“Well, here’s another one that just came up, an old memory of a case presentation at a seminar when I was a student, ages ago. The patient was a man who had a blissful honeymoon on some tropical island, one of the great times of his life. But the marriage deteriorated rapidly during the next year, and they divorced. He learned at some point from his wife that, throughout their time together, including their honeymoon, she had been obsessed with another man. His reaction was very similar to yours. He realized that their idyllic relationship on the tropical island was not a shared experience, that he, too, was playing a solo. I don’t recall much more, but I do recall that he, like you, sensed that reality was fractured.”
“Reality fractured . . . that speaks to me. It’s even there in my dreams. Last night I had some powerful dreams but can only recall a bit. I was inside of a dolls’ house and touched the curtains and windows and felt how they were paper and cellophane. It felt flimsy, and then I heard loud footsteps and was afraid that someone would stamp on the house.”
“Charles, let me check in again about our reality right now. I give you notice: I’m going to keep doing this. How are you and I doing now?”
“Better than anywhere else, I guess. I mean we’re more honest. But still there are some gaps. No, not some gaps—there are big gaps. We’re not really sharing reality.”
“Well, let’s keep on trying to narrow the gaps. What questions do you have for me?”
“Hmm. You’ve never asked that before. Well, many questions. How do you see me? What’s it like to be in the room with me right now? How hard is this hour for you?”
“Fair questions. I’ll just let my thoughts run and not try to be systematic. I’m moved by what you’re going through. I’m one hundred percent in this room. I like you, and I respect you—I think you know that—or I hope you do. And I have a strong desire to help you. I think of how you’ve been haunted by your father’s death, how it’s left its mark on your whole life. And I think of how awful it’s been to have found something precious in your relationship with James Perry and then to have that wrenched away from you so suddenly. I imagine, also, that the loss of your father and of James looms large in your feelings toward me. Let’s see what else comes to mind. I can tell you that when I meet with you, I face two different feelings that sometimes get in the way of one another. On the one hand, I want to be like a father to you, but I also want to help you get past the need for a father.”
Charles nodded as I spoke, looked down, and remained silent. I asked, “And now, Charles, how real are we being?”
“I’ve misspoken. The truth is that the major problem isn’t you. It’s me. There’s too much I’ve been withholding . . . too much I’ve been unwilling to say.”
“For fear of driving me away?”
Charles shook his head. “Partly.”
I was certain now I knew what it was: it was my age. I’d been through this with other patients. “For fear of giving me pain,” I said.
He nodded.
“Trust me: it’s my job to take care of my feelings. I’ll hang in there with you. Try to make a start.”
Charles loosened his necktie and unbuttoned his top button. “Well, here’s one of last night’s dreams. I was talking to you in your office, only it looked like a woodshop—I noticed a stack of wood and a large table saw, a plane, and a sander. Then suddenly you shrieked, grabbed your chest, and slumped forward. I jumped up to help you. I called 911 and held you till they came, and then I helped them put you on a stretcher. There was more, but that’s all I can remember.”
“Hunches about that dream?”
“Well, it’s very transparent. I’m very conscious of your age and worried about your dying. The woodshop element is obvious, too. In the dream I’ve blended you with Mr. Reilly, my woodshop teacher in junior high school. He was very old, a bit of a father figure to me. In fact we all called him Pop Riley. Even after I graduated I used to visit him.”
“And feelings in the dream?”
“It’s vague, but I recall panic and also a lot of pride in my helping you.”
“It’s good you’re bringing this up. Can you speak of other dreams that you’ve avoided telling me?”
“Uh, well. It’s uncomfortable, but there was one a week or ten days ago that stuck in my mind. In the dream we were meeting like we are now in these chairs, but there were no walls, and I couldn’t tell if we were inside or outside. You were grim-faced, and you leaned toward me and told me you had only six months to live. And then . . . this is really weird . . . I tried to strike a bargain with you: I would teach you how to die, and you would teach me how to be a therapist. I don’t remember much else except that we were both crying a lot.”
