Our existence unfolds within a world of objects, shaped by temporal, physical, and psychological dimensions. I believe reality emerges from the interplay of these dimensions in relation to the objects that surround us and our own selves. By creating and modifying our relationships with and between objects, we develop a sense of agency crucial for development of a healthy self. To illustrate this, I propose conceptualizing the self as divided into two parts: the ‘making-self’ and the ‘made-self.’ This distinction, employing the same verb in different tenses, highlights the dynamic between agency and passivity within the self. Two sides of the same coin.

Making-Made Objects

Since we are in our mother’s womb, our life begins with a dynamic interplay of agency and passivity. The ‘making-self’ is evident in the active processes of cell multiplication, organ growth, and the establishment of bodily mechanisms. Simultaneously, under optimal circumstances, we are nurtured and cared for by our mother’s body, receiving nutrients, hearing our parent(s)’ words, and experiencing the profound sense of being desired and awaited. This aspect of our existence, which I term the ‘made-self,’ represents the experience of being yearned for by others. Consequently, the self emerges as a ‘making-made object’ navigating the complex matrix of psychological, temporal, and physical space.

Concurrently with positive experiences, negative ones emerge from the outset of life. I assign to the adjective ‘positive’ the growth aspect, and to ‘negative’ the meaning of deterioration and decline. For instance, during embryonic development, as cells multiply, programmed cell death also occurs. Neurons are initially overproduced and subsequently eliminated, a process known as synaptic pruning. Creation and destruction are evident in both aspects of the ‘making-made-self.’ Similarly, our relationships are infused with the drives of Eros and Thanatos, the life and death instincts.

The Nature of Reality

Reality begins to be constructed from the moment we gain the capacity to sense the world in utero, a gradual process that ultimately culminates in a subjective sense of self. The reality initially perceived as a ‘made-object’ gradually acquires the qualities of a ‘making-object,’ or perhaps more accurately, an ‘object-in-making.’ This network of objects, relationships, self, space, time, and subjective experiences is in constant flux. Driven by the forces of Eros and Thanatos, living beings actively shape the reality it cohabits with others. These networks of realities are further enriched by qualia — instances of conscious, subjective experiences, such as the perception of ‘redness’ or the taste of food, as described in the philosophy of mind. I see reality is perceived through the lens of our constructed schemas, which are shaped by the cross-pollination of all these networks of realities. Object relations begin to emerge at these fundamental levels.

While qualia represent subjective and often indescrivable aspects of conscious experience, I see object relations as characterized by distinct attributes. These attributes, such as distance, proximity, and power dynamics, are not solely subjective but also exist within the object reality co-constructed through interactions. While influenced by individual qualia, these attributes contribute to the overall structure and dynamics of the relationship. Object relations have qualities that can exist independently from the subjective experience, despite being influenced by them. In them, different objects co-construct a reality which carries within attributes, leading to the establishment of new realities.

For instance, a friendship might be characterized by attributes such as strength, endurance, and resilience. This relationship can also elicit various sentiments in others, such as inspiration, hope, or even envy or anger. Importantly, the relationship continues to exist even after the individuals involved may have changed or moved on. It persists in the memories of others, in the spaces it influenced, and in the impact it had on the objects involved.

To conclude, from the moment of consciousness, the ‘making-made-self’ navigates object relations using the schemas of networks that emerged within the physical, temporal and psychological spaces that it inhabits.

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Since starting my career in mental health as a psychoanalyst in New York City, I always had a mission in mind: make mental health services accessible to everyone, men included. Growing up in a small town, I witnessed firsthand the societal expectations that men endure in life (and the ripple effects those have on their mental wellbeing). Society tells us that men should be strong and self-reliant and discourages them from seeking help. The stigma surrounding mental health can make men feel ashamed or weak for admitting their struggles. Shame turns into repressed emotions and a learned inability to express them.

Lack of awareness about mental health resources and the belief that they can handle problems independently can prevent men from seeking support. This attitude toward mental health contributes to harmful coping mechanisms like substance abuse, alcohol dependence, and self-destructive behaviors.

Fear of Judgment: Our Biggest Enemy

In the past few years, starting with the Covid pandemic, there has been an increase of awareness about mental health struggle and many mental health conditions have been de-stigmatized. Of course, we have all benefitted from it: patients, clinicians, and the society as a whole. However, some communities still view mental health and psychotherapy as a stigma, especially for fear of judgement. To some, the fear of seeking help becomes so overwhelming and encompassing that cannot be tolerate. Hence, self-destruction behaviors pave the way to suicide attemps.

