Stories from the World of Medicine
Season
6
Episode
5
|
Mar 14, 2024
Growing Up
Psychiatrist Carson Brown was terrified to tell her mother that she was moving to Minnesota. But with inspiration from Carl Jung, and some of her own psychotherapy patients, she finds the courage to make the announcement, and feels her way into a new chapter of adulthood.
0:00/1:34
Illustration by Stephanie Singleton
Stories from the World of Medicine
Season
6
Episode
5
|
Mar 14, 2024
Growing Up
Psychiatrist Carson Brown was terrified to tell her mother that she was moving to Minnesota. But with inspiration from Carl Jung, and some of her own psychotherapy patients, she finds the courage to make the announcement, and feels her way into a new chapter of adulthood.
0:00/1:34
Illustration by Stephanie Singleton
Stories from the World of Medicine
Season
6
Episode
5
|
3/14/24
Growing Up
Psychiatrist Carson Brown was terrified to tell her mother that she was moving to Minnesota. But with inspiration from Carl Jung, and some of her own psychotherapy patients, she finds the courage to make the announcement, and feels her way into a new chapter of adulthood.
0:00/1:34
Illustration by Stephanie Singleton
About Our Guest
Dr. Carson Brown is a psychiatrist and writer interested in climate psychiatry, futures literacy, and the impact of systems of oppression on mental health. She would like to thank her husband, Scott; her therapist, Katharina; her Nocturnists story coach, Kristin; her family, friends, colleagues, and patients. Carson’s understanding of enmeshment is informed by the work of Kenneth Adams and Bethany Webster.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
About Our Guest
Dr. Carson Brown is a psychiatrist and writer interested in climate psychiatry, futures literacy, and the impact of systems of oppression on mental health. She would like to thank her husband, Scott; her therapist, Katharina; her Nocturnists story coach, Kristin; her family, friends, colleagues, and patients. Carson’s understanding of enmeshment is informed by the work of Kenneth Adams and Bethany Webster.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
About Our Guest
Dr. Carson Brown is a psychiatrist and writer interested in climate psychiatry, futures literacy, and the impact of systems of oppression on mental health. She would like to thank her husband, Scott; her therapist, Katharina; her Nocturnists story coach, Kristin; her family, friends, colleagues, and patients. Carson’s understanding of enmeshment is informed by the work of Kenneth Adams and Bethany Webster.
About The Show
The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.
resources
Credits
This season of The Nocturnists is sponsored by The Physicians Foundation. The Nocturnists is made possible by the California Medical Association, and donations from people like you!
Transcript
Note: *The Nocturnists* is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.*
TRANSCRIPT:
Emily Silverman
You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. Some people are close to their parents. But how close is too close? We want to love and support each other as we transition from one phase of life to the next. But we also want the freedom to evolve as individuals to make our own choices and build our own families. In today's story, psychiatrist Carson Brown explores the idea of adulthood, and what it means to arrive there, sometimes much later in life than one might expect. In the conversation that follows, Carson and I talk about motherhood, the pain of separating from our children and the diverging philosophies of Sigmund Freud and Carl Jung, two giants in the world of psychology. Carson is a psychiatrist in Minneapolis who specializes in anxiety, depression, codependency and trauma. She incorporates somatic practices, dream work and guided meditation into her practice. She went to UCSF for medical school and did her residency training at San Mateo County, but also draws inspiration from her undergraduate work in English, where she developed a love for literature and storytelling. Take a listen to Carson's story Growing Up, which she performed live in Minneapolis in 2023.
Carson Brown
It's this glorious spring day in the San Francisco Bay Area where the trees are blooming, I'm getting a little sunburn on my neck and I'm over at my brother's house in the Berkeley hills. My kids are frolicking with their cousins and the dogs and my husband Scott is grilling with my sister-in-law and my mom has just arrived. I see her get out of her car and she's carrying this very heavy cardboard box and I know exactly what is weighing down this box; it is quiches. My mom makes a lot of quiches and she brings them to all these family events to send home with all of us. So she's kind of lugging it up and she manages to kind of wave at the kids. And she's just got this grandmother glow going on. Today's the day I have to make an announcement that I've been postponing and dreading for months. My family is moving from the Bay Area to Minnesota, because it's awesome. It's where Scott is from, and I've never really left the bay I grew up there I went to college, medical school, psychiatry residency all within a very tight radius of San Francisco and my mom. No Mom, no parent, is stoked to get the news that their child is moving away, that their grandchildren are moving away, but with my mom, it's kind of this other level. In mental health, in the biz, we have a word for this dynamic between my mom and me, which is enmeshment, you might want to google it. What she feels, I feel. It's kind of like being conjoined twins except instead of sharing parts of our body we share parts of our psyche and what happens when a conjoined twin moves away? You know when I was very young child, the enmeshment situation was great. We were always together. We're driving around all my activities, we're like singing oldies in harmony in the car. I'm very helpful and collating her League of Women Voters newsletters with her. I'm sitting on the couch, we're watching Jeopardy and I'm like just brushing her long beautiful hair and she never wants me to stop. I start to get a little older and I want to like have sleepovers at other people's houses. And she's like, okay, but like, only if they sleep over here. My senior year of high school, I came home one afternoon after school and saw her standing in front of a mirror, trying on my prom dress. And I didn't really have the language to understand how invasive it felt. My junior year of college, I did leave, I did actually leave this one time, I went to England for my junior year of college, and she very quickly came to visit. And we go to Stonehenge, and we're standing in the long shadows, and we're feeling the druid vibe. And she looks at me really intensely. And she says, last time I was here, you were in my womb. It's true. It's a fact. And that night, we go out to the pub with my group of friends. And we're having our room temperature flat ale. And one of my friends pulls me aside and is like, 'Dude, why is your mom here?' Like, why isn't your mom here? Dude, you know, I don't, I don't know. So there was one instance where she deviated from this pattern of collapsing the space between us and staying merged. This one instance was after my daughter was born. And she came to the hospital and met her. But then for the next month, I did not see her. And barely heard from her. I would have told you she would have been banging down my door to get our hands on this baby. But she was just, she was nowhere. And I remember I'm nursing my daughter. It's that like, very worst hour of the day at like 4am. And I'm looking at my phone. The attachment parenting books say not to do that. But I'm looking at my phone. And I'm looking at this long list of text invitations to her, photos, and nothing's coming back. And just in that moment, I feel so hungry. Like all the calories of my body are going into this other person. And I fish in the pocket of one of those glider rocking chairs. I fish in this cloth pocket and I find one sad pretzel. And it's dry and stale. And I eat it. And it's just very bleak. And all I can think is I could really go for a quiche right now. I need it. So on the day of my announcement at my brother's house in Berkeley, my mom is sitting in an Adirondack chair, you know, like a queen on her throne. And she's looking out at this priceless view of the Golden Gate, San Francisco skyline. And she says this is the best place in the world. She's a die hard Bay Area person. And she hates temperatures below 50. And so I know she's not going to follow me to Minnesota. But historically her only other play has been to ghost me. And so I am legitimately scared she's gonna ghost me again. And that this time I mean, this one's big, you know this, this could be for good. So I'm paralyzed with fear. And I have the thought, W W M P D? What would my patients do? Because I've seen them go through that, I've accompanied them; my therapy patients go through this many times. So I start to imagine what would they say to me if they saw me being a giant hypocrite and not doing what I tell them to do? So I start to hear them in my mind. They're like, Dr. Brown. Remember when I had to move out of my parents house, but I wanted their approval, I wanted their blessing. You said to me, 'Individuation is not a negotiation.' Did I say that?? 'Dr. Brown, remember when I did not go home for Christmas, and I was consumed by guilt. And you said that that guilt was a good sign? If I could tolerate it that guilt was information that I was on the right track doing the heroic work of dismantling dysfunctional intergenerational patterns.'
Carson Brown
That sounds like something I might say. So bad! 'Dr. Brown, may I remind you of one of your favorite quotes you like to trot out? When you stop people pleasing, people will not be pleased.'
Carson Brown
Okay, so with my patients as my inspiration, I clicked my glass and said, 'Everybody, I have something very important to tell you.' It all goes badly after I very awkwardly kind of get the information out. I look at my mom in that chair. And she's like a statue, she will not make eye contact with me. She doesn't say anything. I go and sit on the grass next to her and I put my hand on top of her hand. And it's like cold stone. She does not, you know, take my hand back. And pretty soon after that she leaves and days pass with no word from her... silence. And I am unraveling. It appears that the worst case scenario is happening. And I've made an independent decision and I am banished. That's what it looks like. So on day five of this silent period, I collapse into bed. I'm kind of like diagonal sideways on the bed, my head kind of toward the bottom corner I'm wearing those full goblin mode sweats. It's like one sock and I'm crying - I'm someone who cries a lot. But this is another level is like hemorrhaging, but it's tears and just the whole day. And from my very weird angle on the bed, I'm looking right at my bookshelf that's dedicated to my psychiatry and psychology books that I've collected over like 15 years. And I'm like, 'What do you got for me guys?' Like, help a sister out? You know, and I grabbed the book that's closest to me. I open to a random page through the blur of tears. I'm like, okay, this is my buddy Carl Jung. He's talking about alchemy, which I always find very esoteric and not applicable. Alchemy, the alchemical transformation of the psyche. And this one word jumps out at me. The nigredo... mysterious. It's the first stage of the alchemical transformative process and it's where the psyche is burned to black ash, unrecognizable. The nigredo is just decay, decomposition, putrefaction, chaos and death. I feel seen. Carl gets it. Carl knows I'm in the nigredo. I'm in the nigredo! So that night Scott spoons me and his his heartbeat against my back is a beacon and over the next couple of days I very slowly start to kind of reconstitute. I'm playing some Uno with my kids. I'm sending Big Lebowski memes back and forth with my brother. I have this kind of epic day at work where everything's working. I'm thinking I'm in this like raw undefended state and my patients are kind of like, what is going on but I like it. And the ninth day, I take a hike with my shrink friend. And she knows about the whole situation with my mom in detail. We don't even really talk about her. We talk about our own pain as moms. We have young kids, but they are already separating the second you cut that cord. They're separating. And it's brutal. And we just vow, we vow, pinky promise to support each other in what's really like grief, as we just have to incrementally let them go. And by that ninth night I still really want to hear from my mom badly. But I'm like, I might not. And that would be devastating and tragic. And I would survive, because I'm not a dependent little girl anymore. I'm a grown ass woman. It only took 44 years, but it did happen. It's only with that realization, it's in that moment late on the ninth night that I get an email from her. And the email is fine. It exists. But my main emotional reaction to it is, I feel so grateful that it took her exactly that long to send it because I needed every excruciating second in that crucible to alchemize and rebirth myself.
Emily Silverman
I am sitting here with Carson Brown. Carson, thank you so much for being here today.
Carson Brown
Thanks for having me, Emily.
