He asked me for a favor, actually a bit more than a favor. It amounted to me paying for everything…something about his mother and her medical bills…frankly, I didn’t pay much attention to the details. He said he had to loan her a lot of money but she’d pay him back and then he’ll square off with me. After three months of this “paying for everything” thing, we were out at a restaurant. I said “How about you pick up the tab tonight?” It was very awkward. He said something vague about doing it “soon”, but he got distant, not apologetic…so I dropped it.

But I was getting…it’s painful to admit this… suspicious.

Then I had to call him at the office, which I never do, and guess what…he didn’t work there anymore. I completely freaked out. I confronted him and he said he was planning on telling me about his job but he didn’t want to upset me. He said had a job interview coming up the following week, and on and on. He said he trusted his mother to reimburse him soon and I shouldn’t worry. He talked and talked. I was listening but not hearing at the same time.

I felt like I was in a trance. I believed him even though this was implausible. When I am away from him I know he must be lying to me but when we are together he seems persuasive and sincere. He is the center of my world and I don’t want to lose him. I love him. Maybe there is some alternative explanation. Please help me figure this out.

Dr. J replies:

The sad thing is that the person at the center of your world, the one you love, may not exist. You fear losing him, but you never had him…and you do not have him now. You are infatuated with a fantasy. Rather that face this, you are denying the obvious.

The person you are describing is a classic portrait of a psychopath. Psychopaths are socially facile, charming, and persuasive, often ruthlessly manipulative. They blackmail people, leveraging benign wishes to love and be loved, sucking out their care and energy for some type of gain, in this case financial.Regardless of the situation with your partner’s mother, and even this part of the story doesn’t make a lot of sense, the outright falsification about his job is already a serious betrayal. Consider how much strategy was involved in concealing this for months. He had a job…then lost the job…and never told you. You were paying for everything while this essential reality was obscured. Your terror of losing the relationship, and perhaps your terror of your own rage, then resulted in a period of collusion.

Real psychopaths are remarkably good at deception. I believe that you have been victimized, and feel unsafe because your sense that you could trust someone close to you has been violated. Your sense that you know who is trustworthy and who is not has faltered. Often “signs” that seem obvious in retrospect are easy to miss, especially if this person is, as you say, the center of your world. This is a heartbreaking outcome to a relationship that began with romance and hope. I think you need to examine the temptation to deny what you “know” to keep something or someone that you need and want.

The vulnerability to betrayal usually has roots in childhood; needs to rescue someone central to your well-being. It is sometimes linked to fears of abandonment and narcissistic insecurities. It is, above all, the need to deny the presence of evil in the world. Hopefully, you are resilient and will use your resources to heal. Give yourself time and do not jump into a new relationship before mourning this one.

I am in a maddening situation. About a year ago, I started to itch. This itch migrates…it rarely is in the same place for very long. It is very distracting, and I am always tired from trying to function through it, or over it. First I went to mainstream doctors, then to specialists. The good news: nothing was wrong. The bad news; nothing was wrong. After a while my internist seemed to lose interest, to not realize how much I was suffering. Finally, in an exasperated voice, he said, “ I think you need a shrink”. I am no dope. I know that a shrink does not treat itching. This was totally unhelpful and disappointing.

I finally went down an alternative medicine route. This practitioner suggested that I consult a therapist too! As much as I think this is absurd, I am sobered that two people have said the same thing. I said to this doctor, “Just how is that going to help? And she said, “That is something to take up in your treatment.” I felt dismissed, even patronized. Infuriating!

So, now I am asking for your opinion. And even more, maybe you could explain to me how psychotherapy is better
than a pill or a cream? I still believe I need to find the right kind of specialist and the right kind of medicine.

Dr. J replies:

Itching, along with nausea, is among the most baffling and complex of disorders, and you are correct that many doctors become irritated when their limitations to “fix it” are exposed. I think your doctors have failed to articulate the mind-body connection, possibly because they underestimate it themselves, or perhaps because they felt you were unreceptive at the time to considering it.

You ask how psychotherapy could be better than a pill or a cream, but you have been quite clear that you have gone the medical route, and even alternative medical route, and you didn’t get any relief. So, it is unlikely that yet another pill or cream will cure you.

I do think there is something wrong with you, and it manifests itself in a very real, very problematic physical symptom. However, that does not mean its true origin is not inside your head, something psychological. A psychologist will pursue a detailed inquiry into precisely what was happening in your life just before the symptom began, any patterns in the locale of the itch, and how it affects your life right now. This would include what activities this itch precludes and how your symptom affects the people around you.

This is a symptom I would call “psychosomatic”, but not because it is in your mind, in the sense that you are imagining it. That is a common misunderstanding. It means that its point of origin is between your ears…it begins in your mind. Your body is telling you about some kind of problem, some kind of past or present distress. But bodies have no language…they cannot put this pain into words…so they “talk” through physical symptoms.

