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Susan Rako M.D.

The Only Socially Acceptable Psychosis

Wisdom of Dr. Elvin Semrad

In his 1977 film, "That Obscure Object of Desire," the Spanish surrealist director Luis Buñuel created a visually concrete demonstration of how falling in love has less to do with the person loved than with the fantasies and projections of the lover. In this film, the male protagonist has fallen in love, and the part of his beloved is played by TWO different women, women of notably different appearance and temperament and who appear unpredictably in separate scenes.

Buñuel's point cannot be missed. "That Obscure Object of Desire" is a fantasy of the lover, projected upon whatever woman has fallen into the role.

Extreme, without a doubt. However, we—and our patients—who are not creations of the artistic imagination of Luis Buñuel are nonetheless vulnerable to "cupid's arrow."

I am grateful to have had the opportunity to learn from Dr. Elvin Semrad, the most influential teacher of the art of psychotherapy of his and subsequent generations.

Semrad recognized psychosis as a state characterized by the use predominantly of the three primitive coping defenses: avoidance, denial, and projection.

About love, Semrad said:

"Love is an unexplainable state, where there are so many things you choose, for the purpose of gratification, not to see."

"Nobody in love has good judgment; everybody wishes, and confuses fantasy and reality."

And, ultimately: "Love is the only socially acceptable psychosis."

Semrad also said, “After satiation comes a day of reckoning. Then you really notice those things that you didn’t notice before. And sometimes you make new decisions on that basis — whether to put up with it or not put up with it.”

Patients often come to consult with me as a consequence of having come to that “day of reckoning.” I have found that the resistance to making the transition from the state of having “fallen in love” back to reality can result in blame, self blame, tantrums worthy of a two-year-old, depression … any distraction from having to find a way to make peace with what one actually has in life. The challenge, when approached with courage and care, is an important opportunity for growth.

About his words, Semrad used to say, "Take what you find useful, use it and pass it on. As for the rest, throw it away."

I am glad to pass this on.

References

Rako, S, & Mazer, H. (2003). Semrad: The Heart of a Therapist. iUniverse.

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About the Author

Susan Rako, M.D., is the author of several books including That’s How the Light Gets In: Memoir of a Psychiatrist and is co-editor of Semrad: The Heart of a Therapist.

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Susan Rako