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Dead Patients

Dead patients live on in my mind.   My relationships with them continue in quite different ways than when they were alive, much more one-sided, but still with considerable similarity.   They are with me even as I am without them in the outside world.   In some cases, I get to know them better or at least differently after they have entered the past tense .   While I was on vacation one summer a number of years ago, a patient of mine, a young man in his twenties, hung himself.   Suicide had been a preoccupation of his for many years as a way out, as a total solution to vexing problems. His death was a shock and also not a surprise because he had been on the verge of it many times.     After I heard I swam all the way around quite a large pond on Shelter Island. It was hard to assimilate what had happened, horrible to think of his resolve, of his last moments. I was very grateful to the fresh water for how it held me and still let me move.   I could not believe that it had happened and also did not have the luxury of not believing that it had happened.  I thought of all the things I might have done differently. I thought of the futility of this thinking.   Shortly after I got back from vacation, I met with the patient’s parents.   We had already spoken on the telephone, but this did not make the meeting any less difficult, any less heartbreaking. They had other children but the loss of this one... read more


Chungwo, China, Middle Kingdom – but my sense is “Middle Kingdom” may not give the full flavor of the name.   Kingdom that is the center of everything may be better. Or simply center of the world.   Bicycles are gone. Urban China belongs to cars in bewildering numbers being driven so assertively that it seems that a twenty four hour game of chicken is being played on the roads.   The pedestrian does not have the right of way and the carnage is considerable. Vehicles collide with vehicles and vehicles collide with people on foot.   You have to be very alert crossing the street.     In the last thirty years China has built a road system that spans the greater part of the nation. This has involved the construction of innumerable bridges, overpasses and tunnels. Much of motor vehicle travel in China feels modern, although there are anomalies.   On a road outside Pingyao a shepherd and his working dog are moving a flock of some hundreds of sheep. This brings to an unhappy halt convoys of heavy trucks headed in both directions.   Cars and trucks produce carbon emissions far beyond what bicycles do.   This is not good for the air.   In fact, the air in cities is often miasmatic, obscuring the sky, threatening the health of the lungs that breathe it.   Of course, the burning of coal, often coal that is dirty, is responsible for much of the degradation of air quality. The energy is needed to power development, but it comes with a bundle of costs.   Could development be smarter and slower?   “Ah,” says one of our local guides... read more


Each patient resonates differently. Resonance is a matter both of the inner strings of the therapist and of the inner strings of the patient.   When a note is truck near a piano, it often sets strings singing, waking sound from them by elective affinities. It is a matter of a string’s recognizing something of itself in the waves of sound that reach it.   So it is between patient and therapist.   Resonance explores links and kinships that may not be obvious.   One was a young guy, big, burly, voluble when his mood was not so low that it interfered with his getting out of bed. He was unmarried, without a girl friend.   He had no children. He had hallucinations, delusions.   Sometimes he did things hat made perfect sense to him, but only to him because he had his own distinctive take on what was going on around him.   Or you could call it his own idiosyncratic rake on things.   He was sometimes too much for himself, often too much for others.   His size scared people, as did his intensity, suggesting that he was out of control.   Most often, when others saw him as out of control, he was not quite out of control, near there but not having reached it.   He had suicidal impulses, not just when he was down, but also when he was flying high.   Yet he had never gone too far and injured himself or anyone else.   He could not tolerate sitting still in an office and talking.   So we walked and walked and walked and talked as we walked, noticing what was... read more