A habit merits the term “addiction” when it costs you more than it’s worth; when you try to stop it, but find you can only put it “on pause” for a short while; and when you find your thinking (especially your judgment) is distorted by the high priority you place on repeating the habit. Another criterion is perhaps less important because it’s outside you, but it can be very important indeed: when multiple neutral or friendly people tell you they think you have a problem—especially if they haven’t spoken to each other about it beforehand. 

In an excellent book called In the Realm of Hungry Ghosts: Close Encounters with Addiction (2010), Gabor Mate argued that addictions have their roots in early trauma. He tells the story of the thousands of American soldiers who fought in the war in Vietnam, which at that time was part of the “golden triangle,” a geographical area that produced a large share of the world’s heroin supply. U.S. troops coped with horrific levels of combat trauma, including guilt/moral-injury; anxiety, uncertainty, and fear; bereavement and loss; the shock of seeing so much injury and death; and the various physical wounds, ruined health, lost limbs, and so on. Many became habitual heroin users. But when they came home, it turned out that for the most part, the soldiers who remained stuck in heroin addiction were those who had suffered childhood trauma, long before the war. The others were able to drop the habit, though heroin is perhaps the most addictive substance on Earth. 

Not every addict has a trauma background. But most do, and when you meet one who apparently does not, you can’t be certain they have (or have shared) a full knowledge of their own relevant personal history. While many different kinds of trauma can happen to a kid, the CDC lists a few of the big ones in its online material about Adverse Childhood Experiences (or “ACEs”):

Experiencing violence, abuse, or neglect.

Witnessing violence in the home or community.

Having a family member attempt or die by suicide.

Substance use problems.

Mental health problems.

Instability due to parental separation.

Instability due to household members being in jail or prison.

They add “not having enough food to eat, experiencing homelessness or unstable housing, or experiencing discrimination.”

This painful picture of deep human suffering should not be taken as a portrait of an “average addict,” since there’s no such entity. And what amounts to trauma is not actually the stuff that happens to somebody, but how it’s experienced. The mystery of resilience has to do with the kid’s temperament, circumstances, culture, and especially the interpersonal supports that did or did not keep the situation from being even worse. There are people who endured every ACE listed here, who have never been addicted to anything. And there are others who had only one or two of these to deal with, and in adolescence or adulthood became dependent on one or more substances or behavioral habits that cost them dearly. 

The difference is not a moral one, and there is no rational calculus about who had it worse, or who went on to put up the best fight against addiction or depression or anxiety. These pseudo-questions involve impossible apples-and-oranges comparisons and fictitious quantifications of how bad different childhoods were. The feelings are most important; the facts matter, too; but the measurements of them are largely illusory. The reality of trauma has to do with what happened inside the child: what the bad stuff meant to him or her. If parents are neglectful or abusive, a kid will infer that young person in the mirror is deeply flawed, and deserved the bad experiences. But if the same kid also has a benevolent art teacher, a well grounded mentor, a kind and wholesome uncle who is reliable and interested, sane and warm—the kid may be protected from drawing that toxic conclusion about the self, and grow up less susceptible to addiction, to cults, to swindles, to sadomasochistic attachments, and so on.

The trauma theory of addiction is the profound claim that we mammals, we primates, we human beings, have universal evolutionary needs for nurturance and protection, and when these go unmet, or are met with harm mixed in, addiction often results. The person seeks out whatever will soothe away the pain of neglect and/or abuse from long ago. Usually, it’s pain from very long ago: infancy is the first love relationship we ever have, the mother-baby dyad that sets the emotional foundation for the whole lifespan. Even if things don’t go relatively wrong until later in childhood, it’s the inner baby part-of-self within the older kid that’s most overwhelmed. Freud taught that each of us is all the ages he or she has ever been, so the baby who craves a substitute for the warm and milky breast is actually still active inside the active addict, running the show—which is why the addicted adult can be found making such poor decisions. A brilliant, short book by Abraham Twersky, Addictive Thinking (1997), spells out what that kind of cognitive distortion can sound, look, and feel like. 

