Private Wisdom

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Ralph Waldo Emerson had this to say about the giving of advice, and the drive within each of us to offer it – thinking, as we do, that we are offering a wondrous gift:

Although this garrulity of advising is born with us, I confess that life is rather a subject of wonder, than of didactics. So much fate, so much irresistible dictation from temperament and unknown inspiration enters into it, that we doubt we can say anything out of our own experience whereby to help each other.

All the professions are timid and expectant agencies.

The priest is glad if his prayers or his sermon meet the conditions of any soul; if of two, if of ten, ’tis a signal success. . .

The physician prescribes hesitatingly out of his few resources, the same tonic or sedative to this new and peculiar constitution, which he has applied with various success to a hundred men before. If the patient mends, he is glad and surprised. . .

The judge weighs the arguments, and puts a brave face on the matter, and, since there must be a decision, decides as he can, and hopes he has done justice, and given satisfaction to the community . . .

And so is all life a timid and unskillful spectator. We do what we must, and call it by the best names. ‘Tis little we can do for each other.

We accompany the youth with sympathy . . . but ’tis certain that not by strength of ours, or of the old sayings, but only on strength of his own, unknown to us or to any, he must stand or fall.

That by which a man conquers in any passage, is a profound secret to every other being in the world, and it is only as he turns his back on us and on all men, and draws on this most private wisdom, that any good can come to him.

Or, in perhaps less lofty terms, I offer this delicate observational plum, from a former patient at the Memphis V.A. Hospital, circa 1971:

Hell, Doc, you may think you know everything, but when it comes to me, you don’t know shit.

And to think, he knew that without ever reading Emerson!

But we all know it, don’t we, without having to consult Emerson, Freud, Dr. Phil or even Dear Abby; we all know that, when it comes down to us, other people, no matter how smart they are, don’t really know shit.

When I, as a therapist, have to write something about what I ‘know’ on my website, or on a referral site, or to a potential new patient, what do I say?

That I know all about relationships, mood disorders, substance abuse, career issues, loss, life transitions, and a long laundry list of other things that people struggle with? That I have a tremendous amount of experience with almost any issue that might come up?

Or that, when it comes to your life, your experiences, and what keeps you up in the middle of the night, I really don’t know shit, but that I promise to listen hard, respect you, and try my heart out, and that, together, maybe we can chase some of the shadows away and put you on the path to a better life?

Which would you rather hear? Right: you want EXPERTISE, not the old college try, don’t you? I mean, when you’ve got a mysterious skin rash that’s been making your whole life hell for months, and you finally haul yourself off to Dr. Whitesnow, the (expensive) dermatologist, for help, you don’t expect to hear,

“Dude – that’s gotta hurt!”

Hell, no – you want him to fix the ‘affected area’ with a gimlet eye and start rattling off fancy-sounding terms and unpronounceable potions that will fix you right up, don’t you? You want sureness, exactitude and precision. I mean, that’s how we tell we’re in the presence of a pro, isn’t it? We want white hair, a deep voice, and a little, knowing chuckle as the Doc says,

“Sure, son – seen it a million times, and every single time, it’s been Dermaticularis Aureolitica, commonly known as High Mountain Rash. Have you been on a ski trip within the last six months?”

And you slap your head and say, “Oh my god, Doc – of course, now it’s all so clear: it all began that weekend we went up to Mammoth. But how did you know?”

And he chuckles again, benignly, as he peers at you over his half-glasses. “Son, when you’ve gotten your medical training at Harvard, interned at Johns Hopkins, are a Lifetime Fellow of the International Dermatological Institute, have an Endowed Chair in Dermaticularis Aureolitica, and are the Director Emeritus of the American College of Rashes and Bumps, you just know.”

You’re feeling better already. “So, you think I really have this, this, uh . . .”

“You can just call it D.A. if you want – we do. And yes, that’s definitely what you have, son.”

See – that’s what we want: expertise, advice, certainty, for god’s sake!

But, uh oh, now he says, “However, there’s often a psychological component to these things. So to be absolutely sure, I’d like you to see a colleague of mine, Dr. Schleppinger.”

Oof!

Did he say, Psychological Component?

You mutter, “Sure, Doc,” imagining you’re going to be sent to someone who maybe has a sub-specialty in the Low To Mid-Mountain Rash variations of D.A. or something. No problem. But then he hands you a business card:

“Leo Q. Schleppinger, Ph.D. Consulting Psychologist.”

Oh shit – here we go! I must be a real mess if they’re bringing in the witch doctors! I thought I was going to be treated by experts, not some clown who’s going to ask me when I first started liking girls, or what it felt like when my pet rabbit died when I was five. Am I going to have to look at ink blots and tell them this one looks like my Uncle Fred – the one who always wore ladies’ hats? Am I going to have to ask my mother whether my first word was boo boo? Damn it to hell, I came here for expertise – for advice, not mumbo jumbo!

So, you dutifully nod and tuck the card away in your shirt pocket, thinking, maybe it won’t be that bad – maybe he’ll do hypnosis or something, or some ‘technique’ that’s over and done with in three visits, like your friend Hap, who stopped smoking with that guy who just ‘put him under’ and told him he didn’t need cigarettes anymore.

Yeah, that’s it. You think, maybe I can ask him to help me sleep better, while he’s at it, or stop snoring, or lose weight. Hey, this might not be that bad after all: three sessions and I’m a new man! He’ll just wave his fingers in my face like in those old Abbott and Costello movies, put me in a trance and say, “Rash, rash, go away – come again some other day,” and bingo bango, it’s gone!

You call the guy and set up an appointment for Wednesday at 6:00. You have to leave work a little early, but it’s okay – you told your boss you have an allergy appointment. You know, like with a real doctor. Heaven forbid anyone finds out you’re going to a nutcracker! But, nutcracker or not, you smile to yourself: wait till they see the slim me, the rash-free me, the good-night’s-sleep me.

The new me!

By Wednesday late afternoon you’re walking on air. It’s hard to even concentrate on your work. You think, “Gee, I wonder if it’s like at a cafeteria: just point to the stuff you want, and it’s done! One from Column A, one from Column B: stop snoring, lose weight, feel happy all the time. Hey, maybe he can make me want to go to the gym again, like I used to! As I do my reps, I’ll chant, “Advice! Expertise! Hypnosis! Advice! Expertise! Hypnosis!”

Wow, by this time next year, I could be ripped!

The traffic’s miserable. It’s a rainy night and suddenly everyone’s a student driver. And you’re starting to get a little nervous. Heck, that cream the Doc gave me is already helping my D.A. – why the hell do I have to go to a head-shrinker anyway? Just so Dr. Whitesnow can cover his ass, in case I have a nervous breakdown and sue him? In case the rash, in one patient out of a million, is actually an early sign of an impending meltdown, and I’m the one in a million? Did the Doc see something that he didn’t tell me? Something that made him think I’m actually going off my rocker? Something that cries out, “Have this guy put under observation, quick!” Something that you only pick up if you’re the Endowed Chair of the . . . what the heck was it again – The Fellowship of the Pimple, or something? Damn, now I can’t even remember a conversation I had just a week ago. Am I losing my memory? My mind? My mind and my memory? Wait, maybe that’s good: if I can’t remember anything, I wouldn’t remember that I went out of my mind, would I? Maybe I’ll end up one of those happy lunatics, content to sit and fill in coloring books in the day-room of the Shady Grove Home For The Mostly Gone. Would my wife come to visit me, or would she take up with that neighbor that’s always giving her the eye – what’s his name? Herb, Hubie, Harv – dammit, I can’t even remember my wife’s future lover’s name anymore. Herk, Howie . . . Oh yeah – Joe. Well, I was close, wasn’t I? I wonder if this Schlossinger guy can bring my memory back? But then, would I even want to remember going crazy and losing my wife? It is Schlossinger, isn’t it? Oh no, here we go again: Schlepperdink? Schlerdenbaum? Hell, what’s the difference, as long as it’s Advice, Expertise, Hypnosis!

With a start, you snap out of it and see the sign: Midtown Professional Building. That has a nice, solid ring to it, and that helps, some. Doesn’t it at least show that this guy is accepted in the company of other professionals? That they’re not ashamed to be seen with him, or at least not ashamed to pass him in the halls once in a while? Or do they even see each other in the halls? Do they eat together? Do they compare notes, and laugh, over meatloaf and mashed potatoes?

I just saw this guy who couldn’t even remember my name! What’s more, he couldn’t even remember the name of his wife’s future lover! Can you believe that? He came in for a rash, but we all know a rash like that is just a big red danger signal, flashing: Stop Me Before It’s Too Late! Say, pass me those rolls, wouldya?

You sit in your car in the parking lot, watching the rain make its way down your windshield, thinking, “Should I even go in? If he thinks I’m gonna sit still while he prods and pokes around in my mind, only to make fun of me over meatloaf, well he’s got another thing coming! He can take his Psychological Component and . . .”

But then cooler heads prevail (seeing as how you’re now under observation as a split personality), and you decide, fair is fair – at least give the guy a chance to actually abuse you, before you hit the panic button and count him out. And Dr. Whitesnow said the guy might help, and after all, he has a full head of white hair, so he should know: give the new guy a fair shot. I mean, he might not be that bad: maybe he’ll confine his lunch comments to tamer stuff, like the ink blots and Uncle Fred. I mean, maybe the other guys at lunch won’t even want to hear about some guy’s rash, while they’re trying to eat, right?

You scan the impressive name board in the lobby: Samuels, Sapperstein, Schaum – yes, there it is: Schleppinger! He’s right up there with the legitimate doctors, so he can’t be that bad, can he? At least he’s got his name up there on the fancy board, in the company of decent people. Let’s see – Room 444. Not too low, not too high – that’s good. Didn’t your high school locker number used to be 444? That’s a good sign. Hey, maybe this whole thing will pan out after all – especially if I get ripped.

You enter the elevator and push 4. You ride up, and the doors open. Not bad – they have carpeting on the floors, not too worn, not too garish or anything, just regular-looking, like decent people might have. Of course, he probably didn’t do the decorating himself, but still, it doesn’t do any harm either: decent carpeting goes with decent people, doesn’t it? You bet it does!

On the way down the hall, you repeat your mantra: Advice, Expertise . . . and dammit, what was that third thing again? Gotta hide that memory loss – that’s a dead giveaway. Oh yeah – Hypnosis! See – I’m fine!

The waiting room’s okay. At first all you could see is Vogues and Elles, but then, thank god, you root around and find a couple old Sports Illustrateds under the pile: you grab one of ’em, quick, and make sure you’re reading an article on the Detroit Lions when the door opens.

“Mr. Quigley?”

You put down the magazine (making sure the Lions page is still open and visible). “Yeah – that’s me.”

“I’m Dr. Schleppinger – pleased to meet you.” He offers his hand. Older guy, looks like maybe once upon a time he had a body, but if he’s doing self-hypnosis for his own gym workouts, it sure isn’t working. But all in all, not bad – no beard or anything, no sandals with socks or anything else suspect, if you know what I mean. For a second you consider going to a quick fist-bump to mess with him, but that’d only look weird. Gotta be careful. Firm handshake is best: keep it simple.

You’re ushered into one of those offices where you can’t tell if the guy’s a shrink or an anthropologist. Couple of weird masks on the wall, some Navajo-lookin’ blankets here and there. No pictures of Tom Brady or Peyton Manning, that’s for sure, but we’ll let that pass. He may not have an endowed chair, but at least he’s got a Barcalounger.

“So, Mr. Quigley – what can I do for you?”

You go blank. Think, think: you can’t show that memory loss right off the bat, you fool! What’s my doctor’s name, for the love of god? Say something – anything!

“Uh, that guy – you know, the one with the white hair, says I’ve got D.A., and I’m here for my Psychological Component.”

You can’t believe that just came out of your mouth.

He leans forward, brow knitted. “Excuse me, Mr. Quigley. Did you say the D.A. referred you? Is this in reference to some legal matter?”

You’ve got to do better this time. You take a deep breath. “No, no, Doc. It’s this rash that I got while I was skiing. He says it’s Dermococcus Auroriata, or something, and that I’ve gotta be checked out for a nervous breakdown.”

Now he’s leaning back, scribbling notes furiously. “Have you been hospitalized before?”

“Yeah, I had a real bad strep when I was in college, and, well, they thought, you know, just for precautionary . . .”

“No, I mean for your psychiatric condition, Mr. Quigley.”

You panic. “What psychiatric condition? Look, Doc, you’re just supposed to check me out for the D.A.”

