Love's Executioner (28 page)

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Authors: Irvin D. Yalom

Tags: #Psychology, #Movements, #Psychoanalysis, #Research & Methodology, #Emotions

BOOK: Love's Executioner
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Under ordinary conditions Marie could be a difficult patient, but after her accident she was astonishingly resistive and caustic.
“Hypnosis works for stupid people or people with weak wills. Is that why you’re suggesting it for me?”
“Marie, how can I persuade you that hypnosis has nothing to do with will power or intelligence? The ability to be hypnotized is simply a trait someone is born with. What’s the risk? You tell me that the pain is unbearable—there’s a good possibility a one-hour consultation will offer some relief.”
“It may sound simple to you, but I don’t want to be made a fool of. I’ve seen hypnosis on TV—the victims look like idiots. They think they’re swimming when they’re on a dry stage, or that they’re rowing a boat when sitting in a chair. Someone’s tongue was stuck out and she couldn’t get it back in.”
“If I thought that sort of thing would happen to me, I’d feel as concerned as you. But there’s all the difference in the world between TV hypnosis and medical hypnosis. I’ve told you precisely what you can expect. The main thing is that no one is going to control you. Instead, you’ll learn to put yourself in a state of mind where you can control your pain. It sounds like you’re still having trouble trusting me and other doctors.”
“If doctors were trustworthy, they would have thought of calling the neurosurgeon in time and my husband would still be alive!”
“There’s so much going on here today, so many issues—your pain, your concerns (and misconceptions) about hypnosis, your fears of appearing foolish, your anger and distrust of doctors, including me—I don’t know which to attend to first. Do you feel the same way? Where do you think we should start today?”
“You’re the doctor, not me.”
And so therapy had proceeded. Marie was brittle, irritable, and despite her avowed gratitude to me, often sarcastic or provocative. She never stayed focused on any issue but quickly moved on to other grievances. Occasionally she caught herself and apologized for being bitchy, but invariably, a few minutes later, was once again irritable and self-pitying. I knew that the most important thing I could do for her, especially in this time of crisis, was to maintain our relationship and not allow her to drive me away. Thus far I had persevered, but my patience was not unlimited, and I felt relieved to share the burden with Mike.
I also wanted support from a colleague. That was my ulterior motive in the consultation. I wanted another to bear witness to what I had been going through with Marie, someone to say to me, “She’s tough. You’ve done a helluva good job with her.” That needy part of me did not act in Marie’s best interests. I did not want Mike to have a smooth and easy consultation: I wanted him to struggle as I had to struggle. Yes, I admit it, a part of me was rooting for Marie to give Mike a hard time: “Come on, Marie, do your stuff!”
But, to my amazement, the session proceeded well. Marie was a good hypnotic subject, and Mike skillfully induced her and taught her how to put herself into a trance. He then addressed her pain by using an anesthetic technique. He suggested that she imagine herself in the dentist’s chair getting an injection of novocaine.
“Think of your jaw and cheek growing more and more numb. Now your cheek is very numb, indeed. Touch it with your hand and see how numb it is. Think of your hand as a storehouse of numbness. It becomes numb when it touches your numb cheek, and it can transfer that numbness to any other part of your body.”
From there it was an easy step for Marie to transfer her numbness to all the painful areas of her face and neck. Excellent. I could see the look of relief on her face.
Then Mike discussed pain with her. First, he described the function of pain: how it served as a warning to inform her just how much she could move her jaw and how hard she could chew. This was necessary, functional pain in contrast to the unnecessary pain stemming from irritated, bruised nerves which served no useful purpose.
Marie’s first step, Mike suggested, was to learn more about her pain: to differentiate between functional and unnecessary pain. The best way to do that was to begin to ask the right questions and to discuss her pain in depth with her oral surgeon. He was the one who knew the most about what was happening in her face and mouth.