Why are Men more at risk of suicide?

The vast majority of suicide attempts and death by suicide affects the male population in the Western world. Back in 20219, The Center for Suicide Prevention in Canada issued statistics that confirm this trend: out of the 4,012 death by suicide 3,058 were suicides by men. Despite access to mental health has been more accepted by society during and post-Covid, statistics only got worse. In the United States, the suicide rate for males is four times that of females. Males account for 79% of all suicides, with approximately 100 men dying by suicide each day, totaling over 36,000 per year (CDC).

Boys are frequently advised not to cry, and men are encouraged to “suck it up” and “take it like a man” when facing life’s challenges. They are expected to display toughness and stoicism, while emotional vulnerability is perceived as a flaw in their masculinity. Societal pressures deters men from seeking help for mental health issues, leading to harmful coping strategies (Seager et al., 2014; Ogrodniczuk & Oliffe, 2011). Men’s suicide methods are often more lethal than women’s, resulting in men dying by suicide three times more often, despite women attempting suicide twice as often (Canetto & Sakinofsky, 1998).

Healthy Coping Mechanisms

Stress reduction techniques and healthy coping mechanisms can help men proactively monitor their mental health, rather than waiting for a crisis. For example, regular exercise offers numerous benefits, including reducing stress, anxiety, and depression. But sometimes, sport may not be enough and professional help is needed. Here below are some resources you can share with the men around you who struggle with mental health:

• Men therapists in New York: directory on Psychology Today.

• Men’s issues therapists in New York: directory on Zen Therapy.

• Suicidal thoughts and crisis: Call or text 988 for support, or dial 911.

How can men help their peers struggling with mental health?

Although it might be challenging for men, beginning with an open dialogue can be the most effective method. If you observe someone in your life who might be having difficulties, men or others, consider using these suggestions to initiate a conversation:

• Express concern: “Hey, I’ve noticed you seem a bit down lately. Is everything okay?”

• Avoid judgment: “It’s okay to not be okay. We all have tough times.”

• Listen actively: Give your full attention and validate their feelings.

• Offer support: “I’m here for you, no matter what.”

• Encourage professional help: “Have you considered talking to a therapist or counselor?”

Remember, it is crucial you find a clinician who understands your struggle and can walk with you on your mental health journey. There is no one size fits all, but studies have repeatedly shown that the clinician-client relationship contributes to better therapeutic outcomes.

This is true for men, too!

Thank you for reading.

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Do you ever feel like you’re “not good enough”? As if you’re constantly being judged or criticized? That feeling is called internalized shame. It can feel like carrying around a heavy backpack filled with negative thoughts about yourself. Perhaps, you often lack self-esteem and confidence in your skills. Those feelings show up in how you avoid interacting with others and “taking risks” in life, sitting in the background of your life experiences, watching others moving forward.

Internalized shame can be a deeply ingrained and painful experience, leaving us feeling inadequate, unworthy, and disconnected from ourselves.

It is not a new ailment experienced by the younger generations. Think about the culture of hubris in ancient Greece and how doing and saying things that cause shame to others was a major flaw.

My approach to help patients heal from internalized shame

Gestalt Therapy is a type of therapy that can help you deal with this. It’s like exploring a map of your own mind. Instead of just thinking about your problems, you also pay attention to how your body feels. Maybe you feel a tightness in your chest when you think about past mistakes. Gestalt Therapy helps you understand how your body and mind are connected.

Here’s how it can help with internalized shame:

• Finding the Source: You learn to recognize the thoughts and feelings that make you feel ashamed. Where do these thoughts come from?

• Challenging the Inner Critic: Imagine you’re talking to a friend who is feeling down on themselves. Would you be as harsh? Gestalt Therapy helps you challenge that inner critic and replace those negative thoughts with kinder ones.

• Listening to Your Body: You learn to pay attention to how your body feels when you experience shame. This helps you understand how shame affects you physically and emotionally.

• Taking Back Your Power: Gestalt Therapy helps you realize that you have the power to change how you think and feel about yourself. You can learn to accept yourself for who you are and break free from the grip of internalized shame.