“The first part is clear—of course you’re aware of my age and worried about how long I’ll live. But what about the second part, wanting to be a therapist?”
“I don’t know what to make of that. I’ve never thought I could be a therapist. It would be beyond me. I don’t think I could deal with facing strong feelings all the time, and I do know I admire you a great deal. You’ve been kind, very kind, to me and always know how to point me in just the right direction.” Charles leaned over to take a Kleenex and wipe his brow. “This is very difficult for me. You’ve given me so much, and here I sit inflicting pain by telling you these dreadful dreams about you. This is not right.”
“Your job here is to share your thoughts with me, and you’re doing it well. Of course my age concerns you. We both know that at my age, at eighty-one, I’m approaching the end of my life. You’re now grieving for James and also for your father, and it’s only natural that you’re worried about losing me as well. Eighty-one is old, shockingly old. I’m shocked myself when I think about it. I don’t feel old, and over and over I wonder how I got to be eighty-one. I always used to be the youngest kid—in my classes, on my summer camp baseball team, on the tennis team—and now suddenly I’m the oldest person anywhere I go—restaurants, movies, professional conferences. I can’t get used to it.”
I took a deep breath. We sat quietly for a few moments. “Before we go further, I want to stop for another check, Charles. How are we doing now? How about the size of the gap?”
“The gap has narrowed quite a lot. But this is really hard. This is not normal conversation. You don’t usually say to someone, ‘I’m worried about your dying.’ This has got to be painful for you, and right now you’re one of the last persons in the world I want to hurt.”
“But this is an unusual place. Here, we have, or we should have, no taboos against honesty. And keep in mind you’re not bringing up anything I haven’t thought about a great deal. A central part of the ethos of this field is keeping your eyes open to everything.”
Charles nodded. Another brief silence passed between us.
“We’re having far more silences today than ever before,” I ventured.
Charles nodded again. “I’m really all here and totally with you. It’s just that this discussion is taking my breath away.”
“There’s something else important I want to tell you. Believe it or not, looking at the end of life has some positive effects. I want to tell you of an odd experience I had a few days ago. It was about six o’clock, and I saw my wife at the end of our driveway reaching into our mailbox. I walked toward her. She turned her head and smiled. Suddenly and inexplicably, my mind shifted the scene, and for just a few moments I imagined being in a dark room watching a flickering home movie of scenes from my life. I felt much like the protagonist in Krapp’s Last Tape. You know that Samuel Beckett play?”
“No, but I’ve heard of it.”
“It’s a monologue given by an old man on his birthday as he listens to tape recordings he has made on past birthdays. So, somewhat like Krapp, I imagined a film of old scenes of my life. And there I saw my dead wife turning toward me with a large smile, beckoning to me. As I watched her, I was flooded with poignanc
y and unimaginable grief. Then suddenly it all vanished, and I snapped back to the present, and there she was, alive, radiant, in the flesh, flashing her beautiful September smile. A warm flush of joy washed over me. I felt grateful that she and I were still alive, and I rushed to embrace her and to begin our evening walk.”
I couldn’t describe that experience without tears welling up, and I reached for a Kleenex. Charles also took a Kleenex to dab his eyes, “So you’re saying, ‘Count your blessings.’”
“Yes, exactly. I’m saying that anticipating endings may encourage us to grasp the present with greater vitality.”
Charles and I both glanced at the clock. We had run over a few minutes. He slowly gathered his things. “I’m wiped out,” he whispered. “You’ve got to be tired too.”
I stood up straight, shoulders squared. “Not at all. Actually, a deep and true session like this one enlivens me. You worked hard today, Charles. We worked hard together.”
