Coming of Age on Zoloft (19 page)

THERAPY WAS NOT
like anything I’d ever done before. It was certainly nothing like seeing a psychiatrist. John didn’t have lists of questions. He didn’t even seem interested in coming up with a name for my affliction; I spoke to him of my depression, sometimes, but he rarely said the word back to me. Our fifty-minute sessions were formless, except for the form we imposed on them. We seemed to be engaged in a strange, noncompetitive sport with only one rule: you will sit in your chairs and interact.

I wasn’t even quite sure what I wanted from John. Partly I wanted help with the questions that had tortured me so much when I first showed up in town: What was I supposed to be doing with my life? Had coming to grad school been the mistake that it sometimes felt like? Somehow, the idea of being a person who got depressed and took antidepressants made those questions seem harder to answer. When I felt bad, did that mean that I was doing something wrong, or was it just a symptom, best squelched or ignored? Were antidepressants helping me achieve something that was healthy and good for me, or were they preventing me from finding my way to the life I was supposed to live—a life that would suit a version of myself that didn’t have to take drugs? These questions drove me wild, and I think I hoped that John could help me solve them, absolutely and forever. Most of the time, when I walked into his office with my cup of coffee, it was in the expectation of attacking one of these forbiddingly abstract topics head on. As I sank into the cushions of his red chair, though, I’d usually find myself diverted to more mundane concerns: boys I liked, my professors, my students, my family. Often I felt resentful about this, as if it were something that John, with his overwhelming interest in relationships, were
doing
to me. He was letting us get distracted from my Big Questions!

“You’re really concerned with being productive, aren’t you?” he said to me, sometime during our first month, when I chided us for losing sight of the target. I looked at him as though he’d just suggested that we both stand and throw money out of the window. But he had just delivered one of the first lessons of therapy, a lesson I kept getting dragged back to again and again during our two years of appointments. Our lives are made up of moments, brief interactions strung together into a whole. In a sense, the quality of a life is the aggregate quality of those moments; it is hard to be right in the entire picture of your life if you aren’t right in the details. Big questions can feel unanswerable because they often are. My fantasy of an equally big solution, he was saying, was never going to work. He wanted me to start by letting go of my dream of a top-down approach, and taking a clear look at the things that were right in front of me.

Week by week, we worked our way toward a routine. I brought John little stories about my past and my present, and he responded to them. There is a stereotype out there, in movies and TV, of the maddeningly quiet therapist, who says nothing or turns every statement into a cryptic question. John wasn’t quiet, though, and he wasn’t cryptic. He never gave direct advice, as much as I longed for him to. But I would tell my tales and give my own commentary on situations, and sometimes John would nod and say, “That sounds right,” as if he were a musician listening to a student piece and finding it harmonious.

The differences between the therapy I did in John’s office and psychiatry as I’d known it were numerous and often funny. Pharmacology sessions with Dr. Barbara had always seemed amusing to me because, although they were all
about
emotion, there was no emotion in them. Especially when I was feeling all right. After she quizzed me, via multiple-choice questionnaire, about my sleeping habits, and my intake of various lawful and unlawful substances, Dr. Barbara would get to the feely part of her interview. “Any thoughts of harming yourself, or maybe not wanting to live anymore?” she would read from her paper, in a gingerly nonchalant tone of voice. The question seemed to vaguely embarrass her, and it distinctly embarrassed me. “No,” I’d say heartily, feeling nothing but a wish to distance myself from this baffling hypothetical counterpart of mine who might find ordinary life so burdensome as to want a permanent way out. We’d make small talk for a minute, and then she’d hand me the prescription for the medicine that would supposedly re-arrange all my innermost feelings, and I would thank her blithely and say I’d see her next time.