But acute or chronic trauma need not be the only reason for addiction, and often there is a very useful significance to the person’s particular “drug of no choice,” as it’s sometimes called in twelve step culture. For example, with or without the expectable ACEs, people who have uncontrolled habits of excessive sexuality may be trying to prove to themselves that they are indeed attractive sexual beings, capable of evoking erotic participation from others. Boys who were repeatedly rejected by the girls they hoped to kiss—and that’s most boys, who mature more slowly than girls tend to do—can grow up with a lot to prove. Many spend their late teens, twenties, and even their thirties struggling to establish that they are not icky “involuntary celibates” who will never find a mate (even if the guy himself is now the only person who sees him that way). If they can do this without deception, and without heaps of gender-based resentment, and without excessive risks to physical and mental health, they may manage to accumulate enough sexual experience to falsify their own worry about it. They can be fortunate enough to realize one day that they have indeed established what they were so desperate to establish. Now they are free to let go of the pattern that looked like, or really was, “sex addiction.”

Shopping addiction can be like that, too. I’ve said “people with uncontrolled habits of excessive sexuality may be trying to prove to themselves that they are indeed attractive sexual beings.” Well, people with uncontrolled habits of excessive consumerism may be trying to prove to themselves that they are indeed successful participants in the world of consumption, including the spells cast by advertising. Ads comprise a powerful technology of conscious and unconscious persuasion that links people’s self-esteem to their capacity to get hold of whatever product or service is being defined as beautiful, validating, and necessary. If I succumb to this, my identity will be bound up with my ownership of the bag, the boots, the car, the designer version of whatever I’ve been convinced I need.

Insofar as this is true of somebody in particular, that person’s sobriety will have a lot to do with identity: achieve an internal locus of value, and you can also build up an internal locus of control that defeats the addiction. When a person suddenly comes into a sum of money, a lot can be learned by watching how they spend it: the speed of the spending, but more importantly, the buying choices they make. If you are making large purchases of “designer stuff,” you might be an erudite connoisseur of fine handbags and their nuanced history since the year 1588. But it’s more likely you are buying an Hermes bag for $9,850 because that is what the surrounding culture told you was important, valuable, and above all, validating for the identity of the buyer. It is, ultimately… a bag.

A designer purse like that “says” plenty, but just what it says depends on the wisdom of the beholder. The message can range from “look, I am successful, you would be fortunate to share sex, love, friendship, or business with me” to “look, I cannot think for myself, and remain profoundly naive about the available better uses to which money can be put.” Those uses include appropriately limited altruism, where you get good feelings by helping others who need help; buying experiences (especially travel, but also course-taking, conference-going, skill-building, etc.) rather than things; connecting to the past and to the globe by acquiring works of art that speak to you; funding ambitious projects that you find fascinating and beneficial to the communities of which you count yourself a part; and so on.

I know brilliant, beautiful, accomplished people who collect high-end designer handbags. I see it as an expression of their aesthetic enjoyment of these exquisite objects. I also see it as a mechanism of compensation for early experiences of having to do without the goods that other kids had. If your peers in elementary school and middle school and high school all wore flashy stuff and drove expensive bikes, while you wore hand-me-downs and walked to school without wheels, you might well benefit from disproving the worry that they are blessed and deserving while you are deprived and unworthy. And the collectors I’m thinking of are at least as psychologically sophisticated as I am; they know all about their own formerly unconscious motivations for spending “real money” on glam and bling. But they do it anyway, and apparently it serves them well. Rather than judging anybody for buying or selling luxury goods, I am commenting on some of the common underlying dynamics that contribute to habitual choices which can come to feel quite unfree.

