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The strangest thing about Tanzania was how familiar it was to me in February of 2016 after a gap of nearly fifty years. 1. I left Tanzania in 1969. When I was there long ago, I was young and Tanzania was young. Now I am old and Tanzania is still young, very young, with a huge portion of its population under 20. It has an enormous and stunningly diverse youthful population that needs an education, work, a sense of purpose and meaning, pathways to dignity and integrity, pathways not so easy to find in the maze of the modern world in which traditions have been radically disrupted. My very first trip to East Africa took place when I was eight. I travelled through the portal of triangular postage due stamps issued by the Nyassa Company of Mozambique, then a Portuguese colony.   These stamps showed wildlife within their escalloped borders. I remember giraffes and zebras, each with a hint of the savannah behind them. These hints conveyed the vastness of the savannah and so, too, the existence of another world in which I was wholly absorbed. I would have loved to own these stamps, but knew better than to ask because I knew we did not have the money for such luxuries. So they remained in their glass case at Halle’s.   In retrospect this was a stroke of good fortune.   The imaginative experience remained free of the weight of concrete possession.   So it possessed me all the more deeply. I recently looked for these very stamps and found them figured on the internet, even as they still figure in my imagination.... read more

Devotion And Common Sense

I took on the inpatient care of an African-American woman in her later thirties after her previous psychiatrist was banished for misconduct and terrible judgement. I was a resident just about her age and the small extra amount of money I got paid for adding her to my case load made a difference to me.   She was intensely suicidal, but without vegetative signs of a deep depression. She had more children than fingers on one hand. It was her avowed purpose to treat each one as if that child were an only child. She felt that it was her job to give each child everything that child might need or want. These requirements were absolute, as she saw them. It was all too easy to see the shortcomings of such a model for practical child rearing policy.   From the point of view of psychological economy and personal energy it was obviously not viable.   A real effort to implement it could not help but leave a mother in a seriously depleted state. This was a grandiose project that demanded a regime of self-oppression that was virtually unthinkable.   It had no limits. Here she was wanting to end her life, refusing to make concessions to reality, as if any concession would be a source of boundless shame. The degree of harshness against herself, the all-or-nothing features of her thinking were striking. She was beautiful and quite used to being envied because of it, not that she ever avowed either of these. Her beauty was striking. It was something it was literally impossible not to notice.   She was intelligent.   She was quiet,... read more

Unaccountable Fatigue

Why am I so tired at the end of the day?   What do I do all day long? I sit in a handcrafted cherry wood rocker whose flexible staves provide exquisite lumbar support and talk with people.   I listen and I talk. More than one patient has remarked that it is good to have a shrink who is on his rocker.   Probably most of what I do is inside myself. I ponder. I simulate. I take in and I take on. I call on my own experiences to help me which means they come to life again. In this second (or third or fourth, but always from a slightly different angle) coming there is both joy and pain.   Most of the maneuvering I do is inside myself. Some of it has shape that I can describe, but most of it is well below the surface of declarative awareness.   It has to do with who I am and the road (or roads) I have travelled to get to myself. It is implicit in each breath that I take. Why am I so tired at the end of a day of being with patients? In one way seeing patients is absolutely ordinary.   I open the door to my office. The patient and I greet each other. We sit down. There is nothing so special about the furniture, the windows, the light, the rug on the floor. Yes, my office is in an old brick building at the top of a hill. Yes, just outside the window is an old cherry tree which bursts into glorious bloom each spring.   Its... read more


I am listening to a psychiatric resident describe her therapy session with a patient in her late fifties, someone whose attachments are unusual and unsatisfactory. Parents, spouse, children, step-children all present difficulties for this patient, who would like to bring people together and have them, if not cherish each other then at least get along without too much hostility and disharmony.   She does a lot of work to bring this about, taking care of diverse people in diverse ways. She does a lot of cooking in addition to her full time job which she enjoys and where she is recognized in a way that she is not in her personal life. The patient’s tone as the resident mimics it is a pale sort of whining, with some anger, but definitely on the mousy side. This is not a person who puts her foot down.   She is trapped in her relationships and yet they are where she dwells. She is not about to issue ultimatums to her husband or anyone else. She fears psychological homelessness. She is attached to the qualified loneliness of what she knows as opposed to the possible radical loneliness of major change.   She has come to psychotherapy for help which she rejects with each breath even as she seeks it. The resident who is kind, in her late twenties, interested, wanting to be of use,is completely baffled by the patient.   She says she has no idea what to say, so thatshe finds herself falling back on that ancient friend of the psychotherapist: “Um-hm,um-hm”. She can’t imagine what the patient is getting out of the sessions but... read more