Love's Executioner (33 page)

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Authors: Irvin D. Yalom

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

BOOK: Love's Executioner
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In a sense, I, too, had exploited this trait in Saul (but for his own good, I told myself): to please me, he had begun to charge a fair price for his services and to refuse many requests he did not want to grant. The change in behavior (even though conceived out of a neurotic wish to gain and retain my love) initiated an adaptive spiral and begot many other salubrious changes. I tried the same approach with the letters, expecting that Saul, at my request, would open them immediately. But, obviously, I had miscalculated. Somewhere Saul had found the power to take a stand against me. I could have rejoiced in his new strength had not the cause it served been so self-destructive.
Saul did not show up for his next appointment. About thirty minutes before the hour, he called my secretary to inform me that he had thrown out his back and was unable to leave his bed. I called back immediately but reached only his answering machine. I left a message that he call me, but several hours passed with no word from him. I phoned again and left a message irresistible to patients: to call me because I had something very important to tell him.
When Saul called later that evening, I was alarmed by the somber and aloof timbre of his voice. I knew that he had not injured his back (he often avoided unpleasant confrontations by malingering), and he knew I knew it; but the crisp tone of his voice signaled unmistakably that I no longer had the right to comment on it. What to do? I was alarmed for Saul. I worried about rash decisions. I worried about suicide. No, I would not permit him to terminate. I would trap him into seeing me. I hated that role—but saw no other way.
“Saul, I believe I misjudged the amount of pain you were experiencing, and put too much pressure on you to open the letters. I’ve a better idea about how we should work. But, one thing for sure, this is not the time for us to miss sessions. I propose that, until you’re well enough to travel, I visit you at home.”
Saul demurred, of course, raising many objections, predictable objections: he wasn’t my only patient, I was much too busy, he was already feeling better, it was no emergency, he should be able to travel to my office soon. But I was as tenacious as he and refused to be dissuaded. Finally, he agreed to receive me early the following morning.
On my way to Saul’s house the next day, I felt cheerful. I was back in a nearly forgotten role. It had been a long time since I had made a home visit. I thought of my medical student days, of my home-visit clerkship in South Boston, of the faces of patients long gone, of the smells of the Irish tenements—the cabbage, the staleness, yesterday’s beer, the bedpans, the aging flesh. I thought of one old regular patient on my rounds, a diabetic who had both legs amputated. He would quiz me with some new fact gleaned from the morning paper: “What vegetable has the highest sugar content? Onions! Didn’t you know that? What are they teaching you in medical school nowadays?”
I was pondering whether onions really
do
have a lot of sugar when I arrived at Saul’s home. The front door was ajar, as he had told me it would be. I hadn’t asked who would leave it ajar if he were confined to bed. Since it was best that Saul lie to me as little as possible, I had asked few questions about his back or how he was being cared for. Knowing he had a married daughter living nearby, I had intimated, in passing, that I assumed she was looking after his needs.
Saul’s bedroom was spartan—bare stucco walls and wooden floors, no decorative touches, no family pictures, no trace of an aesthetic sense (or of a woman’s presence). He lay immobile, flat on his back. He expressed little curiosity about the new treatment plan I had mentioned on the phone. Indeed, he seemed so distant that I decided the first thing I had to do was tend to our relationship.
“Saul, on Tuesday I felt about the letters the way I believe a surgeon feels about a large, dangerous abscess.” Saul had in the past been amenable to surgical analogies, being familiar with them from medical school (which he had attended before settling on a research career); moreover, his son was a surgeon.
“I was convinced the abscess had to be incised and drained and that what I needed to do was to persuade you to permit me to do it. Perhaps I was premature, perhaps the abscess hadn’t pointed yet. Maybe we can try the psychiatric equivalent of heat and systemic antibiotics. For the time being, let’s leave the opening of the letters out of our discussion ; it’s clear you’ll open them when you’re ready.” I paused, resisting the temptation to make a reference to a month’s time frame as though he had made a formal commitment; this was not the time for manipulation—Saul would see through any guile.