And that’s the issue with therapy for troublesome habits: is the habit a free and informed choice? Is it an addiction, or would we get better results framing it as a mere habit that needs tending? The more it costs you—in money, time, opportunity, relationships, access, etc.—to continue with the habit, the easier it is to decide that you must stop. The less it costs you, the more reluctant you or I will be to use the term “addiction,” or recommend 12-step programs, or insist that only abstinence will constitute recovery. Mild addictions to substances or behaviors can be addressed with a commitment to “harm reduction.” Someone who drinks a few times a week but does not lie about it, nor have blackouts, nor have a Jekyll-and-Hyde personality change when they’re intoxicated, is probably a person who can reduce drinking by, say, 65% without too much struggle. But if it turns out to be a big struggle, then the language of addiction might be very useful for getting hold of the habit and changing it.

If you’re dealing with repeated behaviors that you suspect are costing you too much in money, time, peace of mind, or otherwise, consider booking a session with me. We can join forces to help you figure out your relationship to the habit in question, and find the best ways to change for the better—guided by your values and goals.

Email me through the contact form on this website, or call 917-873-0292.

What’s “hoarding”? Well, the DSM-V includes hoarding in its section on obsessive compulsive disorders. There’s OCD, which is a pattern of behavior and inner experience, and there’s OCPD (Obsessive-Compulsive Personality Disorder), which includes that pattern, but also extends to deep-seated and pervasive concerns with order, regularity, and tight control. You exert unnecessary and excessive control over variables you can actually affect, like neatness or punctuality, but your opportunities to do so are often subject to other variables beyond your reach, like the weather, traffic, or other people’s actions. This brings plenty of episodes of frustration, when highly charged efforts at maintaining order get interfered with by unpleasant surprises from outside. The irony is that someone suffering from OCD or OCPD is exercising what can look like a heightened personal mastery over their immediate environment, but it’s actually a type of helplessness: they cannot control their relentless need for control.  

OCD tends to start in childhood, but like most personality disorders, OCPD usually (not always) shows up a bit later, in adolescence or early adulthood. Hoarders typically don’t have OCPD. They don’t care much about order; their environments tend to be chaotic, and they often hold onto broken or incomplete items without repairing or maintaining what they insist might someday come in handy. Their problem is classified next to OCD because it’s a maladaptive behavior pattern they can’t regulate, with a thinking style that’s distorted to legitimize it. Of course, this fits addiction, too (so does disordered eating), and compulsivity is part of addiction—especially behavioral addictions that aren’t drug use, like shopping, sex, or gambling. Psychological diagnosis and “nosology” (the part of our science that divides human troubles into discreet categories) are not entirely scientific, and plenty of books (here’s a favorite) rightly criticize the Diagnostic and Statistical Manual of Mental Disorders for the limitations of its ever-changing categories (a more nuanced and humane approach has produced the Psychodynamic Diagnostic Manual, or PDM, by Vittorio Lingiardi and Nancy McWilliams). We do need some way of talking about what ails people; imprecision is inevitable; and imprecise terms are far better than none.  

Like many ailments, hoarding occurs on a spectrum of severity. It can be a light nuisance, a serious problem that impinges on one’s life-possibilities, or a severe mental affliction with potentially dire implications for physical health. Like some other conditions, it’s a distorted version of some natural and necessary mental functions. In the deeply ancient world, long before civilization, people generally kept almost nothing, or only what they could carry. When the Paleolithic (“Old Stone Age”) became the Neolithic (“New Stone Age”), the first settlements were established where people lived for an entire season, or even year-round, storing food and artifacts. Evolutionary psychology of this sort can easily jump to mistaken conclusions, but it seems likely that somewhere along the line it became adaptive to try and hang onto stuff that might be useful later on. A temperament that disposed people to a more retentive attitude became partly heritable—despite the fact that it could also cause trouble, like plenty of other genetic traits. Even if OCD were entirely DNA-based, which it isn’t, activating it would still require a releasement mechanism in the form of a lived experience. Such mechanisms are usually traumas of one kind or another, having to do with some kind of scarcity: food insecurity, inadequate love and affection, episodes of being robbed or cheated—all these can make someone err “on the safe side” by keeping too much stuff.  