Emily Silverman
So Carson, one of the things I loved about your story is that it's a relatively intense story. From a content standpoint, we're talking about mother/daughter dynamics and the pain of individuating from your family and letting go. But your performance was so funny. And I was wondering, did you know that you were this funny?
Carson Brown
That's so flattering and nice. I mean, really the only other time I am ever onstage is for karaoke, which I used to really like a lot. I'm definitely talkative, but definitely not an improv person. I think I'd be terrified of that. And this seemed possible because it was very rehearsed. And I very much knew what I thought was gonna happen.
Emily Silverman
Something else I loved about your story is how it gave us a window into your psychoanalytic mind. You're telling the story, but you're also giving us definitions of these psych terms like enmeshment. And there's that scene at the end, where you're crying in bed, and you look up and you see the wall of psychiatry books, you pick a book off the shelf, and it's Carl Jung, and you start telling us about Carl Jung and the nigrado. And I just loved how educational the story was, in addition to being a story, it kind of helped us understand what it's like to be a psychiatrist. And I was just curious if you could tell us about your journey to psychiatry.
Carson Brown
Psychiatry is the best, you know, I love it. And I think almost everyone's interested in it, because it's really just the human experience. So those types of details I see as fun for everybody. But I definitely came into medical school thinking I was going to do primary care and interested in integrative medicine. That was sort of how I saw myself initially, but a lot of the advice I got about choosing specialties was find your people. And I liked lots of different people. But I think psychiatrists are people very comfortable with gray area, very comfortable with, well, more comfortable with not knowing. All of medicine is about the human condition, but something about psychiatry just puts that very front and center. Once I was really exposed to it, it's very clear. That's, that's what I wanted to do. That's where I fit.
Emily Silverman
Do you specialize in any particular type of psychiatry?
Carson Brown
I do general adult psychiatry, so I feel like I see a broad range. But somehow over time, I feel like a lot of my patient panel has, I call it complex trauma, which isn't a DSM diagnosis, but it's something that's used more and more - Complex PTSD, meaning not a specific incident, but more like something that we would call developmental trauma or attachment deficits, which respond to both medication and psychotherapy, best in combination, and it's very rewarding work. And then I think the story, you know, plays into certain elements of that, too, I think enmeshment is a type of attachment deficit and a developmental issue somehow, maybe because it resonates for me that that's a lot of how my practice has taken form.
Emily Silverman
You mentioned enmeshment is one type of attachment deficit. And that caught my attention. Because when I think of enmeshment, or at least how you describe it in your story, it seems almost like the opposite, like over attachment, rather than an attachment deficit. And so I was wondering if you could tell us more about what it is and how you think about it? And where does that come from? How does it cross over from healthy into unhealthy? And how do you know the difference?
Carson Brown
The deficits of enmeshment are just being very, very unclear on what belongs to oneself and what belongs to other person? What am I responsible for emotionally, and what is the other person responsible for emotionally and that's just completely scrambled in an enmeasurement dynamic, and can really cause relationship problems later. For me, it shows mainly in this over responsibility feeling of, I have to manage everybody else's emotions for them. What's really tricky is I think my job as a psychiatrist also pulls me into that role. Like, I'm kind of asked professionally to manage other people's emotions for now. And really trying to learn how to distinguish in personal but also in these professional relationships, what's my job, and then where does my job end and the patient takes over. And it's, it's their job. Because definitely starting out, I was bringing very much of an enmeshed vibe to the professional interaction of like, okay, you're here, it's my job to fix your life, it's my job to make sure you never feel bad again, it's my job to contort myself, even in this professional relationship. I mean, that'll lead to burnout if you keep doing that. My main motivation has to be acting from my own authenticity, rather than my main motivation has to be placating the other person. And it's easy to say, but it's been very hard to unlearn and actually do.
Emily Silverman
Yeah, I remember, once I was having a lot of stress, and I use an app to get a massage. I was like, I'm gonna do some self care. So I use this app. And this guy shows up in my house with a massage table, and he's giving me this massage. And I remember at one point, he got to some tension in like my left arm or something, and he was massaging it. And he was like, oh, and he was like picking something up. And I was like, what, what? And he was like, I just feel like whatever this is in your arm, like it's not yours. And I had never really had a massage therapist speak to me that way. And it really got me thinking about like, even more than just what we have in our minds or in our heads, like, how do we understand tensions that are being held in our bodies that aren't even ours to begin with? And so I was wondering if you've ever experimented with that, as well? Does the body have anything to offer in helping us understand what is ours? And what is not ours? And what can be released? I know it's a very like California woowoo question. But you are from California.
Carson Brown
You're asking a whole other really interesting question, what all types of somatic therapy really take up, which is the profound ways our bodies actually know so much more than our cerebral cortex. Sometimes it's called bottom up, information that's coming from our viscera up to our brain; this can be so much more informative if we know how to listen to it. Most of us are not acculturated to do that. We culturally really prioritize thinking over emotions, and then definitely over sensation, which, you know, people call gut feeling all kinds of different things. But there's not a definitive answer, it's more just paying attention to sensations and honoring that they contain information. I don't think there's specific sensations necessarily associated with enmeshment globally, but I think for certain people you can start to notice that they do have certain patterns of holding when when things get activated, and over time, it can help people discern like, Am I doing this authentically? Or am I doing this to please? Because it can be a hard question to answer. And I have seen people, and I'd love to do it more with myself, really learn what it feels like in my body when I'm being authentic and I know a specific kind of signature fingerprint that comes up for me when it's more like fawning or pleasing or an enmeshed response.
Emily Silverman
The last part of your story was very nonverbal. You were almost describing an experience that happened in your body where there's the initial terror of disclosing this information to your mother. There's the worst fear realized where your mother responds with, I guess separation or coldness. And then you talk about laying in bed and you're crying and one sock is off. And you're just kind of going through this internal negredo, you say it's like a process by which the self is burned down to ash and then reconstituted. And it's all happening inside. And you bring us through the different stages of that, where at first you're in a state of despair. And then things start to feel a little bit more hopeful. And you have like, weirdly, a good day at work. And then you go on this walk with this friend, and then it's almost like, right, as the cycle is completing, you get the email from your mom, and you're glad that the email was delayed, because it gave you the opportunity to go through that process. And so I'm wondering if you can, I know it's hard probably to put words to, but what is that process happening internally? It's just like an energetic movement, or what is it that happened?
Carson Brown
The entirety of Carl Jung's body of work is trying to answer that as as well as other thinkers and feelers, obviously. But I did use that word crucible towards the end, and he uses another word, the tenemos, which is a container, and we talked about the container and the frame and psychotherapy a lot.
Emily Silverman
What are the container and what's the frame?
Carson Brown
It's almost ... I'm thinking of the word 'rules'. But just like the agreements of the psychotherapeutic encounter, the time, the space, we meet from this time to this time, on this day, it's almost the ritual of it. It is also the therapist's boundaries, different therapists. And across time, ideas about self-disclosure and other types of boundaries do shift, but there are still certain boundaries that a therapist is holding. And the idea is just having this defined space is a chunk of the work. It's not even the talking or the emotive part, it really is there's this defined space where I do this type of self reflection. Obviously, there's a lot more to being a therapist than just holding that space. But it is sort of the fundamental requirement and enables everything else to happen. And there is a sense, a lot of the times, that the psyche has a natural impulse towards self healing, that it's it's looking for channels to move in, towards healing, towards something more integrated, towards something more comfortable or resolved, and just giving it this type of consistent, compassionate attention, it will unfold in that direction, as long as we stay out of the way. So I think, you know, the situation I was describing at the end, it was definitely post verbal, I think it was so overwhelming and so catastrophic to my psyche, that it was not something I could talk about while it was happening. And that's sort of a definition of trauma also is something that's overwhelming and can't be assigned meaning or processed in real time. It's something that's so overwhelming that it's it outstrips our capacity to do that. But but there was a holding space just in my home from my husband, I actually left a line out of the live telling of the story, which was Scott bringing me tea and taking away my snotty tissues. And there was just space for me to collapse mostly provided by him.The books...I think they are part of the support structure too. I do think that bookshelf meant a lot to me like I'm probably not the first one going through this, I'm probably not the first one to think about this, there probably is a way to assign some type of structure, meaning, understanding to something that feels unfathomable to me right now. So it was sort of like, I was looking for a book to be my life preserver ring thing, and it did happen. I think having any type of word to just grab onto did feel like that life preserver of like, okay, this is at least one way to conceptualize what's happening right now. And there's a comfort. That was a humor, I was kind of going for it. Even though it was so horrible, your psyche being burned to ash, that basically the worst thing that there was something comforting in having that described. I think that's what we try to do as therapists too is we'll float out 'Oh, do you mean this or is it this type of thing? Or is it this word?' And a lot of times we're like, 'oh, that's not quite it.' But sometimes they'll be like, 'exactly, yes. Thank you.' And you do feel it as like a sustenance for somebody as as a ballast.
Emily Silverman
Is that a term that you had heard before in your studies? Or was it something that you just came across for the first time in that moment,
Carson Brown
My fourth year of residency training, I was at the San Francisco Jung Institute for the whole year, as about a third of my time was there. I had psychotherapy patients through them, and they had their own set of didactics. So even all that time was like scratching the surface. And they have an entire psychoanalytic training program. So it was really just the introduction, but I had spent a lot of time with his work. And then contemporary Jungian thinkers also. So I definitely had been exposed to it before, there's a really brief line I say in the story that I hadn't found applicable before this, his most esoteric stuff is around these alchemy processes. And prior to having my own experience of this, I was like how, like, how do I apply it, and it had felt too esoteric to me before it, it felt a little ungrounded. But then I was like, oh, it does match up to actual phenomena. I think it just hadn't of clicked for me. He's so abstracted. And, you know, so much of his work is about symbols, that sometimes connecting it back to day to day modern life takes a little translating, but then it made a lot of sense in that moment.
