Creatures of a Day: And Other Tales of Psychotherapy (18 page)

Ah yes, that thought experiment. I had forgotten all about that, though I didn’t wish to admit it. “So where are you in your thinking about that experiment?”

“I think I’ve found a solution. I’m pretty sure you were implying that I am lacking a self, that
I’m looking for me in you
, that my hollowness makes it impossible to identify my needs and my desires, and
that’s
why I didn’t or couldn’t make a decision about Marie and forced her to make the decision—and
that’s
why I craved some existence in your mind.”

I was stunned. Speechless. For several moments I just looked up at Jarod’s face. Did I know this man? Is this the same Jarod I’d met with for a year? His comments about the thought experiment were by far the most astute and honest comments about himself I had ever heard him utter. How to respond? As always, when I don’t know what to say, I stuck to the truth.

“That thought experiment was a work in progress, Jarod. I didn’t spend much time formulating it and had no definite answer in mind. It simply sprang up as we were ending our session, and I took a chance in telling it to you. My gut told me it might guide you to the right territory, and I think it succeeded. But let me ask something: I’m struck by your commenting that this is what you think
I
meant, what
I
thought. Can you own that yourself? What do
you
think?”

Jarod smiled, “Well, it’s impossible to answer that, isn’t it, because, if I lack a self, then who or what is the entity that’s positing its own nonexistence?”

Oops, there he is again, the old Jarod, full of pratfalls and paradox. I didn’t bite on this one, not for a second. “I don’t recall that you’ve ever spoken before of this feeling of hollowness. That sounds important, and we should spend time exploring that. I’m struck by how much this weekend seems to have affected you. You seem so much more open, more willing to examine your own mind. Tell me, what was there in Marcus Aurelius that catalyzed this change?”

“I
knew
it! I
knew
you’d ask that. I’ve been asking myself the same question.” Jarod opened his folder containing the pages of
The Meditations
and extracted a handwritten page. “Just before I came today I jotted down a few of the passages that made me shiver the most. I’ll read them. They’re in no particular order.”

I have often wondered how it is that every man loves himself more than all the rest of men, but yet sets less value on his own opinion of himself than on the opinion of others.

If any man despises me, that is his problem. My only concern is not doing or saying anything deserving of contempt.

Never esteem anything as an advantage to you that will make you break your word or lose your self-respect.

“I like these very much, Jarod. And, indeed, they do speak straight to the issue we’ve been discussing—that the center of one’s self-esteem and self-judgment should be within
yourself
rather than in the mind of another—that is, my image of you.”

“Yes, I’m slowly getting the point. Here’s another with a similar message:

“‘If someone can prove me wrong and show me my mistakes in any thought or action. I shall gladly change. I seek the truth, which never harmed anyone: the harm is to persist in one’s own self-deception and ignorance.’”

Jarod looked up from his page. “Sounds like these were written precisely for me. I have one last one. Shall I read it?”

I nodded. I love being read to, especially when the words are laden with wisdom.

“‘Remember that this noble vintage is grape juice, and the purple robes of imperial office are sheep wool dyed with shellfish blood. . . . Perceptions like that—latching onto things and piercing through them, so we see what they really are—that’s what we need to do all the time—all through our lives when things lay claim to our trust—to lay them bare and see how pointless they are, to strip away the legend that encrusts them.’”

A dynamite passage! It made me shiver, too. And as he read, I thought of how this session was a mirror image of our last one: today he the reader and I the listener.

“I think I know your next question,” said Jarod.

“And that is?”

“To be specific, to tell you exactly how these effected change.”

“You’re right on. Batting a thousand today. Can you take a crack at that one?”

“That seems so logical a question, but I can’t really give you the answer. It just didn’t work like that—it’s not that I read a wise statement and suddenly changed.”

Uh oh, here we were again. As usual, nothing was easy with Jarod. I longed for Andrew, who even without my prompting immediately pointed to the passage and the idea that changed everything for him. Why is Jarod so difficult? Why can’t Jarod,
just once
, act like Andrew?