Obsessions are a cognitive thing, with affective (i.e., emotional) dimensions, manifest as intrusive repetitive thoughts, preoccupation with certain themes or figures, or recurring words that take up too much mental space for no good reason. Compulsions are behavioral; often they’re involuntary rituals, involving repetitive counting, arranging objects in spatial patterns, or “checking” again and again that one really did lock the door or turn off the stove, far beyond the point where you’ve already secured that important information. There’s usually some misery in it, along with efforts to conceal the problem. Hoarders rarely have people over to visit, because shame is usually involved—unless the person is oblivious to other people’s judgments, or to their own disorder, two features of more severe presentations. If you suspect you may be hoarding, it’s likely a good thing that you’ve got the perspicacity to be concerned.  

It’s a lot easier to deal with hoarding when it’s got other meanings to it besides the traumatic, maladaptive ones. If you’re a collector—of art, musical instruments, rare handmade tools, antiquities, autographs—you may manage to sublimate the underlying anxiety into a life-enhancing fascination with some aspect of culture that speaks to you. A “philatelist” collects stamps, a “numismatist,” coins. Book collectors may be captive to their enormous holdings, and being only human, they don’t have the necessary centuries to read every book they own—but come on, it’s the cumulative wisdom of the world on those shelves, not, say, a hundred pairs of shoes (ok, I’m a bit of a bibliomaniac myself). Then again, hearing a balanced, articulate shoe collector hold forth about his or her favorite specimens might be interesting enough to earn a guest’s instant respect. There’s something cool about a passion that builds expertise and a refined capacity to appreciate the larger meaning, history, and design of what appeals to you, however esoteric it might be. But there are limits. 

When there’s no unifying theme to the possessions, when they’re not in good shape, when their owner can’t find anything, and the space is cluttered to the point that the room is hard to cross without knocking things over, when dust is a major issue, when acquiring and retaining things has crowded-out self care, sociality, and financial prudence—and above all, when there is no joy in having all this stuff, well, that’s obsessive-compulsive hoarding disorder.  

Aristotle recommended “the golden mean,” the sweet spot between the extremes: “nothing in excess.” It may seem odd that people who endure opposite insults like “neat freak” and “slob” will find their problems listed on the same pages, but remember the horseshoe metaphor? The extremes have more in common with each other, than with the center. Dante put the Spendthrifts and the Misers in the same circle of the Inferno, where they taunted each other forever, shouting “Why hoard?” and “Why squander?” That’s also the soundtrack of the hoarding experience whenever it’s time to try and escape it: the first question is your exasperation at all the junk you’re living with, but as soon as you pick up any single item of it and try to throw it away, the second question kicks in.  

Let’s linger on that a moment. You’ve just picked up one of your hoarded objects… an extra audio speaker, a bundle of obsolete cords, a chipped tureen, the wrong-sized pair of old new shoes you never got around to listing on eBay. You’re holding it in your hands. The pleasure of keeping it is only a very brief moment of relief at not having to part with it. But the pleasure of removing it lasts, because you keep noticing the cleared space you freed-up by releasing it. Suppose you hang onto a belt sander for eight years because you might have a carpentry project one day. Then you get fed up, or you’re given an ultimatum by a lover or a landlord, and finally manage to fetch $40 for it on Craigslist. A week later, your favorite aunt Facetimes you out of the blue, about the wooden stairs at her place—how they keep giving her splinters, and they need “a coat of varnish or something.” Waves of self-reproach come flooding in from your inner tyrant: How could I let myself give up that sanding machine, after keeping it for eight years! Now I need it! I knew this would happen. The people who urged me to get rid of it were wrong! Now I’ll have to spend a hundred dollars to buy another one! 