Emily Silverman
He's such a famous person in the psych literature, I think, probably Freud, and Jung are the two, you know, big names for people who have maybe heard those names before, but aren't really sure what the one liner is for what each of them believed, or their theories, or I think their theories might even come into conflict with each other. But is there a way to boil down some of these young Jungian approaches versus Freudian approaches? Or is it more that they had like many different theories and philosophies and you can only really get it if you do a deep dive,
Carson Brown
Probably something in between, I'm feeling slightly daunted trying to give a one liner but I will try. You know, there they are some of the OGs of the whole field, which is super important and impressive in certain ways. And also they are very much products of their time and place and intersections of various identities. And so a lot of the time since then, has been critiquing, mostly critiquing, unpacking, modernizing, there's a lot that's problematic is sort of the short way to say it, there's anti semitism, and there's sexism, there's all kinds of difficult stuff in there. And there are some of the building blocks of the whole field. So I mean, what I say about Freud sometimes is, he was the first person in the Western tradition, there were plenty of other thinkers and people having all kinds of different experiences in different parts of the world. But he was really the first European to say, the unconscious mind exists. So that was on the level of Copernicus to me of someone asserting something that basically everyone else thinks is crazy at the time. Copernicus at least had telescopes and other instruments and mathematics to back him up. The unconscious, you know, we can't measure, see, directly perceive it kind of by definition. So someone saying this thing that's unperceivable exists was, not to overstate it, a complete turning point in European thought. And then yes, he and Jung were close, close colleagues. Jung was basically Freud's right hand man. And then they had a major schism, which happens repeatedly through the history of psychiatry and psychology. People get pretty heated about these topics. My one liner on Jung, people have probably heard collective unconscious, you know, so he did take this idea of the unconscious and be like, it's not just seated in each individual mind. There's also a collective or societal level of it. And that's what he thought about archetypes and themes that you find running through all cultures really fascinated him. It's fascinating how did all these different groups of people come up with similar symbols or similar ways of thinking about things? So that's one of his major contributions. I also just think of him as really bringing symbol and how symbols operate. That's one of his major contributions to and that comes up a lot in dreams. A lot of people when they think of Jung their word association to him, and he did word association work, is dreams, because he saw dreams as the way our unconscious communicates with us. But that the language of the unconscious is not literal. It's symbolic. And whereas Freud was sort of like, well, if someone dreams about feces, that is money, it was sort of a one-to-one symbol to meaning. Jung was very much more like no, no, the symbol is individual to the person and has to be teased out and understood in the context of that person.
Emily Silverman
In your practice, I mean, you seem to be really interested in the therapy side of Psych. So you know, psychoanalysis and Freud and Jung and kind of talking through things using symbol, using story to help people heal and make sense of their experience. Do all psychiatrists build that into their work? Or do you feel like sometimes the field splits off where it's like the psychiatrists are dealing with the pills, and it's the therapists, you know, who maybe aren't physicians, but who are trained in therapy, who are doing the talk therapy and doing some of these other things? What is it like in your practice? And are you unique? Or do you feel like most psychiatrists veer more toward like the medical approach as opposed to some of this more, I guess, abstract approach?
Carson Brown
Right? I mean, I think more and more, it's becoming the MD psychiatrists prescribe and non MD therapists do the therapy. I think that's the way insurance companies want it. I think that there's financial incentive for psychiatrists to work that way. I went to an unusual residency program at San Mateo County, that is a gem of a program if anyone's looking for one that really does emphasize psychotherapy. And people have long term psychotherapy cases starting in second year, and there's a lot of psychotherapy training. My understanding is that at most psychiatry programs that's being whittled, and it is becoming more solely focused on psychopharmacology and then also interventions like TMS, ECT, the higher tech interventions. So my residency program was unusual. And then where I work now, at Bay Well Psychiatry Group is also unusual that we are a group of psychiatrists and psychologists but psychiatrists are encouraged and supported to do as much psychotherapy as they want. So we have the flexibility to do that. And it's a personal financial decision, you can make more money doing just meds, but that decision is left to everyone to make individually and is not dictated by the practice. So it has attracted a group of providers who are very interested in psychotherapy. And we have monthly psychotherapy case conferences and lots of consultants who come in and we get to do lots of fun psychotherapy stuff. So I like to preserve the combination. I think patients really like having a one stop shop, where the same person who prescribes to them is also their therapist, people really like that. And then I definitely think it makes me a better prescriber. It's not a checklist of someone's symptoms. It's an ongoing in-depth conversation about the nuances of people's experience. Evidence and studies have shown us that the combination is the most effective. And then it doesn't have to be in the same person. But there is something special about being the person to do both.
Emily Silverman
Patients often wonder about their therapists or their psychiatrists and their personal lives and their problems. And one of the funniest parts of your story was, as you're dealing with your own problems, you're actually having memories of patients, who you've talked to, who you've coached, who you've even coached through problems similar to the one you're going through. Do you ever wonder about them wondering about you? And how do you think about that one sidedness of the equation versus maybe like flipping it around? And in this case, it was like the patients almost were inspiring you in a in a reverse way.
Carson Brown
I am so curious about my own therapist, I'm always just like what is their life like? And you know, and there's so many different schools of thought about it more old school was, you know, the therapist is a blank screen. You know, the therapist can't reveal anything because then that tampers with what the patient can project onto you. And you know, some people still practice that way the more people have gotten the postmodern memo about there not being any objective space to occupy, but there's a whole field of psychological thought called intersubjectivity. So I'm fully in this postmodern, intersubjective school of thought of, there's no way to not bring yourself into it. And that it's not a matter of trying to eradicate that it's a matter of trying to be aware of it and make sure it's not interfering in the patient's process. So then that informs a lot of people's decisions about, I think I use the term earlier, self disclosure, how much to say about yourself. And I definitely don't tell patients this story, I've wondered what would happen if a patient runs across this podcast or whatever else. When patients have experiences that are similar to mine, I have to really remind myself that it might be similar, but it is not the same. And they are not the same as me that there can be a real temptation to just directly map my experience onto them, assume their response to things is the same as my response to things. So there really does have to be a tapping of the brakes. That said, my patients inspire me every day. And I learned from them every day, I said this to one of my supervisors at the Jung Institute, I said to her very sheepishly and kind of like thinking I was doing something wrong, I was like, I'm really learning a lot, not just about psychotherapy, but about like my own life, from this one patient in particular, who was going through something, and I felt kind of guilty about that, like, I wasn't supposed to be getting anything out of it. And my supervisor, and with a real lightness was like, oh, no, it's just one of the perks. Yeah, that's just one of the perks of the job. This is a tough job. Of course, we need to, you know, of course there's gotta be some perks. And yeah, so she really normalized it, she was just like, obviously, obviously, we're sitting with people all day grappling with deep human struggles. Of course, we're going to glean something from that, and there's nothing wrong with that.
Emily Silverman
I want to come back to your story. There's a scene toward the end, where you're walking with a friend, and you don't discuss what happened with your mom. But you do discuss the pain of separating from one's children. I think you say something in the story about how soon as they're born, it's just a gradual process of separation. And as somebody who's a relatively new mother, I really connected to that. And it reminded me of this moment, shortly after my daughter was born, she must have been, I don't know, six or eight weeks old or something like that. And the inlaws came to visit, and she was lying on her back on this play mat, and they were playing with her. And I was there. And then I had to go to the bathroom. So I stepped away, I went to the bathroom. And when I came back, they were all like smiling and laughing. And something had happened, like my daughter had done something silly or funny or made a face. And they had had some kind of experience. And I hadn't been a part of it. And I just remember, it felt so strange that my baby, my daughter, had, like, had an experience that I hadn't been a part of, after, you know, obviously, nine months of like, literally being the same being.
Carson Brown
I think this is such a journey of parenthood, I think it is, there's a specific wrinkle for the birthing parent because of what you said that the baby is literally contained in your body for a period of time and there is a physical, then separation at birth. So there's there's a specific wrinkle to that. But I think even for the non birthing parent, who also bonds so, so closely, that there's a similar process. You know, I'm not to the point of some of my empty nester friends where they really leave home. But I hear from them and I hear from other people. And I have felt that I think it's pretty much our hardest job as parents is allowing the separation. And it gives me a ton of empathy for my mom. And for anyone else, I understand how an enmeshed dynamic comes about because it's extremely difficult and extremely painful. So of course, people want to short circuit it or avoid it. Who wouldn't want to do that? I called it grief in the story. I really I think that's the most accurate word I have, but there are probably a lot of them. Yeah, we're gonna miss things. We're going to not understand things about them. We're gonna be things about them we just never even know. And it's just, it's just a huge adjustment. There's a huge benefit to doing it, too. You know, sometimes my kids say to me, because I love babies and I just want to I see babies and snuggle them all the time. And they say you wish we were still babies. And I pause and I'm like, I actually don't because if you stayed babies, I wouldn't get to see this these amazing 9 and 12 year olds, you know, and so it doesn't erase the grief or pain, but it at least isalongside it is like, wow, I get to see this person blossom. And that's the reward for tolerating the very real grief and pain.
Emily Silverman
How is living in Minneapolis after living in the Bay Area for so long?
Carson Brown
It's 1 degree today. I think 1 is the funniest temperature. Sometimes they say it is as degree. Or I was joking recently when that when the high is a negative number. I won't call it a high. But I'm loving it. It's wonderful here. I think it's really enlivening to kind of have beginner's mind about a place. I mean, we're going dogsledding next weekend and we, yesterday we're at these barrel saunas by a lake and we're doing cold plunge into the like, throw a hole in the frozen lake. And I was like, I've never done this before, I wouldn't have done this. I found it really enlivening to have a change at this point in my life. And it's it's a really beautiful place.
Emily Silverman
Well, Carson, I just want to thank you so much for telling your story with The Nocturnists and coming into chat with me today. I've just so enjoyed this conversation. I feel like I've probably gotten a little therapy out of it myself. So thanks again for coming on and for being here.
Carson Brown
Thanks. It was a really profound experience for me to get to do it. So I'm just so grateful for the opportunity and for today too, thank you.
Note: *The Nocturnists* is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.*
TRANSCRIPT:
Emily Silverman
You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. Some people are close to their parents. But how close is too close? We want to love and support each other as we transition from one phase of life to the next. But we also want the freedom to evolve as individuals to make our own choices and build our own families. In today's story, psychiatrist Carson Brown explores the idea of adulthood, and what it means to arrive there, sometimes much later in life than one might expect. In the conversation that follows, Carson and I talk about motherhood, the pain of separating from our children and the diverging philosophies of Sigmund Freud and Carl Jung, two giants in the world of psychology. Carson is a psychiatrist in Minneapolis who specializes in anxiety, depression, codependency and trauma. She incorporates somatic practices, dream work and guided meditation into her practice. She went to UCSF for medical school and did her residency training at San Mateo County, but also draws inspiration from her undergraduate work in English, where she developed a love for literature and storytelling. Take a listen to Carson's story Growing Up, which she performed live in Minneapolis in 2023.
