Maybe You Should Talk to Someone / Может, вам стоит с кем-то поговорить (by Lori Gottlieb, 2019) - аудиокнига на английском

Part One Nothing is more desirable than to be released from an affliction, but nothing is more frightening than to be divested of a crutch. —James Baldwin 1 Idiots CHART NOTE, JOHN: Patient reports feeling “stressed out” and states that he is having difficulty sleeping and getting along with his wife. Expresses annoyance with others and seeks help “managing the idiots.” Have compassion. Deep breath. Have compassion, have compassion, have compassion . . . I’m repeating this phrase in my head like a mantra as the forty-year-old man sitting across from me is telling me about all of the people in his life who are “idiots.” Why, he wants to know, is the world filled with so many idiots? Are they born this way? Do they become this way? Maybe, he muses, it has something to do with all the artificial chemicals that are added to the food we eat nowadays. “That’s why I try to eat organic,” he says. “So I don’t become an idiot like everyone else.” I’m losing track of which idiot he’s talking аbout: the dental hygienist who asks too many questions (“None of them rhetorical”), the coworker who only asks questions (“He never makes statements, because that would imply that he had something to say”), the driver in front of him who stopped at a yellow light (“No sense of urgency!”), the Apple technician at the Genius Bar who couldn’t fix his laptop (“Some genius!”). “John,” I begin, but he’s starting to tell a rambling story about his wife. I can’t get a word in edgewise, even though he has come to me for help. I, by the way, am his new therapist. (His previous therapist, who lasted just three sessions, was “nice, but an idiot.”) “And then Margo gets angry—can you believe it?” he’s saying. “But she doesn’t tell me she’s angry. She just acts angry, and I’m supposed to ask her what’s wrong. But I know if I ask, she’ll say, ‘Nothing,’ the first three times, and then maybe the fourth or fifth time she’ll say, ‘You know what’s wrong,’ and I’ll say, ‘No, I don’t, or I wouldn’t be asking!?’” He smiles. It’s a huge smile. I try to work with the smile—anything to change his monologue into a dialogue and make contact with him. “I’m curious about your smile just now,” I say. “Because you’re talking about being frustrated by many people, including Margo, and yet you’re smiling.” His smile gets bigger. He has the whitest teeth I’ve ever seen. They’re gleaming like diamonds. “I’m smiling, Sherlock, because I know exactly what’s bothering my wife!” “Ah!” I reply. “So—” “Wait, wait. I’m getting to the best part,” he interrupts. “So, like I said, I really do know what’s wrong, but I’m not that interested in hearing another complaint. So this time, instead of asking, I decide I’m going to—” He stops and peers at the clock on the bookshelf behind me. I want to use this opportunity to help John slow down. I could comment on the glance at the clock (does he feel rushed in here?) or the fact that he just called me Sherlock (was he irritated with me?). Or I could stay more on the surface in what we call “the content”—the narrative he’s telling—and try to understand more about why he equates Margo’s feelings with a complaint. But if I stay in the content, we won’t connect at all this session, and John, I’m learning, is somebody who has trouble making contact with the people in his life. “John,” I try again. “I wonder if we can go back to what just happened—” “Oh, good,” he says, cutting me off. “I still have twenty minutes left.” And then he’s back to his story. I sense a yawn coming on, a strong one, and it takes what feels like superhuman strength to keep my jaw clenched tight. I can feel my muscles resisting, twisting my face into odd expressions, but thankfully the yawn stays inside. Unfortunately, what comes out instead is a burp. A loud one. As though I’m drunk. (I’m not. I’m a lot of unpleasant things in this moment, but drunk isn’t one of them.) Because of the burp, my mouth starts to pop open again. I squeeze my lips together so hard that my eyes begin to tear. Of course, John doesn’t seem to notice. He’s still going on about Margo. Margo did this. Margo did that. I said this. She said that. So then I said— During my training, a supervisor once told me, “There’s something likable in everyone,” and to my great surprise, I found that she was right. It’s impossible to get to know people deeply and not come to like them. We should take the world’s enemies, get them in a room to share their histories and formative experiences, their fears and their struggles, and global adversaries would suddenly get along. I’ve found something likable in literally everyone I’ve seen as a therapist, including the guy who attempted murder. (Beneath his rage, he turned out to be a real sweetheart.) I didn’t even mind the week before, at our first session, when John explained that he’d come to me because I was a “nobody” here in Los Angeles, which meant that he wouldn’t run into any of his television-industry colleagues when coming for treatment. (His colleagues, he suspected, went to “well-known, experienced therapists.”) I simply tagged that for future use, when he’d be more open to engaging with me. Nor did I flinch at the end of that session when he handed me a wad of cash and explained that he preferred to pay this way because he didn’t want his wife to know he was seeing a therapist. “You’ll be like my mistress,” he’d suggested. “Or, actually, more like my hooker. No offense, but you’re not the kind of woman I’d choose as a mistress . . . if you know what I mean.” I didn’t know what he meant (someone blonder? Younger? With whiter, more sparkly teeth?), but I figured that this comment was just one of John’s defenses against getting close to anybody or acknowledging his need for another human being. “Ha-ha, my hooker!” he said, pausing at the door. “I’ll just come here each week, release all my pent-up frustration, and nobody has to know! Isn’t that funny?” Oh, yeah, I wanted to say, super-funny. Still, as I heard him laugh his way down the hall, I felt confident that I could grow to like John. Underneath his off-putting presentation, something likable—even beautiful—was sure to emerge. But that was last week. Today he just seems like an asshole. An asshole with spectacular teeth. Have compassion, have compassion, have compassion. I repeat my silent mantra then refocus on John. He’s talking about a mistake made by one of the crew members on his show (a