“What does the D.A. have to do with why you’re here?”

Now you’re getting mad. “It’s the whole reason I’m here, man. There’s nothing else wrong with me but this rash.” You roll up your sleeve to show him the red bumps up and down your arm. “And if you want to laugh about this over lunch – well, so be it.” That’s tellin’ him!

“Why would I laugh about it over lunch?” He stops scribbling and puts down the pad. “Look, Mr. Quigley, maybe we’d better start all over. Why are you here to see me?”

“Didn’t you already talk to Dr. Whitesnow? I thought all you guys were thick as thieves.”

“Look, Mr. Quigley, whoever Dr. Whitesnow is, I’ve never met him, or talked to him. So let’s just pretend I know nothing about your case, especially since I don’t know anything about your case. Now let’s just take it from the top. Please calm down and tell me why you’re here.”

“Now you’re talking. That’s the first thing you’ve said that makes any sense at all.”

“I appreciate your confidence. Now, if you’ll just tell me the whole story, from the beginning.”

Okay, so here’s the deal . . .”

You fill him in on how the rash was making your life a living hell, the visit to Dr. Whitesnow, about D.A., then about the dreaded Psychological Component. “So you see, Doc, what I want you to do is basically the same kind of stuff they did for Hap, but including the rash.”

“Who’s Hap?”

“My neighbor, who was hypnotized out of smoking, by one of you guys. I’m sure you must know him – I can’t remember his name.”

“And I would know him, of course, because we’re all thick as thieves?”

“Well, sorry about that one. I just meant . . .”

“That’s okay, Mr. Quigley, but the fact of the matter is, I’m not the kind of thief that does hypnosis.”

“Then why am I here?”

“I thought you were here to get help with your rash.”

“Well, I am, but if you don’t really even know how to do anything . . .”

“Did Dr. Whitesnow tell you I do hypnosis – or that that’s what you need?”

“Well, no, but . . .”

“So your knowledge of psychology comes mostly from Hap?”

“That’s not exactly what I . . .”

“Are you willing to talk to me about what I actually do, and how it might help you? You know, kind of get a second opinion, other than Hap’s? I mean, especially since you’re already here and everything.”

You’re calming down a bit. This guy’s kind of a nut, but not really a bad nut. It couldn’t hurt to stick around and hear him out, could it? “Sure, fire away.”

“Is it alright with you if I ask a few questions first? Sometimes I like to find out a few things about the patient, before I start offering solutions to his life – you know, even if only to keep in fighting trim.”

Maybe this guy’s alright, even though he doesn’t really know how to do anything. “Look, Doc – I’m sorry I shot my mouth off before. I guess I was pretty nervous about this whole thing. I mean, a Psychological Component can’t be a good thing, can it? And I’m sorry about the meat loaf, too.”

“I can let the meat loaf go, if you can let it go that I’m not thick with Hap’s hypnotist.” He stuck his hand out. “Deal?”

You shake hands. “Deal.”

Forty-five minutes later, you walk out feeling a lot better, though you can’t imagine why. The guy didn’t do anything, really, didn’t say anything, really. He didn’t even do any of the Big Three: no Advice, no Expertise, no Hypnosis. Kind of a fraud, but a nice fraud – the kind of fraud you don’t mind coming in to talk to again.

You do come in again to talk to him, a bunch of times. It comes out, somehow, that you’re a pretty angry guy (who knew?), that you resent the hell out of your wife (that’s what she always said, but you always thought she was a damn liar), and that you hate your new boss – you know, the young punk they brought in to replace the old, ‘good’ boss; the new kid with an attitude, who said he needed to ‘get to know you better’ before he knew how to work with you. Yeah sure – let’s get together and bake crescent rolls, kid! Imagine the nerve! The stupidity!

Well, anyway, after you talk to this Schleppinger guy a while, you find out a few things about yourself: you never talk to anyone, never trust anyone, and treat your whole life like it’s fifteen rounds with Mike Tyson.

Like I say – who knew?

And worst of all, no Advice, no Expertise, and no Hypnosis – what a gyp. But the guy was okay after all, you think to yourself: the rash is gone, and I don’t even mind my boss so much anymore, especially after Doc S. suggested I tell him I’m willing to try and talk it through – no, not baking crescent rolls or anything, but you know, just kind of getting a fresh start. And my wife – she says I should have done this years ago, that I’m acting like a human being again. She even told me to tell the Doc, ‘Thanks.’ I mean, the wife and I even started having . . . . well, you’re all big boys and girls, you know what I mean, right?

But the thing I never could figure out was – what took the Doc so long? I mean, why didn’t he just bring in the heavy artillery right at the start: you know, Advice, Expertise, Hypnosis? Why beat around the bush, bobbing and weaving all that time, when he just could have hit me with his best shot, right off? I don’t think he’s the type to just drag it out for the money – no, I don’t believe it’s that. I still don’t get it – he could have just told me off right at the beginning:

“You’re being an asshole – stop it!”

You know, something like that – something direct, so I would have known where I stand right away, instead of pussyfooting around the truth, playing ring-around-the-rosy with me all that time.

I still didn’t get it, so on our last session, I asked him, straight out: “Hey Doc, you know I really appreciate everything you did for me and all. But I just want to ask you, how come you didn’t just come out and tell me right away that I was angry, that I was holding my wife at arm’s length, and that I was being unfair to my boss?”

His answer made no sense, but I’ll tell it to you anyway, just for the sake of completeness.

Well, at first he started quoting Emerson at me, something about “profound secrets” and “private wisdom” – you know, the kind of crap you’d expect from a guy like that. No offense, but you know what I mean: I wanted a real answer.

Well, I cut him off, quick, and said, “Look – can’t you just cut the crap and answer me, in the most plain English you can think of, why you didn’t just tell me all about myself, right off the bat?”

Well, he nodded slowly – you know, like it was gonna kill him to speak English. Then he just shrugged and said,

“Who knew?”

See what I mean? Kind of a nut, but like I say, a good nut. So, the whole thing worked out pretty good, in the end.

Oh yeah – except for one thing:

I never did get ripped.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

The Goner, Part II: Blowing Out the Speakers

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(Note: Please first read The Goner, Part I: Whistling Through the Grass)

The summer weeks drifted by in Asheville: group therapy, botanical rounds, the cockroach and raccoon wars, loving a neighbor’s puppy named Shane, doing individual therapy sessions, hopes borne out with some patients, hopes dashed with others, teaching my wife how to drive a stickshift in the Blue Ridge Mountains, claiming my gifts, accepting my limitations, crossing back and forth through Beaucatcher Tunnel, work and home, heat and humidity, summer rain, lessons, lessons, under the hot Southern sun . . .

A new patient arrived: Victor. A Vietnam vet. His diagnosis: Depression. I don’t know why, but I gravitated to him. Make no mistake – all patients are not treated the same. Not that all don’t get the benefit of everything the program has to offer, but sometimes you take a special liking to, or a special interest in, a particular one, and spend “more time than you’re getting paid for,” as a supervisor once put it, in his care and treatment. Such was the case with Victor.

He was a big, likable guy, a heavyset bear of a man with a deep, resonant voice that you noticed right away. Paul Robeson’s voice came to mind – and William Warfield, maybe Billy Eckstine, but for obvious reasons I wouldn’t have made any of those particular comparisons to Victor’s face. White guys from Mississippi don’t like that.

I scheduled some individual sessions with him, and we talked of all kinds of things: the wife he still loved (she had left him for another man while he was in ‘Nam), his lonely childhood (an only child of a drunken mother and a father who was on the road all the time), his own drunkenness and addiction to pills (he had kicked both years before, “on his own”), and most devastating of all, his loss of the guys he called ‘the only family I’ve ever known’ – the platoon that was annihilated by the Viet Cong, all but him.

Victor was the first person I ever heard say, “I wish I had died instead of them,” and really mean it. He explained, “The dead get to rest. I have to face hell for the rest of my life, because aloneness, and life without The Goners, is hell.” That’s what he called them – The Goners.

I thought about that, and thought I could understand it, a little. I had never suffered a significant loss of a person in my life, but I could see what he meant about the dead ‘getting the best of the deal’, in that their struggles were over, while the living had to go on and face life without their loved, and lost, ones.

But what about that peculiar phrase, The Goners? For some reason, I felt I needed to file that question away for later.

In the meantime, I tried to talk to him about the things he did have to live for.

What about other women?

He would shake his head sadly, and say, “For me, Joanie was the beginning and the end.”

Subject closed.

New friends?

“What’s the point? You let people matter, then you just lose them, and it’s worse than never having them in the first place.”

Subject closed.

Work?

“I’m an electrician. I do my job. I go home. What else is there to say?”

Another one bites the dust.

Finally, I mentioned his voice.

“You’ve got quite a voice. Ever done any singing?”

That got a small smile. “Singing? Sure – when I was a kid, in church. I was a soprano. Then, my voice changed.”

“It sure did.”

He really smiled, for the first time ever. “Now I’m a bass – like Daddy.” He grinned, proudly.

Hmmm – were we finally onto something? “Daddy?”

“Yeah, you know – my father.”

I smiled, “Yeah – even a Yankee knows what ‘Daddy’ means, Vic. It’s just that I never heard you talk about anyone before – anyone other than Joanie, or The Goners – with any feeling. I guess your Dad meant a lot to you.”

He pursed his lips in thought. “He meant everything to me.” He paused, his eyes moving as he searched his past. “He used to sing.”

“To you?”

“He sang all the time – in church, everywhere.” He paused, his eyes lighting up, head nodding proudly.  “He used to blow out speakers, you know.”

“What do you mean?”

“Sure – a really powerful, deep bass can do that, you know.”

“No – I had no idea.”

He was quiet a moment. “But he also sang, special – to me.”

“How do you mean – special?”

“At night, in my room.”

“Like, bedtime songs – lullabies?”

“Not lullabies. Just anything: popular songs, hymns, gospel – you know, church.”

I smiled. “Yeah, I know gospel has something to do with church.” I paused, considering. “Would you sing for me?”

He did a double-take. “What – right here?”

“Yes – right here.”

He looked at the closed door. “Is that okay?”

I did my best Edward G. Robinson. “If they come to arrest us, I’ll take the rap, see?”

He looked down, clearing his throat. “Well, I don’t really sing anymore. It’s kinda like, when Daddy died . . .”

“The songs went with him?”

“Um hmm.”

“So, you don’t really feel entitled to do it on your own?”

“I don’t know about that – I just haven’t done it.”

“Would you do it for me? I’d be honored.”

He looked around again, like we were up to something illicit. “What do you want to hear?”

I shrugged. “I don’t know – maybe some of that hymn and gospel stuff you were talking about?”

“Like, what hymns?”

“I have no idea – I’m just a Jew-boy from California.”

That earned a rumbling laugh. He looked down and cleared his throat again. “Okay, then”

He began, timidly,

Shall we gather at the river,
Where bright angel feet have trod,
With its crystal tide forever,
Flowing by the throne of God?

Now, he really gave it his all – his voice molten gold:

Yes, we’ll gather at the river,
The beautiful, the beautiful river,
Yes, we’ll gather at the river,
That flows by the throne of God.

He looked at me. I nodded, “Keep going.” He continued through the verses, belting it out, body swaying, his eyes closed, and ended with,

Soon we’ll reach the shining river,
Soon our pilgrimage will cease;
Soon our happy hearts will quiver,
With the melody of peace.

Yes, we’ll gather at the river,
The beautiful, the beautiful river,
Yes, we’ll gather at the river,
That flows by the throne of God.

By god, I almost converted, right there on the spot!

There was a knock at the door.

Victor flinched.

I said, “Yes? Come on in.”

The door opened, and two nurses poked their heads through a crack in the door, timidly, one head on top of the other. “Is everything alright in here?”

I nodded. “Everything is great in here.” I looked at Victor, then back at the nurses, asking them, “What did you think?”

The one on the bottom had her hand clapped over her mouth. They both had tears in their eyes. The one on top said, “It was just . . . just so beautiful.”

Victor looked alive for the first time since I had known him. Something had happened – it doesn’t matter what, or why, or how, only that it happened. A spark of life had been struck. Now it was my job to keep that spark alive.

I continued to meet with him, and, while he was still depressed, it seemed he had turned a corner and stepped out onto the street of life. There was only one thing I still wanted to know, and I waited till our last meeting to ask him. Maybe he’d be willing to tell me now.

“I know you don’t like to talk about the War, but could I just ask you one thing?”