Carson Brown
It's this glorious spring day in the San Francisco Bay Area where the trees are blooming, I'm getting a little sunburn on my neck and I'm over at my brother's house in the Berkeley hills. My kids are frolicking with their cousins and the dogs and my husband Scott is grilling with my sister-in-law and my mom has just arrived. I see her get out of her car and she's carrying this very heavy cardboard box and I know exactly what is weighing down this box; it is quiches. My mom makes a lot of quiches and she brings them to all these family events to send home with all of us. So she's kind of lugging it up and she manages to kind of wave at the kids. And she's just got this grandmother glow going on. Today's the day I have to make an announcement that I've been postponing and dreading for months. My family is moving from the Bay Area to Minnesota, because it's awesome. It's where Scott is from, and I've never really left the bay I grew up there I went to college, medical school, psychiatry residency all within a very tight radius of San Francisco and my mom. No Mom, no parent, is stoked to get the news that their child is moving away, that their grandchildren are moving away, but with my mom, it's kind of this other level. In mental health, in the biz, we have a word for this dynamic between my mom and me, which is enmeshment, you might want to google it. What she feels, I feel. It's kind of like being conjoined twins except instead of sharing parts of our body we share parts of our psyche and what happens when a conjoined twin moves away? You know when I was very young child, the enmeshment situation was great. We were always together. We're driving around all my activities, we're like singing oldies in harmony in the car. I'm very helpful and collating her League of Women Voters newsletters with her. I'm sitting on the couch, we're watching Jeopardy and I'm like just brushing her long beautiful hair and she never wants me to stop. I start to get a little older and I want to like have sleepovers at other people's houses. And she's like, okay, but like, only if they sleep over here. My senior year of high school, I came home one afternoon after school and saw her standing in front of a mirror, trying on my prom dress. And I didn't really have the language to understand how invasive it felt. My junior year of college, I did leave, I did actually leave this one time, I went to England for my junior year of college, and she very quickly came to visit. And we go to Stonehenge, and we're standing in the long shadows, and we're feeling the druid vibe. And she looks at me really intensely. And she says, last time I was here, you were in my womb. It's true. It's a fact. And that night, we go out to the pub with my group of friends. And we're having our room temperature flat ale. And one of my friends pulls me aside and is like, 'Dude, why is your mom here?' Like, why isn't your mom here? Dude, you know, I don't, I don't know. So there was one instance where she deviated from this pattern of collapsing the space between us and staying merged. This one instance was after my daughter was born. And she came to the hospital and met her. But then for the next month, I did not see her. And barely heard from her. I would have told you she would have been banging down my door to get our hands on this baby. But she was just, she was nowhere. And I remember I'm nursing my daughter. It's that like, very worst hour of the day at like 4am. And I'm looking at my phone. The attachment parenting books say not to do that. But I'm looking at my phone. And I'm looking at this long list of text invitations to her, photos, and nothing's coming back. And just in that moment, I feel so hungry. Like all the calories of my body are going into this other person. And I fish in the pocket of one of those glider rocking chairs. I fish in this cloth pocket and I find one sad pretzel. And it's dry and stale. And I eat it. And it's just very bleak. And all I can think is I could really go for a quiche right now. I need it. So on the day of my announcement at my brother's house in Berkeley, my mom is sitting in an Adirondack chair, you know, like a queen on her throne. And she's looking out at this priceless view of the Golden Gate, San Francisco skyline. And she says this is the best place in the world. She's a die hard Bay Area person. And she hates temperatures below 50. And so I know she's not going to follow me to Minnesota. But historically her only other play has been to ghost me. And so I am legitimately scared she's gonna ghost me again. And that this time I mean, this one's big, you know this, this could be for good. So I'm paralyzed with fear. And I have the thought, W W M P D? What would my patients do? Because I've seen them go through that, I've accompanied them; my therapy patients go through this many times. So I start to imagine what would they say to me if they saw me being a giant hypocrite and not doing what I tell them to do? So I start to hear them in my mind. They're like, Dr. Brown. Remember when I had to move out of my parents house, but I wanted their approval, I wanted their blessing. You said to me, 'Individuation is not a negotiation.' Did I say that?? 'Dr. Brown, remember when I did not go home for Christmas, and I was consumed by guilt. And you said that that guilt was a good sign? If I could tolerate it that guilt was information that I was on the right track doing the heroic work of dismantling dysfunctional intergenerational patterns.'
Carson Brown
That sounds like something I might say. So bad! 'Dr. Brown, may I remind you of one of your favorite quotes you like to trot out? When you stop people pleasing, people will not be pleased.'
Carson Brown
Okay, so with my patients as my inspiration, I clicked my glass and said, 'Everybody, I have something very important to tell you.' It all goes badly after I very awkwardly kind of get the information out. I look at my mom in that chair. And she's like a statue, she will not make eye contact with me. She doesn't say anything. I go and sit on the grass next to her and I put my hand on top of her hand. And it's like cold stone. She does not, you know, take my hand back. And pretty soon after that she leaves and days pass with no word from her... silence. And I am unraveling. It appears that the worst case scenario is happening. And I've made an independent decision and I am banished. That's what it looks like. So on day five of this silent period, I collapse into bed. I'm kind of like diagonal sideways on the bed, my head kind of toward the bottom corner I'm wearing those full goblin mode sweats. It's like one sock and I'm crying - I'm someone who cries a lot. But this is another level is like hemorrhaging, but it's tears and just the whole day. And from my very weird angle on the bed, I'm looking right at my bookshelf that's dedicated to my psychiatry and psychology books that I've collected over like 15 years. And I'm like, 'What do you got for me guys?' Like, help a sister out? You know, and I grabbed the book that's closest to me. I open to a random page through the blur of tears. I'm like, okay, this is my buddy Carl Jung. He's talking about alchemy, which I always find very esoteric and not applicable. Alchemy, the alchemical transformation of the psyche. And this one word jumps out at me. The nigredo... mysterious. It's the first stage of the alchemical transformative process and it's where the psyche is burned to black ash, unrecognizable. The nigredo is just decay, decomposition, putrefaction, chaos and death. I feel seen. Carl gets it. Carl knows I'm in the nigredo. I'm in the nigredo! So that night Scott spoons me and his his heartbeat against my back is a beacon and over the next couple of days I very slowly start to kind of reconstitute. I'm playing some Uno with my kids. I'm sending Big Lebowski memes back and forth with my brother. I have this kind of epic day at work where everything's working. I'm thinking I'm in this like raw undefended state and my patients are kind of like, what is going on but I like it. And the ninth day, I take a hike with my shrink friend. And she knows about the whole situation with my mom in detail. We don't even really talk about her. We talk about our own pain as moms. We have young kids, but they are already separating the second you cut that cord. They're separating. And it's brutal. And we just vow, we vow, pinky promise to support each other in what's really like grief, as we just have to incrementally let them go. And by that ninth night I still really want to hear from my mom badly. But I'm like, I might not. And that would be devastating and tragic. And I would survive, because I'm not a dependent little girl anymore. I'm a grown ass woman. It only took 44 years, but it did happen. It's only with that realization, it's in that moment late on the ninth night that I get an email from her. And the email is fine. It exists. But my main emotional reaction to it is, I feel so grateful that it took her exactly that long to send it because I needed every excruciating second in that crucible to alchemize and rebirth myself.
Emily Silverman
I am sitting here with Carson Brown. Carson, thank you so much for being here today.
Carson Brown
Thanks for having me, Emily.
Emily Silverman
So Carson, one of the things I loved about your story is that it's a relatively intense story. From a content standpoint, we're talking about mother/daughter dynamics and the pain of individuating from your family and letting go. But your performance was so funny. And I was wondering, did you know that you were this funny?
Carson Brown
That's so flattering and nice. I mean, really the only other time I am ever onstage is for karaoke, which I used to really like a lot. I'm definitely talkative, but definitely not an improv person. I think I'd be terrified of that. And this seemed possible because it was very rehearsed. And I very much knew what I thought was gonna happen.
Emily Silverman
Something else I loved about your story is how it gave us a window into your psychoanalytic mind. You're telling the story, but you're also giving us definitions of these psych terms like enmeshment. And there's that scene at the end, where you're crying in bed, and you look up and you see the wall of psychiatry books, you pick a book off the shelf, and it's Carl Jung, and you start telling us about Carl Jung and the nigrado. And I just loved how educational the story was, in addition to being a story, it kind of helped us understand what it's like to be a psychiatrist. And I was just curious if you could tell us about your journey to psychiatry.
Carson Brown
Psychiatry is the best, you know, I love it. And I think almost everyone's interested in it, because it's really just the human experience. So those types of details I see as fun for everybody. But I definitely came into medical school thinking I was going to do primary care and interested in integrative medicine. That was sort of how I saw myself initially, but a lot of the advice I got about choosing specialties was find your people. And I liked lots of different people. But I think psychiatrists are people very comfortable with gray area, very comfortable with, well, more comfortable with not knowing. All of medicine is about the human condition, but something about psychiatry just puts that very front and center. Once I was really exposed to it, it's very clear. That's, that's what I wanted to do. That's where I fit.
Emily Silverman
Do you specialize in any particular type of psychiatry?
Carson Brown
I do general adult psychiatry, so I feel like I see a broad range. But somehow over time, I feel like a lot of my patient panel has, I call it complex trauma, which isn't a DSM diagnosis, but it's something that's used more and more - Complex PTSD, meaning not a specific incident, but more like something that we would call developmental trauma or attachment deficits, which respond to both medication and psychotherapy, best in combination, and it's very rewarding work. And then I think the story, you know, plays into certain elements of that, too, I think enmeshment is a type of attachment deficit and a developmental issue somehow, maybe because it resonates for me that that's a lot of how my practice has taken form.
Emily Silverman
You mentioned enmeshment is one type of attachment deficit. And that caught my attention. Because when I think of enmeshment, or at least how you describe it in your story, it seems almost like the opposite, like over attachment, rather than an attachment deficit. And so I was wondering if you could tell us more about what it is and how you think about it? And where does that come from? How does it cross over from healthy into unhealthy? And how do you know the difference?
Carson Brown
The deficits of enmeshment are just being very, very unclear on what belongs to oneself and what belongs to other person? What am I responsible for emotionally, and what is the other person responsible for emotionally and that's just completely scrambled in an enmeasurement dynamic, and can really cause relationship problems later. For me, it shows mainly in this over responsibility feeling of, I have to manage everybody else's emotions for them. What's really tricky is I think my job as a psychiatrist also pulls me into that role. Like, I'm kind of asked professionally to manage other people's emotions for now. And really trying to learn how to distinguish in personal but also in these professional relationships, what's my job, and then where does my job end and the patient takes over. And it's, it's their job. Because definitely starting out, I was bringing very much of an enmeshed vibe to the professional interaction of like, okay, you're here, it's my job to fix your life, it's my job to make sure you never feel bad again, it's my job to contort myself, even in this professional relationship. I mean, that'll lead to burnout if you keep doing that. My main motivation has to be acting from my own authenticity, rather than my main motivation has to be placating the other person. And it's easy to say, but it's been very hard to unlearn and actually do.
Emily Silverman
Yeah, I remember, once I was having a lot of stress, and I use an app to get a massage. I was like, I'm gonna do some self care. So I use this app. And this guy shows up in my house with a massage table, and he's giving me this massage. And I remember at one point, he got to some tension in like my left arm or something, and he was massaging it. And he was like, oh, and he was like picking something up. And I was like, what, what? And he was like, I just feel like whatever this is in your arm, like it's not yours. And I had never really had a massage therapist speak to me that way. And it really got me thinking about like, even more than just what we have in our minds or in our heads, like, how do we understand tensions that are being held in our bodies that aren't even ours to begin with? And so I was wondering if you've ever experimented with that, as well? Does the body have anything to offer in helping us understand what is ours? And what is not ours? And what can be released? I know it's a very like California woowoo question. But you are from California.
