bit of a divergence, because I think we can stay on track here, but I had an experience on a meditation retreat that I think is relevant. Yeah. So two things I wanna say about this meditation retreat. Tenday Vipassana Insight. Yeah, yeah, yeah, yeah. Did you go to, yeah, yeah, I know, I know. Yep, very much. Okay, go ahead. It was great. I wouldn’t recommend it to anyone, but if anyone’s inclined, they absolutely should. I generally tell people not to go on retreats unless they’ve been meditating on their own for a minimum of five years. Absolutely, I think that’s fair. Because this was like a marathon of like gnawing back pain and boredom, and one person had a psychotic break out there. Yeah, it can be overwhelming. It can be overwhelming. It’s not for the faint of heart, yeah. Not for the faint of heart. But two things I wanna say about my meditation retreat. One is a peak experience, which again, I’m gonna say it wasn’t the point, but it’s the thing that you remember, because it is the point in a way because it’s the explicit, it’s the thing you can hang your hat on. Yeah, it’s a pivot point. Yeah. Again, there was the sense of oneness. And just briefly, I was walking through a forest path, a woodpecker flew nearby, landed on a tree. Sounds like nothing, but like the experience- I know what you’re talking about very much. Totally, totally. And that sense of moreness. There’s just, ah, yeah, yeah, yeah. Yeah, and just this oneness. Yeah, oneness. And like you said, you’re in that place. It’s an effortless participation rather than a passive reception or an active imposition. You’re just sort of flowing with it. The other way to put it is it felt like a pane of glass had dropped away between myself and- Oh, yeah, yeah, yeah, that, yeah. And it’s like, this is how things really are. This is how things were meant to be. And I’m just finally seeing it for what it all was all along. Yeah, that, yeah, that’s another, that’s a beautiful image, Peter, the pane of glass that we normally don’t see because it’s transparent and then it falls away. We realize that it’s there, like that’s a transparency opacity shift. And then we get that sense of contact and real co-presence. That’s so beautiful. That’s so beautiful. Now, is that experience that- I assume the reason why you took us there is that experience bears on what’s, right? There’s a connection in your mind between that experience while on retreat and what was happening with Dora. Am I right to say that? That’s right, that’s right. And the other thing I just wanted to say briefly about my retreat is that there was a discipline, a culture of discipline that was inculcated into me or that I kind of took on. Yes, yes. I actually think that that’s the point because that is what the real value was of the retreat because since then I’ve been able to use that to motivate and to maintain- Right, excellent, yeah. In meditation practice. But it’s a unique experience that sort of serves as the, I don’t know, it’s the charity. Right, right, yeah, yeah. It’s the charity or something. Yeah. It’s not about altered states of consciousness. It’s about altered traits of character. And right, I believe Dyckman said that. Yeah, these are sort of pivot episodes, but they point to where we start to inculcate virtues and virtuosity and that’s what really matters. That’s what I meant about the insight machinery rather than the particular description of the experience. Yeah, one last thing about the meditation retreat. Somebody asked when we were allowed to talk after these long 10 days were over, somebody asked, how do we know if it’s working? How do we know if we’re making progress? And the response was something like, when you feel more gratitude. Yeah, yeah. And so I think that’s maybe a better indicator rather than, oh, I went to a meditation retreat and I had a peak experience. Yeah, yeah, yeah, exactly, yeah. I’m a more grateful person. Yeah, yeah, that’s what I tell my students. I tell them, does it transfer into your lives? You feel more connectedness and appreciation. And all the senses of understanding and gratitude and valuing, right? And more importantly, that other people noticed it in you way more than you’re noticing it in yourself. Good, that’s great. Yeah, so, but yeah, I did wanna mention all of that because I feel like that helps, maybe that’ll help the listeners kind of appreciate what’s going on for me in this session with Dora because these were not distractions. This all was maybe an effort on my part to articulate how deeply connected I was with her. I was connected. And apparently she was too. So, and that’s the other interesting thing I hope we’ll get to because even though we were separated by hundreds of kilometers, it appears that she may have had a parallel emotional experience. Yeah, I want- I feel like we were in the same place even though we were not in the same place. Yeah, that could be in contemporaneous. So you said there was an image and then there was an emotion and then there was a physical aspect. What’s the physical aspect? Right, so it was the heaviness in the pit of my soul and the fear in my stomach. This was like fear, maybe. But again, to maybe use the analogy of being at the top of the mountain, it’s almost like looking down from a high cliff. Right, it’s precipitous. Yeah, yeah, yeah. It was kind of like a feeling of fear or a feeling of like great pressure. It’s kind of like, Peter, now that you’ve had this experience, do something with it. Right, wow, there’s a sense of demand of being called almost. Something like that. It was terrifying because it’s like, I don’t know what to do with this. I don’t even know what this is. Yeah, do you know that poem by Rilke where he’s looking at the bust of Apollo and he gives you this whole description and then the final line is, you must change your life. You must change your life, right? That comes out of this. Oh, that’s perfect. Like that’s very much how I felt at the end of this. Right, right. But here’s the thing though. Here’s the other piece of the feeling of heaviness in the pit of my stomach. It wasn’t just fear. It wasn’t just a burden. It was also this amazing sense of empowerment. Yeah, yeah. So it’s almost