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Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Mirror Is for ReflectionA Mirror Is for ReflectionA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst MarriageAgainst Moral 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Values and ScienceCutting to the CoreCyborg CitizenDamaged IdentitiesDeaf Identities in the MakingDeath Is That Man Taking NamesDebating ProcreationDebating Same-Sex MarriageDecision Making, Personhood and DementiaDecoding the Ethics CodeDefining DifferenceDefining Right and Wrong in Brain ScienceDefining the Beginning and End of LifeDelusions of GenderDementiaDemocracy in What State?Demons of the Modern WorldDescriptions and PrescriptionsDesert and VirtueDesire, Practical Reason, and the GoodDestructive Trends in Mental HealthDeveloping the VirtuesDid My Neurons Make Me Do It?Difference and IdentityDigital HemlockDigital SoulDignityDignityDisability BioethicsDisability, Difference, DiscriminationDiscrimination against the Mentally IllDisordered Personalities and CrimeDisorders of VolitionDisorientation and Moral LifeDivided Minds and Successive SelvesDoes Feminism Discriminate against Men?Does Torture Work?Doing HarmDouble Standards in Medical Research in Developing CountriesDown 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Challenged ProfessionsEthicsEthicsEthicsEthics and AnimalsEthics and ScienceEthics and the A PrioriEthics and the Discovery of the UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics at the End of LifeEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Everyday PlacesEthics in Health CareEthics In Health Services ManagementEthics in Mental Health ResearchEthics in PracticeEthics in PsychiatryEthics in PsychologyEthics in Psychotherapy and CounselingEthics of PsychiatryEthics without OntologyEthics, Culture, and PsychiatryEthics, Sexual Orientation, and Choices about ChildrenEvaluating the Science and Ethics of Research on HumansEvilEvil GenesEvil in Modern ThoughtEvil in Modern ThoughtEvolution, Gender, and RapeEvolutionary Ethics and Contemporary BiologyEvolutionary Psychology and ViolenceEvolved MoralityExperiments in 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AmericaOxford Handbook of Psychiatric EthicsOxford Studies in Normative EthicsOxford Studies in Normative Ethics, Volume 7Oxford Textbook of Philosophy of PsychiatryPassionate DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonalities on the PlatePersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmaceutical FreedomPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, 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RightsThe Age of CulpabilityThe Age of CulpabilityThe Aims of Higher EducationThe Almost MoonThe Altruistic BrainThe American Psychiatric Publishing Textbook of Forensic PsychiatryThe Animal ManifestoThe Animals' AgendaThe Art of LivingThe Autonomy of MoralityThe Beloved SelfThe Best Things in LifeThe Big FixThe Bioethics ReaderThe Biology and Psychology of Moral AgencyThe Blackwell Guide to Medical EthicsThe Body SilentThe BondThe Book of LifeThe Burden of SympathyThe Cambridge Companion to Virtue EthicsThe Cambridge Companion to Virtue EthicsThe Cambridge Textbook of BioethicsThe Case against Assisted SuicideThe Case Against PerfectionThe Case Against PunishmentThe Case for PerfectionThe Case of Terri SchiavoThe Challenge of Human RightsThe Character GapThe Code for Global EthicsThe Colonization Of Psychic SpaceThe Commercialization of Intimate LifeThe Common ThreadThe Connected SelfThe Constitution of AgencyThe Cow with Ear Tag #1389The Creation of PsychopharmacologyThe Criminal 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ChildThe Woman RacketThe Worldwide Practice of TortureTherapy with ChildrenThieves of VirtueThree Generations, No ImbecilesTimes of Triumph, Times of DoubtTolerance Among The VirtuesTolerance and the Ethical LifeTolerationToxic PsychiatryTrauma, Truth and ReconciliationTreatment Kind and FairTrusting on the EdgeTry to RememberUltimate JudgementUnborn in the USA: Inside the War on AbortionUndermining ScienceUnderstanding AbortionUnderstanding CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Kant's EthicsUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and 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How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
Survivors of abuse by psychotherapists are very often asked the question, "Why did you stay with the therapist if you knew that the therapy was making you worse?" Or, "If you really were being abused, why didn't you simply leave?" In "You must be dreaming", Barbara Noël tells the story of her therapy with Dr Jules H Masserman, therapy which lasted for more than eighteen years, and only ended when she half-woke from the drugs he had given her and discovered that he was lying on top of her, raping her. Although she did not know until then that he was sexually abusing her, there were other aspects of her therapy that were abusive, or at the very least, potentially harmful and dangerous, but yet she carried on seeing her therapist for all those years. Why?