Carson Brown
You're asking a whole other really interesting question, what all types of somatic therapy really take up, which is the profound ways our bodies actually know so much more than our cerebral cortex. Sometimes it's called bottom up, information that's coming from our viscera up to our brain; this can be so much more informative if we know how to listen to it. Most of us are not acculturated to do that. We culturally really prioritize thinking over emotions, and then definitely over sensation, which, you know, people call gut feeling all kinds of different things. But there's not a definitive answer, it's more just paying attention to sensations and honoring that they contain information. I don't think there's specific sensations necessarily associated with enmeshment globally, but I think for certain people you can start to notice that they do have certain patterns of holding when when things get activated, and over time, it can help people discern like, Am I doing this authentically? Or am I doing this to please? Because it can be a hard question to answer. And I have seen people, and I'd love to do it more with myself, really learn what it feels like in my body when I'm being authentic and I know a specific kind of signature fingerprint that comes up for me when it's more like fawning or pleasing or an enmeshed response.
Emily Silverman
The last part of your story was very nonverbal. You were almost describing an experience that happened in your body where there's the initial terror of disclosing this information to your mother. There's the worst fear realized where your mother responds with, I guess separation or coldness. And then you talk about laying in bed and you're crying and one sock is off. And you're just kind of going through this internal negredo, you say it's like a process by which the self is burned down to ash and then reconstituted. And it's all happening inside. And you bring us through the different stages of that, where at first you're in a state of despair. And then things start to feel a little bit more hopeful. And you have like, weirdly, a good day at work. And then you go on this walk with this friend, and then it's almost like, right, as the cycle is completing, you get the email from your mom, and you're glad that the email was delayed, because it gave you the opportunity to go through that process. And so I'm wondering if you can, I know it's hard probably to put words to, but what is that process happening internally? It's just like an energetic movement, or what is it that happened?
Carson Brown
The entirety of Carl Jung's body of work is trying to answer that as as well as other thinkers and feelers, obviously. But I did use that word crucible towards the end, and he uses another word, the tenemos, which is a container, and we talked about the container and the frame and psychotherapy a lot.
Emily Silverman
What are the container and what's the frame?
Carson Brown
It's almost ... I'm thinking of the word 'rules'. But just like the agreements of the psychotherapeutic encounter, the time, the space, we meet from this time to this time, on this day, it's almost the ritual of it. It is also the therapist's boundaries, different therapists. And across time, ideas about self-disclosure and other types of boundaries do shift, but there are still certain boundaries that a therapist is holding. And the idea is just having this defined space is a chunk of the work. It's not even the talking or the emotive part, it really is there's this defined space where I do this type of self reflection. Obviously, there's a lot more to being a therapist than just holding that space. But it is sort of the fundamental requirement and enables everything else to happen. And there is a sense, a lot of the times, that the psyche has a natural impulse towards self healing, that it's it's looking for channels to move in, towards healing, towards something more integrated, towards something more comfortable or resolved, and just giving it this type of consistent, compassionate attention, it will unfold in that direction, as long as we stay out of the way. So I think, you know, the situation I was describing at the end, it was definitely post verbal, I think it was so overwhelming and so catastrophic to my psyche, that it was not something I could talk about while it was happening. And that's sort of a definition of trauma also is something that's overwhelming and can't be assigned meaning or processed in real time. It's something that's so overwhelming that it's it outstrips our capacity to do that. But but there was a holding space just in my home from my husband, I actually left a line out of the live telling of the story, which was Scott bringing me tea and taking away my snotty tissues. And there was just space for me to collapse mostly provided by him.The books...I think they are part of the support structure too. I do think that bookshelf meant a lot to me like I'm probably not the first one going through this, I'm probably not the first one to think about this, there probably is a way to assign some type of structure, meaning, understanding to something that feels unfathomable to me right now. So it was sort of like, I was looking for a book to be my life preserver ring thing, and it did happen. I think having any type of word to just grab onto did feel like that life preserver of like, okay, this is at least one way to conceptualize what's happening right now. And there's a comfort. That was a humor, I was kind of going for it. Even though it was so horrible, your psyche being burned to ash, that basically the worst thing that there was something comforting in having that described. I think that's what we try to do as therapists too is we'll float out 'Oh, do you mean this or is it this type of thing? Or is it this word?' And a lot of times we're like, 'oh, that's not quite it.' But sometimes they'll be like, 'exactly, yes. Thank you.' And you do feel it as like a sustenance for somebody as as a ballast.
Emily Silverman
Is that a term that you had heard before in your studies? Or was it something that you just came across for the first time in that moment,
Carson Brown
My fourth year of residency training, I was at the San Francisco Jung Institute for the whole year, as about a third of my time was there. I had psychotherapy patients through them, and they had their own set of didactics. So even all that time was like scratching the surface. And they have an entire psychoanalytic training program. So it was really just the introduction, but I had spent a lot of time with his work. And then contemporary Jungian thinkers also. So I definitely had been exposed to it before, there's a really brief line I say in the story that I hadn't found applicable before this, his most esoteric stuff is around these alchemy processes. And prior to having my own experience of this, I was like how, like, how do I apply it, and it had felt too esoteric to me before it, it felt a little ungrounded. But then I was like, oh, it does match up to actual phenomena. I think it just hadn't of clicked for me. He's so abstracted. And, you know, so much of his work is about symbols, that sometimes connecting it back to day to day modern life takes a little translating, but then it made a lot of sense in that moment.
Emily Silverman
He's such a famous person in the psych literature, I think, probably Freud, and Jung are the two, you know, big names for people who have maybe heard those names before, but aren't really sure what the one liner is for what each of them believed, or their theories, or I think their theories might even come into conflict with each other. But is there a way to boil down some of these young Jungian approaches versus Freudian approaches? Or is it more that they had like many different theories and philosophies and you can only really get it if you do a deep dive,
Carson Brown
Probably something in between, I'm feeling slightly daunted trying to give a one liner but I will try. You know, there they are some of the OGs of the whole field, which is super important and impressive in certain ways. And also they are very much products of their time and place and intersections of various identities. And so a lot of the time since then, has been critiquing, mostly critiquing, unpacking, modernizing, there's a lot that's problematic is sort of the short way to say it, there's anti semitism, and there's sexism, there's all kinds of difficult stuff in there. And there are some of the building blocks of the whole field. So I mean, what I say about Freud sometimes is, he was the first person in the Western tradition, there were plenty of other thinkers and people having all kinds of different experiences in different parts of the world. But he was really the first European to say, the unconscious mind exists. So that was on the level of Copernicus to me of someone asserting something that basically everyone else thinks is crazy at the time. Copernicus at least had telescopes and other instruments and mathematics to back him up. The unconscious, you know, we can't measure, see, directly perceive it kind of by definition. So someone saying this thing that's unperceivable exists was, not to overstate it, a complete turning point in European thought. And then yes, he and Jung were close, close colleagues. Jung was basically Freud's right hand man. And then they had a major schism, which happens repeatedly through the history of psychiatry and psychology. People get pretty heated about these topics. My one liner on Jung, people have probably heard collective unconscious, you know, so he did take this idea of the unconscious and be like, it's not just seated in each individual mind. There's also a collective or societal level of it. And that's what he thought about archetypes and themes that you find running through all cultures really fascinated him. It's fascinating how did all these different groups of people come up with similar symbols or similar ways of thinking about things? So that's one of his major contributions. I also just think of him as really bringing symbol and how symbols operate. That's one of his major contributions to and that comes up a lot in dreams. A lot of people when they think of Jung their word association to him, and he did word association work, is dreams, because he saw dreams as the way our unconscious communicates with us. But that the language of the unconscious is not literal. It's symbolic. And whereas Freud was sort of like, well, if someone dreams about feces, that is money, it was sort of a one-to-one symbol to meaning. Jung was very much more like no, no, the symbol is individual to the person and has to be teased out and understood in the context of that person.
Emily Silverman
In your practice, I mean, you seem to be really interested in the therapy side of Psych. So you know, psychoanalysis and Freud and Jung and kind of talking through things using symbol, using story to help people heal and make sense of their experience. Do all psychiatrists build that into their work? Or do you feel like sometimes the field splits off where it's like the psychiatrists are dealing with the pills, and it's the therapists, you know, who maybe aren't physicians, but who are trained in therapy, who are doing the talk therapy and doing some of these other things? What is it like in your practice? And are you unique? Or do you feel like most psychiatrists veer more toward like the medical approach as opposed to some of this more, I guess, abstract approach?
Carson Brown
Right? I mean, I think more and more, it's becoming the MD psychiatrists prescribe and non MD therapists do the therapy. I think that's the way insurance companies want it. I think that there's financial incentive for psychiatrists to work that way. I went to an unusual residency program at San Mateo County, that is a gem of a program if anyone's looking for one that really does emphasize psychotherapy. And people have long term psychotherapy cases starting in second year, and there's a lot of psychotherapy training. My understanding is that at most psychiatry programs that's being whittled, and it is becoming more solely focused on psychopharmacology and then also interventions like TMS, ECT, the higher tech interventions. So my residency program was unusual. And then where I work now, at Bay Well Psychiatry Group is also unusual that we are a group of psychiatrists and psychologists but psychiatrists are encouraged and supported to do as much psychotherapy as they want. So we have the flexibility to do that. And it's a personal financial decision, you can make more money doing just meds, but that decision is left to everyone to make individually and is not dictated by the practice. So it has attracted a group of providers who are very interested in psychotherapy. And we have monthly psychotherapy case conferences and lots of consultants who come in and we get to do lots of fun psychotherapy stuff. So I like to preserve the combination. I think patients really like having a one stop shop, where the same person who prescribes to them is also their therapist, people really like that. And then I definitely think it makes me a better prescriber. It's not a checklist of someone's symptoms. It's an ongoing in-depth conversation about the nuances of people's experience. Evidence and studies have shown us that the combination is the most effective. And then it doesn't have to be in the same person. But there is something special about being the person to do both.
Emily Silverman
Patients often wonder about their therapists or their psychiatrists and their personal lives and their problems. And one of the funniest parts of your story was, as you're dealing with your own problems, you're actually having memories of patients, who you've talked to, who you've coached, who you've even coached through problems similar to the one you're going through. Do you ever wonder about them wondering about you? And how do you think about that one sidedness of the equation versus maybe like flipping it around? And in this case, it was like the patients almost were inspiring you in a in a reverse way.