He drew in a breath, hesitating. He still didn’t want to go ‘there’, but he said, “Okay – what is it?”

I had earned my one question. “Why do you call your platoon The Goners?”

He smiled. “Oh, is that all? That one’s easy.” His eyes did that moving-back-and-forth thing again, searching the blackboard of time. “When I was a kid, and my Daddy came home, which wasn’t often, he used to play soldier with me all the time. And whenever I would ‘kill’ him, he would clutch his hand to his heart, spin around, say, ‘I’m a goner’, then fall down.

“So, every time he had to leave home again, it became a regular thing that I’d say to him, ‘Guess you’re a goner, huh?’ And he’d say, ‘Yep – I’m a goner, boy.’ Somehow, it made it easier.

“So, when the guys were all killed, I just took to calling them The Goners – like, they were with Daddy, somehow.” He looked at me, but not really at me. “I guess it makes it easier.”

I nodded, and stuck out my hand. “Thank you – I appreciate it. I think I understand, now.”

Little did I know that, thirty years later, I would ‘borrow’ his father, and the platoon, to make it easier for myself when Brett died.

Oh, before I get back to Brett, there’s one more thing about Asheville, and it’s in the nature of an ‘amends’. While we lived in Asheville, the older, nice guy, Bob, whom I mentioned earlier, was wonderful to us. He ‘had us over’ to his lovely house for dinner, did everything possible to make me feel welcome, talked with me patiently about my doubts and questions at work, and even laughed at my dumb jokes sometimes.

And yet, there was something sad about him, something very human. Maybe he was a self-questioner, a self-doubter, like me? I don’t know. I didn’t know, then, that ‘old guys’ were human, too, could need companionship, too, could be lonely, could doubt themselves. I just know that, on my last day at work, on my way out I glibly said to him,

“I’ll be in touch.”

He immediately replied,

“No, you won’t.”

Not like an accusation, or anything of the sort – just straightforwardly, like a statement of hard-won truth. It took me momentarily off guard. People aren’t usually that direct, or that honest. I think I shrugged it off at the time, and continued my merry way down the hall.

So, for the record, and to my shame, I just want to say that, Bob, you were right. I was a boy in a hurry – to get my Ph.D., to grow up, to get paid, to earn respect, to ‘make it’. I so wish that Botanical Rounds, that your generosity toward me, that the South, had taught me to slow down and let my heart put down roots in life, sometimes. I know it now, but I didn’t, then.

And I’m sorry – I’m the one who missed out on the privilege of a continued relationship with you, Bob – I’m the loser. And now that I’m an old guy, I know that age has nothing to do with it: I think you recognized in me a fellow traveler, and wanted to know me longer than my three-month ‘hitch’ in Asheville. Maybe at the time I couldn’t imagine an older guy actually wanting to know me, or finding genuine companionship with me – I didn’t think I had that much to offer.

But now that I’m older than you were then, I see that when a soul connects with another soul – age, or race, or gender, or background doesn’t matter much at all; sure, maybe those superficial similarities make it easier, but if the actual connection isn’t there, those things don’t make up for it. The connection is the precious part – and I let a true connection fall by the wayside when I failed to follow up on our friendship.

Maybe somebody reading this now will learn and realize that truth, and think twice about letting a special connection lapse.

That’s all I can offer you now, Bob, but I am offering it, with all my heart.

(Next: The Goner, Part III: Mission Accomplished)

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

The Goner, Part I: Whistling Through The Grass

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8/29/2014

Today, my son Brett would have been eighteen – knocking on the door of manhood. People say to me, “Well, at least you have another one – and with the same birthday, too.” Yes, that’s true, I do have ‘another one’ (Nick – his twin brother) and that is a balm, of sorts.

We will celebrate Nick’s birthday today, and happily. I am so proud of him I could bust, with all he’s been through in his short lifespan, including, but not limited to, losing his brother, his twin, his protector, and his best friend, at the age of six. I admire him for going on, for making the best of a bad situation: he not only lost his twin, but to some degree, his parents, too, for a few years at least, and in truth, he lost some parts of us for good, for those parts — innocence, naivete, a certain smiling belief in the basic goodness of life — are gone forever.

But I’m not going to talk about Nick here, because he has his whole life ahead of him, and besides, he would be embarrassed and mad at me, for what eighteen year-old boy wants his father to blab a bunch of stuff about him to the whole wide world?

Nope, I’m going to talk about things that have to do with Brett, the ‘goner’. Why do I use that term? Because of a patient of mine who, if he’s still alive, most assuredly doesn’t remember me at all. But more on that after a little background.

A long time ago (1972), in a galaxy far, far away (The South), I did a summer internship at the Oteen Veterans’ Administration Hospital, in Asheville, North Carolina. I have only fond memories of Asheville, though some of them are leavened, and improved, by the passage of time. Like what? Well, like the fact that in the little clapboard cottage (well, shack, actually) where we were staying, out on Old County Home Road, if you turned on the lights at night the walls were teeming with hundreds of big, fat cockroaches. And they didn’t just sit there and look at you when the lights went on – they all scrambled madly for the closest available darkness, making the walls a living Hieronymous Bosch canvas of squirming bugs.

And they invaded the kitchen, too. If we didn’t put our silverware in sealed bags, our food, everything – well, it was ‘game on’. Oh, and it didn’t stop at roaches, either: big, bullying raccoons owned the night, too, and they weren’t subtle or scared – not a whit. They would bang around in the darkness of the night kitchen, searching, angrily and with total ownership, for whatever ‘goodies’ you had, in their opinion, procured for them and them alone.

For years, my wife would laugh about how, that first night, hearing the coons scuffling around aggressively, I jumped up in bed and said, “What the hell – there’s a goddam bear in the kitchen!”

But she wasn’t laughing when, the next morning, as she went to put a tablespoon full of cereal in her mouth, a roach suddenly shot out from the underside of the spoon and made a mad dash for her Cheerios!

And Southern culture is, well, different – or at least it was, then. There was a tunnel I had to transit every day on the way to work. It’s name? Beaucatcher Tunnel. Get it? Only in the South. And there was a famous mountain (part of the Blue Ridge Mountains) that was visible from town, too, with a smaller peak next to it. Their names? Mount Pisgah, and The Rat. No, really – it’s a big deal there.

Asheville is famous for a few things: the author Thomas Wolfe was born there, and his book, Look Homeward, Angel, is set in the Asheville area. The Vanderbilt estate, Biltmore, is a tourist mecca. They have a minor league baseball team, The Asheville Tourists. In the old days, the first tuberculosis sanitarium in the U.S. was established there, and it was widely believed that Asheville’s ‘salubrious’ climate was ideal for healing all manner of ailments. After the Civil War, the government began to establish what were then called “old soldiers’ homes,” to take care of the medical, and later psychiatric, needs of veterans, and one of these was the beginning of the Oteen VA Hospital (now the Charles George VA Medical Center). The hospital has lovely, large grounds and high-ceilinged buildings that give some of the feel of the old, gracious South.

I first realized that the place had a work ethic, and a pace, all its own on my first day on the job. I was gung ho, hoping to impress my superiors with my dedication to my job, my willingness to learn, and my ‘potential’. As we gathered at lunchtime in the office of the Chief of Psychology, I expected, maybe, an informal ‘in-service’ training session, or at the least a grilling on what I had done with myself all morning.

Instead, the Chief and his cohort, Bob, a friendly, older guy who had been there forever, looked at each other and said, “Okay – we’re all here. Ready.”

I looked from one to the other. “Ready for what?”

The Chief smiled indulgently at my ignorance, picked up his hat and said, “Botanical rounds, of course.”

And with that, we all trooped out to take a long, leisurely stroll through the extensive, green grounds of the hospital, which included, as I remember, picking blades of grass and attempting to whistle through them – one of the manly arts of the Southern gentleman (and if you think I’m making this up, check this out). They could name most of the flowers, trees and birds of the grounds, and aside from an occasional bit of juicy gossip about the staff, no business whatsoever was discussed on these daily perambulations. So, it turned out to be a kind of in-service after all, just not one about work. There was a courtliness – a gentility, about this custom, and these men, that I never found anywhere else I ever worked, and though I didn’t get the fast-lane, sophisticated educational apprenticeship about being a ‘working’ psychologist that I had hoped for, I ultimately ingested something far more valuable, merely by the osmosis of hanging out with these guys: namely, that, while work matters, so does Life. Don’t forget who you are; don’t forget the natural world; don’t forget your family; and don’t forget to have some fun every day.

In effect, they were telling me,

Sure, you may think we’re just backwater old-timers, piling up years until our pensions kick in, and maybe we are, but remember this, boy: you may become a big-city fancypants someday, but you’re also just an ordinary Joe, along with the rest of us, so learn to enjoy it, and you’ll be ahead of the game.

And man, were they right. I never did learn to whistle through a blade of grass, but I did learn from them a couple of other crucial ‘manly arts’: humility and the capacity for a light touch.

Amen.

And then there were the patients. For some reason, I seem to remember that most of the guys I dealt with were Korean War vets – forgotten men from a forgotten war.

Two memories, of two men, stand out especially, because they involved lessons taught to a young, arrogant, would-be hotshot who thought he was slumming in Asheville for the summer.

The first one was Sonny, a small, beady-eyed, unprepossessing guy in his mid-forties. He was diagnosed paranoid schizophrenic, and he did have a wild look in his eye, along with a Southern accent of dark molasses. On his tongue, “shit” was a four-syllable word. I was assigned to interview him, to provide a progress report. You understand, everyone was supposed to be making ‘progress’, due to the powers of our treatment plan, which, along with medication, meant group therapy, where we talked about ‘life’ issues, daily problems, and how cute the nurses were. I’m not knocking it – if I was a paranoid schizophrenic veteran in 1972, that’s what I would have wanted, too. It definitely beat sitting in a bare, one-room apartment and nursing your delusions with Camels and Southern Comfort all day.

So, as I say, I was assigned to meet with this guy and assess his ‘progress’, of which there was, to be honest, virtually none. Well, maybe the fact that he wasn’t out stabbing people or causing the police any trouble. But for Sonny, progress mostly meant keeping his inner demons at bay, rather than ‘getting better’ in the sense that a layman would think of it. In truth, he was an odd duck who unfortunately got caught up in an odd war, and it had ‘affected’ him. I remember his mental disability was rated as 80% ‘service-connected’, which meant that somebody, at some point, had determined that whatever happened in Korea had significantly degraded whatever pre-service mental stability he’d ever had. I wouldn’t know, because he wouldn’t talk about the war, or his experiences in Korea, though I asked. I let it go at that. It’s not like in the movies, where you help a guy ‘recover’ lost memories of how a sadistic platoon sergeant sent him out on night patrol for kicks, knowing the area was infested by North Koreans, and then he sobs into a pillow and screams, “I hate him! I hate him!” for an hour, and is miraculously cured.

Nope, Sonny was ‘gone’, for good, and nobody knew, really, what caused it, or ever would. My guess is that, like I said, he was a very odd guy who was probably barely making it in civilian life, and never should have been subjected to whatever things he went through in war – things that would probably have made even a normal man a bit odd for the rest of his life, but pushed this fragile guy around the bend for good.

I didn’t look forward to my assignment: the guy not only had that molasses accent that meant ‘ignorance’ to me, but a major mouth on him, too, to go along with a chip on his shoulder about everything and everybody in general. He had earned his paranoid ‘wings’ honestly: when he wasn’t being crazy, he could slash and carve with the best of ’em, and sometimes the staff almost hoped he was in his private delusions so that he wouldn’t spray around that verbal machine-gun fire and disrupt the staff and patients with his accusations. He was just crazy enough to harbor wild suspicions about everybody, but just un-crazy enough that his suspicions had the ring of truth and could really hurt.

I thought I would try and put him at ease with some small talk, establishing ‘rapport’. After he had taken his seat, I noticed him looking at a poster on the wall – of a castle. I nodded towards it. “Pretty amazing place.”

His eyes shifted from the poster to me, and back. “Oh yeah?”

I nodded. “Yeah – it’s in Austria.”

He smiled. “You mean, that place near Germany?”

Wow, this was going better than I expected. He was ‘responsive’. Actually, I had been to the castle, but I didn’t want to flaunt that in front of him, not now, when we were doing so well. I played it low-key. “Yeah – I guess Hitler stole their country for a while there, but they got it back after World War II.”

He nodded.

Why stop now, when I was doing so well? “I hear Walt Disney used it as the model for the castle in one of his cartoons.”

He pointed. “You mean, that castle?”