Persuasive as that mighty voice may seem, it doesn’t know the whole truth. And the part it does know, isn’t helping you. Sure, you could buy a new sander, but you’ve just learned that the need for this tool arises about once per decade. And for under $40 per day, you could rent one and be rid of it when the job is finished. Look around the living room, the garage, the storage unit. Of all the objects you see, what percentage of them have suddenly come in handy the way the belt sander just did? Wrapping paper will get reactivated on holidays, and candles are a good hedge for a possible blackout. But the extra speakers, the orphaned USB cables, the chipped tureen? Almost no foreseeable scenario will turn their lost importance back on again, and what you see when you look at them is stagnation, anxiety, and reluctance to govern your own affairs without excessive fear of being caught without a tureen, just in case a soccer team drops by with five gallons of soup in a bucket. Giving up that belt sander was a victory. It turned out you could’ve saved some money by keeping it, after all. But there would have been value in getting rid of it years ago, to enjoy the freedom of choice, and the decluttered living space, its absence would afford you.  There are hidden costs to hanging onto things you don’t need now, even if there’s a chance (and there’s always a chance) you might need them in the future.

Suppose you do throw out some usable item, and some years go by. Then the phone call comes, announcing a sudden occasion to make use of what you sold, or gave away, or threw out so long ago. Suppose there’s no option to rent a new one, and no cheap replacement waiting for you on some website or a thrift shop. If you want to do the project, you’ve got to spend $50 that you could’ve kept if you’d only continued hoarding the thing. Well, consider the $50 a small fee you pay for those years of being unencumbered by the thing.  

We know some of the neural correlates of Hoarding Disorder, and there are medications that can be useful components of treatment. While there’s currently no 100% effective psychopharma for it, HD often occurs with depression, so any successful treatment for that mood issue can alleviate HD, sometimes significantly.  

If you believe you may have a milder degree of trouble with hoarding, it may help to watch some of the documentaries and reality TV shows that have been made about cases much worse than what you’re contending with. That can make unpleasant viewing, but it can jolt you into firmer resolve to make some changes.  

An excellent psychodynamic treatment approach for OCD in general is George Weinberg’s book, Invisible Masters.  

Some cultural resources that may help anybody who needs them include Swedish “death cleaning,” which builds on the truism that “you can’t take it with you,” and Japanese housekeeping, which emphasizes an elegant minimalism.  

If this post resonates with you, consider booking an appointment with me at 917-873-0292, or email Jamey@drjameyhecht.com. Licensed in NY, NJ, TX, and CA. www.drjameyhecht.com

Patients sometimes say things like this: “If psychotherapy is largely a process of cultivating self-love, where is it supposed to come from? I don’t feel like I love myself. I can hardly stand myself. Where do I begin?”

Well, anyone who is alive to ask this question has survived, because at some point in the critical period of their infancy they, too, were loved. And babies love their caregivers, because love works as a circuit, a between-ness, like the glue between two surfaces. The love feels good because it works: my caregiver is loving me and I’m receiving it, and when I love her back, I experience my own goodness in the delight she takes in my smiles, my sounds, my touch, my presence.

My goodness is twofold, without any distinction being drawn: I am worthy of the Mother’s love, and my love for her is good. Therefore: I am good. I love myself. Trauma interferes with the benefits of that good foundational experience—but not completely, since you are still here, even though you’re also in pain. The task at hand is to reawaken those early, primitive good feelings and make them sustainable.

First, who do you love? It need not be a human person, but it must be a person in your eyes: a dog, a cat—a bear or an elephant if you know anyone who is an actual member of those species—or your nephew, grandmother, partner, friend—anybody you love. It could be a figure from religion or the arts, so long as admiration is not the main thing, but love. And if there is nobody in your life, bring to mind your feelings on seeing a baby or an elderly person, your spontaneous compassion for children in distress, even kids you don’t know.

If you can think of someone for whom you feel love, think of your feelings for this person. Feel the feelings. Notice that they arise naturally, without structure or measurement or transaction. Notice that they are not based on achievements, or talents, or cost/benefit calculations. As the philosopher Kant taught in the 18th Century, persons are ends in themselves, not means to an end. Adults love the baby because-the-baby.

An infant is too young to have accomplished anything cultural, and it’s too early to tell whether there are any significant talents present or not—thank goodness. That way, these extrinsic grounds for esteem can’t interfere with the fundamentally non-rational flow of love between caregivers and babies that is absolutely necessary for the survival of individuals, and of the species. As we therapists never tire of mentioning, babies tend to die if they aren’t loved-over-time by at least one individual caretaker, whatever other love, food, and shelter they do receive. If you’re still here, somebody loved you. That means you have some experience of the thing you’re looking for.