Carson Brown
I am so curious about my own therapist, I'm always just like what is their life like? And you know, and there's so many different schools of thought about it more old school was, you know, the therapist is a blank screen. You know, the therapist can't reveal anything because then that tampers with what the patient can project onto you. And you know, some people still practice that way the more people have gotten the postmodern memo about there not being any objective space to occupy, but there's a whole field of psychological thought called intersubjectivity. So I'm fully in this postmodern, intersubjective school of thought of, there's no way to not bring yourself into it. And that it's not a matter of trying to eradicate that it's a matter of trying to be aware of it and make sure it's not interfering in the patient's process. So then that informs a lot of people's decisions about, I think I use the term earlier, self disclosure, how much to say about yourself. And I definitely don't tell patients this story, I've wondered what would happen if a patient runs across this podcast or whatever else. When patients have experiences that are similar to mine, I have to really remind myself that it might be similar, but it is not the same. And they are not the same as me that there can be a real temptation to just directly map my experience onto them, assume their response to things is the same as my response to things. So there really does have to be a tapping of the brakes. That said, my patients inspire me every day. And I learned from them every day, I said this to one of my supervisors at the Jung Institute, I said to her very sheepishly and kind of like thinking I was doing something wrong, I was like, I'm really learning a lot, not just about psychotherapy, but about like my own life, from this one patient in particular, who was going through something, and I felt kind of guilty about that, like, I wasn't supposed to be getting anything out of it. And my supervisor, and with a real lightness was like, oh, no, it's just one of the perks. Yeah, that's just one of the perks of the job. This is a tough job. Of course, we need to, you know, of course there's gotta be some perks. And yeah, so she really normalized it, she was just like, obviously, obviously, we're sitting with people all day grappling with deep human struggles. Of course, we're going to glean something from that, and there's nothing wrong with that.
Emily Silverman
I want to come back to your story. There's a scene toward the end, where you're walking with a friend, and you don't discuss what happened with your mom. But you do discuss the pain of separating from one's children. I think you say something in the story about how soon as they're born, it's just a gradual process of separation. And as somebody who's a relatively new mother, I really connected to that. And it reminded me of this moment, shortly after my daughter was born, she must have been, I don't know, six or eight weeks old or something like that. And the inlaws came to visit, and she was lying on her back on this play mat, and they were playing with her. And I was there. And then I had to go to the bathroom. So I stepped away, I went to the bathroom. And when I came back, they were all like smiling and laughing. And something had happened, like my daughter had done something silly or funny or made a face. And they had had some kind of experience. And I hadn't been a part of it. And I just remember, it felt so strange that my baby, my daughter, had, like, had an experience that I hadn't been a part of, after, you know, obviously, nine months of like, literally being the same being.
Carson Brown
I think this is such a journey of parenthood, I think it is, there's a specific wrinkle for the birthing parent because of what you said that the baby is literally contained in your body for a period of time and there is a physical, then separation at birth. So there's there's a specific wrinkle to that. But I think even for the non birthing parent, who also bonds so, so closely, that there's a similar process. You know, I'm not to the point of some of my empty nester friends where they really leave home. But I hear from them and I hear from other people. And I have felt that I think it's pretty much our hardest job as parents is allowing the separation. And it gives me a ton of empathy for my mom. And for anyone else, I understand how an enmeshed dynamic comes about because it's extremely difficult and extremely painful. So of course, people want to short circuit it or avoid it. Who wouldn't want to do that? I called it grief in the story. I really I think that's the most accurate word I have, but there are probably a lot of them. Yeah, we're gonna miss things. We're going to not understand things about them. We're gonna be things about them we just never even know. And it's just, it's just a huge adjustment. There's a huge benefit to doing it, too. You know, sometimes my kids say to me, because I love babies and I just want to I see babies and snuggle them all the time. And they say you wish we were still babies. And I pause and I'm like, I actually don't because if you stayed babies, I wouldn't get to see this these amazing 9 and 12 year olds, you know, and so it doesn't erase the grief or pain, but it at least isalongside it is like, wow, I get to see this person blossom. And that's the reward for tolerating the very real grief and pain.
Emily Silverman
How is living in Minneapolis after living in the Bay Area for so long?
Carson Brown
It's 1 degree today. I think 1 is the funniest temperature. Sometimes they say it is as degree. Or I was joking recently when that when the high is a negative number. I won't call it a high. But I'm loving it. It's wonderful here. I think it's really enlivening to kind of have beginner's mind about a place. I mean, we're going dogsledding next weekend and we, yesterday we're at these barrel saunas by a lake and we're doing cold plunge into the like, throw a hole in the frozen lake. And I was like, I've never done this before, I wouldn't have done this. I found it really enlivening to have a change at this point in my life. And it's it's a really beautiful place.
Emily Silverman
Well, Carson, I just want to thank you so much for telling your story with The Nocturnists and coming into chat with me today. I've just so enjoyed this conversation. I feel like I've probably gotten a little therapy out of it myself. So thanks again for coming on and for being here.
Carson Brown
Thanks. It was a really profound experience for me to get to do it. So I'm just so grateful for the opportunity and for today too, thank you.
Transcript
Note: *The Nocturnists* is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.*
TRANSCRIPT:
Emily Silverman
You're listening to The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. Some people are close to their parents. But how close is too close? We want to love and support each other as we transition from one phase of life to the next. But we also want the freedom to evolve as individuals to make our own choices and build our own families. In today's story, psychiatrist Carson Brown explores the idea of adulthood, and what it means to arrive there, sometimes much later in life than one might expect. In the conversation that follows, Carson and I talk about motherhood, the pain of separating from our children and the diverging philosophies of Sigmund Freud and Carl Jung, two giants in the world of psychology. Carson is a psychiatrist in Minneapolis who specializes in anxiety, depression, codependency and trauma. She incorporates somatic practices, dream work and guided meditation into her practice. She went to UCSF for medical school and did her residency training at San Mateo County, but also draws inspiration from her undergraduate work in English, where she developed a love for literature and storytelling. Take a listen to Carson's story Growing Up, which she performed live in Minneapolis in 2023.
Carson Brown
It's this glorious spring day in the San Francisco Bay Area where the trees are blooming, I'm getting a little sunburn on my neck and I'm over at my brother's house in the Berkeley hills. My kids are frolicking with their cousins and the dogs and my husband Scott is grilling with my sister-in-law and my mom has just arrived. I see her get out of her car and she's carrying this very heavy cardboard box and I know exactly what is weighing down this box; it is quiches. My mom makes a lot of quiches and she brings them to all these family events to send home with all of us. So she's kind of lugging it up and she manages to kind of wave at the kids. And she's just got this grandmother glow going on. Today's the day I have to make an announcement that I've been postponing and dreading for months. My family is moving from the Bay Area to Minnesota, because it's awesome. It's where Scott is from, and I've never really left the bay I grew up there I went to college, medical school, psychiatry residency all within a very tight radius of San Francisco and my mom. No Mom, no parent, is stoked to get the news that their child is moving away, that their grandchildren are moving away, but with my mom, it's kind of this other level. In mental health, in the biz, we have a word for this dynamic between my mom and me, which is enmeshment, you might want to google it. What she feels, I feel. It's kind of like being conjoined twins except instead of sharing parts of our body we share parts of our psyche and what happens when a conjoined twin moves away? You know when I was very young child, the enmeshment situation was great. We were always together. We're driving around all my activities, we're like singing oldies in harmony in the car. I'm very helpful and collating her League of Women Voters newsletters with her. I'm sitting on the couch, we're watching Jeopardy and I'm like just brushing her long beautiful hair and she never wants me to stop. I start to get a little older and I want to like have sleepovers at other people's houses. And she's like, okay, but like, only if they sleep over here. My senior year of high school, I came home one afternoon after school and saw her standing in front of a mirror, trying on my prom dress. And I didn't really have the language to understand how invasive it felt. My junior year of college, I did leave, I did actually leave this one time, I went to England for my junior year of college, and she very quickly came to visit. And we go to Stonehenge, and we're standing in the long shadows, and we're feeling the druid vibe. And she looks at me really intensely. And she says, last time I was here, you were in my womb. It's true. It's a fact. And that night, we go out to the pub with my group of friends. And we're having our room temperature flat ale. And one of my friends pulls me aside and is like, 'Dude, why is your mom here?' Like, why isn't your mom here? Dude, you know, I don't, I don't know. So there was one instance where she deviated from this pattern of collapsing the space between us and staying merged. This one instance was after my daughter was born. And she came to the hospital and met her. But then for the next month, I did not see her. And barely heard from her. I would have told you she would have been banging down my door to get our hands on this baby. But she was just, she was nowhere. And I remember I'm nursing my daughter. It's that like, very worst hour of the day at like 4am. And I'm looking at my phone. The attachment parenting books say not to do that. But I'm looking at my phone. And I'm looking at this long list of text invitations to her, photos, and nothing's coming back. And just in that moment, I feel so hungry. Like all the calories of my body are going into this other person. And I fish in the pocket of one of those glider rocking chairs. I fish in this cloth pocket and I find one sad pretzel. And it's dry and stale. And I eat it. And it's just very bleak. And all I can think is I could really go for a quiche right now. I need it. So on the day of my announcement at my brother's house in Berkeley, my mom is sitting in an Adirondack chair, you know, like a queen on her throne. And she's looking out at this priceless view of the Golden Gate, San Francisco skyline. And she says this is the best place in the world. She's a die hard Bay Area person. And she hates temperatures below 50. And so I know she's not going to follow me to Minnesota. But historically her only other play has been to ghost me. And so I am legitimately scared she's gonna ghost me again. And that this time I mean, this one's big, you know this, this could be for good. So I'm paralyzed with fear. And I have the thought, W W M P D? What would my patients do? Because I've seen them go through that, I've accompanied them; my therapy patients go through this many times. So I start to imagine what would they say to me if they saw me being a giant hypocrite and not doing what I tell them to do? So I start to hear them in my mind. They're like, Dr. Brown. Remember when I had to move out of my parents house, but I wanted their approval, I wanted their blessing. You said to me, 'Individuation is not a negotiation.' Did I say that?? 'Dr. Brown, remember when I did not go home for Christmas, and I was consumed by guilt. And you said that that guilt was a good sign? If I could tolerate it that guilt was information that I was on the right track doing the heroic work of dismantling dysfunctional intergenerational patterns.'
Carson Brown
That sounds like something I might say. So bad! 'Dr. Brown, may I remind you of one of your favorite quotes you like to trot out? When you stop people pleasing, people will not be pleased.'
