SECOND THOUGHTS
By Vincenzo Di Nicola, MPhil, MD, PhD, FCAHS, DLFAPA, DFCPA
Dennis Palumbo, MA, MFT
Introducing Dennis Palumbo – Psychotherapist and Writer
It is a pleasure to introduce Dennis Palumbo, MA, MFT, to the readers of Psychiatric Times. Dennis is a licensed psychotherapist in Los Angeles, CA, where he specializes in treating individuals in the creative arts community of Hollywood. He is uniquely well-suited for this specialized work given his double, even triple, skill sets as a former Hollywood scriptwriter and current detective fiction novelist,1 teacher of creative writing,2 and his work with Robert Stolorow, MD, incorporating intersubjectivity theory in his psychotherapeutic work. Dennis will soon be addressing readers of Psychiatric Times in a monthly column of his own, “Creative Minds: Psychotherapeutic Approaches and Insights.” His latest essay is about his role as Consulting Producer on the recent Hulu TV series, “The Patient.”3
We have had an enriching exchange about art, life, and psychotherapy for several years. Dennis was our invited guest for the inaugural meeting of American Psychiatric Association Caucus on Medical Humanities in Psychiatry in New Orleans, LA, in 2022. Dennis’ uniquely diverse and specialized skill sets allow me to explore the question of the relationship between the psy disciplines and detective fiction. More generally, I wanted to explore the roots of creativity and empathy in creative writing and clinical work and connect it to therapy.
Di Nicola: A friend of mine, Harvard psychologist Steven Pinker, PhD, was asked by Stephen Colbert on his show to describe cognitive neuroscience in 5 words. Without skipping a beat, Steve said, “Brain cells fire in patterns.” That echoed our teacher Don Hebb’s discovery of “cell assemblies” at McGill University. As a social psychiatrist and philosopher, my answer would be that “Meaning emerges in social context.” What would your 5 words be? Either about writing or about therapy?
Palumbo: For writing: “Communicating inner worlds in narrative.”
For therapy: “Therapy explores subjectivity in context.”
Di Nicola: We grew up on opposite sides of the US-Canada border in steel towns with large immigrant working class populations. I am a first-generation Italian immigrant who grew up in Hamilton, ON, while you are a third generation Italian-American from Pittsburgh, PA. What does your Italian heritage mean to you generally and as a writer and therapist?
Palumbo: I take great pride in being an Italian-American. Growing up in Pittsburgh, I learned a lot about the Italian craftsmen, painters, and contractors who built much of the city. I think I have inherited the Italian love of good food, pride in hard work, and talking with your hands! I also value our long legacy as visual artists and performers.
As a therapist, I think my background as a child of Italian-American blue-collar workers informs, consciously or not, my prejudice in favor of hard work, consistency, and passionate emotions. Not that I trumpet these values in session with patients, but I must admit that I am drawn to patients who exhibit them.
I also relate to struggle itself, having grown up hearing of my grandparents’ struggles against ethnic stereotyping and all-out discrimination. So the career struggles of my creative patients, especially in such brutal marketplaces as Hollywood and publishing, affect me deeply, and supporting them comes naturally.
I can only think of 1 or 2 clinical colleagues who share my Italian-American heritage, both of whom take their work seriously and passionately. The rest of my colleagues are primarily Jewish, though one Gentile has snuck in.
In my Hollywood career, most of my fellow writers and producers were Jewish. There are a good number of Italian-American creatives in the entertainment industry, but most felt the need to anglicize their names (best-known example is David Chase—originally DeCesare—creator of “The Sopranos”). This was particularly true for performers, like Tony Bennett (Antonio Dominick Benedetto), Pat Cooper (Pasquale Vito Caputo), and Dean Martin (Dino Paul Crocetti).
As a writer, particularly in my fiction, my Italian-American heritage is front-and-center. The protagonist of my Daniel Rinaldi mystery series is a proud Italian-American, and this aspect of his character, background, and opinions is highlighted throughout the books. (In one of the books, reference is made to a very reticent public figure with a rock-ribbed Republican background. As described to Rinaldi by an acquaintance: “He’s a WASP, Danny. All he cares about is Scotch and quiet.”) Which reveals some prejudice on my part!
Other Italian-American characters show up throughout the series, as well as in some of my short stories. Sometimes, their being Italian-American is an important aspect of their characterization; sometimes it is just incidental.
Di Nicola: Psychiatry and the Cinema explores film from the dual perspectives of the Gabbard brothers: Krin, who teaches comparative literature, and Glenn, who is a well-known psychotherapist.4 What are the implications of transferring insights from the page to the screen for you as an author?