man whose name, in John’s telling, is simply The Idiot) and just then, something occurs to me: John’s rant sounds eerily familiar. Not the situations he’s describing, but the feelings they evoke in him—and in me. I know how affirming it feels to blame the outside world for my frustrations, to deny ownership of whatever role I might have in the existential play called My Incredibly Important Life. I know what it’s like to bathe in self-righteous outrage, in the certainty that I’m completely right and have been terribly wronged, because that’s exactly how I’ve felt all day. What John doesn’t know is that I’m reeling from last night, when the man I thought I was going to marry unexpectedly called it quits. Today I’m trying to focus on my patients (allowing myself to cry only in the ten-minute breaks between sessions, carefully wiping away my running mascara before the next person arrives). In other words, I’m dealing with my pain the way I suspect John has been dealing with his: by covering it up. As a therapist, I know a lot about pain, about the ways in which pain is tied to loss. But I also know something less commonly understood: that change and loss travel together. We can’t have change without loss, which is why so often people say they want change but nonetheless stay exactly the same. To help John, I’m going to have to figure out what his loss would be, but first, I’m going to have to understand mine. Because right now, all I can think about is what my boyfriend did last night. The idiot! I look back at John and think: I hear you, brother. Wait a minute, you might be thinking. Why are you telling me all this? Aren’t therapists supposed to keep their personal lives private? Aren’t they supposed to be blank slates who never reveal anything about themselves, objective observers who refrain from calling their patients names—even in their heads? Besides, aren’t therapists, of all people, supposed to have their lives together? On the one hand, yes. What happens in the therapy room should be done on behalf of the patient, and if therapists aren’t able to separate their own struggles from those of the people who come to them, then they should, without question, choose a different line of work. On the other hand, this—right here, right now, between you and me—isn’t therapy, but a story about therapy: how we heal and where it leads us. Like in those National Geographic Channel shows that capture the embryonic development and birth of rare crocodiles, I want to capture the process in which humans, struggling to evolve, push against their shells until they quietly (but sometimes loudly) and slowly (but sometimes suddenly) crack open. So while the image of me with mascara running down my tear-streaked face between sessions may be uncomfortable to contemplate, that’s where this story about the handful of struggling humans you are about to meet begins—with my own humanity. Therapists, of course, deal with the daily challenges of living just like everyone else. This familiarity, in fact, is at the root of the connection we forge with strangers who trust us with their most delicate stories and secrets. Our training has taught us theories and tools and techniques, but whirring beneath our hard-earned expertise is the fact that we know just how hard it is to be a person. Which is to say, we still come to work each day as ourselves—with our own sets of vulnerabilities, our own longings and insecurities, and our own histories. Of all my credentials as a therapist, my most significant is that I’m a card-carrying member of the human race. But revealing this humanity is another matter. One colleague told me that when her doctor called with the news that her pregnancy wasn’t viable, she was standing in a Starbucks, and she burst into tears. A patient happened to see her, canceled her next appointment, and never came back. I remember hearing the writer Andrew Solomon tell a story about a married couple he’d met at a conference. During the course of the day, he said, each spouse had confessed independently to him to taking antidepressants but didn’t want the other to know. It turned out that they were hiding the same medication in the same house. No matter how open we as a society are about formerly private matters, the stigma around our emotional struggles remains formidable. We’ll talk with almost anyone about our physical health (can anyone imagine spouses hiding their reflux medication from each other?), even our sex lives, but bring up anxiety or depression or an intractable sense of grief, and the expression on the face looking back at you will probably read, Get me out of this conversation, pronto. But what are we so afraid of? It’s not as if we’re going to peer in those darker corners, flip on the light, and find a bunch of cockroaches. Fireflies love the dark too. There’s beauty in those places. But we have to look in there to see it. My business, the therapy business, is about looking. And not just with my patients. A little-discussed fact: Therapists go to therapists. We’re required, in fact, to go during training as part of our hours for licensure so that we know firsthand what our future patients will experience. We learn how to accept feedback, tolerate discomfort, become aware of blind spots, and discover the impact of our histories and behaviors on ourselves and others. But then we get licensed, people come to seek our counsel and . . . we still go to therapy. Not continuously, necessarily, but a majority of us sit on somebody else’s couch at several points during our careers, partly to have a place to talk through the emotional impact of the kind of work we do, but partly because life happens and therapy helps us confront our demons when they pay a visit. And visit they will, because everyone has demons—big, small, old, new, quiet, loud, whatever. These shared demons are testament to the fact that we aren’t such outliers after all. And it’s with this discovery that we can create a different relationship with our demons, one in which we no longer try to reason our way out of an inconvenient inner voice or numb our feelings with distractions like too much wine or food or hours spent surfing the internet (an activity my colleague calls “the most effective short-term nonprescription painkiller”). One of the most important steps in therapy is helping people take responsibility for their current predicaments, because once they realize that they can (and must) construct their own lives, they’re free to generate change. Often, though, people