Mike’s statement was wonderfully lucid and delivered with just the proper mixture of professionalism and paternalism. Marie and he locked gazes for a moment. Then she smiled and nodded. He understood that she had received and registered the message.
Mike, obviously pleased with Marie’s response, turned to his final task. She was a heavy smoker and one of her motives in agreeing to the consultation with him was to enlist his help in stopping. Mike, an expert in this field, began a well-practiced, polished presentation. He emphasized three major points: that she wanted to live, that she needed her body to live, and that cigarettes were a poison to her body.
To illustrate, Mike suggested, “Think of your dog or, if you don’t have one now, imagine a much-loved dog. Now imagine cans of dog food with labels marked ‘poison.’ You wouldn’t feed your dog poisoned dog food, would you?”
Once again, Marie and Mike locked gazes; and, once again, Marie smiled and nodded. Though Mike knew that his patient had grasped the concept, he nonetheless pressed the point home: “Then why not treat your body as well as you would treat your dog?”
In the remaining time, he reinforced his instructions on self-hypnosis and taught her how to respond to cigarette craving with auto-hypnosis and increased awareness (hyperception, as he put it) of the fact that she needed her body to live and that she was poisoning it.
It was an excellent consultation. Mike had done a superb job: he had established a good rapport with Marie and had effectively achieved all of his consultation goals. Marie left the office obviously pleased with him and with the work they had done.
Afterward, I mused about the hour we three had shared. Although the consultation satisfied me professionally, I had not gotten the personal support and appreciation I had been seeking. Of course, Mike had no idea of what I really wanted from him. I could hardly admit my immature needs to a colleague much my junior. Furthermore, he could not have guessed how difficult a patient Marie had been and what a herculean job I had done with her—with him, she had played, perhaps from sheer perversity, the model patient.
Of course, all these sentiments remained hidden from Mike and Marie. Then I wondered about the two of
them
—their unfilled wishes, their hidden reflections and opinions about the consultation. Suppose, a year from now, Mike and Marie and I each wrote recollections of our time together. To what extent would we agree? I suspect each of us would barely be able to recognize the hour from the other’s account. But why a year? Suppose we were able to write it a week from now? Or this very moment? Would we be able to recapture and record the real, the definitive, history of this hour?
This is no trivial question. On the basis of data patients choose to provide about events taking place long before, therapists routinely believe they can reconstruct a life: that they can discover the crucial events of the early developmental years, the real nature of the relationship with each parent, the relationship between the parents, between the siblings, the family system, the inner experience accompanying the frights and bruises of early life, the texture of childhood and adolescent friendships.
Yet, can therapists or historians or biographers reconstruct a life with any degree of accuracy if the reality of even a single hour cannot be captured? Years ago I conducted an experiment in which a patient and I each wrote our own view of each of our therapy hours. Later when we compared them, it was at times difficult to believe that we described the same hour. Even our views of what was helpful varied. My elegant interpretations? She never even heard them! Instead she remembered, and treasured, casual, personal, supportive comments I had made.
2
At such times one longs for an umpire of reality or some official sharp-imaged snapshot of the hour. How disquieting to realize that reality is illusion, at best a democratization of perception based on participant consensus.
If I were to write my summary of that hour, I would stucture it around two particularly “real” moments: the two times Marie and Mike locked gazes and she smiled and nodded. The first smile followed Mike’s recommendation that Marie discuss her pain in detail with her oral surgeon; the second when he drove home the point that she would not feed poisoned food to her dog.
Later I had a long talk with Mike about the hour. Professionally, he regarded it as a successful consultation. Marie was a good hypnotic subject, and he had achieved each of his consultation goals. Furthermore, it had been a good personal experience after a bad week, in which he had hospitalized two patients and had a run-in with the department chairman. It was gratifying to him that I had seen him performing so competently and efficiently. He was younger than I and had always respected my work. My good opinion of him meant a great deal. How ironic that he should have gotten from me what I had wanted from him.