Palumbo: Since the beginning of my writing career, prose and screenwriting have been intertwined. I started writing short stories while still in high school and received some very nice rejection notes from many of our finest magazines. I continued writing stories when I arrived in Los Angeles to try to break into TV and film writing. Interestingly enough, the same week my then-writing partner and I were hired as staff writers on the ABC sitcom, “Welcome Back, Kotter,” I sold my first mystery short story to Ellery Queen’s Mystery Magazine. And it was while I worked on that popular sitcom that I sold my first novel, a science fiction thriller called City Wars, to Bantam Books. Throughout my Hollywood career I continued to write Op-Eds, reviews, essays, and short stories.
I would say the biggest takeaway from my scriptwriting experiences, both in TV and film, was a sharpening of my skill at dialogue, which I feel enhances my fiction immensely. Writing for Hollywood also teaches you to “cut to the chase”—as they say in the entertainment business—in that your work in prose becomes more streamlined, less flabby and overwritten. On the other hand, sometimes when adapting a prose work—a novel or short story—for the screen, it is actually better to expand on a scene (or even a sentence) in the work to maximize its dramatic effect. For example, I was once hired to write a screenplay based on a novella by Jim Harrison. At one point in the narrative, the main character goes to a bordello where, as Harrison wrote, “it cost him $300 not to get a hard-on.” A vivid, explanatory sentence, and another rueful reminder of the character’s mid-life crisis. In my script adaptation, that 1 line became the basis for a 3-page scene. It was an event in his life that, while perfectly described as an ironic single sentence in the novella, needed to be dramatized to work onscreen.
In transferring material from the page to the screen, as in much in life, there is no “one-size-fits-all” model. Which, by the way, is exactly how I feel about psychotherapeutic treatment.
Di Nicola: David Gilmour was a delightful film critic for CBC television. When his 16-year-old son Jesse dropped out of school for a year, his father made a deal with him: he had to watch 3 films a week of his father’s choosing. His charming memoir, The Film Club,5 tells the story of that year and what happened to their father-son relationship. What are the implications of transferring insights from the arts (novels, screen) to “real life” and to therapy?
Palumbo: When it comes to this question, the usual answer is that art informs life and life informs art. The latter position is much more easily grasped: things happen to people in life (marriage, divorce, childbirth, job loss, chronic illness, etc) and artists transform these experiences into either a narrative, musical, plastic or visual form. Books, plays, films, TV series, poems, musicals, etc, derive their expressive power by reflecting or transforming or questioning or validating the assumptions associated with the whole range of the human experience. So that part is easy to understand; ie, the phrase “art imitates life.”
Where it gets interesting is when we consider how readily and powerfully the arts inform life. To take a cliched example, after the hundreds of romantic stories produced by Hollywood over the past 100 years, couples have some particular ideas of what their relationship “should” be like. Certainly they are aware that whatever is going on their relationship, it surely does not seem or feel like what has been seen by them onscreen. Case in point: years ago, there was a popular TV series called “Hart to Hart,” in which Robert Wagner and Stefanie Powers played a rich, beautiful, breezily-romantic couple who solved crimes (of course they did). While the series was on the air, the wife in a couple I was seeing explained that her goal for therapy was: “To be like the couple on ‘Hart to Hart’.” Of course, a nearly impossible model to emulate.
None of us are immune. When I was a kid, reading about the witty writers dining regularly at the Algonquin table, I just assumed that when I grew up and became a famous writer, that was how I would spend my evenings: breaking bread and drinking cocktails with smart, sardonic, and well-dressed fellow celebrities. Despite my screenwriting success, the sobering fact that working in Hollywood was not actually like that was pretty dispiriting.
Di Nicola: No, we are not immune, Dennis. The Italian film, Cinema Paradiso by Giuseppe Tornatore, tells the poignant story of Totò, a boy without a father, and Alfredo, a gruff childless film projector who befriends him in their Sicilian town. There are hilarious scenes where the young boy sneaks a peak at the town priest censoring the love scenes from the movies that Alfredo cuts out. Years later, when Totò has become a filmmaker in Rome, he finally returns home for Alfredo’s funeral who has left him a special legacy: a reel of all the “outtakes” from the films of his childhood and youth, representing the love that is absent from his life. When I met my father for the first time in Brazil as an adult, many images and metaphors flooded my imagination but none captured my experience better than those “outtakes” as a concrete metaphor for the missing pieces of my life.6,7
Palumbo: Our models for sexual attraction, courage, success, popularity, and even parenting are being portrayed constantly now online, as well as on film and television, plays and musicals, books and graphic novels. And often these artistic representations of “real life” are so impactful that some people are stirred emotionally more by portrayals they see than by events in their own lives.I had a patient recently who detailed all the effort he was putting into a Valentine’s Day dinner with his girlfriend. “Nowadays,” he told me, “it’s all about the optics.”
Isn’t everything nowadays? Even politics is frequently described as “show business for ugly people.” The implication being that it is all show business.