Remember: Healing from internalized shame is a journey, not a destination. It requires patience, self-compassion, and a willingness to explore the depths of your inner world. With the support of a skilled Gestalt Therapist, you can begin to dismantle the patterns of self-criticism, reclaim your self-worth, and live a more fulfilling life.

Would you like to know more about how Gestalt Therapy can help you heal?

Connect with a certified gestalt therapist here.

Thank you for reading.

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We often hear about mental health: in the media, from the government, at our children’s schools, even from the neighbors down the block. But what exactly is mental health? Psychoanalysts like myself grapple with this question daily. While it’s easier to define mental illness, a healthy mind is much more than just the absence of disorder. It’s a process and like all processes, it can be complex and dynamic for some, and more straightforward for others.

When attending graduate school, I began to ponder this age-old question. I was surprised that there were plenty of exams and courses about abnormal psychology, personality disorders, how to use the DSM-5, and assessments of all kinds. I found that there was little emphasis on defining and cultivating mental well-being. This was, alas, a reflection of the time, place, and culture of my graduate studies in New York City, pre-COVID.

Despite the focus on symptom reduction within the American healthcare system and its reliance on insurance models, patients are increasingly seeking a more holistic approach to mental health centered on well-being and personal growth. How are we, mental health professionals across the nation, supposed to provide a service when there is so little emphasis on prevention and well-being within the current system of care? Insurance companies require a DSM-5 diagnosis and a medical necessity explanation every time someone seeks counseling and this could deter them from getting the help they need. Practitioners of this sacred profession know that sometimes clients need to acquire certain skills to shield themselves from symptoms and more severe conditions. This may not require a formal diagnosis, yet the need of ongoing sessions to cultivate a healthy mind arises.

What is a healthy mind?

I view mental health as a set of capacities, each existing on a spectrum, that contribute to one’s overall well-being and life satisfaction. These capacities, often linked to a longer, more meaningful life (as suggested by the Harvard Study of Adult Development), are influenced by both genetics and our life experiences. Based on my understanding from treating a diverse population of adults, I have identified six key assets that contribute to a healthy mind:

1. Self-Regulation: The ability to experience the full spectrum of emotions without being overwhelmed or stuck in any particular emotional state. Those with impaired self-regulation will feel controlled by emotions and swept away by intense feelings. This is applicable to both negative and positive affects alike. In individuals susceptible to mania, prolonged periods of intense vitality and energy can escalate into a manic state.

2. Forgiveness: The capacity to forgive oneself and others. This is crucial for inner peace, as emphasized by many spiritual and philosophical traditions. For Freud, forgiveness is a conscious mechanism and I see it as a voluntary redirection of feelings of anger, envy, grief and destruction into prosocial attitudes and behaviors like compassion, kindness, connection with others.

3. Healthy Lifestyle Habits: Maintaining a consistent sleep-wake schedule and a balanced diet is crucial for our well-being. Research has consistently shown a strong link between sleep, nutrition, and emotional health. Even a few nights of inadequate sleep can impact one’s mood, resulting in irritability, decreased concentration, and feelings of depression.

4. Resilience and Adaptability: The ability to navigate challenges, learn from setbacks, and adapt to changing circumstances is fundamental to mental health.

5. Stable Sense of Self: A strong sense of self, including ego strength, self-esteem, self-confidence, and self-reliance, are crucial for navigating life’s ups and downs. This involves balancing self-belief with a realistic understanding of one’s strengths and limitations.

6. A Sense of Purpose: Cultivating interests and pursuing meaningful goals can provide a sense of direction and fulfillment, contributing significantly to overall mental well-being. A sense of purpose might be informed by one’s values in life, actualized in the form of a mission, a hobby, an ideal.

Key takeaways

My gestalt therapy and psychoanalytic training informs my view of mental health. For that, I do not see it as a static entity, but as a fluid, complex and dynamic process shaped by the interplay of culture and historical context. Our beliefs, values, and social norms, influenced by the time period we live in, impact how we perceive and address mental health challenges. And like all challenges, they can be embraced, suffered, overcome and, why not, avoided. To prevent them from becoming bigger and unsurmountable, one needs to foster a set of capacities, like the ones I outlined above. Finally, our healthcare system shall pivot to support mental health professionals in this noble calling by making wellness-focused psychotherapy accessible, affordable, and ultimately the norm.