The process of therapy is one of listening to what the body is saying in its own way, thus “decoding” the symptoms, helping to put the underlying issues into words. It is not called “the talking cure” for nothing. Even if therapists debate between themselves over how therapy works, they do agree that it does work, or at least that it sometimes works.

You have nothing to lose by giving it a try. Except your itch.

I do not hesitate to tell “white lies”. For example, I’ll say “I’m busy” to avoid an unwelcome social request. I’ll say I wasn’t home when I didn’t want to answer the phone. I don’t think about the fact that it could be urgent. Most things are not really urgent. In the course of a recent conversation, someone I respect asked me if considered myself an honest person. I realized that I paused…I didn’t just say “yes”. In fact, we both noticed it. The conversation went on like nothing notable had happened. However, privately I felt unsettled. I think of honesty as so important. Yet, I wonder if I am an honest person. It seems like it should be a straight-forward question, “yes” or “no”. What do you think?

Dr. J replies:

Many things which seem straightforward “on paper”, are in fact nuanced and complex. I don’t think honesty can be isolated from motivation and intentionality but there are those who would disagree. Certainly, decisions about social behavior do require reflection and honesty with one’s self. I would urge suspicion in most claims to be doing something deceitful for someone else’s benefit. I think personal integrity can co-exist with “white lies” in the service of tact or sparing minor emotional injuries. However, untruths should never be undertaken lightly, as it is a “slippery slope” to more serious betrayals.

I would urge you to consider whether a particular “white lie”, unexpectedly discovered, would significantly damage your relationship. Would you be prepared to take responsibility for the consequences?

Over time, most lies and secrets have a way of surfacing. People who tell many white lies at some point forget one of them, and are then justifiably perceived as untrustworthy. So the outcome of something thoughtless and casual may be extremely serious.

“White lies” also deprive you of the opportunity to learn if you have underestimated someone. Relationships grow when such small risks are met with empathy. There is nothing more precious than trust. Once broken, it may never be repaired. So, tell a “white lie” at your peril, and strive to be as honest as you can. Not surprisingly, the more intimate the relationship, the higher the stakes for
integrity and the more difficult it is to sustain.

Dr. J replies:

I would encourage you to trust your feelings…that something powerful happened between you. On the other hand, you don’t know this person, and you don’t know if “falling in love” is something that he wants, at least at this moment in his life. Never underestimate timing. The fact that you got so attached so quickly does suggest that you are needy. I don’t know if he registered that and felt overwhelmed. Sometimes people can pick up implicit demands that are never put into words.

On the other hand, there are people who seduce others as a way to entertain themselves and feel empowered. If this is the case, the sooner you know it the better. Many factors make someone unavailable emotionally, at least at a particular time. People who have not fully mourned a prior relationship may “bolt” when meeting someone with romantic potential. You letter suggests that part of why you are feeling terrible is because you have no clarity. You don’t know why what happened happened. You can call him and attempt to get more clarity, but his precipitous departure does not bode well for a constructive conversation. Life is full of mysteries both wonderous and perplexing.

I recently arrived at college, coming from a small town. It is overwhelming. I am having sexual fantasies that are freaking me out.

My roommate is very sophisticated and smart, with nice clothes and big breasts. She walks around our room in her underwear. I masturbate under the covers at night. She came back early from some event and I think she suspected it. Maybe she smelled it. I was mortified and pretended to be asleep. What upset me the most was realizing that I was thinking about her when I was doing it. I am not very experienced about sex and grew up in a religious Catholic family. I feel this is so abnormal. My parents could never face this. Does it mean that I’ll never get married and have kids? I am really shattered. Please help me.

Dr. J replies:

You do sound anguished.

Everyone has sexual fantasies. The relationship between sexual fantasies and real life behavior is extremely complex. Even experts in the field of sexuality acknowledge that we are only beginning to learn about gender identity and how that is related to the gender of chosen partners. No set of fantasies is diagnostic of anything “obvious”, like being a lesbian.

Many people believe that everyone is born bisexual and complex permutations of nature and nurture determine a consolidated sexual orientation in adulthood.
Experimentation with same sex play is found among children and adolescents, but increasingly among adults as well. Rigid gender divisions are dissolving. People perceived as heterosexual may enjoy lesbian or homosexual fantasies. The reverse is true for homosexual and lesbians. We contain many tendencies, some enacted and some not even known to ourselves. These are all normal as long as they do not lead to the abuse of others or non-consensual sex with minors.

You are understandably frightened by your sexual confusion. You need a safe and private place to explore your feelings. It is premature to involve your family. Notice what you are feeling, but try not to leap to conclusions. Most colleges have staff psychologists; you should make an appointment. Be aware that some professionals are more open-minded than others.