“What do you mean, Jarod, ‘It didn’t work like that’?”

“I wrote down passages that had shiver power—passages that shook me up. But I simply cannot make the leap and say
these particular words, these very thoughts,
changed me. It didn’t work that way. There was no single epiphany. It’s more global. It was the overall process.”

“The overall process?”

“How to put it? Look, I’m blown away by this man’s daily practice of self-scrutiny.
Every
morning he took himself more seriously than I have ever done
any morning
in my entire life. I’ve taken him inside of me as a model of how to live. Last week I raised the question, ‘To whom was he writing?’ I understand now. It is obvious that his meditations are messages to his everyday self from that deep part of himself committed to live a good life. I think you implied that. Well, now
I
want to be able to do that. I admire him tremendously. What else can I say? Well, for one thing, this book, these meditations, make me see, really see, how truly fucked up I am. His meditations led me to understand that my whole life is wrong. I’m resolved to change. This week I’m going to level with both Marie and Alicia and tell them the truth: that I’m not ready for a committed relationship with anyone and that I have a ton of work to do on myself. I’m even reconsidering my professional life. I don’t love what I’m doing, and as I once told you, I think I chose to specialize in dermatology because it was an easier life. I don’t mean to knock my field—I mean that I’m not proud of my reasons for choosing it.”

Jarod paused, and we sat in silence for several moments.

But I wanted to know more. Though I’ve been treating patients for fifty years, I continue to thirst for answers to the question of what really helps.

“Jarod, I understand how you were affected by the overall process, and I’ll do all I can to encourage that process in the future. Nevertheless I still believe there may be some value in considering which of the specific meditations affected you. Can I take a look at the ones you just read to me?”

Jarod hesitated for a moment and then handed me the list.

I sensed his hesitation but decided not to comment on it. I knew what it meant:
I was out of tune with him
. My need to know is a good thing in that it fuels my interest in my patient, but sometimes, like that moment, it may be a bad thing in that I can’t be satisfied with simply being present in the hour.

After scanning the list I commented, “I’m struck that several of the meditations you selected point to issues of virtue and integrity. They stress that harm can come to you only through your own vice.”

“Yes, throughout the text Marcus Aurelius repeats that virtue is the only good, vice is the only bad. Again and again he makes the point that you, the core you, cannot be hurt if you maintain your virtue.”

“So in other words he is showing you the path to creating a positive image of yourself.”

“Yes, exactly. I heard that message loud and strong: if I’m virtuous and truthful, both to myself and to others, I will take pride in myself.”

“And when you do that, it won’t matter so much to you what image of you I have in
my
mind. One of my favorite psychiatrists, Karen Horney, wrote that if you want to feel virtuous, you must do virtuous things. It’s a simple and venerable concept, right out of Marcus Aurelius, and Aristotle before him.”

“Right. No more deception. Here with you or anywhere else.”

“Let’s start right now. We’ve still got a couple of minutes today. Let’s use them to check into the feelings you’ve had about me today.”

“Almost all positive. I know you’re on my side and doing your best for me. The only moment when I felt slightly annoyed was when you pressed me about which words of Marcus Aurelius really helped. I felt you were asking me to distort my experience to satisfy your curiosity or corroborate your hunches or maybe to categorize my healing process.”

“Point well taken, Jarod. Very well taken. It’s a good observation and it is something I’ve got to work on.”

***

B
efore my next patient I had ample time to think about Jarod and Andrew and the extraordinary drama I had witnessed. Once again I felt humbled by the endless complexity of the human mind and despaired at the vacuousness of my field’s attempts to simplify and codify and generate how-to manuals to treat patients in some predesigned collective manner. Here were two patients who dived into a great-souled man’s sea of wisdom, and each found benefit in a different way, in a way that neither I, nor any other mind, could possibly have predicted.

