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Pushing Seventy

I am pushing seventy, so that I find myself in what may be prime time for a psychiatrist who takes psychotherapy seriously and works with people in blocks of three quarters of an hour or an hour, instead of fifteen minute snaps, and across years and sometimes decades, not weeks or months.   So possibly I am not just old but old fashioned.   However, to describe something as old fashioned is not necessarily to deny it value. After all, the Pythagorean theorem was born long before any one now alive was conceived. However, as one gets older, it is hard not to reflect on getting older.   Many years ago the New York Times ran a piece by a retired psychiatrist who said that he had stopped practicing because he wanted to have time to read the great novels whose pages he had not yet turned.   The point of the essay was his remorseful discovery that the characters and situations in these novels, their plots and perplexities, were nowhere nearly as interesting to him as his patients had been.   He meant his reflections as a cautionary tale, a navigational aid to help others from going astray as he had. His words were generous.   Why are patients so interesting? In large part this is because we are interested in them.   It is not only the devil that is in the details, but also life itself.   Whether it is characters in a book or actual embodied persons in the consulting room, it is the organ of imagination that we use to take them up and in. Proust’s Baron Charlus and Hamlet and... read more

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.   On 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 one morning in... read more