So what does that mean for therapy? Not only does the clinician have to explore and untangle a patient’s early childhood, the familial dynamics and patterns, but to see this in the context of a media/image-drenched culture in which the patient is embedded. A culture that gives birth to assumptions, prejudices, prescribed desires, and shifting personality models. This means the clinician has to have a significant familiarity with these cultural touchstones and explore their meanings—for him- or herself as well as with the patient.
Just as the arts can provide us with insights into our own issues and concerns, and why certain films or books or poems can “change one’s life,” good therapeutic treatment enjoins with the patient to see what patterns (or narrative, if you like) underlie his or her particular engagement with life. Which means drawing as much from everything the patient has seen, read and listened to as from the real-life events in his or her experience.
Di Nicola: How do you think philosophy informs your work and how does your work reciprocally affect your philosophy?
Palumbo: Good question. I will try to keep my answers short, though it deserves a longer one.
There are certain philosophical books (for example, William Barrett’s The Illusion of Technique and Camus’ The Myth of Sisyphus) that have had a profound impact on my theoretical thinking in terms of my work with patients. Though I have a pretty good grounding in both Gestalt and intersubjectivity theory as guidelines in my work, I have moved away from adherence to any concrete orthodoxy. As a therapist, I do not subscribe to the “one-size-fits-all” model of clinical treatment, and this allows me a certain freedom of approach in my work with patients.
At the same time, my clinical work over these 30 years has informed and given perspective to any philosophical ideas that I too easily embraced. Simply put, my patients and their issues, beliefs, and unique histories are a continual source of surprise and wonder to me. As St. John of the Cross put it (though in a markedly different context), “I came into the Unknown, beyond all science.”
I must admit, I respond more favorably to philosophical writers whose literary skill predominates (Camus, Schopenhauer, de Beauvoir, some Nietzsche) or else whose intellectual reach excites me (Kant, Wittgenstein, Spinoza), whether I agree with them or not. But I do find that these categories of thought provide an intellectual base for my clinical thinking, whereas most conventional “personality theories” tend to restrict it.
Di Nicola: In the middle of the 20th century, Hollywood experienced an entertainment industry blacklist as part of a moral panic called the “Red Scare.”8 Does the Hollywood blacklist have any relevance today?
Palumbo: It has no relevance as such today, though its spirit lives on in “cancel culture.” Both are examples of Hollywood’s timidity and unwillingness to buck social/authoritative forces in fear of diminished profits. I feel similarly about the old Hays office and its code for movies.
These kinds of investigations or codes, whether originating in Congress or self-generated by the industries involved, speak to the single goal of profits, which in turn is based on getting the greatest number of viewers, which really means offending the least number of viewers. To do that, content providers (today’s term, which I loathe) need to conform to and in fact reinforce the conventional beliefs of the audience. Which was the genesis of the Hays Office and its crusade against overt sexuality (straight or gay), substance use (except alcohol, which was permitted as comedy), satiric views of religion, or any plot that hinted at a crime going unpunished. The blacklist occurred as a result of an anti-Communist paranoia, famously spearheaded by Joseph McCarthy. Today’s cancel culture, derived initially from the (long overdue!) #MeToo Movement, has now become merely another way for commercial content providers to insulate themselves from criticism (much of it warranted) that they are insensitive to the experiences of non-white, non-male, and non-straight individuals.
As the culture changes and the pendulum of what is acceptable swings back and forth, it is important for the artist to stay true to his/her creative vision. Certainly, no easy task in a brutal, demanding, and still quite conventional marketplace. For the therapist, often justly accused of being an agent of the dominant culture, it is important to stay attuned to the subjective experience of the patient, in the lived context of the patient’s world.
Di Nicola: How do you feel as a psychotherapist about the level of violence in the culture generally and more specifically in the portrayals of the entertainment industry in which you have been intimately involved in various roles?
Palumbo: That is a complicated question, as most of yours are! It deserves more space than an interview allows. Caveat aside, I have strong feelings about gun violence in the US and think our inadequate gun laws lead to more domestic shootings, road rage events, and gunfire outbreaks in public places like bars or parties. As a psychotherapist, I have seen how the level of violence has increased an overall unease in some patients. In addition, the rise of anti-Semitism and anti-Muslim violence has been particularly disturbing, both to me and to my patients.
Yet, while the level of violence is unacceptable, its depiction on the news and social media has an effect on consumers that is somewhat unwarranted. History shows us that violence has been an aspect of our lives as a species and as nations since time began, so it is probably untrue that the level it is at now is somehow unique. As Neil Postman pointed out, in the past, before world-wide communication, “bad news” was learning that your neighbor’s farm had burned down, and so you and everybody else in town could go help rebuild it. Nowadays, with global communication’s unprecedented reach, we learn of wars, famines, and violent revolutions occurring all over the world, about which we can do very little. This adds to our feeling that “things are getting worse,” and yet this may or may not be empirically true. So addressing my patients’ concerns about how dangerous and violent the world seems has become more and more front-and-center in our clinical work. Especially when it affirms old childhood messages about the patient's vulnerability about external events, how treacherous and dangerous others can be, how incompatible ethnic and religious differences are.