I wondered what this sea held for me as I approached my eighty-second birthday, full of life and passion and curiosity but saddened by the loss of so many people I had known and loved, at times mourning my lost youth, and distracted by my deteriorating scaffolding, my obstinate, creaking joints, my fading hearing and vision, and ever aware of the deepening dusk and relentless approach of the final darkness. I opened
The Meditations
, scanned the pages, and found the message meant for me:

Pass, then, through this little space of time in harmony with nature and end thy journey in contentment, just as an olive falls off when it is ripe, blessing nature who produced it, and thanking the tree on which it grew.

Afterword

The most important thing I, or any other therapist, can do is offer an authentic healing relationship from which patients can draw whatever they need. We delude ourselves if we think that some specified action, be it an interpretation, suggestion, relabeling, or reassurance, is
the
healing factor.

Over and again the patients in these tales found benefit in ways I could not possibly have anticipated. One patient anoints me as witness to the fact that a significant person had deemed him significant. A patient’s sense of fractured reality is mended by an unflinchingly authentic encounter with her therapist. Another grasps that real life is lived in the present moment. Another patient’s life is changed by my referring him to a household organizer. A nurse is introduced to her better self. A muted writer finds her voice. A dying patient’s last days are imbued with meaning when she serves as a pioneer of death for her friends and family. A patient, who is also a therapist, realizes that diagnosis may impair and distort understanding. A patient finds himself by emulating the practice of an ancient thinker. In each instance, I devised, or sometimes stumbled on, a unique approach for each patient that would not be found in any therapy manual. Because we may never know with precision
how
we have helped, we therapists have to learn to live comfortably with mystery as we accompany patients on their journey of self-discovery.

I write for those of you who have a keen interest in the human psyche and personal growth, for the many readers who will identify with the ageless existential crises depicted in these stories, and for individuals who contemplate entering therapy or are already in the midst of it. I hope these tales of reclamation will provide encouragement for those combatting their own demons.

It is also my great wish that the novice therapist will find value in this text. Its ten stories are meant to be teaching vehicles offering graphic lessons in psychotherapy that are not generally available in contemporary curricula. Most training programs today (often under pressure by accreditation boards or insurance companies) offer instruction only in brief, “empirically validated” therapies that consist of highly specific techniques addressing discrete diagnostic categories, such as depression, eating disorder, panic attacks, bipolar disease, addictions, or specific phobias. I worry that this current focus in education will ultimately result in losing sight of the whole person and that the humanistic, holistic approach I used with these ten patients may soon become extinct. Though research on effective psychotherapy continually shows that the most important factor determining outcome is the therapeutic relationship, the texture, the creation, and the evolution of this relationship are rarely a focus of training in graduate programs.

In these tales I hope to convey how a focus on the here and now can be used advantageously. Again and again I call attention to my bond with the patient: I do process checks; I inquire repeatedly about the state of our encounter during the current session; I ask if the patient has questions for me; I search for commentary on our relationship in dreams. In short, I never fail to place the highest priority on the development of an honest, transparent, helping bond between us.

I hope also that these stories will increase therapists’ awareness of existential themes. In these ten stories I view my patients as suffering from maladies that defy traditional categorization.
A young man attempts to ward off death terror through sexual vitality, an elderly man wrestling with the limitations of aging grasps for youthful spontaneity with its sense of unlimited horizons, a dying patient searches for meaning, a nurse ministers to others but cannot comfort herself, one person yearns for a better past, and another attempts to compensate for his missing sense of self by planting his banner in my memory.

Far more patients grapple with existential issues than is generally thought. The patients in these stories deal with anxiety about death, about the loss of loved ones and the ultimate loss of oneself, about how to live a meaningful life, about coping with aging and diminished possibilities, about choice, about fundamental isolation. To offer help, therapists need a keen sensibility to existential issues and must reach a formulation of what ails and what must be done that differs radically from formulations offered by clinicians of other orientations.