Instead of responding to me, Saul lay still, his eyes averted.
“Agreed?” I prompted.
A perfunctory nod.
I continued, “I’ve been thinking about you the last couple of days.” Now I was reaching deep into my repertory of engaging devices! A comment stating that the therapist has been thinking about the patient outside of their scheduled hour has never, in my experience, failed to galvanize the latter’s interest.
But not a flicker of interest in Saul’s eyes. Now I was really worried but, again, decided not to comment on his withdrawal. Instead, I sought for a way to connect with him.
“We both agree that your reaction to Dr. K. has been excessive. It reminds me of the strong feeling you’ve often expressed of never belonging anywhere. I think of your aunt reminding you so often that you were lucky she agreed to take care of you rather than let you go into an orphanage.”
“Did I ever tell you that she never adopted me?” Saul suddenly was back with me again. No, not really—we were now speaking together but in parallel, not face to face.
“When her two daughters were sick, the family doctor made a house call. When I was sick, she took me to the county hospital and shouted, ‘This orphan needs medical attention!’”
I wondered whether Saul noticed that he had finally, at the age of sixty-three, gotten a doctor’s house call.
“So you never really belonged anywhere, never were truly ‘at home.’ I think of what you told me about your bed in your aunt’s house—that cot you’d unfold every night in the living room.”
“The last to sleep, the first to rise. I couldn’t open up my bed until everyone was out of the living room at night, and in the morning had to get up and fold it away before anyone was up and about.”
I grew more aware of his bedroom, as stark as a second-class third-world hotel room, and thought, also, of a description I had read of Wittgenstein’s bare, whitewashed cell at Cambridge. It was as though Saul still had no bedroom, no room he had made his own, that was unmistakably his.
“I wonder if Dr. K. and the Stockholm Institute don’t represent a real haven. Finally you found where you belong, the home and perhaps the father you had always been seeking.”
“Maybe you’re right, Doctor.” It didn’t matter whether I was or not. Nor did it matter that Saul was being deferential. We were talking—that was the important thing. I felt calmer, we were coasting in familiar waters.
Saul continued, “A couple of weeks ago I saw a book in the bookstore about the ‘imposter complex.’ It fits me closely. I’ve always misrepresented myself, always felt like a fraud, always feared exposure.”
This was routine stuff, we had been over this material many times, and I didn’t bother to challenge his self-reproaches. There was no point. I had often done so in the past and he had a ready answer for everything. (“You’ve had a highly successful academic career.” “At a second-rate university in a third-rate department.” “Two hundred and sixty-three publications?” “I’ve been publishing for forty-two years, that’s only six a year. Besides, most are less than three pages. I often wrote the same article five different ways. Also, that figure includes abstracts, book reviews, and chapters—almost no original stuff.”)
Instead, I said (and could do so with the ring of authority since I was talking about myself as well as him), “That’s what you meant when you said that these letters have been pursuing you all your life! No matter what you have accomplished, no matter that you’ve done enough for three men, you always fear imminent judgment and exposure. How can I detoxify this for you? How to help you see this is guilt without a crime?”
“My crime is misrepresentation. I’ve done nothing of substance in the field. I know this, Dr. K. knows it now, and if you knew something about neurobiology, you’d know it, too. No one is in a position to make a more accurate judgment of my work than me.”
I immediately thought: Not “than
me
”; it’s “than
I
.” Your only real crime is using the wrong form of the first-person pronoun.
Then I noticed how critical I became whenever Saul got feisty. Fortunately I kept all this to myself—where I should as well have kept my next comment.
“Saul, if you’re as bad as you say, if, as you insist, you lack all virtues and all discriminating mental faculties, why is it that you think your judgment, especially your judgment of yourself, is impeccable and beyond reproach?”
No response. In the past Saul’s eyes would have smiled and met mine, but today he was clearly in no mood for wordplay.
I ended the session by establishing a contract. I agreed to help in anyway I could, to see him through the crisis, to visit him at home for as long as necessary. I asked, in return, that he agree not to make any irreversible decisions. 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.