carry around the belief that the majority of their problems are circumstantial or situational—which is to say, external. And if the problems are caused by everyone and everything else, by stuff out there, why should they bother to change themselves? Even if they decide to do things differently, won’t the rest of the world still be the same? It’s a reasonable argument. But that’s not how life generally works. Remember Sartre’s famous line “Hell is other people”? It’s true—the world is filled with difficult people (or, as John would have it, “idiots”). I’ll bet you could name five truly difficult people off the top of your head right now—some you assiduously avoid, others you would assiduously avoid if they didn’t share your last name. But sometimes—more often than we tend to realize—those difficult people are us. That’s right—sometimes hell is us. Sometimes we are the cause of our difficulties. And if we can step out of our own way, something astonishing happens. A therapist will hold up a mirror to patients, but patients will also hold up a mirror to their therapists. Therapy is far from one-sided; it happens in a parallel process. Every day, our patients are opening up questions that we have to think about for ourselves. If they can see themselves more clearly through our reflections, we can see ourselves more clearly through theirs. This happens to therapists when we’re providing therapy, and it happens to our own therapists too. We are mirrors reflecting mirrors reflecting mirrors, showing one another what we can’t yet see. Which brings me back to John. Today, I’m not thinking about any of this. As far as I’m concerned, it’s been a difficult day with a difficult patient, and to make matters worse, I’m seeing John right after a young newlywed who’s dying of cancer—which is never an ideal time to see anyone, but especially not when you haven’t gotten much sleep, and your marriage plans have just been canceled, and you know that your pain is trivial compared to that of a terminally ill woman, and you also sense (but aren’t yet aware) that it’s not trivial at all because something cataclysmic is happening inside you. Meanwhile, about a mile away, in a quaint brick building on a narrow one-way street, a therapist named Wendell is in his office seeing patients too. One after another, they’re sitting on his sofa, adjacent to a lovely garden courtyard, talking about the same kinds of things that my patients have been talking to me about on an upper floor of a tall glass office building. Wendell’s patients have seen him for weeks or months or perhaps even years, but I have yet to meet him. In fact, I haven’t even heard of him. But that’s about to change. I am about to become Wendell’s newest patient. 2 If the Queen Had Balls CHART NOTE, LORI: Patient in her mid-forties presents for treatment in the aftermath of an unexpected breakup. Reports that she seeks “just a few sessions to get through this.” It all starts with a presenting problem. By definition, the presenting problem is the issue that sends a person into therapy. It might be a panic attack, a job loss, a death, a birth, a relational difficulty, an inability to make a big life decision, or a bout of depression. Sometimes the presenting problem is less specific—a feeling of “stuckness” or the vague but nagging notion that something just isn’t quite right. Whatever the problem, it generally “presents” because the person has reached an inflection point in life. Do I turn left or right? Do I try to preserve the status quo or move into uncharted territory? (Be forewarned: therapy will always take you into uncharted territory, even if you choose to preserve the status quo.) But people don’t care about inflection points when they come for their first therapy session. Mostly, they just want relief. They want to tell you their stories, beginning with their presenting problem. So let me fill you in on the Boyfriend Incident. The first thing I want to say about Boyfriend is that he’s an extraordinarily decent human being. He’s kind and generous, funny and smart, and when he’s not making you laugh, he’ll drive to the drugstore at two a.m. to get you that antibiotic you just can’t wait until morning for. If he happens to be at Costco, he’ll text to ask if you need anything, and when you reply that you just need some laundry detergent, he’ll bring home your favorite meatballs and twenty jugs of maple syrup for the waffles he makes you from scratch. He’ll carry those twenty jugs from the garage to your kitchen, pack nineteen of them neatly into the tall cabinet you can’t reach, and place one on the counter, accessible for the morning. He’ll also leave love notes on your desk, hold your hand and open doors, and never complain about being dragged to family events because he genuinely enjoys hanging out with your relatives, even the nosy or elderly ones. For no reason at all, he’ll send you Amazon packages full of books (books being the equivalent of flowers to you), and at night you’ll both curl up and read passages from them aloud to each other, pausing only to make out. While you’re binge-watching Netflix, he’ll rub that spot on your back where you have mild scoliosis, and when he stops, and you nudge him, he’ll continue rubbing for exactly sixty more delicious seconds before he tries to weasel out without your noticing (you’ll pretend not to notice). He’ll let you finish his sandwiches and sentences and sunscreen and listen so attentively to the details of your day that, like your personal biographer, he’ll remember more about your life than you will. If this portrait sounds skewed, it is. There are many ways to tell a story, and if I’ve learned anything as a therapist, it’s that most people are what therapists call “unreliable narrators.” That’s not to say that they purposely mislead. It’s more that every story has multiple threads, and they tend to leave out the strands that don’t jibe with their perspectives. Most of what patients tell me is absolutely true—from their current points of view. Ask about somebody’s spouse while they’re both still in love, then ask about that same spouse post-divorce, and each time, you’ll get only half the story. What you just heard about Boyfriend? That was the good half. And now for the bad: It’s ten o’clock on a weeknight. We’re in bed, talking, and we’ve just decided which movie tickets to preorder for the weekend when Boyfriend goes strangely silent. “You tired?” I ask. We’re both working single parents in our mid-forties, so ordinarily an exhausted