Psychotherapy sessions weren’t just about emotion; they were full of emotion, sometimes so full as to border on the absurd. We’d sit there in our chairs like amateur astronomers on a blanket, ready to catch shooting-star emotions as they streaked across the sky. They weren’t hard to catch, because they usually announced themselves with a shower of tears. What is it about therapy and crying? I cried almost every time I went in. Sometimes I cried for what seemed like the majority of the session. I laughed too, but it’s the tears I remember most, leaching out of my face and into the endlessly crumbled tissues that I held in my hands. I cried when things felt good, and when they felt bad. I cried every time we began to talk about something that I wanted. I cried so much and so often that at one point I got grumpy and made a point of telling John that I wished he could hang out with me just once on the outside.
Oh yes?
he said.
What would that be like?
I told him there was more to me than tears and misgivings. “In the real world,” I said, “well, you know. I’m
fun.
”

WINTER GAVE WAY
to a muddy, slow-starting upstate spring. Graduate coursework hadn’t turned out to be as hard as I’d feared it would be. I had made friends with a group of people that included graduate students from various departments and a handful of people who weren’t involved with Cornell at all. We went to the same concerts, drank at the same bar, danced after hours in one another’s living rooms, and flirted and made out with each other in ever-changing though inescapably finite permutations. It was an unhurried life, and it left plenty of time to think about the work that John and I were doing. One thing that the cultural representations of therapy hadn’t led me to expect was how much mental energy it takes up. Especially in the first months, therapy was always there, like a program that runs silently in the background, hogging RAM. I began to watch myself in the world with a new kind of attention, and bring to John any detail that seemed like it might help.

One of the things that lodged therapy so firmly in my mind was its new vocabulary. Psychotherapy’s use of a special language is one of its most immediately obvious characteristics. It’s something we use to mock therapy (when we call it “psychobabble”), and sometimes this mockery is well deserved. But deliberate language is also one of the things that makes therapy work. John specialized in regular words employed in unfamiliar ways:
collude
,
ward off
,
integrate
,
bear. Attachment
,
projection
,
boundaries
,
wish.
Learning those words and the ways in which he meant them was like learning about a whole new system of forces at work on the universe. It reminded me of being in high school physics class, catching myself thinking about gravity, acceleration, and surface friction while I did something as ordinary as brushing my teeth.

John spoke frequently of “needs” and “unmet needs,” and I struggled with the meaning of these simple English terms. He asked me to consider what mine were, and I found it surprisingly hard to do. I was used to thinking about what I wanted to
achieve
down the road, or
how I wanted my life to be
, but this was different in some way that kept slipping from grasp: not about what would be impressive to me or other people, but what I really wanted, what felt good. One of the things I was curious about when I first came to therapy was relationships; I wanted to know why, after four years of serial monogamy in college, I suddenly didn’t feel like I had any idea about how to relate to guys. John helped me apply the question of needs to my various entanglements, to think out whether I was getting what I wanted from the men in my life. At the time, the answer was usually somewhere between “no” and “no way,” but just learning to ask the question had a revelatory value on its own.

John had a way of paraphrasing my stories back to me, so that I could really hear what I had said. Sometimes he would read between the lines, telling me about my own desires and interests as he understood them. Toward the end of our first session, he told me that I had a longing for deep personal intimacy but had had a hard time finding it. I felt like a rube at a storefront fortune-teller’s shop:
Gosh, I guess I do! But how did you know?
Later, when I remarked that sometimes I longed to be back in Portland or New York, he said, “So many of the things you miss are things with people.” This was so true, yet I had never put it to myself in just that way before—in the moments after he said the words, I could practically feel them being laser-engraved on my brain. I must have known on some level that connectedness made me happy, even though I had taught myself to consider time spent with other people to be time stolen from more worthy-seeming pursuits like writing or studying. But John named it, and over time that helped me to take it seriously.