Carson Brown
Okay, so with my patients as my inspiration, I clicked my glass and said, 'Everybody, I have something very important to tell you.' It all goes badly after I very awkwardly kind of get the information out. I look at my mom in that chair. And she's like a statue, she will not make eye contact with me. She doesn't say anything. I go and sit on the grass next to her and I put my hand on top of her hand. And it's like cold stone. She does not, you know, take my hand back. And pretty soon after that she leaves and days pass with no word from her... silence. And I am unraveling. It appears that the worst case scenario is happening. And I've made an independent decision and I am banished. That's what it looks like. So on day five of this silent period, I collapse into bed. I'm kind of like diagonal sideways on the bed, my head kind of toward the bottom corner I'm wearing those full goblin mode sweats. It's like one sock and I'm crying - I'm someone who cries a lot. But this is another level is like hemorrhaging, but it's tears and just the whole day. And from my very weird angle on the bed, I'm looking right at my bookshelf that's dedicated to my psychiatry and psychology books that I've collected over like 15 years. And I'm like, 'What do you got for me guys?' Like, help a sister out? You know, and I grabbed the book that's closest to me. I open to a random page through the blur of tears. I'm like, okay, this is my buddy Carl Jung. He's talking about alchemy, which I always find very esoteric and not applicable. Alchemy, the alchemical transformation of the psyche. And this one word jumps out at me. The nigredo... mysterious. It's the first stage of the alchemical transformative process and it's where the psyche is burned to black ash, unrecognizable. The nigredo is just decay, decomposition, putrefaction, chaos and death. I feel seen. Carl gets it. Carl knows I'm in the nigredo. I'm in the nigredo! So that night Scott spoons me and his his heartbeat against my back is a beacon and over the next couple of days I very slowly start to kind of reconstitute. I'm playing some Uno with my kids. I'm sending Big Lebowski memes back and forth with my brother. I have this kind of epic day at work where everything's working. I'm thinking I'm in this like raw undefended state and my patients are kind of like, what is going on but I like it. And the ninth day, I take a hike with my shrink friend. And she knows about the whole situation with my mom in detail. We don't even really talk about her. We talk about our own pain as moms. We have young kids, but they are already separating the second you cut that cord. They're separating. And it's brutal. And we just vow, we vow, pinky promise to support each other in what's really like grief, as we just have to incrementally let them go. And by that ninth night I still really want to hear from my mom badly. But I'm like, I might not. And that would be devastating and tragic. And I would survive, because I'm not a dependent little girl anymore. I'm a grown ass woman. It only took 44 years, but it did happen. It's only with that realization, it's in that moment late on the ninth night that I get an email from her. And the email is fine. It exists. But my main emotional reaction to it is, I feel so grateful that it took her exactly that long to send it because I needed every excruciating second in that crucible to alchemize and rebirth myself.
Emily Silverman
I am sitting here with Carson Brown. Carson, thank you so much for being here today.
Carson Brown
Thanks for having me, Emily.
Emily Silverman
So Carson, one of the things I loved about your story is that it's a relatively intense story. From a content standpoint, we're talking about mother/daughter dynamics and the pain of individuating from your family and letting go. But your performance was so funny. And I was wondering, did you know that you were this funny?
Carson Brown
That's so flattering and nice. I mean, really the only other time I am ever onstage is for karaoke, which I used to really like a lot. I'm definitely talkative, but definitely not an improv person. I think I'd be terrified of that. And this seemed possible because it was very rehearsed. And I very much knew what I thought was gonna happen.
Emily Silverman
Something else I loved about your story is how it gave us a window into your psychoanalytic mind. You're telling the story, but you're also giving us definitions of these psych terms like enmeshment. And there's that scene at the end, where you're crying in bed, and you look up and you see the wall of psychiatry books, you pick a book off the shelf, and it's Carl Jung, and you start telling us about Carl Jung and the nigrado. And I just loved how educational the story was, in addition to being a story, it kind of helped us understand what it's like to be a psychiatrist. And I was just curious if you could tell us about your journey to psychiatry.
Carson Brown
Psychiatry is the best, you know, I love it. And I think almost everyone's interested in it, because it's really just the human experience. So those types of details I see as fun for everybody. But I definitely came into medical school thinking I was going to do primary care and interested in integrative medicine. That was sort of how I saw myself initially, but a lot of the advice I got about choosing specialties was find your people. And I liked lots of different people. But I think psychiatrists are people very comfortable with gray area, very comfortable with, well, more comfortable with not knowing. All of medicine is about the human condition, but something about psychiatry just puts that very front and center. Once I was really exposed to it, it's very clear. That's, that's what I wanted to do. That's where I fit.
Emily Silverman
Do you specialize in any particular type of psychiatry?
Carson Brown
I do general adult psychiatry, so I feel like I see a broad range. But somehow over time, I feel like a lot of my patient panel has, I call it complex trauma, which isn't a DSM diagnosis, but it's something that's used more and more - Complex PTSD, meaning not a specific incident, but more like something that we would call developmental trauma or attachment deficits, which respond to both medication and psychotherapy, best in combination, and it's very rewarding work. And then I think the story, you know, plays into certain elements of that, too, I think enmeshment is a type of attachment deficit and a developmental issue somehow, maybe because it resonates for me that that's a lot of how my practice has taken form.
Emily Silverman
You mentioned enmeshment is one type of attachment deficit. And that caught my attention. Because when I think of enmeshment, or at least how you describe it in your story, it seems almost like the opposite, like over attachment, rather than an attachment deficit. And so I was wondering if you could tell us more about what it is and how you think about it? And where does that come from? How does it cross over from healthy into unhealthy? And how do you know the difference?
Carson Brown
The deficits of enmeshment are just being very, very unclear on what belongs to oneself and what belongs to other person? What am I responsible for emotionally, and what is the other person responsible for emotionally and that's just completely scrambled in an enmeasurement dynamic, and can really cause relationship problems later. For me, it shows mainly in this over responsibility feeling of, I have to manage everybody else's emotions for them. What's really tricky is I think my job as a psychiatrist also pulls me into that role. Like, I'm kind of asked professionally to manage other people's emotions for now. And really trying to learn how to distinguish in personal but also in these professional relationships, what's my job, and then where does my job end and the patient takes over. And it's, it's their job. Because definitely starting out, I was bringing very much of an enmeshed vibe to the professional interaction of like, okay, you're here, it's my job to fix your life, it's my job to make sure you never feel bad again, it's my job to contort myself, even in this professional relationship. I mean, that'll lead to burnout if you keep doing that. My main motivation has to be acting from my own authenticity, rather than my main motivation has to be placating the other person. And it's easy to say, but it's been very hard to unlearn and actually do.
Emily Silverman
Yeah, I remember, once I was having a lot of stress, and I use an app to get a massage. I was like, I'm gonna do some self care. So I use this app. And this guy shows up in my house with a massage table, and he's giving me this massage. And I remember at one point, he got to some tension in like my left arm or something, and he was massaging it. And he was like, oh, and he was like picking something up. And I was like, what, what? And he was like, I just feel like whatever this is in your arm, like it's not yours. And I had never really had a massage therapist speak to me that way. And it really got me thinking about like, even more than just what we have in our minds or in our heads, like, how do we understand tensions that are being held in our bodies that aren't even ours to begin with? And so I was wondering if you've ever experimented with that, as well? Does the body have anything to offer in helping us understand what is ours? And what is not ours? And what can be released? I know it's a very like California woowoo question. But you are from California.
Carson Brown
You're asking a whole other really interesting question, what all types of somatic therapy really take up, which is the profound ways our bodies actually know so much more than our cerebral cortex. Sometimes it's called bottom up, information that's coming from our viscera up to our brain; this can be so much more informative if we know how to listen to it. Most of us are not acculturated to do that. We culturally really prioritize thinking over emotions, and then definitely over sensation, which, you know, people call gut feeling all kinds of different things. But there's not a definitive answer, it's more just paying attention to sensations and honoring that they contain information. I don't think there's specific sensations necessarily associated with enmeshment globally, but I think for certain people you can start to notice that they do have certain patterns of holding when when things get activated, and over time, it can help people discern like, Am I doing this authentically? Or am I doing this to please? Because it can be a hard question to answer. And I have seen people, and I'd love to do it more with myself, really learn what it feels like in my body when I'm being authentic and I know a specific kind of signature fingerprint that comes up for me when it's more like fawning or pleasing or an enmeshed response.
Emily Silverman
The last part of your story was very nonverbal. You were almost describing an experience that happened in your body where there's the initial terror of disclosing this information to your mother. There's the worst fear realized where your mother responds with, I guess separation or coldness. And then you talk about laying in bed and you're crying and one sock is off. And you're just kind of going through this internal negredo, you say it's like a process by which the self is burned down to ash and then reconstituted. And it's all happening inside. And you bring us through the different stages of that, where at first you're in a state of despair. And then things start to feel a little bit more hopeful. And you have like, weirdly, a good day at work. And then you go on this walk with this friend, and then it's almost like, right, as the cycle is completing, you get the email from your mom, and you're glad that the email was delayed, because it gave you the opportunity to go through that process. And so I'm wondering if you can, I know it's hard probably to put words to, but what is that process happening internally? It's just like an energetic movement, or what is it that happened?
Carson Brown
The entirety of Carl Jung's body of work is trying to answer that as as well as other thinkers and feelers, obviously. But I did use that word crucible towards the end, and he uses another word, the tenemos, which is a container, and we talked about the container and the frame and psychotherapy a lot.
Emily Silverman
What are the container and what's the frame?
Carson Brown
It's almost ... I'm thinking of the word 'rules'. But just like the agreements of the psychotherapeutic encounter, the time, the space, we meet from this time to this time, on this day, it's almost the ritual of it. It is also the therapist's boundaries, different therapists. And across time, ideas about self-disclosure and other types of boundaries do shift, but there are still certain boundaries that a therapist is holding. And the idea is just having this defined space is a chunk of the work. It's not even the talking or the emotive part, it really is there's this defined space where I do this type of self reflection. Obviously, there's a lot more to being a therapist than just holding that space. But it is sort of the fundamental requirement and enables everything else to happen. And there is a sense, a lot of the times, that the psyche has a natural impulse towards self healing, that it's it's looking for channels to move in, towards healing, towards something more integrated, towards something more comfortable or resolved, and just giving it this type of consistent, compassionate attention, it will unfold in that direction, as long as we stay out of the way. So I think, you know, the situation I was describing at the end, it was definitely post verbal, I think it was so overwhelming and so catastrophic to my psyche, that it was not something I could talk about while it was happening. And that's sort of a definition of trauma also is something that's overwhelming and can't be assigned meaning or processed in real time. It's something that's so overwhelming that it's it outstrips our capacity to do that. But but there was a holding space just in my home from my husband, I actually left a line out of the live telling of the story, which was Scott bringing me tea and taking away my snotty tissues. And there was just space for me to collapse mostly provided by him.The books...I think they are part of the support structure too. I do think that bookshelf meant a lot to me like I'm probably not the first one going through this, I'm probably not the first one to think about this, there probably is a way to assign some type of structure, meaning, understanding to something that feels unfathomable to me right now. So it was sort of like, I was looking for a book to be my life preserver ring thing, and it did happen. I think having any type of word to just grab onto did feel like that life preserver of like, okay, this is at least one way to conceptualize what's happening right now. And there's a comfort. That was a humor, I was kind of going for it. Even though it was so horrible, your psyche being burned to ash, that basically the worst thing that there was something comforting in having that described. I think that's what we try to do as therapists too is we'll float out 'Oh, do you mean this or is it this type of thing? Or is it this word?' And a lot of times we're like, 'oh, that's not quite it.' But sometimes they'll be like, 'exactly, yes. Thank you.' And you do feel it as like a sustenance for somebody as as a ballast.