I nodded, enthusiastically.

He pounced. “You mean, Neuschwanstein?”

Paranoid schizophrenia: 1

Bernstein the Intern: 0

I scrambled to regain lost ground. “So – you were stationed in Germany?”

“Nope, never seen the place – I think it’s pretty common knowledge that Ludwig II built it as a refuge for himself. Like me, he didn’t particularly like people.” Spoken with no accent – could have been elocuted by an Oxford don.

Johnny Reb: 2

Yankee Fool: 0

Of course, you know what I was thinking at that point, but he even anticipated that.

He smiled at me, knowingly, his accent back full strength. “Yeah, yeah – if ah’m so smart, what the hail am ah doin’ heah? Well, what the hail else ah got to do? They don’t make no jobs for crazy folks, and gals don’t cotton to ’em much, neither, an’ that’s a fack.” He paused. “Ah on’y tail you this cuz ah lah’k ya.” He paused, then muttered, “Y’all done good with Bobby.”

I racked my brain, and finally made the connection. “Bobby” must have referred to a black patient the staff called Robert – who insisted on being called Robert, in fact. Some of the staff had been trying to transfer him to another unit because he was annoying and provocative to staff and other patients. I dimly remembered a heated discussion at the nurses’ desk weeks earlier, where I had pointed out that his ‘problems’ were precisely why he was here in the first place, and that to transfer him because of them ran counter to the whole purpose of our being there. Apparently Sonny had overheard the conversation, or someone else had, and passed it down the grapevine.

But two things really struck me: one, that a confirmed Southern redneck had appreciated my standing up for a black man. And two, the realization that the white patients apparently called him Bobby all along. It took me a long time, but because of this incident and others, I realized that Southerners didn’t just ‘hate’ black people, pure and simple, as I’d thought. White Southerners saw black people almost as children – hence the automatic use of the diminutive (even affectionate) ‘Bobby’, a name which Robert probably accepted as normal from them. And, they felt in a sense protective of blacks, as they would toward children. From their point of view, the real problems only came when blacks didn’t know their ‘place’, and therefore forfeited their status as protected children. Yes, I know it’s called paternalism, and like I say, it’s ugly and I don’t condone it, and it had to change, but I learned that it wasn’t as simple as pure hate, either. As someone once said, stereotypes work best from a distance. Once you get up close and personal, it’s a little more complex.

I think Sonny had used up all his energy making his ‘point’ with me. Soon after his victory over my own ‘paternalism’, he lapsed back into his psychotic delusions, and though he nodded to me, vaguely, whenever he saw me, we never really connected again.

But I’ll never forget, and will always honor, even the momentary glimpse I was afforded, into the mind of what could have been an extraordinary man.

(Coming Soon: The Goner, Part II: Blowing Out the Speakers)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Just Passing Through

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We live and we die
Like fireworks
Our legacies hide
In the embers
May our stories catch fire
And burn bright enough
To catch God’s eye

We live and we die

Like fireworks
We pull apart the dark
Compete against the stars
With all of our hearts
Till our temporary brilliance turns to ash
We pull apart the darkness while we can
In the Embers – Sleeping At Last

What’s a nice species like us doing in a place like this? We live and we die, and we know it; we are glory, we are dust, and we know it; we are giants in the earth, we are a hunk of bones, just passing through, and we know it. We are prisoners on death row, who don’t even have the grace of knowing how death is coming, or when. But that, exactly, is our glory – here we are, in this impossible, ludicrous situation, but we make the best of it.

Oh sure, we live in denial of what’s coming – of death, of physical breakdown, of the indignities of aging. Sometimes I think there should be a Dying Anonymous for all of us, where we have to get up in the meetings and say, ‘Hi, my name is Joe Jones, and I’m going to die.”

In his book, Living Your Dying, author Stanley Keleman describes two normal phases in the great flow of human life: Self-expanding is expressive, reaching out beyond the physical body to newness and social interaction; Self-collecting gathers inward, withdrawing from the social world to define the self and its boundaries. We see these pulsations constantly in therapy.

New therapists are often surprised that, after a dynamic, boundary-stretching session, the following session is comparatively ‘dead’, quiet and more pulled back. But this is exactly how growth and change occur, in pulses: expansion, then consolidation; rupture, then repair.

For example, in one session, someone might experience deep despair, feeling meaningless, hopeless, and hollow. If they are allowed to ‘drink deeply’ of that despair, to experience it fully, to breathe into it, held emotionally by the therapist, the next session might seem relatively tame, disconnected, thoughtful, leading the therapist to wonder if he is doing something ‘wrong’. But if the therapist stays with it, honoring the flow of experience, it pays off. On the way out the door, the patient might turn and say, “You know, I used to love dancing.” What does this mean? It means ‘Thank you’, it means ‘With your help, I’m remembering myself’, and it means that, if we can stand up to despair together, like facing a bully, there might be a way out of this. Does the patient know this? No. Do you say any of this out loud? Of course not – but you file it away, you hold it emotionally for the patient, and, most likely, you sigh to yourself that maybe, like Scherezade, you’ve earned the right to therapize another day.

So we face crazy, impossible things, like the unknown, our physical limitations, death and infirmity, sometimes alone, sometimes together. Where I used to work, in an alcohol rehab program, there was a poster up on the wall – a picture of a mouse, standing on the railroad tracks, giving the finger to an oncoming train. The caption was,

The last great act of defiance

In a way, we are all that mouse, insisting, in the face of overwhelming evidence all around us, that we MATTER. We pulse, expanding and consolidating, reaching out and withdrawing within, changing, changing, as we try to make sense of it all, find our place in it all, even though there are no ultimate answers. In Keleman’s book he tells this tale:

Plato, on his deathbed, was asked by a friend if he would summarize his great life’s work, the Dialogues, in one statement. Plato, coming out of a reverie, looked at his friend and said ‘Practice dying.’

But what does it mean, this ‘practice’? I think it means standing up to our emotional bullies within, not resisting that inside us which is trying to be born, breathing into change. In baseball, they talk of ‘making adjustments’: a kid comes into the league, with a great reputation for batting. He has torn up the minor leagues, and now he is poised to bring terror to the hearts of major league pitchers. And for a while, he does. But what happens? Major league pitchers are smart: they see his tendencies, and they adjust. They see that he is vulnerable to curve balls, low and away. Now what does the new kid do? If he is ordinary, he just continues to flail away at low-and-away curves, gradually becoming predictable, and mediocre. But if he has greatness, he adjusts back: he learns to let those curves go, forcing pitchers to throw him something hittable. And he studies them, too: he learns their tendencies, their patterns, their weaknesses, and he uses all of it against them. Life, also, is a game of adjustments. Things change, constantly. What we held on to for dear life yesterday, is lost for good; what was our best ‘material’ yesterday is irrelevant today.

So, what does Plato mean by practicing dying? Possibly, having an open attitude to changes, the ‘little deaths’ that happen to us throughout our lives. It means being light on our feet in the face of new information, not being unduly attached to ideas, images, or the status quo, not having to have things a certain way, being willing to not be in control all the time. And, maybe most of all, being committed to seeing things as they are. This doesn’t mean being wishy-washy, passive or uncaring. It doesn’t mean not being yourself. It means standing there and bringing your Self to each situation, meeting reality face to face and engaging it fully, in all its complexity, sitting with unsureness, if necessary, until a greater whole presents itself.

We all have our ‘tendencies’, to be sure – these are the legacy, for better or worse, of our early family lives, our genetic predispositions, our unique interactive experiences with life. And to some extent, we are all prisoners of our tendencies. The famous psychologist Alice Miller once wrote a remarkable book, which she called Prisoners of Childhood. It discussed exactly this – how we are all shackled, to a greater or lesser degree, to our early childhood experiences. The book didn’t sell well. Finally, she changed the name to The Drama of the Gifted Child. Sales took off and it became a best-selling classic. No need to explain why: we don’t want to know our ‘tendencies’, our limitations, our flaws. But, if we are willing to face them, to “adjust back” to life, we can do great things, and even if we don’t do great things, we can do ordinary things with a kind of greatness.

I have read quite a bit about prisoner of war experiences in World War II. One of the most surprising things I learned was the importance of rumors. Incorrect rumors. Yes, in memoirs man after man wrote that rumors, most of them begun by the prisoners themselves, were a major source of hope and ‘entertainment’. At first, I was shocked: I would have thought it would make a prisoner enraged to hear that, say, “General MacArthur is forming a 200,000 man army and is only two weeks from returning to free us”, and then learn that it is Wrong. But rumors were a cheap, available and defiant means of keeping up hope and morale, something the Japanese guards could not control, or codify, or influence. They became an expression of creativity, a way of keeping the men open to possibility, and a middle finger raised to the oncoming train.

So, yes, it’s true that death is the oncoming train in all of our lives. We are all on death row, prisoners of childhood, living on rumors. Our position is laughable to some, ludicrous to others, and wholly absurd to anyone who is a fair witness to it all. If you ask ‘heroes’ about their outrageous acts of bravery, they will invariably say, “I was just doing my job.”

And that’s what we do. If we are ludicrous, we are also magnificent: we “pull apart the darkness while we can”, and if we do not live forever, well, we do our best to live now, and that is heroic – that is our job.

 

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Rocky Road (Part II)

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A while ago, I wrote a blog piece called Rocky Road, about a folk song, not a road. Well, this is about a different rocky road, but still not a road. This one is about coherence, elegance, fittingness, and grace: the quality that would have inspired my mother, when looking at a living room, to nod approvingly, and say, “It’s pulled together”.

Today, my daughter, who’s in the music business with Sony, and the songwriting business with herself, in L.A., told me about a ‘pop’ song on Youtube that she wanted me to check out. I watched and listened. It was odd, unusual, fascinating and even a bit disturbing, but it held my attention from start to finish. It definitely wasn’t my ‘thing’, but I definitely appreciated it. I fished around for a way to describe its merits, and finally emailed her the following:

Well, it’s like this: you can eat almonds, then marshmallows, then chocolate ice cream, and it’s all pretty darn good. But when you eat rocky road ice cream – that’s something else again, something a whole lot better than the sum of its parts. This song has an artistic vision that’s cohesive and consistent, with a real authorial ‘voice’ to it. It’s pulled together. It’s rocky road.

And that’s the goal of the kind of therapy I do: to help people become someone, some particular someone, who’s cohesive and ‘of a piece’ – pulled together. But why do people need this, and how do they get to the point where they need it?

Well, think of a baby: what does it do all day? It just babies around, needing things, blurting out whatever is going on inside it, drinking when it’s thirsty, eating when it’s hungry, and then peeing and pooping it all out. That’s its job, and it’s good at its job. So far, so good.

But then storm clouds appear: Mom gets mad for some reason when I poop, Mom gets nervous when I crawl near her special vase, Mom looks really tired when I cry too much, or ask too much, and her mouth turns down when I don’t respond the right way to those stupid noises she makes (later I found out they’re called Words – big deal); so I try not to poop, but mostly it doesn’t work, I try not to ask too much of her, but what am I supposed to do when I can’t do things for myself? And I try to smile like she likes when she makes those stupid noises, but sometimes that makes her mad, too – especially when her mouth makes a circle and she goes “NO!” Jeez, if saying “NO!” makes her that mad, why does she keep doing it?

The whole thing’s crazy to me, but it’s the only game in town, so I try to work with it the best I can. Trouble is, after a while I get so caught up in trying to ‘game the system’ to get goodies and smiles instead of “NO!” and loud voices, that I kind of forget my insides – I forget what I feel, what I need and, well, I kind of come unstuck from who I am, inside, so I’m more drifting around in search of not getting in trouble than I am being Me. Being Me didn’t work – drifting around did – kind of, so I became a better drifter than a Me. And, after awhile, I kind of forgot the Me anyway, so I didn’t mind it that much.

Drifting isn’t really that bad, once you get used to it. And later I found out that most people really don’t mind you not being a Me anyway, as long as you do the stuff they want and expect. It’s kind of like wearing a magic suit: as long as you have the magic suit on, you can ‘pass’ for real, and no one ever really checks your id anyway (no, not Freud’s ‘id’, I mean your identity, though come to think of it, no one really ever checked Freud’s id, either, but we’ll let that go), so you’re good to go.

Then, when you get to school, the whole thing works even better: the kids who get in trouble are the ones who are too much Them, whereas the ones who can play the fake-Me game hardly ever get in trouble, and since they don’t stick out too much and do individualistic things that draw attention to themselves, they don’t get teased or picked on very much either. And if they are tempted to revert back to being Them, all they have to do is look at what happens to the weirdos who aren’t smart enough to hide out in their magic suits. Boy, nobody wants that, right?