I remember coming to feel as if I finally understood what therapy was. It happened when I realized that my relationship with John wasn’t just an irrelevant side effect of the fact that we spent a couple hours talking every week. In the early days, I used to get impatient: John would want to remind me that I could act toward him in any way that I pleased, or would want to know how it had felt for me to run into him by accident on the streets of town, and I’d get irritated—I didn’t come here, I’d think, to create yet another relationship in need of being analyzed! What I didn’t understand until later was that therapy works on the premise that our lives, and our relationships, are filled with patterns, and that themes that assert themselves in the patient’s other relationships will come out in the relationship with the therapist as well. The opportunity of therapy is to notice these patterns and work on them in real time, using the unusually structured affiliation between the therapist and the patient as a tool.

One day I went into his office and said to John, “Working on self-hate feels like trying to scratch my left elbow with my left hand.”

“Katherine,” he said, “that’s why there are two of us.”

IN THE END,
therapy isn’t as formless as the pop culture version of it sometimes makes it seem to be. It’s not just a sea of “say how you feel.” You do say how you feel, but over time all that talking and feeling, all that Kleenex, add up to a surprisingly logical activity. You are looking for patterns and trying to puzzle them out. Why is the experience of desire, for you, always followed by shame? Why does disappointment lead to self-hate, as reliably as a rifle shot generates a kickback? Therapy is about noticing these chains of emotion and working back through them link by link to figure out what’s going on.

As I went through this process with John, a wonderful change started to take place. For the first time ever, I began to seriously consider the possibility that I might make sense. As we put the basic pieces of the system in place, I realized that there were some things that were true whether I was on medication or not. Connection made me happy. Transitions were hard. I realized how many of my depressions had come at times when structure—school, a relationship, a job—was withdrawn, severing many familiar routines in one swoop. I started to appreciate that if I did certain things (spend time with a good friend, go to the gym, say “no” to obligations I didn’t really have time for), I’d feel better, and if I did other things (spend too much time without seeing people, pile on more commitments than I could manage in a certain span of time, indulge my crush on that emotionally vacant guy), I’d feel worse. Feelings, even my feelings, were subject to their own rules of cause and effect.

DURING MY SECOND
year in Ithaca, blundering around in the dimly lit stacks of Cornell’s graduate library, I stumbled across a book that would give me a more refined way of thinking about the magic that was happening in John’s office. Karen Horney was a German psychoanalyst who emigrated to the United States in the 1930s. I hadn’t heard of her, and I’d been looking for something else when I found her book
Neurosis and Human Growth
wedged into a bottom shelf next to some of the heavyweights of twentieth-century psychology, but its strange old title called out to me, and on a whim I took it home.

Horney’s premise was that, in childhood, most people suffer from the feeling of being small and powerless in a dangerous world; she considered the feeling so common that she called it “basic anxiety.” She believed that children attempt to soothe their fears and insecurities by resorting to their imaginations, beginning to picture a version of themselves that embodies all the traits that the child, or the people around her, find most admirable. By adolescence, these imaginings begin to solidify into the image that Horney calls the “ideal self.” Our ideal selves are the smartest, the kindest, the shrewdest, the most lovable—depending on how we want to see ourselves. But what starts out as a protective fantasy quickly becomes an instrument of self-torture too, giving rise to the tricky system of inner conflicts and secondary insecurities that Horney called neurosis. Specifically, she wrote, neurotics suffer from the strain of their own doomed quest to become the superhuman image they have created. They flagellate themselves with a barrage of statements that include the word
should
. The “shoulds” are the demands that must be satisfied in order to transform the neurotic person into his idealized self—and his failure to live up to them leads to the slow, seeping growth of self-hate.

Reading
Neurosis and Human Growth
was an astonishing experience. Horney wrote about things I didn’t know anyone else had noticed, let alone been able to explain. At moments, getting through it felt difficult and almost embarrassing; Horney hadn’t even had to meet me to see me at my worst. She had grasped the feelings of superiority I tried to hide, even from myself, and also the appalling lack of confidence that was right beside it. She understood what I’d never been able to, which was how the two could coexist, how they were actually functions of one another. But it was the understanding, of course, that made the reading bearable. It was worth being flayed a little to get a wise take on old mysteries.