Jul 19, 2010 | Imaginative, Psychiatric Writings |
Patient: “I’d like to be someone else, really, anyone else. I’d like to slip out of my skin and be free to become something I can’t even imagine. As it is, this skin has a stranglehold on me. I’ll die in it like a prisoner in his cell. It’s really quite simple: I want to be free and I want my freedom to have genuine meaning. I want to go somewhere that is not on my map.” Doctor: “Isn’t this why people take up acting, or become writers, or playwrights or even painters or sculptors or musicians? But perhaps actors go at it most directly?” Patient: “But actors bend the knee to reality. What they do is pretend and often wildly off the mark. When you think about it, acting is pretty shabby, quite without real convictions or daring. Seeming to take risks while not really risking anything is like eating your cake and having it, too. I acted in high school and in college and was told I was quite good at it, good enough even to warrant trying to make a career out of it. But as an actor I disgusted myself.” Doctor: “Why was that?” Patient: “I was a confidence man trying to play a trick that had little if any meaning. I suppose that now I act some in everyday life and certainly when I’m trying a case.I don’t know how I ended up going to law school. It was a whim, that was then unbelievably boring and then turned into a test of how much unpleasantness I could tolerate, an ordeal that challenged me,...
Jul 5, 2010 | Imaginative, Psychiatric Writings |
“I’d kill myself if I could attend my own funeral.” The speaker is a seventy-five year old man, a lawyer who specializes in wills and estates, always peculiar, now semi-retired with a sterling professional reputation as someone who can craft a complex trust so that it can not be broken. He is from an old family, himself the beneficiary of rich trusts, but has made a fair amount of money by his own labors in the arcane province of wills and estates. “The reason that I would like to attend my own funeral is that I would be the center of attention while yet remaining exempt from the obligation to exert any effort. I would be glad even to pretend that I wasn’t there. In life, if you want to be the center of attention it requires such a lot of work. It saps your energy to arrange your self-presentation just so after having compiled extensive intelligence concerning the tastes and distastes of those you wish to arrange in circles around you. It has always been beyond me. I have tried but I never lasted more than a few weeks. I can’t imagine running for office. I’m simply not robust. I’m not even sure I could serve as a hereditary monarch unless I were permitted to remain out of sight for decades at a time.” He has shown me pictures of himself from decades gone by. Tall and thin with an air of elegance, he is a handsome man in these photographs, perhaps with just a hint of fragility. Long nose, long thin fingers, pale blue eyes – in...
Mar 13, 2010 | Clinical, Psychiatric Writings |
I am listening to the psychiatric resident describe her session with her patient. She is well along in her training, reasonably poised and reasonably convinced in her approach. She is telling a story and, in this story, she comes off as both kind and competent, The patient comes off as a bit confused, clumsy, dependent, not very good either at thinking or feeling. The patient seems pale and out of focus. I keep wanting to sharpen the focus to make the patent clearer. Of course I can’t do this. I am mildly annoyed that I can’t – mildly annoyed at the patient, at the resident and at myself. I ask myself, “Why do you ask for the impossible? Why can’t you just be patient and let things be what they are and find their own natural pace of development? I am sitting in my rocking chair. I am, as more than one patient has pointed out, “on my rocker.” My rocker is a beautiful hand made cherry rocker with flexible back slats so constructed as to provide considerable unobtrusive lumbar support. The chair is the vanquisher of the back troubles that were incipient when I got it. For this, I am very grateful to it and to my wife at whose instigation I got it. It is the single most expensive piece of furniture I have ever bought. I remember how acutely uncomfortable I was waiting for it to arrive from northern California nine months after I had ordered it, how worried I was that after all the expenditure of money and effort I would hate it. I do...
Mar 13, 2010 | Clinical, Psychiatric Writings |
I sometimes urge that I should be titled the Vicar of Towson, since I specialize in vicarious experience, sitting and listening and living with what people tell me. I do this on the grounds of Sheppard Pratt, one of America’s great old and very beautiful mental hospitals. Just outside my office is a beautiful old ornamental cherry tree. I have lived in Towson immediately north of Baltimore for more than twenty-five years now. I am acquainted in depth and detail with many parts of town where I have never been or through which I have passed only occasionally – Dundalk, Glen Burnie, Pikesville, Pig Town, Randallstown and so forth. There are houses and and dinning rooms and basements and kitchens and bedrooms and yards and woods and school rooms that live vividly in my mind although I have never seen them and they existed in other times and other places. I have lived vicariously, too, in foreign countries – Israel, Iran, Zimbabwe,France, England, Trinidad, Argentina and more Proust wrote that “the only real voyage of discovery consists not in seeing new landscapes, but in having new eyes, in seeing the universe with the eyes of another, of hundreds of others, in seeing the hundreds of universes that each of them sees.” Psychotherapy is an art of such listening that the other can world forth a world, this world being his world – and have it shared, not statically, but so that it can live and breath, declare itself and grow. Psychotherapy is a partnership in presence. A good psychotherapist is a gifted story listener. In his great ballad about...
Mar 11, 2010 | Imaginative, Psychiatric Writings |
The eighteenth century French poet Jean Pierre Claris de Florian wrote, “Plaisir d’amour ne dure qu’un moment/ Chagrin d’amour dure toute la vie.” (Pleasure of love lasts only a moment; the sorrow of love lasts all of life) “ The twentieth century duo of bossa nova composer Tom Jobim and lyricist Vicinius de Moraes produced the lovely and haunting “Felicidade,” which begins, “Tristeza nao tem fin; felicidade, sim” (Sadness has no end; happiness, yes) How these two sets of lines, written centuries apart at a great geographical remove from each other resonate not so much in our minds alone but also profoundly in our hearts. Brazilian audiences often applaud with great fervor when Felicidade is being performed.There is no way to put into words how Tom Jobim’s music works, with its limber rhythms and understated fluency. But the music has a flavor that might almost be called a happy melancholy, a wise appreciation of what life is and of our situation in this life which is so rich and yet also limited. The pleasure of love and happiness are always limited in their tenure. We know this before, during and after. It is a knowledge against which we struggle, even one against which we revolt. Yet the struggle and the revolt are to no avail. We can no more give them up than we can prevail in them. We are well and truly caught. It is a part of our nature that we struggle and that we revolt against the fleeting nature of the pleasure of love, of our happiness. After the pleasure of love, after the intimate glory...
Mar 11, 2010 | Clinical, Psychiatric Writings |
Don Quixote, the incomparable, comic, tragic, absurd, possessed by his destiny, dispossessed of his life by his destiny, an explorer who leaves home to find himself but loses himself in trying to find himself, someone perpetually homeless and proud of this homelessness as a quest for the impossible but imaginable. Sancho Panza, a man like other men, moored in a web of human relationships, not so very grand, but very real, a nobody who is somebody by reason of how he carries being a nobody, being as close to the earth as any other clod, capable of a loyalty that is itself a kind of realization of the imaginary, someone who lives as himself but not so much for his own sake. A distinguished, tall, thin. extremely learned, very ill elderly man came to see me looking for I didn’t at the time know exactly what and I still don’t know exactly what it was that he was seeking. I find myself thinking he was looking to be made whole. In life as in the law this concept of being made whole is no simple one. This man yearned to be restored to being who he thought he was. Actually it went far beyond yearning to an insistence that bordered not only on religious faith but on an idiosyncratic religious fanaticism – “I can only be if I am who I take myself to be, even if who I take myself to be is not only complicated but also multiplex, fabulous.” Ailing had been an integral part of his life, reaching back into childhood. Part of ailing was an...