A variety of different answers and reasons are woven into Noël's compelling narrative. She explains that the reputation of her therapist and his confident manner led her to trust him, which is understandable, given that he was once the president of the American Psychiatric Association. She also describes the heady mixture of fear and hope that she felt at the start of the treatment: fear of the unknown, fear that she really was more mentally ill than she had thought, and hope that she would be able to resolve her troubled relationship with her parents and her performance anxiety.
The suffering that Noël experiences in her therapy is interpreted by her therapist as a sign that the therapy is progressing well: uncomfortable feelings are making themselves known, with physical as well as emotional effects. Dr Masserman gives her Amytal, a barbiturate, intravenously on many occasions, supposedly in order to break down her resistance and emotional barriers so that progress can be made. Subsequently, Noël interprets her itchy skin, headaches and irritability as release of her feelings, but later finds out that they are known side-effects of the drug, caused either by an allergic reaction or too high a dose. The suffering contrasts with the blissful feeling that the Amytal gives her, but another kind of suffering is caused by her therapist's manipulative behaviour with the Amytal: sometimes withholding it, sometimes making her beg for it. Interestingly, Noël acknowledges her addiction to Amytal and also, incidentally, to alcohol, but does not appear to have been addicted to the talking part of the therapy.
Another factor which makes it harder for Noël to straighten out her feelings about the therapy and the therapist is the inconsistency of the therapist's behaviour. For example, he gives her good advice about helping her husband's children and her alcoholic father. Sometimes he is cold and angry towards her; at other times he treats her with respect, "like an equal". On some days he speaks to her sympathetically, as if she is a lost and lonely child, whereas at other times he calls her a spoiled brat. The constant confusion and unpredictability makes it much harder for Noël to decide whether to stay or to go.
Noel tries several times to stop therapy. On one occasion, the therapist responds by offering to cut his fee in half, and, overwhelmed by his generosity, she decides to carry on. At other times, she manages to stay away for a while, but her addiction to the Amytal proves to be too much for her, and she returns once again. It is only the shock of discovering that her therapist has been raping her that enables her finally to end the therapy. At first she feels intense grief, as if her therapist has died and is lost to her forever, but then anger and action take over, and the rest of the book describes her struggle to find a lawyer who will represent her, her encounters with other patients of her therapist who have had similar experiences, and her progress in one-to-one therapy with another therapist, who turns out to be ethical, competent and trustworthy.
It is interesting to follow Noël's own progress towards understanding and dealing with her emotional problems. Her original reasons for seeing Dr Masserman are performance anxiety as a singer, together with headaches, facial pain and voice loss at times, all of which she believes at the time to be emotionally based. After several years of therapy, quite by chance, she needs to see a dentist, and since her usual dentist is not available, goes to a dentist recommended by her friends, who mysteriously seems to know all about her symptoms already, without being told. He diagnoses a jaw dysfunction, treats it, and the physical problems disappear. His attitude is interesting because it is the exact reverse of what Noël initially believes about her problem: rather than emotional problems being the root cause of physical problems, physical problems can be the root cause of emotional problems. Pain can cause depression, and it depletes energy, leaving the sufferer with fewer resources to cope with life's other events and problems. The trouble is, the dentist explains, is that women, in particular, are often assumed to be generating the physical symptoms from unconscious emotional problems, whereas the opposite may be true.
However, Noël does believe that her problems have an emotional cause as well as a physical cause. A theme that runs through her book is that the abuse she suffered as a child set up a pattern which she recreates with her abusive therapist. At the time of starting therapy with Dr Masserman, she has no conscious memory of the abuse, and it is not until she undergoes what she describes as "real therapy aimed at helping me grow" that she begins to discover the secrets that she has hidden from herself.
So, in Noël's case, there is no single answer to the question of why she stayed with her abusive therapist. The emotional problems from her past, addiction to Amytal, misplaced trust in her therapist, ignorance about what took place during her drug treatment, ignorance about what should constitute good therapy: all these seem to have contributed to the events she describes in her book. No doubt her therapist's status and confidence also made it difficult for her to admit to herself what was happening, but perhaps it was the strength of the patient's needs, rather than the reputation of the therapist who treated her, that propelled her into a situation where normal judgement and rational decisions were suspended.
This book is out of print. However, you can buy it at Half.com.
© 2001 Natalie Simpson
Natalie Simpson is a mathematics graduate of Oxford University, England, and holds a diploma in hypnotherapy. She developed an interest in psychology, psychotherapy and hypnosis after experiencing hypnotherapy herself. Her specific concerns include the assessment of the effectiveness and risks of psychotherapy, and the difficulties of obtaining informed consent of clients.