silence would mean nothing. Even when we aren’t exhausted, sitting in silence together feels peaceful, relaxing. But if silence can be heard, tonight’s silence sounds different. If you’ve ever been in love, you know the kind of silence I’m talking аbout: silence on a frequency only your significant other can perceive. “No,” he says. It’s one syllable but his voice shakes subtly, followed by more unsettling silence. I look over at him. He looks back. He smiles, I smile, and a deafening silence descends again, broken only by the rustling sound his twitching foot is making under the covers. Now I’m alarmed. In my office I can sit through marathon silences, but in my bedroom I last no more than three seconds. “Hey, is something up?” I ask, trying to sound casual, but it’s a rhetorical question if ever there was one. The answer is obviously yes, because in the history of the world, nothing reassuring has ever followed this question. When I see couples in therapy, even if the initial response is no, in time the true answer is revealed to be some variation of I’m cheating, I maxed out the credit cards, my aging mother is coming to live with us, or I’m not in love with you anymore. Boyfriend’s response is no exception. He says: “I’ve decided that I can’t live with a kid under my roof for the next ten years.” I’ve decided that I can’t live with a kid under my roof for the next ten years? I burst out laughing. I know there’s nothing funny about what Boyfriend has said, but given that we’re planning to spend our lives together and I have an eight-year-old, it sounds so ridiculous that I decide it has to be a joke. Boyfriend says nothing, so I stop laughing. I look at him. He looks away. “What in the world are you talking about? What do mean, you can’t live with a kid for the next ten years?” “I’m sorry,” he says. “Sorry for what?” I ask, still catching up. “You mean you’re serious? You don’t want to be together?” He explains that he does want to be together, but now that his teenagers are leaving for college soon, he’s come to realize that he doesn’t want to wait another ten years for the nest to be empty. My jaw drops. Literally. I feel it open and hang in the air for a while. This is the first I’m hearing of this, and it takes a minute before my jaw is able to snap back into position so I can speak. My head is saying, Whaaaaaat? but my mouth says, “How long have you felt this way? If I hadn’t just asked if something was up, when were you going to tell me?” I think about how this can’t possibly be happening because just five minutes ago, we picked our movie for the weekend. We’re supposed to be together this weekend. At a movie! “I don’t know,” he says sheepishly. He shrugs without moving his shoulders. His entire body is a shrug. “It never felt like the right time to bring it up.” (When my therapist friends hear this part of the story, they immediately diagnose him as “avoidant.” When my nontherapist friends hear it, they immediately diagnose him as “an asshole.”) More silence. I feel as though I’m viewing this scene from above, watching a confused version of myself move at incredible speed through the famous stages of grief: denial, anger, bargaining, depression, and acceptance. If my laughter was denial and my when-the-hell-were-you-going-to-tell-me was anger, I’m moving on to bargaining. How, I want to know, can we make this work? Can I take on more of the childcare? Add an extra date night? Boyfriend shakes his head. His teenagers don’t wake up at seven a.m. to play Legos, he says. He’s looking forward to finally having his freedom, and he wants to relax on weekend mornings. Never mind that my son plays independently with his Legos in the mornings. The problem, apparently, is that my son occasionally says this: “Look at my Lego! Look what I made!” “The thing is,” Boyfriend explains, “I don’t want to have to look at the Legos. I just want to read the paper.” I consider the possibility that an alien has invaded Boyfriend’s body or that he has a burgeoning brain tumor of which this personality shift is the first symptom. I wonder what Boyfriend would think of me if I broke up with him because his teenage daughters wanted me to look at their new leggings from Forever 21 when I was trying to relax and read a book. I don’t want to look at the leggings. I just want to read my book. What kind of person gets away with simply not wanting to look? “I thought you wanted to marry me,” I say, pathetically. “I do want to marry you,” he says. “I just don’t want to live with a kid.” I think about this for a second, like a puzzle I’m trying to solve. It sounds like the riddle of the Sphinx. “But I come with a kid,” I say, my voice getting louder. I’m furious that he’s bringing this up now, that he’s bringing this up at all. “You can’t order me up ? la carte, like a burger without the fries, like a . . . a—” I think about patients who present ideal scenarios and insist that they can only be happy with that exact situation. If he didn’t drop out of business school to become a writer, he’d be my dream guy (so I’ll break up with him and keep dating hedge-fund managers who bore me). If the job wasn’t across the bridge, it would be the perfect opportunity (so I’ll stay in my dead-end job and keep telling you how much I envy my friends’ careers). If she didn’t have a kid, I’d marry her. Certainly we all have our deal-breakers. But when patients repeatedly engage in this kind of analysis, sometimes I’ll say, “If the queen had balls, she’d be the king.” If you go through life picking and choosing, if you don’t recognize that “the perfect is the enemy of the good,” you may deprive yourself of joy. At first patients are taken aback by my bluntness, but ultimately it saves them months of treatment. “The truth is, I didn’t want to date somebody with a kid,” Boyfriend is saying. “But then I fell in love with you, and I didn’t know what to do.” “You didn’t fall in love with me before our first date, when I told you I had a six-year-old,” I say. “You knew what to do then, didn’t you?” More suffocating silence. As you’ve probably guessed, this conversation goes nowhere. I try to understand if it’s about something else—how could it not be about something else? After all, his wanting his freedom is the ultimate “It’s not you, it’s me” (always code for It’s not me, it’s you). Is Boyfriend unhappy with something in the relationship that he’s afraid to tell me about? I ask him calmly, my voice softer now, because I’m mindful of the fact that Very Angry People aren’t