I opened the office door for him, and, as always, we shook hands as he left. I closed the door and then suddenly slapped myself on the forehead and said, “No, I can’t do this. I can’t end the session this way.” So I opened the door, called him back, and said, “Charles, I just slipped back into an old mode and did exactly what I don’t want to do. The truth is I am tired from that hard deep work, a bit wiped out in fact, and I’m grateful I have no one else on my schedule today.” I looked at him and waited. I didn’t know what to expect.
“Oh Irv, I knew that. I know you better than you think I do. I know when you’re just trying to be therapeutic.”
~ 3 ~
Arabesque
I was perplexed. After fifty years in practice I thought I had seen everything, but I had never before had a new patient enter my office offering me a photograph of herself in the bloom of youth. And I was even more unnerved when this patient, Natasha, a portly Russian woman of seventy or so, stared as intently at me as I stared at the photograph of a beautiful ballerina in arabesque pose, balanced majestically on one toe and stretching both arms gracefully upward. I turned my glance back to Natasha, who, though no longer slender, had coasted to her seat with a dancer’s grace. She must have sensed I was trying to locate the young dancer in her, for she raised her chin and turned her head just a bit to offer me a clear profile. Natasha’s facial features had been coarsened, perhaps by too many Russian winters and too much alcohol. Still, she was an attractive woman, though not as beautiful as before, I thought, as I glanced once again at the photograph of the young Natasha, a marvel of elegance.
“Was I not lovely?” she coyly asked. When I nodded, she continued. “I was a prima ballerina at La Scala.”
“Do you always think of yourself in the past tense?”
She drew herself back. “What a rude question, Dr. Yalom. Obviously you’ve taken the bad manners course that is required for all therapists. But,” she paused to consider the matter, “perhaps it is so. Perhaps you are right. But what is strange in the case of Natalya the ballerina is that I was finished as a dancer before I was thirty—forty years ago—and I’ve been happier, ever so much happier, since I stopped dancing.”
“You stopped dancing forty years ago and yet here, today, you enter my office offering me this picture of you as a young dancer. Surely you must feel that I would be uninterested in the Natasha of today?”
She blinked two or three times and then looked about for a minute, inspecting the décor of my office. “I had a dream about you last night,” she said. “If I close my eyes, I can still see it. I was coming to see you and entered a room. It wasn’t like this office. Perhaps it was your home, and there were a lot of people there, perhaps your wife and family, and I was carrying a big canvas bag full of rifles and cleaning equipment for them. I could see you surrounded by people in one corner, and I knew it was you from the picture on the cover of your Schopenhauer novel. I couldn’t make my way to you or even catch your eye. There was more, but that’s all I recall.”
“Ah, and do you see any link between your dream and your offering me this photograph?”
“Rifles mean penises. I know that from a long psychoanalysis. My analyst told me I used the penis as a weapon. When I had an argument with my boyfriend, Sergei, the lead dancer in the company and, later, my husband, I would go out, get drunk, find a penis, any penis—the particular owner was incidental—and have sex in order to wound Sergei and make me feel better. It always worked. But briefly. Very briefly.”
“And the link between the dream and the photograph?”
“The same question? You persist? Perhaps you’re insinuating that I am using this picture of my young self to interest you in me sexually? Not only is this insulting, but it makes no sense whatsoever.”
Her grand entrance holding the photograph was loaded with meaning. Of that I had no doubt, but I let it go for the moment and got down to business in a more direct fashion. “Please, let’s now consider your reasons for contacting me. From your email I know you will be in San Francisco for only a short time and that it was extraordinarily urgent I meet with you today and tomorrow because you felt you were ‘lost outside of your life and couldn’t find your way back.’ Please tell me about that. You wrote that it was a matter of life and death.”
“Yes, that’s what it feels like. It’s very hard to describe, but something serious is happening to me. I’ve come to visit California with my husband, Pavel, and we’ve done what we’ve always done on such visits. He met with some important clients; we’ve seen our Russian friends, driven to Napa Valley, gone to the San Francisco opera, and dined at fine restaurants. But somehow this time it’s not the same. How to put it? The Russian word is ostrannaya. I’m not truly here. Nothing that happens sinks in. I have insulation around me; I feel it is not me here, not me experiencing these things. I’m anxious, very distracted. And not sleeping well. I wish my English was better to describe things. Once I lived in the US for four years and took many lessons, but my English still feels clumsy.”