I asked him about the two smiles. He remembered them well and was convinced that they signified impact and connection. The smiles, appearing at points of power in his presentation, signified that Marie had understood and was affected by his message.
Yet, as a result of my long relationship with Marie, I interpreted those smiles very differently. Consider the first, when Mike suggested that Marie seek more information from her oral surgeon, Dr. Z. What a story there was behind Marie’s relationship with him!
She had first met him twenty years before when they were college classmates in Mexico City. At that time he had tried energetically, but unsuccessfully, to court her. She had lost touch with him until her husband’s automobile accident. Dr. Z., who had also come to the United States, worked at the hospital where her husband was brought after his accident, and was a major source of medical information and support to Marie during the two weeks her husband had lain in terminal coma with a fatal head injury.
Almost immediately after her husband’s death, Dr. Z., despite his wife and five children, renewed his courtship and began to make sexual overtures to Marie. She rebuffed him angrily, but he was not deterred. On the telephone, in church, even in the courtroom (she sued the hospital for negligence in her husband’s death), he winked and leered. Marie regarded his behavior as odious and gradually became harsher in her refusals. Dr. Z. desisted only when she told him that she was disgusted by him, that he was the last man in the world with whom she would have an affair, and that she would inform his wife, a formidable woman, if he continued to harass her.
When Marie fell from the cable car, she struck her head and was unconscious for about an hour. Awaking to extraordinary pain, she felt desperately alone: she had no close friends, and her two daughters were vacationing in Europe. When the emergency room nurse asked her for the name of her doctor, she moaned, “Call Dr. Z.” By general consensus he was the most talented and experienced oral surgeon in the area, and Marie felt that too much was at stake to gamble with an unknown surgeon.
Dr. Z. contained his feelings during his initial major surgical procedures (apparently he had done an excellent job), but they came pouring out during the postoperative course. He was sarcastic, authoritarian, and, I believe, sadistic. Having persuaded himself that Marie was hysterically overreacting, he refused to prescribe adequate medications for pain relief or sedation. He frightened her by making off-hand statements about dangerous complications or residual facial distortions and threatened to leave the case if she continued to complain so much. When I spoke to Dr. Z. about the need for pain relief, he grew belligerent and reminded me he knew a lot more than I did about surgical pain. Perhaps, he suggested, I was tired of talking treatments and wanted to switch specialties. I was reduced to prescribing Marie sedation
sub rosa.
I listened for many long hours as Marie complained about her pain and about Dr. Z. (whom she was convinced would treat her better if she would even now, with her mouth and face throbbing with pain, accept his sexual advances). Her dental sessions in his office were humiliating: whenever his assistant left the room, he would make sexually suggestive comments and manage frequently to brush his hands across her breasts.
Finding no way to be helpful to Marie in her situation with Dr. Z., I strongly urged that she change doctors. At the very least, I urged that she obtain a consultation with another oral surgeon, and supplied her with names of excellent consultants. She hated what was happening, and she hated Dr. Z., but my every suggestion was met by “but” or “yes, but.” She was a “yes, but-er” (also referred to in the trade as a “help-rejecting complainer”) of considerable prowess. Her major “buts” were that since Dr. Z. had started the job, he—and only he—really knew what was going on in her mouth. She was terrified of having a permanent facial or oral deformity. (Always greatly concerned about her physical appearance, she was even more so now that she was entering the singles world.) Nothing—not anger, pride, or hostile brushing of her breasts—took precedence over her functional and cosmetic recovery.
There was one additional and important consideration. Because the cable car had lurched, causing her to fall as she was leaving it, she had initiated a lawsuit against the city. As a result of her injury Marie had lost her job, and her financial situation was precarious. She was counting on a sizable financial settlement, and she feared antagonizing Dr. Z., whose strong testimony about the extent of her injury and suffering would be essential in winning the suit.

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