The unfinished stays with us within us, nagging at us in different ways at different times, sometimes with considerable creativity, sometimes just as a subliminal itch.

More than twenty-five years ago a patient came to see me with complaints that were in no way out of the ordinary. You will see as we go along that there is no way that I could violate his privacy rights by writing about him. He complained of being ill used at work, unappreciated at home. He wondered why it was his lot always to have to hold up under such a load. There were tinges of depression, even tinges of suicidality. I remarked that he maintained a peculiar subtle distance from all that he said, as if he were talking not quite about himself, yet not quite about someone else. In the fifth session, I had the sense of him fading out just a bit more, so that it was not exactly a surprise to me when he did not come for he sixth session.

He did not come and he did not call. I was concerned about him, puzzled about what had occurred in him, what had taken place between the two of us. I waited a week and then started actively to search for news of him. I called the phone number he had given as his home number. The person who answered the phone said she had never heard of any such person, that it was certain that no such person lived at this address. I called the number he had given as his work number. The person who answered the phone said he had never heard of any such person, but perhaps I should call the personnel people, whose extension he very courteously provided me. The woman in personnel was polite and then, after a few minutes of investigation, firm when she said no such person had ever worked for this large company. I asked if it might be possible that they had lost someone. She assured me that they kept very careful records.

I looked in the telephone book. I considered calling social security to see what they could tell me about the person attached to the collection of digits on the form I had in my hand. I realized that social security, in all probability, would refuse to tell me anything at all. What was on the form was, quite likely, just an invented set of digits crafted to look like a social security number.

So I was left with nothing at all. It has continued just that way until this very day. Needless to say, I did not get paid. I had no way to contact him. I had no no way to send out a bill. I was left with the astonishing idea that this man had made himself up in order to go tell a psychiatrist about his troubles which were some amalgam of real and imaginary, the precise proportion of each lying well beyond the bounds of specification. I had no inkling that he was psychotic. Was he dissociative? I had no way productively to touch this question. He was fictional, but very real. He had been in my office, shared space and air with me, even smiled shyly two or three times. He had simultaneously sought human contact and avoided it. His was an extreme instance of the injunction, “Hug me but don’t touch me.”

He has stayed with me over the years. I have told the story more than once to colleagues, friends, residents, framing it as an open ended riddle, any answer to which would necessarily be fictional. I have wondered about the varying extents to which patients make themselves up simultaneously to seek and avoid treatment and also about the varying extents to which psychiatrists and psychotherapists make themselves up in order to provide and to avoid providing treatment. The so-called real and the so-called fictional have complex and shifting boundaries, perhaps so complex and so unstable that they can not be specified. This is not a new frontier but rather a very old frontier.

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