So, you pass along smoothly, grade to grade, until graduation. Uh oh – now people suddenly start asking you stupid questions – things they never asked before: What are you going to do with your life? What are your PLANS?, and things like that. Holy cow, what’s with the sudden interest? No one bothered you with that stuff for years and years, and now, boom – suddenly, they HAVE to know? But, not to worry – as it turns out, they don’t really mean it: you can just go to college and they don’t bother you for a few more years. Yeah, some of that Me stuff crops up in college: stuff like your MAJOR, and having to do a lot of schoolwork that seems meaningless, but mostly you can just pass your classes and put it all off, and it works pretty good. The magic suit still protects you, and besides, now there’s drugs, alcohol, sex, music, movies, and relationships to distract you from You and to distract other people from bugging you about You. Whew.

The real trouble starts after all that – when you enter the Real World, which, as it turns out, isn’t all that Real either, but here’s the rub: now you find out it isn’t enough to just Get By. Sure, you’ve still got, maybe, a Job, maybe a Relationship, and maybe even Kids, to distract you from You, and to keep everyone else off your back (since you’ve done the Regular Thing and gotten a Job, a Relationship and maybe even Kids, they shut up and leave you alone), but as the years go by, you find yourself wondering: What am I doing in this life? How did I get into all this? What’s wrong here? I still play The Game, I still wear the Magic Suit, but somehow, it doesn’t work for me anymore – it isn’t enough. And the last time you said “this isn’t enough”, Mom got really, really mad, if you can even remember back that far.

You find yourself wondering if, maybe, you made a mistake by detaching from your Me and wearing the magic suit all those years: but what choice did you have?  You had to survive, didn’t you? And how could you possibly have known that, one day, just coasting wouldn’t be enough? But damn – by now, you’re so out of practice being a Me that you couldn’t find your way back with a dowsing rod, a GPS unit and Daniel Boone to lead the way. You’re Lost, is what you are.

You wish you could just sleep through the whole thing, but you can’t even seem to sleep right anymore, so you get up and pace around for hours. You try drinking, but that just makes you feel like hell the next day. You try smoking some weed, but no matter how good you might feel for a while, you have to Come Back – and when you do Come Back, you’re even further behind than you were when you left. You might even try an affair, or overeating, or overworking, or getting massages by cute girls with ‘happy endings’, but here’s the problem with all of these ‘fixes’: they might change your relationship to reality for a while, but they don’t change REALITY. And reality is – you’re lost. You’ve lost your connection to yourself, and you’ve lost your way back to who that person ever was.

You realize, now, that it’s not about pleasing everyone, or being good, or doing the regular thing, or blending in, or not standing out, or having Mom smile.

It’s about Your Life.

Shit!

So, now what?

That’s where I (or someone like me) come in.

I’m a patient Daniel Boone, a friendly dowsing rod, and a GPS with a heart. I’m Howard, the maddening old goat of a prospector in The Treasure of the Sierra Madre. Together, we set out to look for signs of Gold – your lost Me. We talk, feel and pay close attention until a trail emerges, a trail an old buzzard like me knows how to follow. In the meantime, I don’t get mad if you have to poop, I don’t smile just because you act like you like it when I say my stupid noises (Words – remember?), and I don’t turn my mouth down just because you need more than I can give at the moment: we’re after Gold, not the fool’s gold of feeling good temporarily, or the relief of not facing hard things, or the comfort of coasting along. I’m interested in You – not in you doing things the ‘regular’ way, or the ‘right’ way, or the way everyone else does it. I’m interested in helping you find your way, and Your way.

At first, it sucks. It sucks to sit with feelings, and needs, you long ago decided were “stupid”, “embarrassing” and “weak”. It sucks because you have no idea what’s happening, it sucks because you don’t know what to do, and it sucks because you hate not knowing what to do, and being bad at things, and man, you are bad at this.

Of course, that’s when your friendly local therapist says, “Naturally – that’s why we’re doing it.”

Shit – who’s on first?

So, you sit there with tears in your eyes, or anger boiling up inside you, or sadness pressing down on your shoulders, or all three, and you ask me, “So, what am I supposed to do?”

And I answer, “You’re doing it.”

What the hell!

You think, the heck with this guy – where’s the instruction manual for this shit?

There isn’t one. Turns out sitting there and feeling whatever you’re feeling is actually supposed to DO something, but the son of a bitch won’t say just WHAT it’s supposed to do, or WHEN. Damn, where’s that Internet site again – the one that says that Cognitive Behavior Therapy can get rid of this stuff in just a few weeks? Jeez, for the first time in your life, you’re asking for homework, and the guy won’t give you any! What has your life come to?

So you sit there some more, feeling, talking; it’s weird, but it actually feels kind of better: not all the way, but you can see that maybe this guy isn’t just lying to keep you coming to therapy and wasting your time: maybe there is some kind of “process” (oh, he LOVES that word!) that is going on, that might actually change your life. And it is starting to feel like, maybe, this guy is on your side – not that you asked for that, or need it, or really care, mind you, but, well, he seems to actually care about you and how you’re doing, and he never uses stuff you tell him against you, like you thought he might at first.

This guy is weird – this whole thing is weird, but you do feel better, and you think you’re learning things about yourself, though you almost never actually talk about your ‘stuff’ directly, and he never actually ‘teaches’ you things, exactly.

The whole thing is just – weird.

So, like the greenhorn would-be prospectors in The Treasure of the Sierra Madre, he drags you up hills and down dales, as cactus and brambles tear at your clothes and dangerous animals lurk in the dark, but you keep a goin’ until the hills and dales seem to flatten out a bit, the scary animals seem less frequent and less scary, and you actually begin to see signs of Gold – real gold, not that quick-fix, tin-plated, phony stuff that the suckers believe in.

And you think, “The Gold doesn’t look like I thought it would, either – it looks, well, more like ME. This is not what I set out to look for – I wanted instructions, and tips, and brilliant insights. But now I, myself, seem to be coming up with instructions, and tips for myself, and some not-too-shabby insights about myself, to boot. After all, I am the expert on Me. Imagine that.”

So, after a while, after you’ve worked hard, and stayed on the trail, and suffered some bramble scratches and cactus scars and maybe fought off a few wild animal attacks, you look at yourself and you realize,

I’m of a piece, I’m pulled together, I’m a Me.

I’ve got good stuff inside me: nuts, marshmallows and chocolate. But I’m a lot more than my pieces:

I’m Rocky Road!

 

 

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Please Remember Me

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Today, I heard another one of those “Where have you been all my life?” songs on the radio. I tracked it down and found it’s called Dante’s Prayer, by Loreena McKennitt, who has apparently been around forever, with me being shamefully ignorant of her amazing voice, her soul and her talent. So, now that I know, I want you to, too. I know it’s annoying when you’re trying to skim along through someone’s writing (mine, in this case), and they (me, in this case) insist you stop and do something, but this gal has major soul, and I really encourage you to follow the link below and actually listen to the song first before going on. Furthermore, listening to the song will be good ‘practice’ for you, in slowing down and actually being PRESENT for a few moments. Being where you are, when you are: what a concept! (Aren’t therapists obnoxious?) Okay, so here is the link, and I’ll see you on the other side.

{{This space reserved for you, the beautiful, conscious and conscientious reader, to slow down and make room for what Ms. McKennitt went to all that trouble to do for you.}}

This song was apparently inspired by Dante’s The Divine Comedy, which McKennitt was reading while on the Trans-Siberian Railroad (yeah, I’m a regular passenger on it, too – I just don’t brag about it. Not!). While it’s above my pay grade to do an in-depth exegesis of how the song relates to The Divine Comedy, I fortunately found a personal story that somebody posted about attending a concert by McKennitt that will do just as nicely. Apparently she told this story at the concert, by way of introduction to the song. While transiting Siberia, the train stopped regularly so the passengers could get out and purchase food from local vendors along the line, the train not having a dining car or food service available. They had exactly twenty minutes to get their food and get back on the train. There was an attendant on the train who looked particularly glum throughout the day, as the train stopped, and passengers got off and did their thing, then back on. At first, McKennitt assumed that maybe her demeanor was just a reflection of Russian culture.

But one time, as McKennitt got back on the train and saw the attendant, she gave the glum lady some of the food she had bought, and was rewarded with a sudden smile of surprise and gratitude. Loreena wondered if anyone else had ever taken the time and care to consider the woman, as she traveled back and forth across the vastness of Siberia, mile after mile, year after year. McKennitt was struck by the smile, and hoped that during the woman’s dark moments, she would stop to remember McKennitt’s act of kindness, and it would return the smile to her face. And in that moment of connection, the song was born, and the plaintive refrain, Please remember me.

And, in your dark moments, whom do you ‘remember’? And do you ever wonder who remembers you? As a therapist, I get to hear the real story (not the one for public consumption) about who really mattered, who made a difference, in the lives of my patients. And some of the answers would surprise friends and family members: a remembered pat on the butt from a coach, a nod from a teacher, a fishing lesson from a neighbor man, a kind act by a stranger, can literally make the difference between life and death. And sometimes I even get unexpected ‘appreciations’ of me that are kind of stunning in their way. For instance, one day a young man I had worked with for years, and had never particularly voiced his feelings about me, suddenly said,

Gregg, I’m going to see you till you die, and after you die, I’m going to find a medium who can contact you, and then I’m going to see you through her, for as long as I can. 

No, I don’t intend to see him till I die, and no, he doesn’t literally mean that – he’s just expressing a feeling – but how many people are able to do work where they get to hear something so moving and beautiful, to have the gift of working with people at that depth, to be a team with someone who would say that to them? I mean, “How sweet it is” to work with people, walk beside them, and believe in them.

But back to Please Remember Me: I know the song stayed with me, because a couple of days after hearing it, I was taking a walk with my ear buds in my ears, trudging blithely along, and a song by Van Morrison came on: Have I Told You Lately That I Love You? Suddenly, it all came together and hit me like a ton of bricks: I should be saying ‘I love you’ to God, or whatever force made us all, who has given me, and all of us, so very much. I actually teared up, right there on the street, and felt ashamed for having taken so much for granted, without giving any thanks in return. I tilted my head up (He is ‘up’, right?) and said,

 Oh my God (like, literally – not OMG!) – I haven’t even spoken to you for months, maybe years – I’m so sorry and ashamed for having ignored and neglected you, and taken you for granted. Thank you so, so much for all you have given me – and all of us. I promise not to forget that fact, and you, for so long again. I love you.

And I wondered how many times, how many years of my life, have gone by with my not even thinking to give thanks and appreciation, to the Creator, to Creation, to Life, for everything. All the times I partook of glory, both the little and the big, but didn’t give back: a beautiful song, a sunset, the rain (my all-time favorite weather), people that do and say amazing, surprising things, the people I love and who love me. How many times did I take these things for granted, instead of stopping and letting them sink in, good and proper, then offering my thanks for all that is given?

Well, back to my walk. I thought my ‘prayer’ (or whatever you want to call it) was over, but I discovered it wasn’t. I went on, addressing Whoever’s In Charge:

And now that I actually think of it, I also wanted to say thank you for ‘letting it go’ that I never gave you back even a word of thanks, and for understanding, for being patient, and for not making a ‘big thing’ of it, even though, now that I give it a second’s notice, it IS a big thing. So thank you for that, too.

Oh, I know there are infinite ways to give thanks to you, and I guess my way has been trying to be a good person, mostly – busting my ass to be the good parent I never had, to be a good husband, a good friend, and a good therapist to my patients. But now, somehow, those don’t seem enough – like they are just the regular ways of being, stuff we all do routinely, and damn, you must have noticed all along that I was skating.

Well for what it’s worth, I’m going to try to make a habit of noticing and giving thanks to you whenever I can – no, not going to church or tithing or reading the Bible – those are all fine, but they’re not for me, and I know you know that, so you’ll understand I have to do it my way. I’m no Holy Joe, god knows, but then I’m no heathen, either – just an oddball who can feel things deeply without all the window dressing of choirs and sermons and stained glass. For me, it’s enough that when I say I’ll try, you know I ‘mean it’, because you know All.

And I’ll also work on not hating you anymore for taking away my son, which I still maintain is one of your all-time screw-ups, and no, I’m not one of those Pollyannas who says “God works in mysterious ways” and lets it go; nope, I don’t let it go that you did that – not to me, but to Brett (my son), of all people – the most joyous person I ever met. You were wrong there – real wrong.

