I began to appreciate Elvaher marvelous sense of humor, her intelligence, her drollness. Throughout this period of rapid weight loss, another extraordinary phenomenon was taking place. Nor was it necessary to sweep from my mind derogatory thoughts about her appearance. We met thrice weekly during this time, and I attempted to help her understand the source of her tears. Penny was ready to change into something else. When I meet a new person whom I like, I start right away to imagine what it will be like to say goodbye to them., I knew this was an important issue, and that we would return to it. Maybe its too painful to feel. And when Im impotent, it is not because I fail sexually as a man but because Im asking sex to do things that sex cant do., Exactly. Penny nodded. Stay focused! The verdict was mixed: in some areas he had maintained his changes; in others he had done some backsliding. He really cared, he really accepted me. Im going to interrupt you for a minute, Thelma, if I may. There is no adventure more exciting, nothing so wonderful and frightening, and so fraught with danger, as delving into the mind of a human being. At the same time as I was conducting this gentle, somewhat concrete therapy with Marvin, I was also engaged in a fascinating discourse with the dreamer, that vastly enlightened homunculus housedor, one might say, jailedby Marvin, who was either ignorant of the dreamers existence or allowed him to communicate with me in a spirit of benign indifference. Without them I might run wild., That was a curious comment. She had continued to live as ifas if the world were safe, as if Albert were there, back in the workshop next to the garage. It took me a week, until our next session, to realize that the litany was depression-spawned propaganda. Marvin took himself very seriously: he was practically my only patient with whom I could never joke or banter. Phyllis said all this with such facility that I forgot for a moment the great strain she was under.
Love's Executioner Irvin D. Yalom, MD 1. I had forgotten how they ended! My last physical exam was over fifteen years ago., Another group member: You look like youre in great shape, Dave, whatever your age., Thank you. Im here today to be helpful to Thelma. My implicit contract with Marge (as with all my patients) is that when I am with her, I am wholly, wholeheartedly, and exclusively with her. The impact of death on her sons? She then notified the police about the threat (but not, of course, about the highway chase), and for the last week her house had been under constant police surveillance. (Nor, it turned out, was he willing to resume individual therapy with me or anyone else. If, for example, she was able to trust and to reveal herself to me more than to anyone previously, then she contained within herself that experience as well as the ability to do it again. It was deeply frustrating. His recovery appeared remarkably solid. Im going to have to work on thissomeday. Although most of the ads placed by men explicitly specified a slim woman, one did not. She had been doing so well that, just before the time of the purse snatching, I had been considering raising the question of termination. For one thing, Marge stuttered on every word. Was he acting as Marvins agent to help me to help Marvin? For those twenty-seven days. Thats why I dropped out of school. On several other such attempts in the past, she had been stood up by men who probably spotted her from afar and left without speaking to her. I struggled to find some handhold. In this case, Phylliss agoraphobia was not her symptom but their symptom, and it served to maintain the marital equilibrium: Phyllis was eternally there for Marvin; he could venture forth into the world, provide for their security, yet feel secure in the knowledge that she was always there waiting for him. God knows he had no one else to talk to!) She was right. At one meeting, however, the tone turned deeply serious. Without doubt, we had made progress in therapy. She was terrified of having a permanent facial or oral deformity. The past, the true story, the chronicle of real events, is unrecoverable. Perhaps the most reasonable hypothesis was that Matthew was working on (or acting out) some personal psychosexual issuesand using his patient (s) to do it. Besides, though Nietzsche was a seer in many domains, he was no guide to interpersonal relationshipshas there ever lived a lonelier, more isolated man? One might guess twenty-five: perhaps, without her makeup, thirty. Shes not that short. Love's Executioner offers us the humane and extraordinary insight of renowned psychiatrist Irvin D. Yalom into the lives of ten of his patients - and through them into the minds of us all Why was Saul tormented by three unopened letters from Stockholm? Oh no! Three pairs of sunglasses. What she had feared at the very onset of treatment had come to pass: she had allowed herself to feel deeply about me and was now going to lose me. Furthermore, being an observer would provide me an unusual opportunity to reevaluate Marie. He liked to talk to me, but I believe that the