by Carol W. Berman, 2011
Suzie is twenty-three with blonde hair that she wears pulled back into a chignon like a ballerina. She’s my patient: I’m her psychiatrist. No one would ever guess from her perfectly composed face that she suffers from daily panic attacks so severe that they cause her to have suicidal wishes. The only outward signs of distress are the premature lines above her aquiline nose and the glassiness of her azure blue eyes. She perches on a black leather couch in my office, far above the bustling New York City traffic and noise. Behind us, the floor-length ivory drapes shield us from scrutiny. Have I provided a safe enough environment where Suzie can reveal her innermost fears and disappointments?
“The last attack? Oh, excuse me.” Suzie picks up her ringing cellphone. “Mom?” She proceeds to have a banal five-minute conversation with her mother about dry cleaning. My own phone is off, because I, as keeper of the boundaries during her forty-five minute session, must devote my undivided attention to her. She isn’t interested in concentrating on her problems with me. In fact, she “wants” (unconsciously) to be interrupted by her cellphone. Colleagues have suggested many different techniques to make her shut off her phone. “Throw her out until she does,” says one. “Take the phone away,” demands another. Most of the time when I ask her to shut off the phone during sessions, she agrees and then “forgets” to cooperate as soon as her phone rings. I have decided that when she answers the phone, I will interpret it as resistance, passive aggressiveness, negative maternal transference, narcissism, etc.
As more and more young patients insist on never being separated from their cellphones and always answer them, I begin to think of these behaviors, not as instances of individual pathology but rather, as a sea change in society. In theaters, buses, trains and other public places I observe that people, especially those under thirty, feel compelled to answer their cellphones, even though many times it’s impolite or the rules explicitly forbid cellphones. These aren’t medical emergencies or even urgent situations. People prattle to friends, parents, business associates, anyone.
Suzie is emotionally dependent on her mother. Even though she earns a good living as a financial consultant on Wall Street, Suzie lives at home with her fifty-year-old divorced mother who claims that she wants her daughter to move out. The panic attacks began when my patient attempted to comply with her mother’s requests to find her own apartment. In psychoanalytical terms, Suzie has abandonment anxiety manifesting as panic attacks. I will gently make this interpretation to my patient at the right time. Suzie isn’t ready yet. When she’s able to shut off her phone and express curiosity about why her mother is always calling (of course her mother knows when Suzie is having a session with me), she will be prepared. In the meantime, her mother unconsciously sabotages Suzie’s treatment and fosters dependency while Suzie lets her.
Other young patients have similar dynamics with their parents. According to an article in The New York Times Magazine of 12/21/03, the phenomenon is called “transitional adulthood.” The proverbial uncut umbilical cord now comes in the form of a cellphone. The usual psychological separation between parent and child never need occur. Dependency without individuation can last well into a person’s twenties or thirties. Mom or Dad will always be just a phone call away. Also interesting are my patients who are parents, who complain that their children never move out or constantly rely on them financially and emotionally. Many of these parents fail to realize that they are contributing to dependency with their behavior.
In the world of cellphones, aggression and territoriality are hidden under seemingly innocuous behavior. Suzie dominates space and time whenever she yells loudly into her cellphone. Usually she is the meekest of individuals humbly blending into the background wherever she goes even though she is so good-looking. However, when she is on her cellphone, her personality expands as she shouts and badgers whomever she’s talking to in an unconscious assertion of herself. My job is to make her aware of her behavior, so that she will be able to choose to be quiet or conspicuous, as she desires, instead of just leading an unexamined and neurotic life. Very often panic attack patients are not able to express their aggression directly and suppress themselves, which may contribute to the continuation and progression of their disorder.
A few days ago, I inadvertently observed her in the public park across from my office building. First she sat quietly on a bench, eating a sandwich and drinking a Pepsi before our session. When her cell rang, all eyes turned to her. She stood up when she answered and immediately took up more space, pacing as she shouted into her cell at her mother. Thus, she established her territory just as a dog or cat would mark a spot by urinating on it. This has been called “cell yell.” (New York Times article, Nov. 22, 2001) None of her behavior is conscious. When I point out anything of this sort, she is incredulous and denies any significance. “I’m just talking to my mother,” she says. “You can’t think it means anything special.”
Another young patient had been sitting in a park, also talking to her mother, when she was attacked and raped. She’d had a false feeling of safety while chatting with the person closest to her. The illusion was that she was on home turf. She dominated her territory with cell yell, but failed to recognize that anyone else could be more dominant and dangerous.
Denial seems to be a significant factor in cellphone use. Users deny not only dangers in their immediate environment, but also dangers to themselves and others. Warnings about possible brain cancers or other health issues are routinely disregarded. In New York we are not permitted to use handheld phones while driving because we believe such use leads to more accidents. Yet, how many drivers do we see every day, flouting these laws and using handheld cells as they drive? Denial is considered one of our most primitive defenses, on the level with other narcissistic defenses like projection and distortion. Neurotic denial allows one to avoid being aware of painful aspects of reality. Suzie and the patient who was raped demonstrate neurotic denial. Psychotic denial of reality can lead to fantasies and delusions. An illustration would be a schizophrenic patient believing the devil was communicating directly with him by cellphone.
Erik Erikson’s epigenetic theory of ego development describes the tasks appropriate to each stage of life. His explanation of the need for intimacy versus possible isolation in young adulthood is particularly relevant here. Suzie and my other patients have opted for isolation and shied away from true intimacy with others by resorting to their cellphones for company. They are not able to transcend early dependencies on their caretakers and establish relationships with significant others. Instead they tend towards autism and narcissism. It is not surprising that we see an increase in these diagnoses.
For now, my main objective in treating Suzie will be to get her to turn off her cellphone. Once I have her attention, we can concentrate on decreasing her suicidal wishes and panic attacks. The final goal would be to make her conscious of her behavior and move her towards individuation.