by Martha Stark, MD / Faculty, Harvard Medical School


Juanita’s mind-boggling experience with an opioid is one of many stories that inspired me to include a 5th model in my Psychodynamic Synergy Paradigm – a brain-based model that relies upon therapeutic memory reconsolidation and focuses on “living life forward” (as opposed to the psychodynamically informed Models 1 – 4, which focus more on “understanding life backward”).


What follows is something that Juanita, a psychotherapy patient on whom I did a consultation several years ago, reported to me.


Juanita was struggling to get over the pain of her grief about the loss of a man whom she had felt was the love of her life. Together for almost 10 years, she and Eduardo had shared what appeared to be almost a storybook life together – although her own, not yet fully processed history of having been sexually abused by her stepfather made her a reluctant sex partner, sadly for both Eduardo and her.


One day, Juanita accidentally discovered, to her absolute heartbreak, that Eduardo had been having an affair with one of his colleagues at work. This precipitated a series of major arguments and, ultimately, a breakup, with Eduardo finally moving out.


Juanita, not only overwhelmed with grief at the loss of Eduardo but also unable to forgive herself for the part she had played in his straying because of her unresolved issues, then found herself experiencing such acute psychic distress and unremitting loneliness that she became profoundly and immobilizingly depressed – and even found herself contemplating suicide as a possible escape from the pain of it all.


One evening, exhausted from the effort of having struggled through each and every day since their breakup, Juanita, someone who ordinarily shunned the idea of using recreational drugs and even medications prescribed by doctors, blindly reached for a few of the hydrocodone pills that she still had in her possession from the time when her wisdom teeth had been removed. Her intent was not to kill herself but to find oblivion in reduced consciousness and sleep.


Fortunately, Juanita did not come close to dying and, instead, after becoming sedated, somewhat numbed, and somehow calmer, eventually fell into a deep, opioid-induced sleep. Upon awakening hours and hours later and more refreshed than she had felt in weeks, she suddenly realized – to her total amazement and delight – that the pills prescribed by her dentist to relieve physical pain had actually obliterated her psychic pain. As Juanita reported it to me, it was almost as if she, in discovering the possibility of living without deep psychic pain (by virtue of the opioid-induced numbing), was able to reframe her entire experience of loss as a manageable, albeit still heartbreakingly sad, way of living.


In any event, Juanita’s mind-boggling experience of an opioid-induced repositioning of herself in relation to what had felt like unbearable grief was yet another demonstration of how changes in the state of the brain will impact mental health – which is why Juanita’s experience could accurately be described as both mind-boggling and brain-boggling!

A special THANK YOU to Bruce Ecker, David Feinstein, Allan Schore, Bruce Lipton, Dawson Church, Joe Dispenza, Arnold Modell, Charles Krebs, Dan Siegel, Marion Solomon, Ed Tronick, Bessel van der Kolk, Beatrice Beebe, Pat Ogden, Patricia Coughlin, Mary Bowles, Rob Neborsky, Steve Shapiro, Jon Frederickson, Diana Fosha, Habib Davanloo, Kristin Osborn, Jim Donovan, Richard Schwartz, Peter Levine, Joan Klagsbrun, Al Pesso, Angela Segal, and Francine Shapiro for opening my psychoanalytic eyes to so many exciting new possibilities and for providing me with the impetus and inspiration for adding Model 5 (a quantum-neuroscientific approach to symptomatic relief and behavioral change) to my Psychodynamic Synergy Paradigm.