Very Approachable. But Boyfriend insists that it’s only about his wanting to live without kids, not without me. I’m in a state of shock mixed with bewilderment. I don’t understand how this has never come up. How do you sleep soundly next to a person and plan a life with her when you’re secretly grappling with whether to leave? (The answer is simple—a common defense mechanism called compartmentalization. But right now I’m too busy using another defense mechanism, denial, to see it.) Boyfriend, by the way, is an attorney, and he lays it all out as he would in front of a jury. He really does want to marry me. He really does love me. He just wants much more time with me. He wants to be able to leave spontaneously together for the weekend or come home from work and go out to eat without worrying about a third person. He wants the privacy of a couple, not the communal feel of a family. When he learned I had a young child, he told himself it wasn’t ideal, but he said nothing to me because he thought he could adjust. Two years later, though, as we’re about to merge our homes, just as his freedom is in sight, he’s realized how important this is. He knew things had to end, but he also didn’t want them to—and even when he thought about telling me, he didn’t know how to bring it up because of how far in we were already and how angry I’d likely be. He hesitated to tell me, he says, because he didn’t want to be a jerk. The defense rests and is also very sorry. “You’re sorry?” I spit out. “Well, guess what. By trying NOT to be a jerk, you’ve made yourself into the world’s BIGGEST jerk!” He goes quiet again, and it hits me: His eerie silence earlier was his way of bringing this up. And although we go round and round on this until the sun peeks through the shutters, we both know in a bone-deep way that there’s nothing else to say. I have a kid. He wants freedom. Kids and freedom are mutually exclusive. If the queen had balls, she’d be the king. Voil?—I had my presenting problem. 3 The Space of a Step Telling somebody you’re a psychotherapist often leads to a surprised pause, followed by awkward questions like these: “Oh, a therapist! Should I tell you about my childhood?” Or “Can you help me with this problem with my mother-in-law?” Or “Are you going to psychoanalyze me?” (The answers, by the way, are “Please, don’t”; “Possibly”; and “Why would I do that here? If I were a gynecologist, would you ask if I was about to give you a pelvic exam?”) But I understand where these responses come from. It boils down to fear—of being exposed, of being found out. Will you spot the insecurities that I’m so skillful at hiding? Will you see my vulnerabilities, my lies, my shame? Will you see the human in my being? It strikes me that the people I’m talking to at a barbecue or dinner party don’t seem to wonder whether they might see me and the qualities I, too, try to hide in polite company. Once they hear that I’m a therapist, I morph into somebody who might peer into their psyches if they aren’t careful to deflect the conversation with therapist jokes or walk away to refill a drink as soon as possible. Sometimes, though, people will ask more questions, like “What kind of people do you see in your practice?” I tell them I see people just like any of us, which is to say, just like whoever is asking. Once I told a curious couple at a Fourth of July gathering that I see a good number of couples in my practice, and they proceeded to get into an argument right in front of me. He wanted to know why she seemed so interested in what a couples therapist does—after all, they weren’t having problems (uncomfortable chuckle). She wanted to know why he had no interest in the emotional lives of couples—after all, maybe they could use some help (glare). But was I thinking about them as a therapy case? Not at all. This time, I was the one who left the conversation to “get a refill.” Therapy elicits odd reactions because, in a way, it’s like pornography. Both involve a kind of nudity. Both have the potential to thrill. And both have millions of users, most of whom keep their use private. Though statisticians have attempted to quantify the number of people in therapy, their results are thought to be skewed because many people who go to therapy choose not to admit it. But those underreported numbers are still high. In any given year, some thirty million American adults are sitting on clinicians’ couches, and the United States isn’t even the world leader in therapy. (Fun fact: the countries with the most therapists per capita are, in descending order, Argentina, Austria, Australia, France, Canada, Switzerland, Iceland, and the United States.) Given that I’m a therapist, you’d think that the morning after the Boyfriend Incident, it might occur to me to see a therapist myself. I work in a suite of a dozen therapists, my building is full of therapists, and I’ve belonged to several consultation groups in which therapists discuss their cases together, so I’m well versed in the therapy world. But as I lie paralyzed in the fetal position, that’s not the call I make. “He’s trash!” my oldest friend, Allison, says after I tell her the story from my bed before my son wakes up. “Good riddance! What kind of person does that—not just to you, but to your kid?” “Right!” I agree. “Who does this?” We spend about twenty minutes bashing Boyfriend. During an initial burst of pain, people tend to lash out either at others or at themselves, to turn the anger outward or inward. Allison and I are choosing outward, baby! She’s in the Midwest, commuting to work, two hours ahead of me here on the West Coast, and she gets right to the point. “You know what you should do?” she says. “What?” I feel like I’ve been stabbed in the heart, and I’ll do anything to stop the pain. “You should go sleep with somebody! Go sleep with somebody and forget about the Kid Hater.” I instantly love Boyfriend’s new name: the Kid Hater. “Clearly he wasn’t the person you thought he was. Go take your mind off of him.” Married for twenty years to her college sweetheart, Allison has no idea how to give guidance to single people. “It might help you bounce back faster, like falling off a bike and then getting right back on,” she continues. “And don’t roll your eyes.” Allison knows me well. I’m rolling my red, stinging eyes. “Okay, I’ll go sleep with someone,” I squeak out, knowing she’s trying to make me laugh. But then I’m sobbing again. I feel like a sixteen-year-old going through her first breakup, and I can’t believe I’m having