“Your English so far is excellent, and you’re doing a good job describing how you feel. Tell me, how do you explain it? What do you think is happening to you?”
“I’m bewildered. I mentioned I needed a four-year psychoanalysis long ago, when I was in terrible crisis. But even then I did not have this feeling. And since then life has been good. Until now I’ve been completely well for many years.”
“This state of not being in your life. Let’s try to trace it back. When do you think this feeling began? How long ago?”
“I can’t say. It’s such an odd feeling and a vague feeling that it’s hard to pinpoint it. I know we’ve been in California for about three days.”
“Your email to me was written a week ago; that was before you came to California. Where were you at that time?”
“We spent a week in New York, then a few days in Washington, and then flew here.”
“Anything unsettling happen in New York or Washington?”
“Nothing. Just the usual jet lag. Pavel had several business meetings, and I was alone to explore. Usually I love exploring cities.”
“And this time? Tell me exactly what you did while he was working.”
“In New York, I walked. I . . . how do you say it in English? . . . looked at people? People watched?”
“Yes, people watched.”
“So I people watched, and I shopped and spent days visiting the Met museum. Oh yes, I am certain I felt good in New York because I remember that, on one beautiful sunny day, Pavel and I took a boat trip excursion around Ellis Island and the Statue of Liberty, and I remember we both felt so wonderful. So it was after New York that I started going downhill.”
“Try to recall the trip to Washington. What did you do?”
“I did what I always do. I followed my usual pattern. I visited Smithsonian museums every day: the Air and Space, Natural History, American History, and, oh yes, yes! There was one st
rong event when I visited the National Gallery.”
“What happened? Try to describe it.”
“I was so excited when I saw a huge outside banner announcing an exhibition on the history of ballet.”
“Yes, and what happened?”
“As soon as I saw that banner, I rushed inside the gallery, so excited that I pushed and forced my way to the front of the line. I was looking for something. I believe I was looking for Sergei.”
“Sergei? You mean your first husband?”
“Yes, my first husband. This won’t really make sense to you unless I tell you some things about my life. May I present some of my highlights? I’ve been rehearsing a speech for days.”
Concerned that she was about to go on stage and that her presentation might use up all our time, I responded, “Yes, a brief summary would be helpful.”
“To start, you must know I absolutely lacked mothering and my lifelong feeling of lack of mothering was the central focus of my analysis. I was born in Odessa, and my parents separated before I was born. I never knew my father, and my mother never spoke of him. My mother hardly spoke of anything. Poor woman, she was always ill and died from cancer just before I was ten. I remember at my tenth birthday party . . . ”
“Natasha, sorry to interrupt, but I have a dilemma. Believe me, I’m interested in all you have to say, but at the same time, I’ve got to be timekeeper here because we have only these two sessions, and I want, for your sake, to use our time efficiently.”
“You’re absolutely right. When I’m on stage, I forget the time. I’ll rush now and promise you to take no side excursions. At any rate, after my mother died, her twin sister, Aunt Olga, took me to St. Petersburg and raised me. Now Aunt Olga was a kind person, and she was always good to me, but she had to support herself—she was unmarried—and she worked hard and had little time for me. She was a very good violinist and traveled with the symphony orchestra much of the year. She knew I was a good dancer, and about a year after I arrived, she arranged for auditions, where I performed well enough for her to deposit me in the Vaganova Ballet Academy, where I spent the next eight years. I became such a good dancer that, at the age of eighteen, I received an offer from the Kirov Opera and Ballet Theater, where I danced for a few years. That was where I met Sergei, one of the great dancers and egotists and philanderers of our time and who is also the great love of my life.”