primary attraction was the opportunity to reminisce, to keep alive the halcyon days of sexual triumph. Furthermore, he was persuaded that something significant must be happening in therapy: hed learned more about himself in the past five months than in his previous sixty-four years! I tried to explore these ideas with Thelma. I can smell death. And the central image was the envelope, an envelope that contained something immune to death and deterioration. As you say, Im being rational, but one of us has to stay rational. Saul didnt crack a smile. Jeff had been gone for two years now and wanted nothing more to do with her, alive or dead. Cemetery plot was what she had said, all right. He must have followed her into the parking lot and, his footsteps muffled by the roaring of the waves, sprinted up and, without breaking stride, ripped her purse away and leaped into his nearby car. Once I worked in a group with a patient who, during two years of therapy, rarely addressed me directly. Ive been having conversations with you all week., Scary, good, bad, up, down Penny rattled these off. I like to donate books, not ever throw them away, but this one here.pfffffft. I dont know what you want., How can you be so sure Im listening professionally? Instead, the opposite occurred: she withdrew even more, claiming that her problem with intimacy doomed our work in therapy. I had spent too many hours in my youth silently hating my mothers vicious tongue. They looked like my two boys, but they had long girls hair and were wearing dresses. Most likely she would reconstruct the hour with Matthew so that her version of reality could once again support her fusion fantasy. A dream illuminated this juncture in therapy:I dreamed that the painters were supposed to paint the outside trim of my house. I want my life to mean something. When Betty told me about going to a western bar where two rednecks sidled up behind her and mocked her by mooing like a cow, I felt outraged for her and told her so. Four major existential concernsdeath, meaning in life, isolation, and freedomplay a crucial role in the inner life of every human being and constitute the thrust of that book. I was afraid that Id fall, and then I grew afraid that Id jump and commit suicide. Thus, though Dave could resist assuming responsibility for his marital problems, he could not resist the immediate data he himself was generating in group therapy: that is, his secretive, teasing, and elusive behavior was activating the other group members to respond to him much as his wife did at home. Discussing her fathers death obviously evoked fears of her own death. You must feel that if Albert were alive, this would never have happened to you. I ignored her flip response that if Albert were alive she wouldnt have been taking three old hens to lunch. Betty responded by giving herself a ten. I was astonished (I had expected a two or three) and told her so. He merely shook his head. No part of this book may be reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles and reviews. Yaloms tone manages to be both enjoyable on a literary level and enlightening on a professional level. When I dance in my dreams, it means Im trying to make everything thats bad disappear. But now what did she have to show for the past twenty years? I, personally, like to work with older patients. Nor, for the same reason, could it permit citations from unpublished papers without the written consent of the co-authors. Surely you want that? She had her back to me, but I thought I could see a slight nod of agreement. No, not just women, but everybody. The other thing is that I start to feel, Why bother? Im here for such a short time. Before we began therapy, I had informed Marge that we could meet for a maximum of eighteen months because of my sabbatical plans. But I was careful to tread a fine line. Number three, Matthew will probably tell the truth, but the wording will be patronizing and would be heavily influenced by Dr. Yaloms presence. I felt cruel during these weeks because of the pain our therapy was uncovering. Worst of all, Marvin could foresee no end to his anxiety. When I am healed and my lawsuit settled, Ill talk to his wife and everybody I know. But listen to me. She knew also that Chrissie was going on to another, healthier, happier life. His wife had left him four years ago. The thirst for religion is too strong, its roots too deep, its cultural reinforcement too powerful. By the third week I was hallucinating and thought that I could see through walls and had total access to both my past and future lives. Or that she had invited Matthew here to speak freely and yet immediately mobilized his guilt by reminding him that she had been on antidepressants since he left her. It was ineffable. Patienthood is ubiquitous; the assumption of the label is largely arbitrary and often dependent more on cultural, educational, and economic factors than on the severity of pathology. Yalom believes that researchers will eventually correlate electrical and biochemical activity in the brain with experience. To focus on what is actually happening