like this crushing weight above me, but also this welling up of courage from somewhere below me. Again, I can’t take credit for it, but I felt like I was rising to this challenge. Yeah, yeah. I want to do something with this. I must do something with this. And John, this is part of the reason why we’re talking today, because I’m doing something with this, Dan. Yeah, exactly. And for me, you did it with your gestures. There’s this thing emanating down on me, this demand, this normative demand, and yet there’s also something emerging and welling up to me to meet it and empower me. That is so appropriate and profound. Yeah, to notice those two dimensions and that they are interpenetrating each other in the heart of your experience. I really admire you for sharing this and also the way that point you just made, that this, De Logos, is part of you trying to address that demand from the empowerment that was given to you by that experience. I’m appreciating you so much right now, John. I mean, your resonation with me is so on point. And again, I’m just feeling a lot of gratitude for this opportunity. Me too. This is exactly what I wanted to do. So, and so that’s the physical. And then you brought in maybe a fourth dimension, which is the interpersonal. You and Dora, you felt like you were both co-present to each other in a kind of a profound way. Well, I think so. And again, cause I didn’t tell her, hey, I had a mystical experience just now, how about you? Not exactly, right? But like we just kind of continued the session at that point, but it felt like there was a shift. As she had been talking about death and I had this terrible sense that she was gonna commit suicide. There was something about me allowing that or me permitting that as if it’s even my place in the first place to permit that. But it’s like there was a release on my part and that seemed associated with a softening up in her tone of voice. Oh, so there was like this, you got some sense that there was like a bit of a reciprocal opening between you opened and then she opened in response. Something like that. And I would love to hear more from her about what her experience was. And in fact, in our psychotherapy, what she and I are up to at this point is I’m encouraging her to do some writing about what her experience was. Yeah. That’s excellent. Yeah, I would like her to contribute to a piece that I’m actually working on. I’m working on writing this up and who knows, maybe I’ll write a book one day or publish this in some way, but I would love for her contribution to be there because I’ve been wanting to hear more from her as to what her experience of that was. The proof is in the pudding though on some level, because I’ve seen her suicidality ease up to a significant degree thereafter. Right, right. So in some way, her connectedness to you or connectedness to herself and her connectedness to her life was somehow shifted or began to shift. Yeah, I think so. I think that’s clear. Here’s one way that she did explain it to me. Through her, we can call this maybe an abysmal sense of self-esteem or an experience having been objectified in the past. She used to live with this palpable sense that she’s a thing, like an item, like a piece of- Right, of course. Yeah, like literally a table. She’s describing. She only sees herself from the third person perspective. Something like that, yeah. Yeah, yeah. Yeah, so there’s been times where she’s just, she’s kind of lived with this, it’s hard to even imagine just how bad a person must feel in order to feel like that, but an object for someone else’s use. Right, right, right. So that’s, but her description of what happened in this session and what’s happened subsequently in a number of sessions where we’ve had this sort of increased sense of connection as opposed to doing to, that she feels like she’s brought to life. And one of her pieces of feedback to me is that she’s like, Peter, or she calls me Dr. Cieplinski. Actually, she doesn’t know what to call me, but she says, you brought a table to life. Do you realize what you’ve done? Like you’ve brought a table. So she has this kind of, she’s not like really verbose or extremely descriptive when she talks, but she can say the most beautiful kind of simply. Yeah, yeah, yeah. That’s amazing. You brought a table to life. And the fact that we use tables as one of our constant metaphors for quantifying and formalizing things, the table of contents and all that sort of stuff. Wow. That’s really profound. That’s my story. I’m really, I’m so glad. Thank you for reaching out. And like, I guess, to do read, which I can, if you do want to write something and you think I could be of some help in that, I would like to help. I would like to help, because I think this, I don’t know what to call it. It’s not even a case study. That would make it sound too clinical, but this, right? Thank you, yeah. This. I think it’s really, it’s something that should be shared. And I understand the tension in you because there’s confidentiality issues, but this is also, it has a, and you’re not, and I understand also you’re hesitant. You don’t want to exploit somebody’s suffering. But on the other hand, this is profound and it’s healing and it’s helpful to other people in a really shareable and expansive way. So I’m just saying, if you think I could be of some help, let me know. I really appreciate that. And I may want to take you up on that. I mean, we’ll see what can come of it. That’s fine. I’m happy to be taken up on it. I, right, right. But yeah, I like, I, in fact, I do think that in some way you should translate this into writing. It’s difficult, especially when you hit the sort of core of that kairos, of that turning, right? Of the metanoia, where all these Greek words make it sound more important. But nevertheless, like what we did here, I think is like, like I said, I think it’s extremely helpful. I mean, there’s a lot of people that are not psychiatric in sort of the diagnostic manual sense, but COVID is making them suffer meaning crisis in a profound way. And it’s exacerbating the meaning crisis in general. And so I just, I guess I’m encouraging you. I think this is extremely valuable. And I understand your