I remember very well when I saw the movie Open Range, there was a scene where the ‘bad guys’ kill Mose, one of Robert Duvall’s cowboy traveling partners, a very lovable guy, who was ‘family’ to Duvall, and kill their trail dog, too, whom they all loved dearly. After the gravesite is prepared, and both are in the ground, it’s time for someone to speak over the grave. Duvall’s second-in-command says to him, “You wanna say some words?” (i.e., as boss of the outfit). Surprisingly, Duvall says, “You wanna speak to the Man Upstairs, go on and do it – I’ll stand right here and listen, hat in hand. But I ain’t talkin’ to that son of a bitch. And I’ll be holdin’ a grudge to Him for lettin’ this befall a sweet kid like Mose.”

Well, God, since this was the first movie I had seen since the death of my son, that scene hit me like an atomic blast, and to say I ‘understood’ would be small potatoes indeed: I more than understood – I’d LIVED it, and that is exactly the way I felt about You, God – or Allah, or Yahweh, or whatever you’re calling yourself this year. I hated you, and I wasn’t nice about it either.

So, God, if that’s way off base to you, I am sorry about that, but I can’t be honest with you and not tell you about it: I guess that’s about the closest I can come to ‘confession’, but then as a lapsed half-Jew, maybe I get a pass on that one too. 

But you do so much more than kill people: for example, you were the one who gave Brett life – so how can I hate someone who gave me my son, even though he took him away? Sure, that is ‘mysterious’, and even a little crazy-making, as we say in the psychology racket (but of course you know that, having created everything, including the psychology racket). So maybe when you screw up (like killing Brett), you’re trying to teach us acceptance, and forgiveness, and big-heartedness, by us having to learn to forgive you, to notice, and admit, that you do so many wonderful things that aren’t screw-ups: could it be that you do these things on purpose, to give us a chance to learn, and expand our hearts? I don’t know – I suppose people who study the Bible or the Koran or the Upanishads have already thought up this concept and talked it to death, but for me, it’s the first time it’s occurred to me, so there’s a minor miracle for ya, that, maybe, I finally gave back to you, after you handed me so many miracles over the years, including the years themselves. And, if you didn’t do it on purpose to teach me forgiveness and acceptance – why, I’m just going to go ahead and use it that way, anyway: so there!

Again, sorry if I’m insulting you – or confusing you. Well, as Doyle Lonnegan said in The Sting, “Ya folla?”

Ah hell, I know you do. (sorry about the ‘hell’)

Oh boy – I can see you sitting up there saying “God damn – that guy can talk”, and you’d be right. I know that, in the Bible somewhere, you said, “Be still, and know that I am God,” so I am actually going to shut up now and just say,

Thank you. Thanks for sending me Please Remember Me, and that Van Morrison song, too – sorry it took me two tries to get it. So, even though I reserve the right to hate your guts sometimes, for you-know-damn-well-what (you’re just gonna have to work with me on that one), I want to stop right now and say, I’ll remember You.

Thank You, from the bottom of my heart, and I’ll be back – often.

Amen.

 

 

 

 

 

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Secretariat and Me

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Today, I was reading a fascinating book about horse racing: Inside Track, by Donna Barton Brothers, a former jockey and current racing commentator. I heard her interviewed on NPR in the days leading up to the Belmont Stakes. It was a big deal because California Chrome had won the Kentucky Derby and the Preakness, the first two storied major races for three-year-olds, and thus had a shot at that rare feat, The Triple Crown, the summa cum laude of horse racing, if he went on to win the Belmont Stakes.

Well, California Chrome didn’t win the Belmont, but Donna Brothers did win me over, and I went out and bought her book: I didn’t really know why, until I was halfway through the book and read the name Secretariat, and felt a thrill run through me. Secretariat – that’s where this story begins.

In 1973 I was a graduate student at the University of Tennessee in Knoxville. I was in my second year in the program, plugging along towards a Ph.D. Studying, attending class and more studying was pretty much my whole life. I knew we were supposed to be fascinated by research, and shooting for a professorship somewhere, preferably at a ‘good’ school. The phrase, “clinical work”, i.e. doing psychotherapy, was usually accompanied by a tolerant frown: oh sure, you were supposed to know your transference from your elbow, and maybe “keep your hand in” by seeing a few patients when you became a professor, but beyond that, well – making a career out of it was simply beneath a serious “scholar-researcher.”

But not for me. In my mind, I was at a trade school, learning my trade: psychotherapy. And to get a license to practice it, I had to jump the hurdles they put in front of me: a make-or-break test the first year, called Comps; a make-or-break test the second year, called Generals (I still shudder at the name), and of course, the crowning glory of all this foolishness, a Dissertation, which you ‘defended’ in your Orals. There may have been even more make-or-break stuff, but in my dotage, I have developed a blessed amnesia for all of it. Nowadays, of course, one can get a Psy.D. pretty much anywhere, which is as close as you can get to actual trade school for doing therapy. After all, Medical School is basically a trade school for doctors, isn’t it? But not then: it was Research Or Bust, and I was determined not to bust.

Well, one day someone happened to mention that, for a nominal sum, you could go see the Kentucky Derby with a group of students, Louisville being not all that far from Knoxville. Imagine that: there was a real world out there, where people actually did real things, and had actual fun! It appealed to me immediately, and I ponied up the necessary grubstake (and when I say ‘nominal’, I mean nominal – I think it was maybe fifty bucks for the whole shebang – transportation, accommodations, and the race itself). Wow, real world here I come!

We piled into an ancient, rattly bus and were off, our sleeping bags stowed in the hold and our bag lunches on our laps (I’m pretty sure we also brought our own three-course dinners for the two nights: cold cuts, chips and Sno Balls). As I remember, the “accommodations” were south of spartan: throw your bedroll down on the concrete floor of a huge warehouse somewhere on the outskirts of town, and try to catnap through the obnoxious blare of the country music that was the lingua franca of U.T. degree-seekers of the time. But no problem: we were in the real world, going to a real event!

The next day we bussed it to Churchill Downs, bleary-eyed but ready to grab the brass ring of history. Everyone went his or her own way: our tickets were for the infield, the horse racing equivalent of baseball’s bleachers, or maybe a knothole in the fence. Oh well, we certainly didn’t have to worry about being overdressed: anyone who had a pair of overalls, shorts or holey jeans to his name was a king. To say people were drinking – well, let’s just say Southern knighthood was in full flower, with multiple mint juleps in plastic cups being the order of the day for those who weren’t guzzling Gallo red or Thunderbird from tote-along jugs, or mixing beer with pink gin shot from squirt guns. Holy hell would be a nice, quiet term for the din and riot of sweaty humanity that spun and thrashed on that grass oval inside the track. Hieronymous Bosch comes to mind.

Well, I had done my homework: I knew a horse named Secretariat – supposed to be pretty good – was the favorite, and I lined up and bought a win ticket, which was something called an ‘entry’ – you bet on two horses at once. I didn’t care if it was madness all around – I had a ticket on the favorite, a plastic mint julep in my mitts, and, after a half hour of pushing, shoving and fierce body blocks, I had myself positioned at the finish line.

They’re off!

Now the insanity rose to new heights, with people climbing on each other, screaming and contorting in ways I didn’t think possible for homo sapiens. Since I had traded any shot at an over-all view of the course for my one millisecond of glory at the finish, all I could do was battle to hold my position in the hysteria and wait it out.

Crowd: Here he comes!

Me: Who?

Crowd: Look at him go!

Me: Where?

Crowd: They’re cominnnnnnngggggg,….!!!!

I pushed, I shoved, I jumped up for a second’s peek. I held my ground savagely, like a nose guard protecting his quarterback. This is MY territory: they shall not pass!

Now I could FEEL ’em cominnnngggg – I pushed forward at the exact instant a huge, reddish monster crossed the finish line. I thought I saw the ‘right’ number flash by, somehow, identifying him as my horse. Could it be…

Crowd: Secretariat! – you did it! We love you, Big Red!

Bedlam, crazed joy, roistering insanity ensued.

By god, ‘We’ had done it – Secretariat and me. Or maybe, me and Secretariat – my old pal, my running mate, my bosom buddy. (Well, possibly, in all candor, seven or nine mint juleps were kicking in by now, as I reveled in my spiritual brotherhood with Big Red, what with my having bought the ticket and all.)

Then I heard the buzz around the infield:

Look at that time!

This is crazy!

Not that I understood a blessed thing from watching the time they posted: 1:59 2/5, but word soon zinged through the crowd like an electric jolt: New Kentucky Derby record! New track record! My god, it was a mythic race, after all – I had seen history made.

After that, Big Red was my horse all the way, as he cruised through the last two legs of the Triple Crown, not only setting Preakness and Belmont race records, but track records for the distance in both of the runs – records which still stand today. If you want a real thrill, and a glimpse of Big Red’s dominance, listen to the announcer at Belmont call the race here.

I can see you saying, “So, what’s your point?”

My point is simply this: your relationship to things changes drastically, when you have a ‘rooting interest’ in them. For years, I never understood why gambling on sporting events was such a big deal: after all, to me, the games themselves were ‘enough’. And why did the Commissioners of Baseball, and Football, seemingly tolerate, maybe even encourage gambling, and betting, on the games, when ostensibly they frowned on such activity? Now I understand: for most people, the games are not enough – they get personally interested only when they have a personal stake in the ‘action’. Like me, in my ridiculous identification with Secretariat in 1973 (and ever after), they feel WE won the game when their ‘guy’ wins, or even that THEY, themselves, won the game, when their team, or horse, wins. It’s not “they did it,” but “we did it” – i.e. a guy roots fiercely only because his own ego (and adequacy, and expertise) is on the line. And, by the same token, if ‘his’ team, or horse, loses, he not only feels a sense of personal failure, but often that the team, or horse, let him down.

So what happens as soon as a new patient walks in the door, sits down and tells you his or her story? You start to develop a ‘rooting interest’ in them, that you would not have had before. In a certain sense, their triumphs become YOUR triumphs, their failures your failures. This is what “makes it a ball game”, to continue the sports analogy – much as the bettor now feels an identification with ‘his’ team’s outcomes. This is the same thing that happens with one’s children, of course, or other family members – a child born to you becomes more than a child, it becomes part of “we”, and you rise and fall with its progress, step by step. Just this – this primal “family identification”, is the real source of why people are so absorbed in sports: going to your home team’s baseball game is more than being a fan – it is being part of a family: it is suddenly okay to talk to the guy next to you; regardless of ethnicity, social class or anything else, you’re brothers for three hours.

And this, to me, is the joy of being a therapist: I care in a deeper way about people than I would if I saw a stranger on the street. Yes, Charlie Brown famously said, “I love humanity – it’s people I can’t stand!” – but the converse is true, too: you can’t possibly care about, and feel for, humanity what you can feel for those who are ‘your people’. Having a therapist-patient relationship with someone pulls the caring out of you – you’re on the same team now, and you have an ego stake in the outcome – no, not to the point of your feelings dominating the scene, but in terms of rooting for the patient, much like a parent would (or should) do. Yes, therapists are taught in school to hide their feelings (even from themselves), to remain ‘objective’ at all times, to maintain a detachment from the patient, and there is a place for this, but come on folks: the experience of being CARED about by someone is a huge part of the healing process for therapy patients.

I wish student therapists (and I have seen so many of them in therapy) were encouraged a little more to admit and acknowledge their feelings openly, rather than (artificially) suppress them, in the service of ‘doing it the right way’ and looking good (i.e. safe) to the supervisor. For only by acknowledging the feelings to yourself, can you make sure they are used in the service of the patient, rather than bubbling along below the surface, creating unconscious imperatives for the patient that neither of you even recognizes (and often repeating the exact unconscious family dynamics that brought them to therapy in the first place). A ‘rooting interest’ is GOOD – it is only misusing it, denying it, or hiding these feelings, that causes trouble. We care because we are personally involved – yes, personally – not just because “I care about people” (i.e. generically).

Sure, we all “care about people”, in the abstract, but what makes you Root for someone, Fight for them, Think about them, Worry about them, and even be willing to Suffer for them, if necessary? Personally caring – that’s what. Having some of yourself invested – that’s what. Feeling that if they win, you win – that’s what.

