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 around us. In the time I worked with him, we never found the right formula for controlling his ups and his downs. The walking calmed him and made him available to relate. It distracted him enough so that he was not so distracted in the channel of being with another person.
Manic depressive, yes, and significantly so.
But the reason I am writing about him, the reason that he has stayed with me is not because of that. The reason is another quality he had, his warmth. This resonated with me, making it possible for me to feel close to him, even when things were very hard for him and he was being very difficult. He let me come near and even indicated that he cherished this.
I do not know if he felt this way, but I felt that I was not so very different than he was. A few small twists of one or another sets of dials, or, as we would say now, a few tweaks of the genome and then a few experiential tweaks on top of those tweaks and I imagined I could have been him, not exactly so, but certainly approximately so.
I have some warmth, some wit, some experience of getting lost inside myself. Years after I stopped working with him, I had a serious loss in my family. He was in another state. I was surprised and not surprised to pick up the telephone and hear him say, “I heard you had some trouble in your family and I just wanted to let you know I was thinking of you.” I do not know how he found out, but the impulse to reach out to me was a kind one.
The second was thirty years older than the first. He had had some serious blows early in his life. He was married and had raised a family, worked and had his ups and downs. He was not as big, nor as burly as the first man. He had been more fortunate, although still beset by shifts in mood, ups that led him to erratic behavior that was not good for him and discouraging downs. Medication was more effective in helping him, once he agreed to take it, although, like so many, he did not want to need it.
He knew the city, its rough, ragged, sketchy parts and he knew people. He was a terrific raconteur. He told stories from last year, from ten years ago and from twenty and thirty years ago. They were colorful, full of drama, charged with narrow escapes. Reflecting and recounting now, he was amazed that he had not gotten seriously hurt or into serious trouble.
I learned a great deal about our city from him. In one session, I remarked to him that he reminded me of Saul Bellow, that his stories had so many layers, such detail, such pleasure in the telling. He brought people long gone strikingly to life. He was enormously pleased by this comparison, which he took as a great compliment, almost as if I had bestowed some local version of the Nobel Prize on him.
I did not make explicit that I had written a good bit, myself and that storytelling is important to me. Nor did I let him know that many of the stories I told about my life made me wonder whether I had lived them or dreamed them.
As time went on, he made it clear that he was always telling himself stories in his head. He was always rehearsing his interactions with others before they happened, so that he could keep himself from being taken off guard. He was in his mind the continuous narrator not just of what had happened but also of what might come to pass.
Throughout his life people had remarked what a nice man he was. He was a nice man, inclined to be friendly, not eager to hold grudges. He had a warmth that embraced people and that led to their embracing him.
There was so much to him that lay outside of the purview of manic depression. Working with him, I found it important not just to notice this but also to emphasize it. Yes, all the manic depressive features were there and he was quite a connoisseur of them. He remarked that he had been studying manic depressive illness for a long time and from up close.
What was harder for him to see was that his judgment of people remained quite good, that much of his thinking was accurate and that people valued him. His grown children often turned to him for help and reassurance. It was much easier for him to see when he was wrong than when he was right.
Warmth is the quality that stood out for me in these two men. It could stand out because I saw them often enough to have a relationship with them that had personal dimensions. I was able to work in the mode of attachment rather than in the mode of detachment. Far from clouding my judgment as a psychiatrist, this enabled me to know in much more depth whom and what I was treating. Just as it made the patients available to me, it made me available to the patients,
Warmth generates closeness and closeness generates warmth. Some resonances are deeper and happier than others, but it is vital that we let ourselves resonate with patients. It is vital that we recognize the kinships that make such resonances