completely legitimate moral concerns and professional concerns, but I think there’s a way you can do this so that you can respect those concerns and yet nevertheless address this to a lot of other people that could be helpful to them. And I can only hope that Dora would also be really pleased to hear this. She obviously has my permission to be discussing this with you here today. Yes, yes. Participation in writing also reveals that she’s aware that I’m planning to do some writing and perhaps publishing. And I think that she could not be more thrilled to know that she might be helping. Let me say it this way. With this maid that I mentioned, medical assistance in dying, which is coming, it’s kind of around the corner. There’s a threat to disabled groups of people, people, the downtrodden of society. There’s the threat that there might be this really easy way of having a socially sanctioned, medically prescribed manner in which we can just be done. And there’s something about that that’s very terrifying. And if there’s something that I can do to help encourage people to develop more psychotherapy resources or to instill a culture where there’s greater kind of engagement with meaning and creating a more meaningful life rather than just, stopping suicide. No. Not just reduce suicide. I wanna contribute to the improvement of people’s quality of life and meaningful engagement in life. I totally resonate with that. I think, again, speaking as a scientist, I distrust and you bumped up against, I distrust the scientific framework as being sufficiently adequate to address many of these situations properly. For example, I mean, it seems, and yours is not an isolated case. It seems that in many situations, I hesitate to use this word, but there’s no better one, but sort of the philosophical spiritual hasn’t been tried. We’ve tried all these techniques, but this dimension has not been tried. And that might be the life-saving dimension. That might be the thing that, what I’m trying to say is people might be committing suicide because they haven’t been presented with the meaning that they’re hungering for. And we might be therefore overconfident in our assessment of the adequacy of how we can address these limit situations. So again, I’m not trying- Wouldn’t it be ironic if our scientifically backed healing institutions kind of perpetuated the core of what is actually contributing to the problem? Exactly, exactly. Yeah, exactly. If this sort of scientific paradigm that I was referring to earlier, if we think that the only thing that can have legitimacy or that it can be of value or that should be taught and promoted is this sort of linear, top-down, unilateral doing to by the professional who’s empowered to act upon the passive recipient patient. It feels like even if we have the best evidence of the techniques that do really good, I wonder if we actually might be missing the whole point in a critical way. Because what I think I presented today and what you’ve helped me unpack today was this sense of coherence or cohesiveness or this simultaneity, these sorts of words, these do not really fit with this linear cause and effect that underlies the scientific worldview. And perhaps that’s not the world we live in or at least on a meaning level, perhaps we’re missing the point if we try to think too scientifically and try to control things too much. So that’s kind of a message that I’m really wanting to put out there. Yeah, I guess I totally resonate. That’s what I was saying too. You said it better. What I would say is we can be so overconfident in our knowledge that we neglect the necessary wisdom. And I think that worries me. That worries me a lot about these kinds of things. I’m not saying that medically assisted… Medical assistance in dying, maybe. Medical assistance in dying. I’m not saying that it should be absolutely prohibited or anything like that. But it sounds like this is what’s implicit in that. This is what’s implicit in that. The scientist has all the requisite knowledge and lays everything out. That’s not totally clear. And secondly, the person is the only person, like the person considering it, they have exactly the resources to make this decision appropriately. And I mean, how do we know that? How do we know that they have… Maybe the philosophical spiritual dimension has not been developed or cultivated in the person. They haven’t presented with the opportunity to bring it to bear. And so we don’t know that. That’s just a presumption on our part. And so, yeah, I share your questioning. I think these questions should be really significantly addressed. I mean, it’s almost like there should be a third person there in addition to the scientist and the patient. There should be a person that comes at this from a philosophical spiritual dimension. Well, there’s something really good about that. Yeah, yeah. Yeah, just to sort of fill out what you’ve said just now, two points that I think are needing to be addressed, irremediability and informed consent. Irremediability, can we guarantee… That’s a criterion for somebody to receive… Can we guarantee or can we ever really know that a person’s condition is irremediable? If Dora can even have a significant step-by-step… Yeah, exactly. Somebody like that, then maybe there’s hope for all of us. Maybe that deeply questions the possibility of irremediability as far as some psychiatric conditions. I won’t say all. But, and then when it comes to informed consent, like can we really know in advance what death is or what potential life awaits you if you were to try to hack it? So yeah, so this is sort of my contribution to this dialogue about made. And yeah, I really appreciate your giving me the opportunity to share this with some people out there. Well, thank you, Peter. It’s been great, really wonderful. Deeply impressed by your authenticity and your acumen and like the beauty of… I mean, you were a little bit worried beforehand about being able to do… You articulated things so beautifully and so eloquently and elegantly. So I really thank you for coming on, voice of the Reveke. And maybe we will do some work together in the future. I would appreciate that so much. And thanks again. Thank you, everyone.