The term “impossible people” has been kicking around western culture for some time; most of us heard someone or other referred to as “being impossible” (possibly ourselves!) long before we started seeing a therapist, or became shrinks, or just started reading self-help books and random neuroscience websites. We all probably periodically think that someone else is “being impossible” when they put us in a no-win situation of some sort.
I had a patient, for example, who (this is all absolutely and completely made up – it is merely narratively true; I’m describing a kind of story I’m used to hearing. Don’t worry -no confidentiality is being broken!) wouldn’t study for his college history tests. Or statistics tests. Or philosophy tests. Or anything.
Why? It made him anxious. Why did it make him anxious? Because he started to feel like he wasn’t going to do well on the test. So then what happened? He showed up for the test and did a bad job and gets a low grade. And then what happened? He felt even more anxious next time it was time to study because now he had evidence that he wasn’t going to do well – look what happened last time! As a results the semesters went by and he didn’t study and did poorly and his job prospects dimmed and he began procrastinating applying for jobs because – of course – he worried he wouldn’t get one. His entire life, in short, was being held hostage by his anxiety, and his anxiety was being driven by his shaky self esteem, and they were going around and around in a death spiral that seemed so unnecessary that anyone who listened to his tortured explanations of his actions would come away thinking he was impossible. Of course any observer would tell him to sit down, study hard for 2 days for one test, take it, do better than he’s used to doing, and repeat. After a semester or two he should be in good shape.
But my patient couldn’t follow this advice because…. he was impossible. He wanted something impossible (to do well without trying), experienced his situation as impossible (can’t bear to study without a guarantee of success), and was experienced by everyone who got pulled into the inner logic of his various ambitions and hangups (like his dad, who was exasperated with paying for school that the son didn’t take seriously) as impossible. He was, in short, what I will call an impossible person. He was impossible to be, impossible to reason with, impossible to make happy.
So far as I know the phrase “impossible person” was coined by James Joyce. In the opening paragraphs of Ulysses the introverted twenty-something Stephen Dedalus, a grandiose but failed writer and bummed-out middle-school teacher whose mother just died is called impossible by his roommate, the exquisitely extroverted medical student Buck Mulligan. When the book starts out, Stephen has been acting mopey all morning – he is suffering from many perceived slights – and Buck has begun to sense that this mopiness may be directed at (unfairly) him. Being a possible person, Buck Mulligan doesn’t duck the issue. He raises it directly.
— Then what is it? Buck Mulligan asked impatiently. Cough it up. I’m quite frank with you. What have you against me now?
They halted, looking towards the blunt cape of Bray Head that lay on the water like the snout of a sleeping whale. Stephen freed his arm quietly.
— Do you wish me to tell you? he asked.
— Yes, what is it? Buck Mulligan answered. I don’t remember anything.
He looked in Stephen’s face as he spoke. A light wind passed his brow, fanning softly his fair uncombed hair and stirring silver points of anxiety in his eyes.
Stephen, depressed by his own voice, said:
— Do you remember the first day I went to your house after my mother’s death?
Buck Mulligan frowned quickly and said:
— What? Where? I can’t remember anything. I remember only ideas and sensations. Why? What happened in the name of God?
— You were making tea, Stephen said, and I went across the landing to get more hot water. Your mother and some visitor came out of the drawing room. She asked you who was in your room.
— Yes? Buck Mulligan said. What did I say? I forget.
— You said, Stephen answered, O, it’s only Dedalus whose mother is beastly dead.
A flush which made him seem younger and more engaging rose to Buck Mulligan’s cheek.
— Did I say that? he asked. Well? What harm is that?
He shook his constraint from him nervously.
— And what is death, he asked, your mother’s or yours or my own? You saw only your mother die. I see them pop off every day in the Mater and Richmond and cut up into tripes in the dissecting room. It’s a beastly thing and nothing else. It simply doesn’t matter. You wouldn’t kneel down to pray for your mother on her deathbed when she asked you. Why? Because you have the cursed jesuit strain in you, only it’s injected the wrong way. To me it’s all a mockery and beastly. Her cerebral lobes are not functioning. She calls the doctor Sir Peter Teazle and picks buttercups off the quilt. Humour her till it’s over. You crossed her last wish in death and yet you sulk with me because I don’t whinge like some hired mute from Lalouette’s. Absurd! I suppose I did say it. I didn’t mean to offend the memory of your mother.