The second part of your question is more problematic. For one thing, I am the author of a series of psychological thrillers which often depict implied or even graphic violence in some scenes. My defense of this aspect of my novels is that these scenes lend authenticity and suspense to the narrative, and are to be expected in the genre. I must admit, too, that I derive a reasonable catharsis from writing these types of stories. My joke is that it is better for my violent urges to be on the page than out in the real world! Parenthetically, most research on the effect of violence in entertainment (primarily visual representations on film and television) is contradictory. There are certainly isolated incidents of a particular violent act depicted in a film replicated in real life by someone who claims to have been inspired by what they saw onscreen, but these are outlier events. Violence in drama has been a staple of narrative since the Greeks, if not before. From Oedipus and Medea to Punch and Judy, from Shakespeare to pulp magazines, violence and popular narrative have been hand-in-hand.
Moreover, in my practice, I treat writers, directors and actors who routinely work in genres whose narratives are often quite violent. My sense is that, since most artists understand that drama demands conflict, and that violence in some cases is both appropriate and expected (based on the genre), the use of it is merely grist for the mill. Though in my own case, I will never forget being a guest on a PBS interview show after the release of my fifth Daniel Rinaldi novel, Head Wounds, which featured several pretty harrowing scenes. The first question the host asked was, “Dennis, are you all right?”
Stillness, Quietude, Equanimity
One of the chapters of Dennis’ book on writing quotes Saul Bellow, a Nobel prize-winning writer born here in Montreal, who said that writing possesses a “stillness that characterizes prayer.”2 In that chapter, Dennis recommends quietude: “A hushed, private space, to which a writer is granted access by the act of writing itself.” It brings to mind a quality that another Canadian, the great physician William Osler, MD called aequanimitas—equanimity. Stillness, quietude, equanimity.
And let me add one last word. I have always been inspired by the first word I learned in ancient Greek, σωφροσύνη, sophrosyne—“soundness of mind,” which I interpret as a judicious balance. Dennis Palumbo has that, in spades.
Resources
- For a superb, reassuring and therapeutic guide to writing, consult Dennis Palumbo’s Writing from the Inside Out. John Wiley & Sons; 2000.
- For his latest Daniel Rinaldi thriller, read Deniss Palumbo’s Panic Attack. Poisoned Pen Press; 2021.
Dr Di Nicola is a child psychiatrist, family psychotherapist, and philosopher in Montreal, Quebec, Canada, where he is professor of psychiatry & addiction medicine at the University of Montreal and President of the World Association of Social Psychiatry (WASP). He has been recognized with numerous national and international awards, honorary professorships, and fellowships, and was recently elected a Fellow of the Canadian Academy of Health Sciences and given the Distinguished Service Award of the American Psychiatric Association. Dr Di Nicola’s work straddles psychiatry and psychotherapy on one side and philosophy and poetry on the other. Dr Di Nicola’s writing includes: A Stranger in the Family: Culture, Families and Therapy (WW Norton, 1997), Letters to a Young Therapist (Atropos Press, 2011, winner of a prize from the Quebec Psychiatric Association), and Psychiatry in Crisis: At the Crossroads of Social Sciences, the Humanities, and Neuroscience (with D. Stoyanov; Springer Nature, 2021); and, in the arts, his “Slow Thought Manifesto” (Aeon Magazine, 2018) and Two Kinds of People: Poems from Mile End (Delere Press, 2023, nominated for The Pushcart Prize).
Dennis Palumbo is a licensed psychotherapist in private practice, specializing in working with creative patients. His award-winning series of mystery thrillers—the latest is Panic Attack—feature psychologist and trauma expert Daniel Rinaldi. He is also the author of Writing From the Inside Out, as well as a collection of mystery short stories, From Crime to Crime. Recently, he served as Consulting Producer on the Hulu limited series “The Patient.” Formerly a Hollywood screenwriter, Palumbo’s credits include the feature film “My Favorite Year,” for which he was nominated for a Writers Guild Award for Best Screenplay. He was also a writer for the ABC-TV series “Welcome Back, Kotter,” among numerous other series. His short fiction has appeared in Ellery Queen’s Mystery Magazine, The Strand, Mystery Weekly, and elsewhere. His work helping writers has been profiled in The New York Times, Premiere Magazine, GQ, The Los Angeles Times and other publications, as well as on NPR and CNN.
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