On August 10th, 2012, I found myself in Boston in the company of about a dozen people for the purpose of exploring black and white photography.   The seminar was given by the camera manufacturer Leica – they of the astronomically priced cameras and lenses fame.   As a photographer, it was an extraordinarily useful day for me.   As a shrink, it was positively introspectively orgasmic.

As I pulled out my comparatively super-cheapo budget model and placed it on the table in front of me so I could take notes during the class, I noticed the other class members were all equipped with top of the line Leicas and lenses, any one of which could have been sold and the proceeds used to buy a really good used car.   This was not penis envy (as Freud would have noted).  This was Leica envy!

And, as the day started, I was sitting there wondering, “What are all these people doing here?  What’s their story?”

To make it more interesting, I quickly found out that there were three of us – a quarter of the class – that worked in the mental health area.  One was a therapist, one was an analyst, and I was the token head-shrinking, psychodynamically attuned, functional neuropsychiatrist of the group.    “What in the world,” I wondered,  “would account for almost a quarter of this class being drawn from the world of shrinkdom?”

For those of you that have not shot black and white in your film camera or in digital photography, let me explain to you: the difference between that and color photography is enormous.   In color photography, as long as you’ve got some pleasing colors and the shot is exposed and focused correctly, you can’t go to far wrong.  With black and white, however, if your subject is not interesting, if the composition and balance are not right, if the tonalities are not right, if your use of selective focus is not right, then all you have is a dull, boring “who would ever want to look at this?” piece of greyish mediocrity.

Therefore, the mindset for shooting black and white has to be clear, and it has to be precise.  Accurate focus.  Meaningful composition.  Pleasing balance.  The photo should “say” something. The exposure also needs to be reasonably accurate – and that includes balancing film speed (or digital sensor sensitivity), how wide the aperture is of the lens, and how long the shutter of the camera stays open.

As I wandered around the North end of Boston for our one hour of “shooting time” in the afternoon, (these concepts having recently been clearly imprinted on the photographic section of my cortex), I became aware of how differently I was thinking and selecting my exposures than I had just done on a trip to Europe.  There, it was reportorial: objective, photojournalistic, realistic… the “you are there” kind of photographic immediacy.  In Boston, however, I found myself framing carefully, selecting focus carefully and experiencing the act  of the selection, framing, and dialing in of the appropriate settings.  This was a slower, more deliberate way of working.   After all, I was trying to do “art!”

It was as I was doing so that the realization hit me of why there were so many people in the photo class that did THERAPY.   In many ways, the art of therapy is very much the same as the art of photography.

Good therapists focus in on specifically what they want “in the picture.”  They do not snap away like American Tourists Gone Wild on some European jaunt.  The balance between what is selectively “in focus” versus what is “out of focus” has to be maintained.   And you’ve got to walk around your subject shooting from different angles, different compositional points of view, and with different ideas.   The same applies to working with patients.   You can’t just sit there on your complacent posterior all day asking the same old questions (the same “point of view”) of every patient.  Every patient, (or subject), is different.   Every patient (or subject) has things that should be brought into focus.   Every patient (or subject) has things that should be left in the shadows for that particular exposure.

Another fascinating concept of photography is how differently the camera (and either digital sensors or film) “see” the gradations of light around us.   Film can do about five “stops” of variation, and digital, about seven.    A “stop” is either half or double the amount of light, depending on which way you are going.  Hence, the range for color negative film is 2x2x2x2x2, or about 32 times from the lightest to the darkest.   The human eye, visual system, and occipital cortex can process a larger dynamic range – about fifteen stops.    For black and white film, the famous American photographer, Ansel Adams, invented the “Zone System” which ranked the “shades of grey” from total white to total black, and everything in between in seven different zones.  This produced a 128:1 ratio of light and dark in terms of light intensity.  In a properly exposed, developed, and printed “zone system print,” Adams asserted that you should be able to have all tonalities represented.  This means, in essence, that you would have been pushing the state of photo technology some 50 – 80 years ago to the very limit in an attempt to expand the range of what could be seen.

The human eye has got that beaten handily, being able to resolve seven to ten stops of light at a glance, and taking in a 15 stop change in a scene by selectively focusing and analyzing sections of the scene at a time.

The ability to explore the dynamic range – from light to dark – is the sensitive exploration of a patient’s history and the ensuing psychotherapeutic work.   There is more than just “black and white” there – there are multiple shades of grey – some of which should be emphasized, and some not, at any particular time.  The life adventure of the patient opens up in the dialogue between him or her and the examining physician (or therapist).

For me, it has been a complete adventure and a privilege to have the opportunity to have worked with so many patients and to have seen the full dynamic range of their lives.  Together, we select the focus, the depth of field, the exposure, of any particular main thematic element in their history or their problem(s) of the moment.   Rather than a psychiatric or psychologically diagnostic proctologic exam of the mind, this becomes a dance: a dance between two people – one committed to have the broadest and most sensitive “film” to “record the image” for further viewing with the patient; the other – who has issues, hurts, and life shadows to discuss and work through.

Unlike still life or landscape photography, where the photographer moves around a stationery subject and the subject stays still and inert, in psychotherapy the two interact.  The perspective changes constantly and cooperatively.  Sometimes it “shimmers” as the dialogue continues, with an emotionally distressing vacillation between a more dysfunctional mental picture of the world, and a more positive, adaptive, and self-empowered one.  Sometimes the subject matter changes… and it can change suddenly.   Sometimes the exposure needs to be brightened to better examine some previously indistinctly seen dark grey shades hiding around the periphery; sometime the exposure needs to be darkened to hide the shadows away from the picture that is being created at that moment to protect the patient’s psyche.  Perhaps someday those shadows will be appropriate and integrated aspects of the total picture of the patient’s psyche, soul, and personhood.

So… as  I returned from my “shoot” and processed the images, I was then struck by the further choices that could be made in digital development – what could be cropped out; how the image could be sharpened; how tonality could be increased.   And in similar fashion, after the allotted time for the appointment is past and the patient has departed, there is sometimes increased insight on my part as to what is truly important and what should be brought on in the development of that image – the image of the patient’s life captured in the therapeutic hour or the multi-hour diagnostic neuropsychiatric interview.

For me, when I do photography, time stops and I become totally focused in the moment – exploring the range of exposures, shadows, perspective, and composition that are relevant.   Something similar happens with patients. However, they are not, emotionless, unfeeling “subjects” for suitable for either a quick snapshot or even a masterfully composed and technically excellent one-off exposure.   Their range of range of issues, emotional tonalities and what is relevant and appropriate to have in the picture is paramount.  They dictate what can be examined and seen.  And they are endlessly fascinating.

Although I have not undergone psychoanalysis, my psychotherapy supervisors at Mayo Clinic shared with me that I was extremely introspective at times.   This is probably one of those times.  After I left Boston, looked at the images that I had taken, and wondering about their content, it became amazingly clear what three mental health care professionals were doing in that class.   We love the pictures.  We love the collaboration with our patients.  With photography,  we get to decide what is important and what should be in the picture.  With psychotherapy and psychological/psychiatric diagnosis, the patient gets to determine what will be in view.  We simply oblige with as sensitive and instrument as we can bring to the encounter.

It is co-creation.   It is thrilling.  Time stops when engaged in it.  And the images of my patients lives, the highlights, and the shadows, continue to engage me in the joy and dialogue of our work.