this reaction in my forties. “Oh, hon,” Allison says, her voice like a hug. “I’m here, and you’ll get through this.” “I know,” I say, except that in a strange way, I don’t. There’s a popular saying, a paraphrase of a Robert Frost poem: “The only way out is through.” The only way to get to the other side of the tunnel is to go through it, not around it. But I can’t even picture the entrance right now. After Allison parks her car and promises to call at her first break, I look at the clock: 6:30 a.m. I call my friend Jen, who’s a therapist with a practice across town. She picks up on the first ring and I hear her husband in the background asking who it is. Jen whispers, “I think it’s Lori?” She must have seen the caller ID, but I’m crying so hard I haven’t even said hello yet. If it weren’t for caller ID, she’d think I was some sicko prank-calling. I catch my breath and tell her what happened. She listens attentively. She keeps saying that she can’t believe it. We also spend twenty minutes trashing Boyfriend, and then I hear her daughter enter the room and say that she needs to get to school early for swim practice. “I’ll call you at lunch,” Jen says. “But in the meantime, I don’t know that this is the end of the story. Something’s screwy. Unless he’s a sociopath, it doesn’t jibe at all with what I saw for the past two years.” “Exactly,” I say. “Which means he’s a sociopath.” I hear her take a sip of water and put the glass down. “In that case,” she says, swallowing, “I have a great guy for you—one who’s not a kid hater.” She also likes Boyfriend’s new name. “In a few weeks, when you’re ready, I want to introduce you.” I almost smile at the preposterousness of this. What I really need just hours into this breakup is for somebody to sit with me in my pain, but I also know how helpless it feels to watch a friend suffer and do nothing to fix it. Sitting-with-you-in-your-pain is one of the rare experiences that people get in the protected space of a therapy room, but it’s very hard to give or get outside of it—even for Jen, who is a therapist. When we’re off the phone, I think about her “in a few weeks” comment. Could I really go on a date in just a few weeks? I imagine being out with a well-meaning guy who’s doing his best to make first-date conversation; without knowing it, he’ll make a reference to something that reminds me of Boyfriend (pretty much everything will remind me of Boyfriend, I’m convinced), and I won’t be able to hold back tears. Crying on a first date is decidedly a turnoff. A therapist crying on a first date is both a turnoff and alarming. Besides, I have the bandwidth to focus only on the immediate present. Right now it’s all about one foot, then the other. That’s one thing I tell patients who are in the midst of crippling depression, the kind that makes them think, There’s the bathroom. It’s about five feet away. I see it, but I can’t get there. One foot, then the other. Don’t look at all five feet at once. Just take a step. And when you’ve taken that step, take one more. Eventually you’ll make it to the shower. And you’ll make it to tomorrow and next year too. One step. They may not be able to imagine their depression lifting anytime soon, but they don’t need to. Doing something prompts you to do something else, replacing a vicious cycle with a virtuous one. Most big transformations come about from the hundreds of tiny, almost imperceptible, steps we take along the way. A lot can happen in the space of a step. Somehow I manage to wake my son, prepare breakfast, pack his lunch, make conversation, drop him at school, and drive to work, all without shedding a tear. I can do this, I think as I ride the elevator up to my office. One foot, then the other. One fifty-minute session at a time. I enter my suite, say hello to colleagues in the hallway, unlock the door to my office, and go through my routine: I put away my belongings, turn off the phone ringers, unlock the files, and fluff the pillows on the couch. Then, uncharacteristically, I take a seat on it myself. I look at my empty therapist chair and consider the view from this side of the room. It’s oddly comforting. I stay there until the tiny green light by the door flicks on, letting me know that my first patient is here. I’m ready, I think. One foot, then the other. I’m going to be fine. Except that I’m not. 4 The Smart One or the Hot One I’ve always been drawn to stories—not just what happens, but how the story is told. When people come to therapy, I’m listening to their narratives but also for their flexibility with them. Do they consider what they’re saying to be the only version of the story—the “accurate” version—or do they know that theirs is just one of many ways to tell it? Are they aware of what they’re choosing to leave in or out, of how their motivation in sharing this story affects how the listener hears it? I thought a lot about those questions in my twenties—not in relation to therapy patients, but in relation to movie and TV characters. That’s why, as soon as I graduated from college, I got a job in the entertainment business, or what everyone called, simply, “Hollywood.” This job was at a large talent agency, and I worked as the assistant to a junior film agent who, like many people in Hollywood, wasn’t much older than me. Brad represented screenwriters and directors, and he was so boyish-looking, with his smooth cheeks and mop of floppy hair he’d constantly swat from his eyes, that his fancy suits and expensive shoes always seemed too mature for him, like he was wearing his father’s clothing. Technically, my first day on the job was a trial. I’d been told by Gloria in human resources (I never learned her last name; everyone called her “Gloria-in-human-resources”) that Brad had narrowed down his assistant candidates to two finalists, and each of us would work for a day as a test run. On the afternoon of mine, returning from the Xerox room, I overheard my prospective boss and another agent, his mentor, talking in his office. “Gloria-in-human-resources wants an answer by tonight,” I heard Brad say. “Should I pick the smart one or the hot one?” I froze, appalled. “Always pick the smart one,” the other agent replied, and I wondered which one Brad considered me to be. An hour later, I got the job. And despite finding the question outrageously inappropriate, I felt perversely hurt. Still, I wasn’t sure why Brad had pegged me as smart. All I’d done that day was dial a string of phone numbers (repeatedly disconnecting calls by pressing the wrong buttons