I came to the 1973 Kentucky Derby on a lark, to get a break from studying for a weekend. Yes, as a general sports fan, I knew the names of the most famous racehorses in history: Swaps, Whirlaway, War Admiral, Citation; the most famous jockeys: Eddie Arcaro, Johnny Longden, Willie Shoemaker, and the names of the ‘Triple Crown’ races: The Kentucky Derby, The Preakness, The Belmont Stakes, but that – a vague sentimentalized overview of racing’s “greatest hits” – is all I knew. But, because of what happened that day at Churchill Downs – happening upon probably the greatest running of the greatest horse racing event of all – I loved Secretariat to the day he died, and I cried – yes, cried – the day he died, a big red horse that I saw flash by for but a millisecond.

And that, more than all the damn courses I took on psychodynamics, differential diagnosis, or professional detachment, is what my whole career, and the enduring joy of my whole career, has been about: how to get involved, and stay involved; how to root for people, to live and die with them, to look at them in their tragedies and say, “We’re in it together”, to look at them in their moments of triumph and say, “We did it together!”

And that’s the story of Secretariat and Me.

 

 

 

 

 

 

 

 

 

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Understanding

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The Blue-Footed Booby

 

Understanding is the booby prize…
— Fritz Perls

People in therapy, people in crisis, people in flux, people in life, want to understand: and they want to understand NOW! They want to know what is happening, why, where it will go next, and everything else they can find out. We love to snoop on the lives of others, especially the ‘inside dirt’. We don’t like it, but when we see the latest copy of People, or The National Enquirer, or Celebrity Burn-Out, or see a headline, “Diana addicted to coke, says butler”, or “Donald Trump: Broke!”, we LOOK – we don’t like it, but we look. We compare, judge, and we congratulate ourselves for not being ‘them’, the famous ones who screwed up. We want to know ‘what went wrong’, and ‘why’?

Well, we do it to ourselves, too. We are cynical and mean to ourselves, we poke and prod and look for weaknesses, in our personal lives, in our work lives; we tear ourselves down when things don’t go so well, we wonder why we goofed up, why we did wrong – Why? Why? Why? If we could just UNDERSTAND, now that would fix everything.

People come to therapy to have you tell them about themselves:

What’s wrong with me anyway?

Why am I like this?

It doesn’t make any sense, but I keep doing it – why?

Always: WHY.

What is this obsession with understanding? Do we think we’re a geometry problem, and the therapist is the tutor? Even a good geometry tutor will tell you that merely giving someone the ‘answer’ is not enough: you have to pay attention to the student’s learning style, his anxieties, his learning history, his assumptions (I’m stupid; I’m lazy), and even that is not sufficient.

Even if the tutor had a perfect understanding of the student’s ‘issues’, it still wouldn’t be enough. Imagine merely explaining to the student: “You can’t learn geometry because your sister is supposed to be the one who’s smart at math, so when you contemplate a geometry problem, you’re actually not allowed to be smart enough to solve it, or else you’d upset the balance of the whole family. Oh, you can have art, and maybe even music, but as for math, the family says it’s a no-no: when it comes to geometry, you’re all washed up, dude.”

Now, do you imagine the student would jump up in glee and say, “Wow – so THAT’S it! Oh my god, it just dawned on me: I LOVE geometry! Praise the Lord, and pass me that theorem!”

I don’t think so. I’ve seen many, many therapy patients who have been in therapy before, sometimes many times before, and their most frequent complaint is this:

In therapy, I think I pretty much figured out what went wrong – what I suppressed, how my fears and insecurities are illogical, what my mother did, what my father didn’t do, how my sister lied to me and how the neighbor boys teased me: so why do I still feel the same, and why do I still do the same stupid things?

Notice that they don’t question the sacred assumption that Understanding is the Key to Change: they just wonder why understanding (all hail!) didn’t work, in their particular case. Or they may say, “I guess therapy doesn’t work for me,” thinking “therapy” equates to “understanding the reasons for your problems.” They even wonder, “Could there be something else wrong with me – something the previous therapists missed?” Maybe they were molested by aliens in a previous life, and in deep age-regression hypnosis, it will all come out? Maybe their sixth-grade teacher once said they were too dumb to take the college prep courses, and they repressed it and that scarred them for life? They want that “Oh my god” moment, the breakthrough insight, that will, as the motivational speakers say, “Unlock the joy,” “Free the soul,” and be “The key to unlimited power and energy”.

Well, we all want that. In the film noir, Somewhere in the Night, a young couple on the run bursts into a waterfront rescue mission to hide out from the bad guys. When the surprised priest asks them why they’re there, the girl answers, “We just came in to be saved.” The priest wags his finger, “There’s a little more to it than that, young lady.”

Indeed.

However, we persist in wanting to understand, to be told. Me, too: to renew my psychology license, I have to take continuing education classes. They’re usually not too horrible, but the bane of my continuing ed existence is when I hear these most dreaded of all words:

It may not have been clear in the syllabus, but this class is mostly experiential: so break up into small groups, please.

AAARRRGGGHHH!!! NO – not that, anything but that! This is when I suddenly have to weigh how much I paid for the course against the relief of fleeing the room and living to be educated (properly!) another day. I want to say, “Look – if you don’t have anything to tell us, why don’t you just admit it, instead of making US do all your work!”

Is that true? Is it fair? No, of course not. I’m sure most of the instructors had marvelous reasons for asking us to break up into small groups, and had a lot to say, but knew we would learn it much more efficiently if we experienced it, rather than sat and listened to it. That is, I’m sure, but I don’t really know, because I usually didn’t stay.

And, likewise, ‘getting better’ is a lot more than understanding. I hate to be the bearer of bad tidings, but like in those horrible continuing education classes, it has to be experiential, not just didactic. As the therapist Frieda Fromm-Reichmann once said,

The patient needs an experience, not an explanation.

No, we don’t have to break up into small groups (thank god), but we do have to have something happen in the therapy relationship, something you can’t get anywhere else, short of a good childhood, and if you’re reading this, you’re probably more than two or three years old, so we can assume it’s probably too late for you to have had the ideal formative experience the first time around.

So, does the therapist become a second parent? No, that’s not necessary. But the therapist does have to perform some functions of the parenting process, and I might add, not only be a ‘good parent’, but a ‘corrective parent’, which is a hell of a lot harder, because you are not only providing good parenting, but compensating for the questionable parenting the patient has already had, whose effects now have to be superseded by the therapy. (The parents got 24/7 access to the patient, from birth to at least 18 years of age, to make their mark; you, on the other hand, get 45 minutes, once or maybe twice a week, to do your thing: foul!) It may seem a crass analogy, but in truth, the therapist is more like a maid than an architect: you don’t get to build the initial structure – you get to clean up the mess someone else has made. And no, I’m not disrespecting what parents do here: I’ve been one and done my share of screwing up, despite my best intentions, and I’ve also been the father of grown children in therapy (ouch!), so I’m talking about damage done (mostly) unintentionally, by parents who are giving it their best shot.

Does that mean the therapist has to care about the patient as much as a parent does? Well, that depends on what you mean by ‘care’. Once, after having had to face a slew of ugly things about my upbringing, I snapped scornfully at my therapist, “Are you telling me hired help (aka my therapist) loves me more than my parents did?” He flinched a bit, but got it together and answered, “No – but maybe more effectively.” Well-played, lad.

A colleague of mine, who went into research, and looked down upon psychologists who ‘wasted their talent’ on becoming therapists, once said to me, “I don’t see how you think just talking to people is going to change them.” I answered, “It’s talking, but in the context of a relationship.” The talking is the ‘words’, but the relationship is the ‘music’, and it takes the skillful use of both to make any kind of magic happen.

Of course you (the patient) want to know “what’s happening,” but in fact, it’s mostly not particularly important that the patient know what’s happening. Because, contrary to the patient’s expectations (and wishes, sometimes), the locus of control is mostly with the therapist, not the patient. It’s not, as most patients would prefer, “Tell me what to do, so I can go off and do it,” it’s more like, “Do me right, for god’s sake, so I can get out of here.” If the therapist knows what he or she is doing, the patient mostly has to show up and be willing. In fact, constant questioning (“Are we there yet?”) is usually detrimental to the process. It’s like planting a plant, then pulling up the roots every ten minutes to see how things are going: it kills momentum and breaks the ‘spell’ of the work.

Frequently, when the patients get frustrated, or confused, or stuck, they say, “What am I supposed to be doing?” or “What am I doing wrong here?” And my response:

“Raise your hand if you’re being paid to do a job right now, please.”

Whoops – I am the only one with his hand in the air, which is as it should be. I am the one who’s supposed to “know what he is doing,” and if anyone is “doing something wrong,” it is I, not the patient. Do I understand what is going on? Usually, yes. Does the patient need to understand what is going on? NO – in fact, if you’re strictly on the ‘understanding’ level, you’re not present enough for therapy to happen. Therapy involves skill, expertise, patience, caring and self-honesty, on the Therapist’s part: the therapist is working, the patient is just required to show up and try to be open, allowing, and willing, if possible, though granted, even that is often not possible, since the patient’s past experiences with sharing, closeness, intimacy and trust have not been such that they are particularly interested in repeating them: after all, that’s why they are in therapy in the first place.

Of course, the patient has a very important, and difficult, role, too, and that is making his ‘insides’ available to the work. I often explain to people I work with:

  It takes two of us to pull this off: I am Mr. Outside, and you are Mr. Inside*. We both need each other: you can’t know what you look like from the outside, and I can’t know what it’s like to be you on the inside. We have to work together, and neither one of us alone is sufficient.

So, therapy is about willingness – about doing, not understanding. As someone smart once said,

If you want something different, you have to do something different.

Note: no mention of “understanding” there. It’s all about willingness. Your mind is just a bystander: sometimes it can help keep you there, by overruling your feelings, which are telling you to flee, like I did in those horrid continuing ed classes. But usually the mind is not particularly an ally of therapy: it is the one that doubts, that questions, that interrogates, that says, “This doesn’t make any sense,” and the famous: “I don’t understand what’s going on here.”

Even when I Do try to ‘explain’ to people what is going on, and why, it often flies right over their head, for a couple of reasons: one, if a patient is actually ‘there’, he is not in a place of words, but of experience. Also, what makes us think that words should necessarily be able to express everything perfectly, or even adequately? How well do they express feelings, flights of fancy, hunches, the quick cuts of the mind? Consider the following sequence, where I had a small ‘insight’ about a patient. If I tried to ‘wordify’ it for the patient, it would go something like this:

Wow – when you said ‘I guess my mother was kind of smothering’, I immediately thought of what you said about your brother being overweight, then I jumped to that time I was in Point Reyes and the cafe was closed, and I was really hungry, and a woman outside offered me a bagel, and I was really grateful, then I jumped to what you said about your mother offering food as love, then I thought about how the time spent doing the cooking is a form of love, and how she probably didn’t feel she had anything else to offer you, so she pushed food at you, and then I realized that she was probably kind of empty inside, and I felt kind of sorry for her, but she is still responsible for her behavior, and then I realized that what you experienced as smothering was really a kind of desperation on her part to get you to love her even though she didn’t have a lot to offer, and that made me really sad for both of you, and that brings us up to date. Any questions?

Do you really want to hear all that? Words, words, words. This is why many, if not most, things of significance that happen in therapy are silent, expressed in gestures, looks, feelings. As the Bible expresses it, “the peace of God, which passeth all understanding”. (In fact, there is a very good article expressing a lot of what I am discussing today, but from a religious perspective, right here.) Or, if you prefer Shakespeare: “Truth hath better deeds than words to grace it.”

It is more about the willingness to trust – the process, the therapist, oneself, than about understanding. In fact, understanding is often wheeled in as a deterrent to therapy, by the forces of negativity, of going-it-alone, and self-sabotage (aka the Goon Squad). Someone can be right in the middle of doing amazing work, when they suddenly look up with a face full of tears and say, “Is anything even happening here?” I often liken it to a boxing referee, stepping in to say, “Okay, you two, break it up!” The Goon Squad hates the trust, the closeness, the openness, of a good therapy relationship, and loves to find ways to distract from the work, to hijack the patient’s mind with sudden questioning (“So – remind me: what are we doing here again?”), anything to “break it up”.

So, is understanding really the booby prize? Well, it has its uses, mostly in the area of using the mind to override the inner forces that try to derail you (“I’m a big fat failure – I should quit now”; “That term paper will keep — nothing wrong with getting high just one more time, is there?”). But for the big stuff, understanding is just along for the ride: understanding how to swim, is not swimming! And understanding your problems, or ‘how therapy works’, for that matter, is not the same as participating actively in the healing process.

So, why settle for the booby prize, when you can have the Grand Prize: a life of your own!