Thinking of a person you love brings up feelings of care, protectiveness, belonging, warmth, similarity, compassion, and esteem. You need to get yourself onto the list of beings who deserve this good stuff from you. Then you need to get yourself up to the top of that list. The fundamental reason to love yourself is because it is your right and role, your dharma, your vocation as a living organism on this planet. But if that currently feels too foreign and far-off, be motivated by altruism. Some depressed people only hate themselves, while others hate everybody; right now, I’m addressing the first group. Love yourself because the oxygen mask on your own face will keep you capable of giving oxygen to somebody else, instead of collapsing for lack of it.

After some time spent trying to love yourself so you can help other people, your motives may ripen and expand to include genuine, intrinsic self-love. Meantime, Nietzsche wrote, “The self-despiser nevertheless esteems himself—as a self-despiser.” In other words, if the only thing you can approve of about yourself is that you have sufficiently high standards by which to condemn yourself, well, those high standards are an esteemable form of investment in the Good, so start from there, and build out. Are you using the high standards as guides to improvement, or as a blunt instrument for self-punishment? If switching from punishment to guidance is hard, there is some internal cruelty in the mix, and you may currently be addicted to that cruelty.

Well, how would you feel and act if the person you love was being treated the way you treat yourself? You would intervene protectively; you would make emotional contact, to make sure the person was ok; and you would help your beloved to defend against attacks. Do that for yourself, as a matter of ordinary responsibility, like washing your hands after you use the bathroom, or like offering a glass of water to somebody who obviously needs it. Decency. If you can’t be kind to yourself, start with being polite to yourself, and work your way up to lovingkindness.

Elsewhere on this blog I’ve written about the inner exercise you can do to get better and stronger at self-love. It is an imaginal exercise, something you do with your imagination. What’s “imaginary” is a mental representation of something physical, compared to which the representation is relatively unreal—it is “merely imaginary.” But working to heal your inner child is itself a mental (both emotional and intellectual, both affective and cognitive) job. The problem, the solution, and the work of applying it are all psychic, not material. They all share the same form of realness, namely psychic reality. Inner actions are actions indeed, just as much as taking out the garbage, changing a tire, or dressing a flesh-wound is taking an action. A better analogy would be practicing with a musical instrument, because each session of practice—with all its frustrations and small glimmers of triumph—improves the prospects for progress the next time. Like therapy.

 If this post resonates with you, consider booking an appointment with me at 917-873-0292, or email Jamey@drjameyhecht.com. Sessions are available in-office in Park Slope, Brooklyn, and remotely in NY, NJ, TX, and CA.

People cheat when they feel cheated. They lie when they feel lied to, and they steal when they feel robbed. Some of that springs from a need for cosmic balance, where I pay-forward whatever I suffered that should not have been my fate. But some of it is a communication, where my behavior is meant to inscribe on the walls of the universe: this thing I do to others, is what was done to me.

Compulsive shoplifting, for example, can be a kind of broadcast to the world, silently announcing that I have been deprived of my due. Typically, the stolen good was not a material object but a form of experience, some crucial, human relational need that I now despair of ever meeting. Why the despair? Because of too many failed attempts to get hold of that primal good, and because the critical period has passed, in which the needful thing could have found its mark, by meaning just what I needed it to mean: that I am a good-enough person, in a good-enough world. If I can believe this belief, then a good-enough life-of-my-own can feel both permissible (fate will allow it) and feasible (I can manage it). If I doubt my own goodness and/or the goodness of people in general, it will be much harder for me to build an ongoing good experience of being myself. So, whence comes this necessary faith in the human good?

According to Heinz Kohut, what children need are parents who can supply two crucial developmental resources: first, a mother (figure) who mirrors our childhood grandiosity and affirms it for us, and second, a father (figure) whom we can idealize and look up to, identifying with him in an aspirational way. Kohut saw these two needs as ordered, both chronologically and in their relative importance. He also saw childhood and youth as eras that often afford us second chances to get what we need, or, if things go poorly, a new round of trauma (from deprivation or other emotional injury). A step-parent, say, can step in and make things much better, or much worse.