between a patient and himself, rather than the past. Men usually must be taught to experience and share (rather than to suppress and evade) their sadness. First, youve got to know exactly what I mean. I leave a lot of messages on his telephone- answering tape. I heard her exhale. In order to stay on her pedestal, she was never able to talk to you about her pain and her fearsor not until very recently.. I panic. These are true stories, but I have had to make many changes to protect the identity of the patients. And now she found that Jim had been lying to her and not making his payments. Underneath obsession, what would I find? So I acknowledged it openly and suggested that we meet six more times and try to do as much as we could. I had never felt that Dave was securely lodged in therapy even though we had worked well with his impotence. In the three or four minutes Saul had been in my office, he had worked himself into a state of deep agitation. The day Betty entered my office, the instant I saw her steering her ponderous two-hundred- fifty-pound, five-foot-two-inch frame toward my trim, high-tech office chair, I knew that a great trial of countertransference was in store for me. Books published by Basic Books are available at special discounts for bulk purchases in the United States by corporations, institutions, and other organizations. Then one hundred ninety. Marvin put aside his notepad and from memory recited:The two men are tall, pale, and very gaunt. I need a solemn promise from you that for the next six months you will do nothing physically self-destructive. I explicitly extracted a promise from him not to injure himself, not (without prior consultation with me) to write Dr. K., and not to repay the fellowship money to the Stockholm Institute. I cant wait another week.
Book Review: Love's Executioner, Irvin D. Yalom Maybe youre right, maybe I do have a serious problem with getting close to people. A couple of weeks later, I saw definite signs of a breast, two breasts. More and more frequently he rambled on interminably about the research ideas he had stolen, the lives he had ruined, the marriages destroyed, the students unjustly failed (or promoted). How could Penny overcome her grief when Jeff refused even to talk about Chrissie; when (and this had initiated a dreadful row) he refused, six months after her death, to attend the graduation of Chrissies junior high school class? I could scarcely find a word of comfort for her. K. He wants Mexico for vacationO.K. For several minutes she sobbed and then finally talked about what had happened. In a conversation, the content consists of the actual words uttered, the substantive issues discussed; the process, however, is how the content is expressed and especially what this mode of expression reveals about the relationship between the participating individuals. [Hats off to you, my dear dreamer friend! Moved by my answers, Marge grew ever bolder but gentler in her talks with me. But what? Yet he was none of these. Marvin grew up in New York, the child of impoverished first-generation Jewish parents. Week after week I chipped away. I want to sink into the embrace of some warm daydream. I hoped to show her that another person could know her fully and still care for her. The dream (recorded verbatim by a student observer):Death is all around me. Imagine two minds pressed tight together and, like paramecia exchanging micronuclei, directly transferring thought images: that would be union nonpareil. She did not want to stop therapy and asked her company to extend her time in California. It was typical of Thelma not to think that I might have some wishes, too. It was the first time he had seen Thelma in eight years, and if he was in any way startled by the physical aging she had undergone, his boyish, good-natured smile gave no evidence of it. Im keeping it secret. Marie reminded me of a beautiful aunt who wore her hair the same way and played a major role in my adolescent sexual fantasies. Never have I had a patient who was willing to uncover such painful material in such a short time. I recalled waiting at a palm-edged Caribbean airport for a plane to land for my lover to join me. Birds in iridescent colors boldly perched in the intricately twisted trees of the garden and caroled strange melodies. What other feelings did you have about them? I think I just collapsed in a kitchen chair and sat there. That takes a special type of person, someone who can tolerate considerable duplicity, someone who embraces intimacy in fantasy but may avoid it in life. Also (as I was able to appreciate only later with a more objective view of myself), it was unfortunate for Saul that he had consulted me at a stage of my professional career when I was impatient and managerial, and insisted that patients promptly and fully confront their feelings about everything, including death (even if it killed them). That was the first important discovery I made about Betty: she was desperately isolated, and she survived this isolation only by virtue of the sustaining myth that her intimate life was being lived elsewhere. I care