Thank you for reading.

I’m here to explore the complexities of the human experience — from life and mental health to psychology, psychoanalysis, philosophy, and the whole shebang. Join me as I delve into these realms and share insights and reflections on the human condition. Subscribe to my profile for regular updates.

Boredom is an integral part of the human experience. From time to time, we lack interests in the outside world, whether it be objects, activities or relationships. While in a state of boredom, we perceive time differently. It passes slower than usual, the tasks at hand feel endless and meaningless.

Classical psychoanalysis views boredom as a manifestation of unmet desires and needs. Freud saw it as linked to a lack of gratification: the id, unable to satisfy its basic instincts driven by the pleasure principle, experiences a lack of stimulation, which manifests itself as boredom.

I conceptualize boredom as a distinct dimension of the ego, characterized by a suspension of the relationship with the external world of objects and experiences. This suspension manifests both temporally and physically. Time appears to slow down, while a sense of detachment from our physical surroundings emerges. We may experience restlessness and fidgeting, feeling trapped within a bubble of time that moves slowly.

A New Conceptualization of Boredom

Attached Ego and Detached Ego

I propose defining boredom as a third dimension of affect, situated between the polarities of depression and mania. In this subjective experience, the ego navigates a blurred state characterized by the interplay of negative and positive emotions, caught in a constant struggle between drive and frustration. I introduce the terms ‘detached ego’ and ‘attached ego’ to describe the extremes of this experience.

The dimension of boredom exists between two polarities: the detached ego and the attached ego. The detached ego represents a state characterized by low and depressed mood, a sense of distance from the surrounding world, and a lack of interest in engaging with external objects. In this state, we experience a disconnection from our surroundings and ourselves, leading to anhedonia, decreased motivation, and neglect of personal hygiene. Conversely, the attached ego represents a state of excessive engagement with the external world, where the self feels fused with its surroundings. However, these two states are difficult for the ego to sustain.

When we remain in a state of attached ego for an extended period, we become fused with the object of our desire, moving with them in the environment as if we were a single entity. Boundaries between self and others become blurred and seem trivial. If this state of attachment persists, it can lead to mania. I view mania as both an unconscious defense against the fear of experiencing the detached ego and a manifestation of a loss of ego boundaries. In this state, internal and external realities blur, and we enter a phase of omnipotence with inflated self-esteem

Both ego states exist within a spectrum, each with varying degrees of intensity. At the extreme ends of this spectrum lie major depression and psychotic mania. Boredom can be conceptualized as a midpoint between states of complete detachment and full attachment:

In other words, both polarities are not fixed entities and are not monodimensional. They can be conceptualized as a reversed cone, where the apex represents the point of maximum attachment or detachment:

The Dimensionality of Boredom

Boredom resides at the middle of the attached/detached ego dichotomy. It holds both characteristics of the detached mind and attached mind. It embodies a space of lack of interests for the world and a frustration stemming from the recognition of the unmet need, whose gratification is constantly reminded by the presence of external objects. This paradoxical state, neither pure excitement nor profound anhedonia, is characterized by a constant search for gratification while simultaneously experiencing a lack of interest and a sense of impasse.

I conceptualize boredom as a sphere, given its both geometrical and metaphorical characteristics. The sphere, with its finite boundary, paradoxically evokes a sense of boundless boredom. Its surface curves endlessly inward, suggesting the infinite and directionless nature of time within this state. The ego, suspended within this spherical space, becomes trapped, lacking a clear direction due to the absence of edges or corners.

From Model to Method

I propose that the ego constantly oscillates between states of attachment and detachment, passing through boredom, even if fleetingly, to shift its affective direction. Reaching either extreme — complete attachment or detachment — may lead to pathological states, such as mania or depression, characterized by anhedonia, euphoria, or a complete disengagement or fusion with the external world.

When traversing the state of boredom, the ego experiences a distorted perception of time. To some, the moment may last seconds, or days, but it is felt as endless. In that state, the ego lacks drive, while still yearning for it, leading to frustration. Hence, the metaphor of boredom as a sphere: the ego lacks direction, like a point on an edgeless globe.