He had spoken himself into boldness. Stephen, shielding the gaping wounds which the words had left in his heart, said very coldly:
— I am not thinking of the offence to my mother.
— Of what, then? Buck Mulligan asked.
— Of the offence to me, Stephen answered.
Buck Mulligan swung round on his heel.
— O, an impossible person! he exclaimed.
It pays to pay close attention to Joyce’s insight here – the insight that Stephen is being impossible – because it is the central psychiatric insight into what it means to be an impossible person as well.
Buck Mulligan calls Stephen Dedalus an impossible person because at a moment in which Stephen should be thinking about his deceased mother he is thinking of himself. And because the self does not exist except in relation – here’s Joyce’s insight – to think of yourself – to think of yourself as existing per se – is to be impossible.
In my clinical work I tend to agree. It is the belief that the self exists as a thing-in-itself that is the cardinal confusion that marks the impossible person. It’s what makes a regular person impossibile. It is the abandonment of this idea, and the taking up, in a real and profound way, an interest in other people, and then, further, an interest in the dynamic relations between the self and others, that marks the transition into possibility and mental health. And it is the psychiatrist’s job, when all is said and done, to facilitate this movement.
In knowing this, Buck Mulligan knew what the author of the fable of narcissus knew, and what Jesus (the historical Jesus, not the supposed son of God) knew, and what the Buddha (again, the historical one, not the supposedly reincarnated one) knew. Once a psychiatrist knows it she finds a kind of clarity comes over her work with these patients.
To understand that self-focus is the core problem is a huge technical advance in psychotherapy. Rather than get sucked into analyzing the details of their lives, the ups and downs of their relationships, the faddish nature of their commitments, the fluctuations of their self-esteem, the variability of their moods, the therapist is able to think in a big picture way about what’s wrong with them. And eventually it gives rise to what Joyce freely admitted he did not have: a sense that Stephen Dedalus (and all impossible people) have a chance of getting better.
In mainstream psychiatry impossible people are not called impossible. They are called personality disordered. This is unfortunate. To my way of thinking it’s a bit like calling Native Americans “Indians.” It is a confused concept – there is no such thing as the personality per se, and worse, it is insulting to those who think they have one to call it names – and worse, it lacks technical precision. It is also, historically, so loaded as to carry with it unwanted stigma.
Impossible people are the bucking broncos of clinical psychiatry. They are by far and away the hardest patients to treat not because they are acutely difficult (manic and psychotic and intoxicated and suicidal patients are that) but because they are chronically difficult; their problems never end.
There is little good data on how to treat them, and there are no medications that bring them rapidly under control (though many benefit from antidepressants and anxiety medications, among others). They stir up furious feelings in their treaters (called, ridiculously, countertransference) – feelings of rage and frustration and exasperation and incredulity and befuddlement and helplessness and lust… well, you name it. No wonder that articles – like the famous Groves article The Hateful Patient.pdf – are passed down from generation to generation of physicians about how difficult it is to work with them year over year.
But on the other hand, like a bucking bronco, working with impossible people is for some of us the most rewarding experience in psychiatry, because the changes that occur in these patients are analogous only to the sorts of changes one sees in protagonists of novels and plays. True evolution and development unfolds, over a period of years, that fundamentally alters the way they relate to themselves and others, and a kind of blossoming occurs not just externally – as they get jobs and fall in love and start families – but internally. What Sinnet called “The Growth of the Soul” is in full display, as people who could not tolerate the existence of others, and even more fundamentally of themselves, wrestle through a host of existential concerns in a concrete and visceral and personal way and emerge as wiser, deeper, more profound people.
Whether you are an impossible person, know one, love one, or are learning to treat one (or all four!), having the experience of sticking by them in will add immeasurably to your social and therapeutic skills and appreciation of the human character. Regardless, in the posts that follow in this section I will try to shed light on the inner logic of impossible people, and on some of the techniques that can be used to make them possible.