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 black branches etched with white snow in winter have another appeal. Yes, there is the rocking chair. Yes, there is a dilapidated old footstool built in the hills of India by poor women many years ago.   It is leather with a top of hand woven many colored fabric. Patients put their feet on it. Many of them love it because it is battered and old and mutely expressive in its own way.

We speak ordinary English, each in his or her own way. Time ticks on in its accustomed way, although it doesn’t always seem so. Sometimes a second is viscous, like molasses dripping slowly. Sometimes it seems to rush. We are each trying to make our way through the life we have been given, the life that we have made. I suppose I am an expert in certain domains, but I am not very impressed with my expertise,   It is so small compared with what I would have liked to have understood. The patient talks.   I listen. I pay attention, even if my attention is a vagabond attention that wanders while it works.  

I have always been a story listener. Someone starts to tell a story. I am captivated.  It becomes in a peculiar way my story as the other person tells it. This is not simply confusion because I have a tiny bit of a craftsman’s detachment.   I listen but I’m always part way outside the frame of the story, as if I were aware that I might need to mount a rescue operation to protect me against the story’s enchantment.   Patients can tell more than one story at a time, so their words make a palimpsest with all the tensions that that implies. Patients like the rest of us are not reliable narrators, but sometimes narrators with a variety of different agendas and perspectives. This is not simple. I often feel that something, maybe what is most important, is missing.  I feel I am hearing hints, some meant to show me the way and some meant to throw me off track.

I was a story listener even as a little boy. I was fascinated with the stories that the older relatives told of life in the old country, of the hardships and intimacies there, the journey to this country with its perils and exhilarations. Were some of them icebacks – not wetbacks – crossing illegally south from Canada in winter? Or is that a story I’ve told myself?  I do not think so, but I know that memory is such a quiet fabulist, most insidiously inventive where we least suspect it.

I was fascinated with how their faces and their hands and the set of their bodies told the stories. It was an oral tradition, a tradition incarnate. I knew early on that there was so much they were not saying even as they said so much.   When she was seventy-five and dying of leukemia and I was twenty-five and emerging from a depression, my maternal grandmother mistook me for her father and spoke to me as if I were her father. Some questions were answered. My own father did not start to tell his story in words until he was safely past sixty. His losses had ripened within him over many years so that they could at last bear the fruit of speech.

Patients talk about anything and everything, They talk about shoes and spouses,  about hopes and fears, about guilt and delight, about wrong turns in their lives and right turns, too, about bodies and envies, about learning and failing to learn…and this is not even a full beginning of the list. They talk about rage and recovery. They talk about moments so tender as to be agonizing. They talk about life and death, about barrenness and creativity. They talk about why and why not.   They themselves often do not what they are going to talk about until they start and they often do not know why they started until long after.   They struggle to change as they talk and they struggle to stay the same.   It is unruly and fecund and it can go through long periods where it is repetitious and boring. These are no fun for me or for the patient.

Sometimes the patients aim directly at the listener, at me, Sometimes the focus is intensely on me. Other times they speak on slants, rising away, or diving down, or off to one side or another.   Sometimes they try to pretend that I do not exist so that they do not have to acknowledge that they are speaking. It’s about their speaking truth not just to power but to powerlessness, the different aspects of themselves, for even the most integrated person is not all that integrated.   We are multiliths not monoliths.  

Each patient creates an individual emotional force field which holds so much . I could say that each patient has a “vibe”, as we call it. in popular parlance, but I am afraid that this does not do the lived experience justice. It can be so dynamic and it can be so static. It can wake you up and it can put you to sleep, literally. I have found myself pinching myself to keep from falling asleep.   This may sound strange, but sometimes doing therapy can feel like sumo wrestling. I struggle to keep my balance and to stay in the ring with things that are very bulky.   Do I ever get to feel light as a feather? I am not so sure that I do.

Listening is an externally passive occupation that is internally very active.   The activity is contained and providing the containment is in itself work. It sometimes feels to me as if what patients recount gets at me from within myself, as if a guerilla detachment or set of guerilla detachments had crossed the border without being noticed and then proceeded to pursue their own tactical and strategic objectives.   Some sessions linger on – or should I say, linger in – for days or weeks or months or even years – for example, the woman whose mother never noticed what she liked to eat and fed her only what she imagined she liked to eat.   This went far beyond the genesis of an eating disorder, a severe one at that. This patient had a terrible time listening to herself at all.  

A patent walks out the door at the end of a session declaring that “It’s all over. You will never see me again.   I’m going to go home and kill myself.”   The door closes. I am still in my rocking chair. I have not even had time to start to get up, not that I know what I would do if I got up. I do not think that she is really going to do it. I expect I will see her again. I have heard this before.   However, what if…   This is a massive “what if…”   Because if she kills herself, she is dead and there is no recourse.  

She has young children. She is connected to many people.   Her death would ripple in the pond like a boulder.   Certainly, it would cause not only others but myself to question my competence. I would still be alive and do what I could to pick up the pieces but I would be very unhappy as I did so. I remain in my rocker, but one thing is certain, namely, that I will find it not so easy to stop thinking about her until the next session.   This may be the point of the whole maneuver. She can’t believe I cherish her enough reliably to hold her in mind, so she has to resort to emergency measures.

Why am I so tired at the end of the day? This has been a long meandering effort to produce something like an account.   I have a ritual when I get home. I go upstairs and change my clothes. I take work off and I put on a pair of battered old jeans and a worn shirt, so the feel on my skin is different.   I do this first thing. It is something I need to do,   It is more like changing my skin, perhaps, than changing clothes. I do not talk about what I have heard or felt during the day.   Or at least I rarely do. I try to let it be in the hope that it will let me be.

This is what it is all about, being.

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