a great deal. Well, I thought, that was something! Yet her problem fascinated me. So, bad as it was, Thelmas distress was a good sign, a homing signal that we were on target. You let him influence you. Something good happened, and she felt great; one criticism from someone, and she was down for days. Every migraine of the last four months was preceded within twenty-four hours by a sexual failure.. Zen masters endlessly aspire to quiescence of the mind, the ballerina to consummate balance; and the priest forever examines his conscience. I didnt know what to say. She continued, with forced cheerfulness, to tell me that the good news was that for the past week she had felt less guilty and less involved with Chrissie. No, he had never had a personal relationship with any other patient. We met weekly for several months, and therapy proceeded well, as it usually does when therapist and patient enjoy each other. The more I thought about it, the more pleased I was that I had restrained my curiosity and had acted selflessly and systematically in the best interests of the patient. He was venturing into such depths that I could scarcely believe I was talking to the same person. After a crash accountancy course, he said goodbye to his students and colleagues and opened an accounting firm, which ultimately proved to be highly lucrative. I ended the session thinking that, though she might fulfill her research commitment, there was little chance she would resume therapy. She had been crying, her eyes downcast, but at my words she stopped sobbing and looked toward me, expectantly. I was going to pontificate about what constitutes a good life in any religious systemlove, generosity, care, noble thoughts, pursuit of the good, charitybut none of that was necessary. There is a long tradition in psychotherapy going back to Carl Rogers and, before him, to Otto Rank, which understood that a preset termination date often increases the efficiency of therapy. And outrageously activeoften charging at a patients defenses with a battering ram! Thelma, now 70 years old has presented for therapy while in crises (suicidal). She looked at me with what I imagined to be more respectas though she were impressed with my mind-reading abilities. She got it. And it is change that is always the true quarry, however much a therapist may court insight, responsibility assumption, and self-actualization. These disturbing feelings had vastly compounded Bettys weight problems. Youve just finished a difficult course of chemotherapy. I feel like an amputation has taken place. So that was one thing in your favor. As a memorial to Chrissie, Penny had kept her room unchanged, with all her clothes and possessions in their familiar places. It was the same quest, she and I were the same. Saul was really digging in but, though I began to question my choice of a direct approach, I persisted. That was an improvement on Dr. Farber., The second reason is that I could understand how you felt. Carlos, do you really believe that if you had walked Ruth to her car youd have a ten- to fifteen-percent chance of marrying her?, One thing could lead to another. Fidelity! She doesnt return your calls, shes been living with a man and now thats breaking up, shes making arrangements to move in with someone else. And another pleaded, I want the parents, the childhood I never had, as he agonized over three letters he could not bring himself to open. I wasnt certain whether it was to obtain his support or to reassure herself that he could tolerate what she had to say. For information, address Basic Books, 387 Park Avenue South, New York, New York 10016 -8810. I dont know why, but I suddenly saw them in a different way!
love's executioner two smiles summary I watched her go down the stairs. Life doesnt seem worth living. I imagined, for a moment, interring them together with mine. I looked forward to our time together. Go on, Carlos, this is importantapply that to yourself and to your life., He bit off each word slowly. Ive seen two cheap therapistsone was still a studentat the county clinic. Could I possibly be serious? The better I knew her, the less interesting she seemed. I shouldnt have used the word enjoy a few minutes ago. Over the last several months, I had constructed a visionor, rather, several alternative visionsof him: an irresponsible, sociopathic Matthew who exploited his patients; a callous and sexually confused Matthew who acted out his personal conflicts (with women in general or mother in particular); an errant, grandiose young therapist who mistook the love desired for the love required. I leaned back, pleased with myself. I was startled, when I looked into the face of that dancer, to meet Thelmas large eyes peering out at me across the decades. I asked, in return, that he agree not to make any irreversible decisions. My idea that keeping the letters would make it harder for Dave to terminate therapy was, I realized quickly, nonsense. I am not sure what criteria were used in picking the case studies he did for the book; I imagine he has rich history of intriguing patients and these are no exception.