I Treat Dead People

Copyright 2009 by Christine M. Skolnik

One of the obvious and yet often forgotten lessons of M. Night Shyamalan’s The Sixth Sense is mutuality in healing. As the ghostly psychologist (Malcom Crowe) heals the boy (Cole Sear), the boy also heals the psychologist. Sear learns not to be afraid of dead people, while Crowe comes to realize that he himself is dead. Up until then Crowe has haunted his wife, in a sense protracting her grief. (He himself is haunted by a past professional failure—the homicidal and suicidal Vincent Gray.) The main relationship between patient and therapist in this film, though paranormal, is in some ways paradigmatic of therapeutic relationships between the living, as it emphasizes the bizarre combination of intimacy and distance in such contexts. It also serves to foreground the limits of a classical empirical epistemology in psychotherapy, and suggests the relevance of quantum physical paradigms to any relationship. Finally, the reversal of roles and authority at the end of the film undermines the concept of therapeutic authority and makes a strong statement about the possibility for equality in a therapeutic relationship even when one party appears so vulnerable.

Shyamalan’s dead therapist can be seen as a metaphor for the requirement of emotional distance and neutrality on the part of the typical psychiatrist or psychologist. Though the traditional Freudian paradigm of a blank screen onto which the patient projects archaic affective energy is rarely adhered to strictly, contemporary professional ethics still require a significant degree of emotional detachment. In this sense the psychological professional remains on some level dead to his or her patients. All patients can see beneath the professional death/mask; highly intuitive patients, however, might be particular disturbed by the discrepancies they encounter between their therapist’s overt behaviors and covert emotional responses. Like Sear they see the ghosts of their therapists.
The tension between psychological intimacy and distance is further emphasized by the fact that many therapists avoid all physical contact with their patients, consciously withholding a caring hug or healing touch, and even shrinking from a patient’s playful tap on the shoulder. The psychological rationale for this prohibition against physical contact is that absolute physical boundaries allow for maximum psychological intimacy, while any type of physical contact would make boundaries fuzzy and inhibit psychological interchange. Though most would agree that sexual touch is never appropriate in a professional context, a complete lack of physical contact is no guarantee of psychological intimacy. In fact such a prohibition may inhibit psychological intimacy. If a patient sees their therapist shrink from casual contact, they might feel like a leper. They might also conclude, perhaps correctly, that the therapist perceives them as a threat. Though a teacher or boss might do the same, this dynamic could be particularly damaging in a psychotherapeutic context as the patient will likely conclude that the therapist does not trust them because of their status as a patient.

Fundamentalist rules against future contact with patients can have a similar effect on the therapeutic alliance. Once the patient terminates therapy he may be banished forever from the therapist’s life (like a leper or a dead person), unless he wants to return in the zombie, living-dead, properly subjected, and possibly sedated role of a patient. How can he, then, aspire to feel whole, healed, or alive within or beyond the therapeutic scene? Doesn’t the therapeutic community categorically deny patients these attributes? The seemingly wise adage “once a patient always a patient” is truly frightening on various levels. Looking at the semantics out of context brings to light an astonishing truth: psychologists in some way damn their patients to second-class status for the rest of their lives. The rule suggests that the patient will never be considered capable of sound judgment in relationship to the therapist, or anyone else for that matter—if the patient cannot accept the patriarchal logic of the therapeutic “incest” taboo, for example. Quite simply, the patient can never be trusted and always remains subordinate to institutional psychiatry--remains “institutionalized” in a sense.

Ironically this rule also damns psychology, as it suggests that psychologists can’t reliably treat mental illness, or determine whether or not a former patient is emotionally stable enough for any type of non-professional relationship after-the-fact. Of course this barrier may be motivated more by legal issues than medical ethics. But psychologists who cooperate with such a marginalizing and, frankly, oppressive order should ask if their need to protect themselves overrides their interest in treating patients as living, breathing human beings.