Finally, this new model of boredom can help psychoanalysts find ways to guide the ego out of this state. By introducing ‘edges’ and ‘corners’ — points of potential redirection — within this conceptual ‘sphere,’ we can help the ego move beyond boredom. These ‘edges’ represent external objects that can either pull the ego towards attachment or detachment, each with its own inherent valence, whether positive or negative.

Thank you for reading.

I’m here to explore the complexities of the human experience — from life and mental health to psychology, psychoanalysis, philosophy, and the whole shebang. Join me as I delve into these realms and share insights and reflections on the human condition. Subscribe to my profile for regular updates.

Behind new year resolutions often lies a longing for change that stems from within. We often tell ourselves things like “I’ll be eating healthy”, “I’ll stop drinking”, “I’ll go to the gym”, only to find that we haven’t done it or tried and didn’t succeed. This cycle of “wishing for change — postponing change” can create a frustrating and self-defeating pattern.

Every year, we make lists of good intentions, hoping to move closer to the ideal self we envision. Psychoanalytically speaking, and informed by Lacan’s later view on gaze, I see the self-image as the representation created when we become conscious of the Other looking back at us and internalize the believe on how we are perceived. Like all representations, the self-image is a complex construct, shaped by our perception of reality, our personal desires, and our imagined selves. When the conflicting forces of fantasy and reality collude, some disturbances may slowly take form: body image issues, eating disorders, social anxiety, and general dissatisfaction with life. This dissatisfaction with our self-image can fuel a strong drive for change, which we often channel into making public resolutions and New Year’s resolutions.

Sublimation of aggressive instincts

This time of the year that culminates with the famous ball dropping in Times Square is a moment when those conflicting forces bring about the need for change. Needless to say, behind the surge of new year resolutions, I see the defense mechanism of sublimation. The aggressive instinct stemming from the dissatisfaction with our image of the self is so strong that we unconsciously channel it into more socially acceptable activities, like writing and posting on social media what we intend to do to pursue change. This act of committing to paper, of publicly announcing our intentions, can be seen as a form of sublimation. Another example is paying for a gym membership with the hope of changing our body, hence, bridging the gap between the realm of fantasy and reality.

The impetus for many New Year’s resolutions is the desire for change. The new year often serves as a catalyst for change, prompting us to make sudden shifts in our behaviors and attitude. However, change is more sustainable and empowering when it comes gradually and from within, while appreciating its intrinsic nature. It’s a process of pushing and pulling toward a direction, a goal that can be more complex than a “I will go to the gym 3 times a week”.

Beyond sudden change: the chaotic world of organic change

Both of my personal experience and formal training in psychoanalysis and gestalt therapy inform my view on how change unfolds and its qualities. Change is not linear and limited, whereas chaotic and pervasive, less motivated by internal decisions than what people think. In life, most of the times, sudden change happens out of a necessity: a new work situation, the loss of a beloved one, a broken foot, or a country at war. When we make sense of it from the inside, the pulling forces from the outside are internalized and continue to propel change as life moves on.

The necessity of change must be first understood, untangled, processed, and accepted. If we come to terms with it, we will most likely succeed on a longstanding trajectory toward change. For instance, think about where the construct of “eating healthy 3 times a week” comes from. How do I feel if I don’t eat healthy? Do I get angry and frustrated? Will I turn those emotions inward and give rise to unconscious conflicts inviting guilt and melancholy in my inner world?

I believe those questions need an answer before devoting oneself wholeheartedly to a new standard for the year. The goal of ‘eating healthy 3 times a week’ might stem from a desire for better health, but if it’s imposed externally or pursued suddenly with unrealistic expectations, it can lead to frustration and even self-sabotage.

Embracing change through conscious sublimation

While in classical psychoanalysis sublimation is considered an unconscious defense mechanisms, I argue that there can be a degree of conscious awareness in the process. Think about what would happen if we had a better understanding of not only the pushing/pulling forces of change, but also of the emotions that change elicits within ourselves.

Instead of a new year resolution that is action-focused we may come up with an emotion-focused approach. For instance, instead of “I will be eating healthier next year”, we could embrace “I will look inside me to understand the feelings I have about what I eat”. Like an artist who may consciously choose to channel their anxieties into creative work, we can come to understand the drive behind the many New Year’s resolutions. In essence, while the initial impulse may be unconscious, the conscious choice to engage in a particular activity that channels that energy can be seen as a form of conscious participation in the sublimation process.

I believe this awareness is the first step toward long lasting change.

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