In the 1970’s, psychologist Urie Brofenbrenner made an observation which has often been quoted, and deserves even more notice today: “In order to develop normally, a child requires progressively more complex joint activity with one or more adults who have an irrational emotional relationship with the child. Somebody’s got to be crazy about that kid.” This Somebody need not be the original parent (biological or adoptive) or a step-parent; it can be, say, a relative, a guidance counselor, or a teacher — often an art teacher, perhaps because art is nearer to the emotions than most other subject areas taught in schools. But the changes in institutional culture of the past two decades have made it more risky and difficult for teachers to show special interest in troubled students who may need it. Among the religious, clergy can be well placed to show this kind of individualized interest, but they, too, have become understandably risk-averse as the stakes of being misunderstood have sharply risen. Librarians sometimes took on this kind of role in children’s lives, with often wonderful results, but smartphones and the internet have so fully replaced books that librarians are fading from view.

If a community is in sufficiently rough shape, an idealistic nonprofit might come along and offer a program that pairs at-risk youth with ethically ambitious adults who help them along in caring ways. But those programs don’t always appear, and not all childhood neglect or abuse happens in poorer cities and towns that are in obvious trouble. Much of American literature is about the family traumas of the middle class, and even the wealthy are often very desperate people — in part because they already have the money that everyone else assumes is the solution to every problem, yet their pain continues. “Spoiled,” remember, does not just mean “pampered.” It means a kid has been given everything except what’s most important: wholesome loving care. It is, after all, a metaphor about rancid milk — because material abundance paired with emotional scarcity can spoil a person’s capacity to believe that real love (which psychoanalytic language symbolizes as the breast milk of a loving Mother) exists anywhere.

Some kids who are deprived of one or more of Kohut’s two essential relational supplies (a mirroring mother figure and an idealizable father figure) become hyper-competent, fiercely independent adolescents. Later in life, they can have trouble coupling-up, because romance involves giving what they never received, and because the offer of love feels strange and dangerous to them. By contrast, some other deprived kids remain dependent for decades, relentlessly hoping the caregivers they need will come along, or indeed, that their own feelings and behaviors will eventually transform the attachment figures they do have into the wise and generous ones they still crave. Then there are those who combine elements of each, presenting as adults with impressive professional success while remaining lonely and emotionally entangled with their withholding parents. These people are ahead of their peers in the outside world, but behind them on the inside.

Much trouble can be avoided if several afflicted kids find each other in time to form a group, where they can do their best to raise one another. But this is hard, because independent kids are reluctant to depend on anyone, including peers; dependent kids may welcome fellowship, but their resentments can get displaced and wreck the very friendships they have loaded with meaning and value. An adolescent friend group, with its intense attachments, passions, and impulses, can work wonders or exacerbate personal trouble, depending which personality elements get validated within it, and how the larger world responds. Plenty of movies are about the various storylines that such a group can be found living through, though it’s rare that a clique of teenagers manages to learn, from a film, how to avoid the pitfalls in its path. Art might seem to promise lessons of useful prudence, but it mainly offers us a deeper understanding of those losses and mistakes we’ve already endured.

The benefits of therapy derive from insight on the one hand, and the therapeutic relationship on the other. Between the two, it’s usually the relationship that does the most good — but it’s a relationship built on a series of conversations whose main ingredients are the patient’s stories of the past and the recent past, expressions of feelings in the present, and interpretations that come from the therapist or from the patient (in other words, insight). Some of what gets illuminated and reframed is the experience of not-getting what we needed. It might seem like a waste of painful effort, to recount what you already know about old yearnings and losses. But it often turns out that the telling is itself a healing process, when someone is listening with consistently reliable respect and empathy. The teller and the listener can then reshape what the story means, shifting control of that meaning from the outside world of the past into the inner world of the present.