The no-suicide contract (a written or oral contract in which the patient promises to call the therapist when feeling dangerously self-destructive, and the therapist vows to terminate therapy if the patient violates the contract by a suicidal attempt) has always struck me as ludicrous (“If you kill yourself, I won’t treat you ever again”). Yet it can be remarkably effective, and I felt much reassured by having established one with Saul. The home visits had their usefulness, too: though inconvenient for me, they put Saul in my debt and increased the power of the contract.
The next session, two days later, proceeded along similar lines. Saul was strongly motivated to send the fifty-thousand-dollar gift, and I continued firm in my opposition to that plan and explored the history of his penchant for buying his way out of problems.
He gave me a chilling description of his first contact with money. From the ages of ten to seventeen, he sold newspapers in Brooklyn. His uncle, a coarse, brusque man whom Saul had rarely mentioned, procured him a spot near a subway entrance and dropped him off every morning at five-thirty and retrieved him three hours later to deposit him at school—no matter that Saul was invariably late by ten or fifteen minutes and began every school day with a reprimand.
Even though Saul, for seven years, turned over every penny of his earnings to his aunt, he never felt he contributed enough money, and began to set unattainable goals of how much he had to earn each day. Any failure to meet these goals was punished by denying himself part or all of his dinner. To that end he learned to chew slowly, to “cheek” his food, or to rearrange it on his plate so that it appeared diminished. If forced to swallow by the gaze of his aunt or uncle (not that he believed they cared about his nutrition), he learned to vomit quietly in the bathroom after meals. Just as he once had attempted to buy his way into his family, he was now trying to buy a secure seat at the table of Dr. K. and the Stockholm Institute.
“My children don’t need any money. My son earns two thousand dollars for a coronary bypass, and often does two a day. And my daughter’s husband has a six-figure salary. I’d rather give the money now to the Stockholm Institute than have one of my ex-wives snatch it later. I’ve decided on a fifty-thousand-dollar gift. Why not? I can afford it. My Social Security and my university pension pay me far more than I need to live on. I’ll make it anonymous. I can keep the money-order receipt and, if the worst happens, I can always produce the evidence that I returned the money. If none of this is necessary, then it’s still all right. It’s for a good cause—the best that I know.”
“It’s not the decision but how and when you make it that’s important. There’s a difference between
wanting
to do something and
having
to do it (to avoid some danger). I believe you’re operating in the ‘having to’ mode right now. If giving fifty thousand dollars is a good idea, it will still be a good idea a month from now. Trust me, Saul, it’s best not to make irreversible decisions when you’re highly stressed and not functioning (as you yourself have noted) entirely rationally. I’m only asking for time, Saul. Just delay the gift for the time being, until the crisis has passed, till the letters have been opened.”
Once again he nodded assent. Once again I began to suspect that he had already sent the fifty thousand dollars and was unwilling to tell me. That would not be uncharacteristic of him. In the past he had so much difficulty sharing potentially embarrassing material that I instituted, in the last fifteen minutes of each hour, a designated “secrets” time, when I explicitly asked him to take a leap and share the secrets he had sheltered over the earlier part of the therapy hour.
Saul and I proceeded in this manner for several sessions. I arrived at his house early in the morning, entered through the door, mysteriously left ajar, and conducted therapy by the side of Saul’s bed, where he lay flattened by an ailment we both knew was fictitious. But the work seemed to be going well. Although I was less engaged with him than in the past, I was doing what therapists are traditionally supposed to do: I illuminated patterns and meanings; I helped Saul understand why the letters struck him as so fateful, how they not only represented some current professional misfortune but symbolized a lifetime’s search for acceptance and approval. His search was so frantic, his need so pressing, that he defeated himself. In this instance, for example, if he hadn’t been desperate for Dr. K.’s approval, he would have avoided the whole problem by doing what any collaborator does—simply keep one’s co-author informed about all developments in their joint work.

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