Essay: Psychotherapy With Diverse Populations

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¶ … Diversity

Using the Memoir as an Instrument for Culturally Driven Psychoanalysis

Cultural Assessment

The presence of lifelong emotional dissonance may be presumed to reflect the impact of a single trauma or the presence of some internal psychological imbalance. What is compelling about the memoir provided by Lucy Grealy (2003) is the degree to which it dispels these assumptions, instead casting our focus toward the impact that cultural dimensions level on one's psychological condition. The author and subject of the memoirs entitled "Autobiography of Face," Grealy suffered from a rare form of cancer called Ewing's Sarcoma when she was nine. Though she beat the disease, the treatment required part of her jaw to be amputated, leaving her visibly disfigured and scarred with a sense of isolation and difference throughout her life. Above all else, the text is a stunning demonstration of the psychological conditions which may be prompted by a tragic series of personal experiences and which, given the sociological realities of human experience including friendship, love and family, may be seen as perfectly natural responses to a situation. Indeed, the memoir approach taken by Grealy is valuable for the insights which it provides into the perspective and cognitive realities facing a person whose physical attributes have consequently foisted psychological dissonance upon them.

The discussion here highlights the relationship between the subject's otherwise fully developed sense of self and the various insulating mechanisms which have protected her from the perceptions of others. What is perhaps most striking about the subject is her relative awareness of the thin line between the judgment of others and her own internal discomfort. Indeed, one dimension of her case that bears noting is her fairly well-developed sense of self-awareness and how this has correlated to her experience in the world. To an extent, her isolation is simultaneously foisted upon her by others and formulated by her own impressions. As the author tells of her interactions with other children while working her 'pony parties,' "through them I learned the language of paranoia: every whisper I heard was a comment about the way I looked, every laugh a joke at my expense. Partly I was honing my self-consciousness into a torture device, sharp and efficient enough to last me the rest of my life." (Grealy, 6-7)

With respect to her cultural experiences, it is clear that Grealy's physical appearance and its resultant feelings of being an 'outsider' were only further compounded by her family's financial woes. The pony parties would serve as a way for the subject to work even as the privileged children around her played and enjoyed indulgent birthdays. This highlighted a sense of distance from the affluent suburban children who surrounded her and, in her estimation, who judged her as different. As Grealy's test reports, "my feelings of being an outsider were strengthened by the reminder of what my own family didn't have: money. We should have had money: this was true in practical terms, for my father was a successful journalist, and it was also true within my family mythology, which conjured up images of Fallen Aristocracy. We were displaced foreigners, Europeans newly arrived in an alien landscape." (Grealy, 8)

Grealy goes on to indicate that had her family been possessed of the wealth of others, it would not have been spent on some well-manicured suburban house. In this respect, she sets herself apart from the materialism of the suburban lifestyle both as an outsider and as one standing in judgment of the lifestyle. This may be deduced as a simultaneous sense of cultural superiority and resentment. Certainly, this is an internal contradiction that raises some questions for us. Namely, one is inclined to consider further the matter that Grealy's feelings of isolation are justified by the behavior of others. Moreover, there is a constant struggle which cannot ever be practically overcome to maintain a sense of confidence and happiness in the face of these isolating behaviors.

According to Szymanski & Gupta (2009), Grealy's well-developed sense of self may be viewed as being confounded by her struggles to over the feeling that others possess a distinctly internalized prejudice toward her. This has resulted in a decided state of depression. As Szymanski & Gupta indicate, "separate but parallel bodies of research have theoretically and/or empirically linked various internalized oppressions (e.g., internalized racism, heterosexism, sexism, and classism) to poorer psychological health among their respective minority subgroup." (p. 110)

Even as Grealy has grown older and found herself less in the vulnerable positions of school and the playground -- where children are not withholding in their taunts and leers -- the degree to which she could still feel the curiosity, revulsion and disinterest of others would have a defining impact on her psychological state. A particularly devastating passage of Grealy's memoir describes her initial experiences during chemotherapy, including details on the experience of going bald. She describes convincing herself that the temporary baldness was the extent of her physical difference, and that this would eventually pass. Accordingly, Grealy remembers that "as the teasing continued, both from strangers and from the very boys whom I'd once regarded as friends, I began to suspect that something was wrong. I identified the problem as my baldness, as this thing that wasn't really me but some digression from me, some outside force beyond my control. I assumed that once the problem was solved, once my hair grew back in, I would be complete again, whole, and all of this would be over, like a bad dream. I still saw everything as fixable." (p. 106)

This lends a basis to the tragic sequence of events that would ultimately mark the subjects life. Simultaneous to her physical deterioration, her twin sister would serve as a false mirror into what she might have looked like absent her cancer. This layer of familial distinction adds yet another layer of personal cultural dimensionality to the way that Grealy would experience her situation. Ultimately, Grealy's literary success with the text at the center of our discussion would be overshadowed by her insecurity with her physical appearance. A life of attempted facial reconstruction surgeries would cause a fatal addiction to prescription painkillers. Her accidental overdose raises a number of treatment questions that might perhaps have been asked as a consequence of her nakedly revealing memoirs.

Part II: Psychotherapy Questions

A major question that comes to the surface asks to what extent following the original 1994 publishing of her memoirs Grealy had sought psychological counseling with respect to her cosmetic insecurities. As a therapist, I would first ask her how wiling she was to renewing a discussion about how her physical appearance makes her feel as an adult. This approach would be underscored by Leary's (1995) notion that "psychoanalytic treatment itself has undergone something of a revolution as of late. New approaches to psychoanalytic process emphasize the way in which the analytic encounter is profoundly relational. Meaning is not something that is exclusively discovered or encountered. In certain respects, analytic reality is now understood by many to be jointly constructed and negotiated by the analytic partners themselves." (Leary, 132)

Grealy's intelligence and self-awareness might have made her a subject with a great capability to work with the counselor in constructing a treatment path. In her own text, Grealy acknowledges unabashedly that she had adopted multiple internal strategies for accepting and adapting to her situation and its permanency. Still, it seems that perhaps the proper questions were not asked with respect to her experience in American and suburban culture. The materialist world in which she lived, referenced frequently in her text, seems an area ripe for consideration where her own discomforts are concerned.

This raises another question which I might have breached in psychoanalysis with Grealy. Namely, I would ask in which ways her cultural differences might have prepared her better than her peers for her unique experiences and in which ways these might have only further magnified her isolation. This question is prompted by research on the need for a multidimensional cultural approach to treatment. According to Croteau et al. (2002), it had previously been a failure on the part of many counseling-related disciplines to adopt a multicultural perspective in implementing treatment. As a consequence, little discourse had been held concerning the way that cultural experiences and contexts will have a significant bearing on social and psychological interaction with and interpretation of events, people and places. Therefore, in cases such as that concerning our memoir subject, there has been a failure to contextualize such experiences even to the suggestion that some aspects of her psychological disposition have been likelier because of these conditions. The discipline is coming more to acknowledge the way that these circumstances impact treatment needs however. Croteau et al. find that "the multicultural literature in counseling-related disciplines has typically taken a unidimensional perspective, focusing only on a single social/cultural group status. The multicultural literature is 'just beginning to attend to the interactive effects of multiple cultural identities." (p. 239)

As this relates to our… [END OF PREVIEW]

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