Empiricism is a mixed blessing to psychiatry and psychology. Most advances in both pharmacological and non-pharmacological treatments in the last century are due to a scientific attitude and various new and wonderful modes of empirical research. The empirical mindset, however, encourages therapists to view their patients as material objects separate from themselves. Whether in prescribing drugs or in their relational stance, therapists aspire to “professional” objectivity. In the context of psychotherapy any experienced therapist knows that she cannot separate her feelings from the relational dynamic; the phenomenon of counter-transference is as old as analysis itself and almost as well scrutinized. And yet even this self-consciousness is intended to counter inappropriate subjective responses. Perhaps some psychiatric professionals would say they need to remain objective in diagnosis, but aware of their personal feelings and responses in the psychodynamic process. However, I believe this to be a false dichotomy. First, diagnosis and drug treatment are surely influenced by subjective elements such as professional training, identification, and experience. Second, the new physics (new empiricism, if you will) denies a separation of subject and object in any context. As neuroscientists begin to understand the quantum mechanical properties of the brain, therapists, I suggest, should be called to view their own work in light of this new science.

While the fictional plot elements of The Sixth Sense may seem strange and removed from every-day professional realities, they are no stranger than the scientific findings of quantum physics. The new physics reveals (among other phenomena) that observers affect “objects” in the mere act of observation, that this influence can happen at a distance and after a significant passage of time, and that “objects” can exist in two or more locations at once. I place the word “object” in quotes here because a critical mass of scientific evidence suggests that the classical (physics) relationship between subject and object is no longer tenable. Thus psychology, in its constant anxiety and aspiration to the status of a science, might look to physics for a model of a new empirical attitude: reverence and awe in the face of great mystery, as opposed to the old positivist arrogance. The patient is no longer an object. She never was. And the therapist can never be epistemologically separated from the patient. Today an attempt to remain “objective” might be considered naïve. In the future it may even be considered unethical. I am not suggesting, for a moment, that therapists let their positive or negative emotions override prudence in a professional context. Rather, I caution against the idea that a therapist can “fool” their patient. In trying to hide their emotional responses therapists undermine their patient’s judgment and agency, and ultimately damage their own ethos. Whether or not a patient is wholly conscious of the mixed signals they receive from a therapist, they are likely to doubt both themselves and their therapists in such a context. They are also likely to feel wounded or at least somewhat betrayed by their doctor.

At a critical moment in The Sixth Sense Sear asks Crowe, “How can you help me if you don’t believe me?” Similarly the paradigmatic patient might ask, “How can you help me if you don’t trust me?” How can patients come to trust themselves when authorities they have come to rely on illustrate so little faith in them and their recovery? How can they overcome their shame of being in therapy when they are treated like lepers by those from whom they seek help? How can they begin to live again, after a period of depression or anxiety or self-recrimination, when therapists treat them like dead people?
[ . . . ]
The man who kills Crowe in The Sixth Sense is enraged because the therapist didn’t protect him as a child. Gray (the former patient) was harassed by spirits of the dead; however Crowe did not believe him and thus could not help him. Gray could see dead people. Crowe could see neither dead people nor his patient—he could not trust or believe him. The former patient comes back into Crowe’s life to kill him before killing himself. Without reifying or debating the issue of “ghosts,” empirical skepticism affords protection for neither the child patient nor the adult therapist in this context. The child expecting protection from an authority figure, in the form of empathy at the very least, becomes the troubled man (Gray) carrying the frightened and abandoned child within him. The therapist is ultimately destroyed by his professional skepticism (as suggested by the coincidence of him receiving a professional award on the night of his death), and can only be redeemed in a twilight zone between life and death by a second troubled child, whom he comes to believe (trust) and help. In doing so he too is redeemed, through insight about himself, his profession, and his relationship with his wife.

The relationship between Sear and Crowe, however, appeals to me most as a counterpoint to the myth of professional authority. Initially we encounter Sear as a small, vulnerable, indeed, fragile child. We also see him as a victim of dark forces. As the film progresses, however, Sear comes to finds his voice and moves into “right relationship” with his therapist and his mother. He is able to persuade Crowe to take him at his word. In fact he becomes a conduit of profound wisdom for both adults. The fact that a child can heal an adult in such a relationship emphasizes that true healing is mutual, that any therapeutic relationship can be equal, and that apparent authority figures can often be corrected by apparent subordinates.

Crowe’s status as an authority figure is completely overturned at the end of the movie. First, we discover that he is dead. Second, we understand that he has been blind to that not insignificant fact for some time. The logic of his skepticism is completely turned on its head, as his questioning of Sear’s claim to see dead people is possible only because he (a dead person) is seen by the child. The paradigmatic therapist is enlightened only when he realizes that the patient can see his ghost.