key: cord-347716-ka2lm62r
authors: Usher, Craigan
title: Existential Returns
date: 2020-06-25
journal: J Am Acad Child Adolesc Psychiatry
DOI: 10.1016/j.jaac.2020.05.002
sha: 
doc_id: 347716
cord_uid: ka2lm62r

nan

onfronting COVID-19 is nothing short of an existential event, one that has required us simultaneously, en masse, to pose and answer questions that might otherwise arise only here and there, in sadnesses and moments of fragility experienced in isolation. Many colleagues and patients have shared with me that this event has sparked a sense of urgency-not only about what we should do or ought not-but how we might think, feel, and tolerate this global encounter with vulnerability and loss.

There are no universal strategies. Yet, in these initial weeks of the pandemic, I've admired how many colleagues and young people for whom I am honored to provide care have coped by leaning into their strengths and sensibilities. Their authenticity and sense of obligation have intensified. This, in turn, has inspired me to reflect on my values and ask: am I leaning into my work and passions? And by that, I don't mean simply: am I productive? But do I feel like I'm living with integrity? Have I shared-with residents, fellows, and my own family-that which I find essential? More importantly, have I made space for them and for my patients to share that which they feel is vital?

To that end, lately I have found myself with a renewed sense of purpose around teaching psychodynamic psychiatry and been sharing more of my favorite films. In light of this and that we are one review short of the intended trio-this due to a child and adolescent psychiatry colleague needing to focus on leadership at her medical center (again, leaning into strengths)-I wished to share with you some thoughts on a favorite film.

Although Groundhog Day was released 27 years ago, even kids today know that when someone says "it's like Groundhog Day," that person is not talking about February 2nd or a celebration of woodchucks, but instead about a sense of eternal recurrence. Lately, a number of parents, children, and teens I know have expressed a Groundhog Day experience-feeling like, with only limited if any online school-every day seems the same. "What have you been up to?" "Same old, same old." Mostly this is spoken with despair, but I think it need not be.

Groundhog Day tells the story of Pittsburgh meteorologist Phil Connors, who, alongside cameraman Larry, and TV producer Rita travels to Puxatawney, Pennsylvania, to film the annual Groundhog Day celebration. Cynical, disgusted by the kitsch of the event, and the "hicks" he feels surrounded by, Phil is eager to film his bit and get back to the city. Yet he is trapped, not only by a snowstorm he inaccurately predicted would miss them, but in a time loop. Phil discovers there is no exit from Punxatawney or February 2nd as he wakes to the same day over and over. What follows demonstrates many 20th century psychoanalytic theories about what might motivate us.

Initially, Phil's behavior follows what Sigmund Freud called "the pleasure principle": he avoids pain and indulges himself. This Phil delights in entire dessert trays, stealing, driving fast, and punching an annoying insurance salesman. Living up to his name (Phil "Con-Hers") he disturbingly picks up details each day to trick women into sleeping with him. Eventually, though, this hedonic drive burns out. Phil's psychic life and actions then become dominated by what Freud initially and Melanie Klein later labeled the death drive. He grows more erratic, careless, depressed, and in order to reduce tensions, he repeatedly attempts suicide.

In the next act, Phil grows more accepting of his circumstance. However, he is not ready for change, only for a patch job on the old way of doing things. Here Phil becomes less scattered in his pleasure-seeking and more infatuated with a colleague, Rita. He imagines relief and ultimate jouissance in partnering with her. Here we might agree that Phil is-as Heinz Kohut once put it-exercising a misuse of empathy. Phil learns about Rita's desires and, down to feigning enjoyment of 19th century French poetry, it appears Phil will finally woo Rita and achieve happiness. Yet, because Rita is discerning and Phil creepy and coercive, this ultimately fails miserably.