on the confusing phone system), make coffee (which was sent back twice), Xerox a script (I pushed 10 instead of 1 for number of copies, then hid the nine extra screenplays under a couch in the break room), and trip over a lamp cord in Brad’s office and fall on my ass. The hot one, I concluded, must have been particularly stupid. Technically, my position was “motion-picture literary assistant,” but really I was a secretary who rolled the call list all day, dialing the numbers of studio executives and filmmakers, telling each person’s assistant that my boss was on the line, then patching my boss through. It was widely known in the industry that assistants were expected to listen in silently on these calls so that we’d know what scripts had to be sent where without the need for instructions later. Sometimes, though, the parties on the calls would forget about us, and we’d hear all kinds of juicy gossip about our bosses’ famous friends—who’d had an argument with a spouse or which studio executive was “very confidentially” about to be sent to “producers pasture,” shorthand for being given a vanity production deal on the studio lot. If the person my boss was trying to reach wasn’t available, I’d “leave word” and move on to the next name on the hundred-person call sheet, sometimes being instructed to strategically return calls at inopportune times (before nine thirty a.m., because nobody in Hollywood arrived at work before ten, or, less subtly, during lunch) in order to miss the person on purpose. Although the movie world was glamorous—Brad’s Rolodex was filled with the home numbers and addresses of people I’d admired for years—the job of an assistant was its opposite. As an assistant, you fetched coffee, made haircut and pedicure appointments, picked up dry cleaning, screened calls from parents or exes, Xeroxed and messengered documents, took cars to the mechanic, ran personal errands, and always, without fail, brought chilled bottled water into every meeting (never saying a word to the writers or directors present, whom you were dying to meet). Finally, late at night, you’d type up ten pages of single-spaced notes on scripts that came in from the agency’s clients so that your boss could make insightful comments in meetings the next day without having to read anything. We assistants put a lot of effort into those script notes in order to demonstrate that we were bright and capable and could one day (please, God!) stop doing assistant work, with its mind-numbing duties, long hours, minimal pay, and no overtime compensation. A few months into the job, it became apparent that while the hot ones at my agency got all the attention—and there were many hot ones in the assistant pool—the smart ones got assigned all the extra work. In my first year there, I slept very little because I was reading and writing comments on a dozen scripts a week—all after hours and on weekends. But I didn’t mind. In fact, that was my favorite part of the job. I learned how to craft stories and fell in love with fascinating characters with complicated inner lives. As the months went by, I got slightly more confident in my instincts, less worried about sharing a silly story idea. Soon I was hired as an entry-level film executive at a production company, with the title story editor; here I got to participate in meetings while another assistant brought in the bottled water. I worked closely with writers and directors, hunkering down in a room and going over material scene by scene, helping to make changes the studio wanted without having the writers, who often felt protective of their material, fly into a rage or threaten to quit the project. (These negotiations would turn out to be great practice for couples therapy.) Sometimes, to avoid distractions at the office, I’d work with filmmakers early in the morning in my tiny starter apartment, picking up breakfast snacks the night before while thinking, John Lithgow is going to be eating this bagel in my crappy living room with the hideous wall-to-wall carpet and popcorn ceilings tomorrow! Could it get any better than this? And then it did—or so I thought. I got promoted. It was a promotion I’d worked hard for and wanted very badly. Until I actually got it. The irony of my job was that a lot of the creative work happens when you don’t have much experience. When you’re just starting out, you’re the behind-the-scenes person, the one who does all the script work at the office while the higher-level people are out wooing talent, lunching with agents, or stopping by movie sets to check in on the company’s productions. When you become a development executive, you go from being what’s known as an internal executive to an external one, and if you were the social kid in high school, this is the job for you. But if you were the bookish kid who was happiest working intently with a couple of friends in the library, be careful what you wish for. Now I was out awkwardly attempting to socialize at lunches and meetings all day. On top of that, the pace of the process began to feel glacial. It could take ages—literally years—for a film to be made, and I got the sinking feeling that I was in the wrong job. I’d moved into a duplex with a friend, and she pointed out that I’d been watching a lot of TV every night. Like, in a pathological way. “You seem depressed,” she said with concern. I said I wasn’t depressed; I was just bored. I hadn’t considered that if the only thing that keeps you going all day is knowing you’ll get to turn on the TV after dinner, you probably are depressed. One day around this time, I was sitting at lunch in a perfectly nice restaurant with a perfectly lovely agent who was talking about a perfectly good deal she had made when I noticed that four words kept running through my mind: I. Just. Don’t. Care. No matter what the agent said, these four words played in a loop, and they didn’t stop when the check came, nor did they stop on the drive back to the office. They rattled around in my head the next day, too, and for the next several weeks, until finally I had to admit, months later, that they weren’t going away. I. Just. Don’t. Care. And since the only thing I did seem to care about was watching TV—since the only time I felt anything (or, perhaps more accurately, the only time I felt the absence of something unpleasant that I couldn’t quite put my finger on) was when I was immersed in these imaginary worlds with new episodes arriving weekly like clockwork—I applied for a job in television. Within a few months, I began working in series development at NBC. It felt like a dream come true. I thought, I’ll get to help tell stories again. Even better, instead of developing self-contained films with neatly crafted endings, I’ll get to work on series. Over the course of multiple episodes and seasons, I’ll have a hand in helping audiences get to know their favorite characters, layer by layer—characters as flawed and contradictory as the rest of us, with stories that are just as messy. It seemed like the perfect solution to my boredom. It would take years for me to realize that I’d solved the wrong problem. 