Emily Silverman
Is that a term that you had heard before in your studies? Or was it something that you just came across for the first time in that moment,
Carson Brown
My fourth year of residency training, I was at the San Francisco Jung Institute for the whole year, as about a third of my time was there. I had psychotherapy patients through them, and they had their own set of didactics. So even all that time was like scratching the surface. And they have an entire psychoanalytic training program. So it was really just the introduction, but I had spent a lot of time with his work. And then contemporary Jungian thinkers also. So I definitely had been exposed to it before, there's a really brief line I say in the story that I hadn't found applicable before this, his most esoteric stuff is around these alchemy processes. And prior to having my own experience of this, I was like how, like, how do I apply it, and it had felt too esoteric to me before it, it felt a little ungrounded. But then I was like, oh, it does match up to actual phenomena. I think it just hadn't of clicked for me. He's so abstracted. And, you know, so much of his work is about symbols, that sometimes connecting it back to day to day modern life takes a little translating, but then it made a lot of sense in that moment.
Emily Silverman
He's such a famous person in the psych literature, I think, probably Freud, and Jung are the two, you know, big names for people who have maybe heard those names before, but aren't really sure what the one liner is for what each of them believed, or their theories, or I think their theories might even come into conflict with each other. But is there a way to boil down some of these young Jungian approaches versus Freudian approaches? Or is it more that they had like many different theories and philosophies and you can only really get it if you do a deep dive,
Carson Brown
Probably something in between, I'm feeling slightly daunted trying to give a one liner but I will try. You know, there they are some of the OGs of the whole field, which is super important and impressive in certain ways. And also they are very much products of their time and place and intersections of various identities. And so a lot of the time since then, has been critiquing, mostly critiquing, unpacking, modernizing, there's a lot that's problematic is sort of the short way to say it, there's anti semitism, and there's sexism, there's all kinds of difficult stuff in there. And there are some of the building blocks of the whole field. So I mean, what I say about Freud sometimes is, he was the first person in the Western tradition, there were plenty of other thinkers and people having all kinds of different experiences in different parts of the world. But he was really the first European to say, the unconscious mind exists. So that was on the level of Copernicus to me of someone asserting something that basically everyone else thinks is crazy at the time. Copernicus at least had telescopes and other instruments and mathematics to back him up. The unconscious, you know, we can't measure, see, directly perceive it kind of by definition. So someone saying this thing that's unperceivable exists was, not to overstate it, a complete turning point in European thought. And then yes, he and Jung were close, close colleagues. Jung was basically Freud's right hand man. And then they had a major schism, which happens repeatedly through the history of psychiatry and psychology. People get pretty heated about these topics. My one liner on Jung, people have probably heard collective unconscious, you know, so he did take this idea of the unconscious and be like, it's not just seated in each individual mind. There's also a collective or societal level of it. And that's what he thought about archetypes and themes that you find running through all cultures really fascinated him. It's fascinating how did all these different groups of people come up with similar symbols or similar ways of thinking about things? So that's one of his major contributions. I also just think of him as really bringing symbol and how symbols operate. That's one of his major contributions to and that comes up a lot in dreams. A lot of people when they think of Jung their word association to him, and he did word association work, is dreams, because he saw dreams as the way our unconscious communicates with us. But that the language of the unconscious is not literal. It's symbolic. And whereas Freud was sort of like, well, if someone dreams about feces, that is money, it was sort of a one-to-one symbol to meaning. Jung was very much more like no, no, the symbol is individual to the person and has to be teased out and understood in the context of that person.
Emily Silverman
In your practice, I mean, you seem to be really interested in the therapy side of Psych. So you know, psychoanalysis and Freud and Jung and kind of talking through things using symbol, using story to help people heal and make sense of their experience. Do all psychiatrists build that into their work? Or do you feel like sometimes the field splits off where it's like the psychiatrists are dealing with the pills, and it's the therapists, you know, who maybe aren't physicians, but who are trained in therapy, who are doing the talk therapy and doing some of these other things? What is it like in your practice? And are you unique? Or do you feel like most psychiatrists veer more toward like the medical approach as opposed to some of this more, I guess, abstract approach?
Carson Brown
Right? I mean, I think more and more, it's becoming the MD psychiatrists prescribe and non MD therapists do the therapy. I think that's the way insurance companies want it. I think that there's financial incentive for psychiatrists to work that way. I went to an unusual residency program at San Mateo County, that is a gem of a program if anyone's looking for one that really does emphasize psychotherapy. And people have long term psychotherapy cases starting in second year, and there's a lot of psychotherapy training. My understanding is that at most psychiatry programs that's being whittled, and it is becoming more solely focused on psychopharmacology and then also interventions like TMS, ECT, the higher tech interventions. So my residency program was unusual. And then where I work now, at Bay Well Psychiatry Group is also unusual that we are a group of psychiatrists and psychologists but psychiatrists are encouraged and supported to do as much psychotherapy as they want. So we have the flexibility to do that. And it's a personal financial decision, you can make more money doing just meds, but that decision is left to everyone to make individually and is not dictated by the practice. So it has attracted a group of providers who are very interested in psychotherapy. And we have monthly psychotherapy case conferences and lots of consultants who come in and we get to do lots of fun psychotherapy stuff. So I like to preserve the combination. I think patients really like having a one stop shop, where the same person who prescribes to them is also their therapist, people really like that. And then I definitely think it makes me a better prescriber. It's not a checklist of someone's symptoms. It's an ongoing in-depth conversation about the nuances of people's experience. Evidence and studies have shown us that the combination is the most effective. And then it doesn't have to be in the same person. But there is something special about being the person to do both.
Emily Silverman
Patients often wonder about their therapists or their psychiatrists and their personal lives and their problems. And one of the funniest parts of your story was, as you're dealing with your own problems, you're actually having memories of patients, who you've talked to, who you've coached, who you've even coached through problems similar to the one you're going through. Do you ever wonder about them wondering about you? And how do you think about that one sidedness of the equation versus maybe like flipping it around? And in this case, it was like the patients almost were inspiring you in a in a reverse way.
Carson Brown
I am so curious about my own therapist, I'm always just like what is their life like? And you know, and there's so many different schools of thought about it more old school was, you know, the therapist is a blank screen. You know, the therapist can't reveal anything because then that tampers with what the patient can project onto you. And you know, some people still practice that way the more people have gotten the postmodern memo about there not being any objective space to occupy, but there's a whole field of psychological thought called intersubjectivity. So I'm fully in this postmodern, intersubjective school of thought of, there's no way to not bring yourself into it. And that it's not a matter of trying to eradicate that it's a matter of trying to be aware of it and make sure it's not interfering in the patient's process. So then that informs a lot of people's decisions about, I think I use the term earlier, self disclosure, how much to say about yourself. And I definitely don't tell patients this story, I've wondered what would happen if a patient runs across this podcast or whatever else. When patients have experiences that are similar to mine, I have to really remind myself that it might be similar, but it is not the same. And they are not the same as me that there can be a real temptation to just directly map my experience onto them, assume their response to things is the same as my response to things. So there really does have to be a tapping of the brakes. That said, my patients inspire me every day. And I learned from them every day, I said this to one of my supervisors at the Jung Institute, I said to her very sheepishly and kind of like thinking I was doing something wrong, I was like, I'm really learning a lot, not just about psychotherapy, but about like my own life, from this one patient in particular, who was going through something, and I felt kind of guilty about that, like, I wasn't supposed to be getting anything out of it. And my supervisor, and with a real lightness was like, oh, no, it's just one of the perks. Yeah, that's just one of the perks of the job. This is a tough job. Of course, we need to, you know, of course there's gotta be some perks. And yeah, so she really normalized it, she was just like, obviously, obviously, we're sitting with people all day grappling with deep human struggles. Of course, we're going to glean something from that, and there's nothing wrong with that.
Emily Silverman
I want to come back to your story. There's a scene toward the end, where you're walking with a friend, and you don't discuss what happened with your mom. But you do discuss the pain of separating from one's children. I think you say something in the story about how soon as they're born, it's just a gradual process of separation. And as somebody who's a relatively new mother, I really connected to that. And it reminded me of this moment, shortly after my daughter was born, she must have been, I don't know, six or eight weeks old or something like that. And the inlaws came to visit, and she was lying on her back on this play mat, and they were playing with her. And I was there. And then I had to go to the bathroom. So I stepped away, I went to the bathroom. And when I came back, they were all like smiling and laughing. And something had happened, like my daughter had done something silly or funny or made a face. And they had had some kind of experience. And I hadn't been a part of it. And I just remember, it felt so strange that my baby, my daughter, had, like, had an experience that I hadn't been a part of, after, you know, obviously, nine months of like, literally being the same being.
Carson Brown
I think this is such a journey of parenthood, I think it is, there's a specific wrinkle for the birthing parent because of what you said that the baby is literally contained in your body for a period of time and there is a physical, then separation at birth. So there's there's a specific wrinkle to that. But I think even for the non birthing parent, who also bonds so, so closely, that there's a similar process. You know, I'm not to the point of some of my empty nester friends where they really leave home. But I hear from them and I hear from other people. And I have felt that I think it's pretty much our hardest job as parents is allowing the separation. And it gives me a ton of empathy for my mom. And for anyone else, I understand how an enmeshed dynamic comes about because it's extremely difficult and extremely painful. So of course, people want to short circuit it or avoid it. Who wouldn't want to do that? I called it grief in the story. I really I think that's the most accurate word I have, but there are probably a lot of them. Yeah, we're gonna miss things. We're going to not understand things about them. We're gonna be things about them we just never even know. And it's just, it's just a huge adjustment. There's a huge benefit to doing it, too. You know, sometimes my kids say to me, because I love babies and I just want to I see babies and snuggle them all the time. And they say you wish we were still babies. And I pause and I'm like, I actually don't because if you stayed babies, I wouldn't get to see this these amazing 9 and 12 year olds, you know, and so it doesn't erase the grief or pain, but it at least isalongside it is like, wow, I get to see this person blossom. And that's the reward for tolerating the very real grief and pain.
Emily Silverman
How is living in Minneapolis after living in the Bay Area for so long?
Carson Brown
It's 1 degree today. I think 1 is the funniest temperature. Sometimes they say it is as degree. Or I was joking recently when that when the high is a negative number. I won't call it a high. But I'm loving it. It's wonderful here. I think it's really enlivening to kind of have beginner's mind about a place. I mean, we're going dogsledding next weekend and we, yesterday we're at these barrel saunas by a lake and we're doing cold plunge into the like, throw a hole in the frozen lake. And I was like, I've never done this before, I wouldn't have done this. I found it really enlivening to have a change at this point in my life. And it's it's a really beautiful place.
Emily Silverman
Well, Carson, I just want to thank you so much for telling your story with The Nocturnists and coming into chat with me today. I've just so enjoyed this conversation. I feel like I've probably gotten a little therapy out of it myself. So thanks again for coming on and for being here.
Carson Brown
Thanks. It was a really profound experience for me to get to do it. So I'm just so grateful for the opportunity and for today too, thank you.
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