In the final act, Phil reflects that he can no longer live or die solely for himself, but is compelled to make a life for and with others. Like a parent who "knows" what their child is up to, anticipating the child's needs, Phil becomes preoccupied with the people of Puxatawney. He is there to catch a boy falling from a tree, poised with a spare tire and a jack for some older women whose car gets a flat. He feeds the poor, perfects his Heimlich technique to save a choking victim, and "sure as heckfire" supports opposed to punching the pesky insurance salesman. It is only at this stage that Phil is ready, like the Winnicottian "good enough" parent, to actually be emotionally affected by others' spontaneous gestures. He does what he can to help, allows himself to be of use without expecting anything in return, and genuinely is tickled by the spontaneous gestures and kindnesses of others. He is no longer compelled to control the outcome of his or others' actions by means of sneering condescension, cunning, selfharm, or using empathy in a manipulative manner. In this way, Phil is finally ready for February 3 and the rest of his life.

Groundhog Day illustrates many psychodynamic concepts and may speak to those of us whose mental lives are dominated by recurring thoughts of the existential, economic, and emotional hardships of others or questions like if or when schools and hospitals will return to "normal." In addition, the film suggests something that, at first glance, sounds quite odd: that doing the same thing over and over again is not, as some have said, the definition of insanity, but instead an insistence of hope. Amidst this pandemic and some of the ways our minds are spinning, Groundhog Day reminds us that through creativity, a commitment to trying something if only slightly different each day, and a zeal to live for and with others, we might find ourselves out of vicious cycles and experiencing something more like virtuous spirals.

This month, two reviewers explore a pair of Oscarwinning films that return to old stories but offer fresh, if controversial, takes. First, a general psychiatrist who works with individuals, couples, and families, Fred Coler provides his perspective on Joker. Coler addresses the controversy surrounding this new-origin story of Batman's arch nemesis, that is, the theoretical risk of Joker inciting violence. He emphasizes that with outstanding cinematography, a haunting score, and standout performances, Joker should not be thought of as a film celebrating violence, but a cautionary tale about the sequellae of extreme childhood abuse and our need to take care of youths and families. To Coler, what makes this film funny, not "funny ha-ha" but "funny peculiar," is that it is unique in seriously addressing the question: what might realistically constitute the background and mental world of one of the most iconic comic book villains?

Child and adolescent psychiatry fellow, Ian Pearson writes about Jojo Rabbit. Set in Nazi Germany, this film also stirred fierce debate as it largely side-stepped the horrors of the holocaust in favor of sanitized satire and director Taika Watiti's trademark whimsy. At the same time, Pearson submits that this is a serious film about the fall of childhood fantasies-imaginary friends, imagined omnipotence-in favor of a more mature, genuine embrace of matters of love, life, and death. Having watched the film with two young people who are the age of the protagonist, I can honestly say that, comic devices aside, they saw the same thing: a Calvin forced to give up his Hobbes embracing a richer, less falsely certain future.

The author has reported no funding for this work.

The author would like to thank collaborator Matt Carges, LMFT, for his intellectual contributions to understanding Groundhog Day as featured in the coled seminar: "The Insistence of Hope: Repetition Compulsion to Recursive Functions from Freud to Fonagy." The author would also like to thank colleagues Neisha D'Souza, MD, Katherine Tacker, MD, David Nagarkatti-Gude, MD, PhD, and Sean Stanley, MD, of Oregon Health Science University, for their leadership and "leaning in." Disclosure: Dr. Usher has reported no biomedical financial interests or potential conflicts of interest.

https://doi.org/10.1016/j.jaac.2020.05.002

CA: Warner Brothers; 2019 hat the film Joker (2019) generated controversy should come as little surprise. Even the three men who created the Clown Prince of Crime in 1940-Bob Kane, Bill Finger, and Jerry Robinson-could not agree who deserved the credit. 1 The violent villain, formerly known as "Red Hood," was inspired by the character "Gwynplaine" from a Victor Hugo novel and the 1928 film, The Man Who Laughs. The Joker is a jesting lawbreaker whose origin story has taken many forms. Casual fans of the Batverse are probably most familiar with a somewhat shallow version wherein Jack Napier