 

*Mr. Inside and Mr. Outside originally referred to the West Point football players Glenn Davis and Doc Blanchard, who played on the great Army teams from 1944-46. And no, this won’t be on the test!

 

 

 

 

 

 

 

 

 

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

Dive! Dive!

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I have always had a fascination with World War II submarines. Is it the beauty and deadly efficiency of the sub itself – a shark on the prowl, unseen, in enemy waters? Maybe. The adventure of setting out on a daring voyage where the possibility – the likelihood, even – of death, from depth charge, from bombs, from equipment failure, from human error, is your constant companion? Possibly. The thrill of being on watch, topside, in the middle of a star-choked night, plunging along at flank speed, with the spume of the huge black waves breaking against your face, just a speck in the glory of all creation? Could be.

But I think it has more to do with being part of a group of men of solitary purpose, there by choice, not conscription, hidden to the world, unknown to most, misunderstood by many, maybe even a bit crazy, but putting that one crucial task above all personal concerns: sink enemy shipping.

In the classic submarine movie, Destination Tokyo, one of the older, married men is explaining what he likes to do when on shore leave: “You fellas know me – I’m no highbrow. When I come home, if there’s any grand opera playing, the whole Connors family goes down there twice a week. Don’t ask me why, but to me it’s like going down in a sub. You shove off, go deep under the sea, and when you come back up, you’ve got something inside, that’s never been there before.”

That’s as good a description of therapy as any I’ve ever heard. It’s a secret mission, strictly confidential, not talked about ‘on the outside’ by the therapist, of course, but usually not even by the patient. You are there to do the hard things you can’t do on the outside – face big fears, make big decisions, ask the hard questions, look at your life unvarnished, tell the whole truth, trust someone else, trust yourself.

And it is certainly judged, questioned, misunderstood and even mocked by those not in the know. My father’s assessment of my career plans: “Why would you want to sit there and listen to a bunch of women whine about their problems all day?” My friend’s father, when I came home to visit, would always snort, “So, all your people still in a tizzy?” My mother was just quietly disappointed that I wasn’t a ‘real doctor’. One of the fathers at my son’s soccer awards dinner leered, “So, how many you got in your stable?” And I can’t count how many people have said versions of, “How can you just sit there like that and hang out with weak, needy people?”

Well, I’ve got news for them all: I get to hang out with my kind of people – the kind who are truth-tellers, seekers, the kind who have the courage to say they don’t know, to admit mistakes, to sit with terror, disappointment and tragedy, to learn how to grieve, how to have fun, how to be a real woman, how to be a real man, how to be a person, and hardest of all, how to be themselves, right out loud.

We dive down into the frightening waters of the past, and learn how to have a different relationship with it all, so that it doesn’t control the present, and future. We find out that, as a team, we can do things that we couldn’t have done alone. We find out that we DO need other people, but that to need isn’t needy – it’s just human. We find out that claiming our own perceptions, and living by them, isn’t selfish – it’s just selfing. And we try on new ways of being that seem unnatural and foreign at first, but we keep at it until they’re a part of us:

The ex-nun who felt so self-conscious when she first wore high heels for her new ‘civilian’ job that she could barely leave the house on Monday. By Wednesday, she felt like a whore. By Friday, she said that for the first time in her life, she felt kind of sexy.

The young man who had spent his whole life in his room, trying to ‘level up’ in video games, who reported that, even though he was terrified, he went to a school dance and had a good time. He raised his head and, looking at me directly for the first time ever, said, “Gee, Dr. B – I guess I leveled up, for real.”

These, and many others, have had the courage to dive down and go to war with old limitations, parental voices that doubt and mock, ideas about human behavior that strait-jacket them, people in their lives who lie and hurt, assumptions about life that cripple and distort the beauty of who they really are, and what life can be.

Yes, we dive down together – and when we come back up, there is something inside, that wasn’t there before.

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.

The Mystery of All Beginnings

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It’s a wise child that knows its own father.

And furthermore, it’s a wise child indeed that really ‘knows’ its own father or mother. I was talking to an older patient the other day who is dealing with her own mother’s decline – making decisions about care facilities, sorting through the boxes and boxes that are all that is physically left of her mother’s life. It seems, and is, strange, that a whole life ultimately comes down to someone rummaging through boxes and saying “In” or “Out”, while a rented dumpster yawns outside. It’s enough to make you philosophical, if you’re an upbeat type, and downright sad if you have an unfortunate predilection for tragic sweep, as some of us do.

Anyway, as she picked, sorted and differentiated the formerly treasured detritus of her mother’s life, she found herself pondering just how well she really even knew her mother. And this got both of us to wondering how well our children know us.

I suppose everyone is now familiar with the term ‘transference’ – the mainstay of traditional psychotherapy. This means, in the Freudian interpretation of things, that the patient will transfer (i.e. project) onto the therapist elements of relationship (internalized transactions, views, issues, interactions, identities, images and ways) that the patient experienced with key figures from their past, usually parents. But what one begins to realize after years of doing therapy, is that this ‘transference’ is also in play in how people relate to their own parents, as well. That is, very often the child’s-eye-view of a parent is skewed, distorted, and colored strongly by a myriad of factors, among them the one-off peculiarities of that child’s relationship with the parent, the stage of life of the parent (and the parents’ marriage or other significant relationship) when the child was young, the specific issues that were going on at the time for the parent (that may or may not be characteristic of their life as a whole), and things the child literally does not know about the parent and his or her life.

This is one of the reasons why I often make it a point to meet the patient’s parents personally, if they are still alive. I sometimes hear things that astound me – no, not just “there are two sides to everything”, though that is certainly true – but things I could not have imagined. Things like this:

A mom who was bitterly described as “always distracted and preoccupied” by her grown daughter (my patient). The mother told me, in strict confidence,

Dr. B – I was battling cancer most of those years. I didn’t want to burden the kids by telling them about it, especially since I was a single parent. Oh sure, I guess I was preoccupied, but you have to understand I was all alone with my pain, and terrified about what would happen to the kids if I died. And please don’t tell her now, because after all, we made it through, so let’s just let sleeping dogs lie.

A father who was called “needy and over-involved” by his son, who confessed, tearfully,

I have to tell you the truth now. My wife, may she rest in peace, was having an affair with our minister for at least twenty years before the diabetes got her. I knew it all along, but she didn’t know I knew, and I never could confront her about it. Sure, I guess I did wrong by taking comfort in closeness with the kids, but she was gone a lot of the time, supposedly on ‘church business’, and I guess I covered up my hurt by throwing myself into being a dad. I know it sounds stupid, but I still loved that woman so much, I could never leave her. So, sure, I was a fool for staying, and I was over-involved with the kids, but sometimes, that’s life.

And often, parents say things that not only confirm what the patient has said, but confirm it in spades, such as this revelation by a woman in her fifties:

I know I should never have had a child. I had no business getting pregnant, and should have taken care of business when I did, but I was too scared to get an abortion, and I thought Joe would help out financially, but he disappeared right away. Honestly, it sounds horrible, but I resented every day I was saddled with that baby. I could have done something with my life, but instead I changed dirty diapers, did laundry and lived on hot dogs and beans. By the time the kid was gone, I was too old to train for doing anything worthwhile, so I got into a bad marriage, for financial security, which took even more years out of my life, and now, well, here I am.

Others are just as surprising – not so much in their words, but rather in their presence or personality. A man whom his son once described as “an overwhelming, towering presence” was in actuality a very slight, mousy man, with a barely audible voice. A woman who was said to be harsh and cold described, with obvious warm feelings, how much she had enjoyed baking brownies for her children’s friends.

Do I take all, or any, of this at face value? Of course not – but these things are all part of the ‘stew’ that makes up the complexity of any parent. Often, when meeting the parent, I will notice, with pleasure, things that are not on the ‘agenda’, such as how much the patient’s voice sounds like the parent’s, or certain small mannerisms of the parent that are echoed in the patient, or ways of saying things, expressions, attitudes, that have been inherited, or appropriated, by the child. Sometimes the parent will reveal hidden stories and motivations that are deep-background clues to ‘what happened’, such as the woman who told me she married the patient’s father on the rebound from her true love, or the accountant who told me that he was on his way to being a saxophonist with a top swing band, when his father died and he had to forget his dreams and get a job to support his mother and three brothers. These things matter, because children pick them up on an unconscious level, and often, knowing this information, you can see how these ‘undigested’ elements in the lives of the parents, play out in the lives, and choices, of the children.

Another thing that flavors this stew, is that families often operate on the level of mythology – aspects of the parents’ (and children’s) lives, and unquestioned ‘family values’ become distilled into a kind of handy (and oversimplified) shorthand:

You know Dad – he’s always happy-go-lucky.

Jimmy’s the brain, Johnny’s the athletic one, and Sally’s always been a dreamer.

Mom’s obsessed with cleaning – it’s all that matters to her.

Well, everyone knows the baby of the family is always spoiled rotten.

Mom and Dad never had a real argument in thirty-five years.

And on and on. While most of these things, like all stereotypes, have a basis in reality, we forget that they are merely short-cuts that ‘stand for’ the person, not the actual whole person. In therapy, we often spend a lot of time helping patients break out of these internalized family stereotypes of themselves, these iron maidens of the soul, and sometimes we help them confront their parents about having these simplistic, limiting views of them. But children do this to their parents, too.

I have often heard patients say that, for example at holiday get-togethers, when wine is drunk and old stories are told, they were shocked and surprised by the things they learned about their own parents.

Uncle Joe told me Dad used to be the one who approached the girls first, because he was the one with all the sex appeal.

My straight-arrow Dad used to sneak into baseball games at Candlestick Park.

Aunt Jane said Mom was a real hottie in her day.

I found out Dad used to be the middleweight boxing champ of the First Division.

And sometimes we glean things that are not so benign, such as past criminal behavior, legal and financial troubles, past marriages and/or children, stories, or whispers, of rape, incest, and other abuse, as victim or perpetrator. Often these things don’t ‘fit in’ with our set ideas about who our parents are, or were, or should be. Human beings like things seamless, packed nicely and tied up in a bow. But lives are not really like the movies – people are complicated and multidimensional, not all one thing or another. Therapy often involves helping people navigate the rapids of disturbing complexity: the woman who was molested by her own father, even though he was ‘the nice parent’ (as opposed to the mother), and in some ways a wonderful person; the mother who was always ‘nice’, but on closer inspection, turns out to have only shown a mask to the world, because she was in fact emotionally uninvolved.

Early in many people’s treatment, therapists have a tendency to reinforce patients’ key, monolithic views of their parents, in order to help the patient access, and express, all the unspoken, unprocessed negative feelings that have been crippling them. They must recognize, and ‘claim’, the child’s-eye-view of the situation, in order to establish a baseline self that they can build upon. At this point, if the therapist were to point out elements of the parent that run counter to what the patient is struggling to express, the patient might tend to retreat from manifesting the new self and say, “Oh, so you are saying I was crazy all along”.

But later in the process, when a more consolidated self has been established, it is sometimes possible to begin to broaden their conception of the parent, without it threatening the self – to begin to see the parent as “only human”, and to understand, in a new way, the actual reasons for the parents’ harmful behavior towards the patient, without using it as an excuse, or a negation of the harm, or of the patient’s (hard-won) feelings about it all. And sometimes this ‘humanization’ of the parent can help the patient adopt a more humane attitude towards him or herself as well.

It is a hard thing to see your parent – the being that was once the center of your world, a titan bestriding the earth, the being that all else flowed from – begin to age and fade, to watch a once-transcendent, critically primary life slouch towards obscurity and disconnection with “fortune and men’s eyes”. It is hard – partly because it is such a confrontation with the reality of our own onrushing fate – to see a life reduced to trash bags.

At those times, it feels as if the Government should provide a wonderful biographer for each and every person, to ensure that their struggles, their ups and downs, their failings and their dreams, realized and not, are properly documented for posterity, and maybe, to establish once and for all, who this person really was. Failing a wonderful biographer, we hope that we, as the children, have at least taken from them and their life story what was of value, what was significant, what really mattered. We hope that we have at least been a witness to their times, a fair witness who took to heart the meaningfulness behind whatever they had to give the world.

Though our aged parents’ last chapters are, as often as not, ignominious, we hope that we are at least the torch-bearers of whatever small measure of glory they possessed. Because, whether we really understood them or not, this carrying forward of their essential humanity is all that remains.

 

 

 

 

 

 

 

 

 

 

Note: All clinical vignettes herein are significantly altered to protect patient confidentiality and privacy.