5 Namast’ay in Bed CHART NOTE, JULIE: Thirty-three-year-old university professor presents for help in dealing with cancer diagnosis upon returning from her honeymoon. “Is that a pajama top?” Julie asks as she walks into my office. It’s the afternoon after the Boyfriend Incident, right before my appointment with John (and his idiots), and I’ve almost made it through the day. I give her a quizzical look. “Your shirt,” she says, settling onto the couch. I flash back to the morning, to the gray sweater I intended to wear and then, with a sinking feeling, to the image of the sweater laid out on my bed next to the gray pajama top I’d taken off before stepping into the shower in my post-breakup daze. Oh God. On one of his Costco runs, Boyfriend had gotten me a pack of PJs, their fronts emblazoned with sayings like AREN’T I JUST A FUCKING RAY OF SUNSHINE and TALK NERDY TO ME and ZZZZZZZZZZ SNORE (not the message a therapist wants to send her patients). I’m trying to remember which one I wore last night. I brace myself and glance down. My top says NAMAST’AY IN BED. Julie is looking at me, waiting for an answer. Whenever I’m not sure what to say in the therapy room—which happens to therapists more often than patients realize—I have a choice: I can say nothing until I understand the moment better, or I can attempt an answer, but whatever I do, I must tell the truth. So while I’m tempted to say that I do yoga and that my top is simply a casual T-shirt, both would be lies. Julie does yoga as part of her Mindful Cancer program, and if she starts talking about various poses, I’d have to lie further and pretend that I’m familiar with them—or admit that I lied. I remember when, during my training, a fellow intern told a patient he would be out of the clinic for three weeks, and she asked where he was going. “I’m going to Hawaii,” the intern said truthfully. “For vacation?” the patient asked. “Yes,” he replied, even though, technically, he was going for his wedding, which was to be followed by a two-week island honeymoon. “That’s a long vacation,” the patient remarked, and the intern, believing that sharing the news of his wedding would be too personal, decided instead to focus on the patient’s comment. What would it be like for her to miss three weeks of sessions? What did her feelings about his absence remind her of? Both of which might be fruitful avenues to explore, but so would the patient’s indirect question: Since it’s neither summer nor a holiday season, why are you really taking three weeks off? And sure enough, when the intern returned to work, the patient noticed his wedding ring and felt betrayed: “Why didn’t you just tell me the truth?” In retrospect, the intern wished he had. So what if a patient learned that he was getting married? Therapists get married and patients have reactions to that. Those can be worked through. Loss of trust is harder to repair. Freud argued that “the physician should be impenetrable to the patient, and like a mirror, reflect nothing but what is shown to him.” Nowadays, though, most therapists use some form of what’s known as self-disclosure in their work, whether it’s sharing some of their own reactions that come up during the session or acknowledging that they watch the TV show that a patient keeps referring to. (Better to admit that you watch The Bachelor than to feign ignorance and slip up by naming a cast member the patient hasn’t mentioned yet.) Inevitably, though, the question of what to share gets tricky. One therapist I know told a patient whose child was diagnosed with Tourette’s syndrome that she, too, had a son with Tourette’s—and it deepened their relationship. Another colleague treated a man whose father had committed suicide but never revealed to the patient that his own father had also committed suicide. In each situation, there’s a calculation to make, a subjective litmus test we use to assess the value of the disclosure: Is this information helpful for the patient to have? When done well, self-disclosure can bridge some distance with patients who feel isolated in their experiences, and it can encourage more openness. But if it’s perceived as inappropriate or self-indulgent, the patient will feel uncomfortable and start to shut down—or simply flee. “Yes,” I tell Julie. “It’s a pajama top. I guess I put it on by mistake.” I wait, wondering what she’ll say. If she asks why, I’ll tell the truth (although not the specifics): I wasn’t paying attention this morning. “Oh,” she says. Then her mouth twitches the way it does when she’s about to cry, but instead, she starts laughing. “I’m sorry, I’m not laughing at you. Namast’ay in Bed . . . that’s exactly how I feel!” She tells me about a woman in her Mindful Cancer program who’s convinced that if Julie doesn’t take yoga seriously—along with the famous pink ribbons and the optimism—her cancer will kill her. Never mind that Julie’s oncologist has already informed her that her cancer will kill her. This woman still insists it can be cured with yoga. Julie despises her. “Imagine if I walked into yoga wearing that top and—” Now she’s laughing uncontrollably, reining it in and then bursting out with another round. I haven’t seen Julie laugh once since she learned she was dying. This must be what she was like in what she calls “B.C.” or “Before Cancer,” when she was happy and healthy and falling in love with her soon-to-be husband. Her laughter is like a song, and it’s so contagious that I start laughing too. We both sit there laughing, her at the sanctimonious woman, and me at my mistake—at the ways in which our minds betray us as much as our bodies do. Julie discovered her cancer while having sex with her husband on a beach in Tahiti. She didn’t suspect it was cancer, though. Her breast felt tender, and later, in the shower, the tender spot felt funky, but often she had areas that felt funky and her gynecologist always found them to be glands that changed size at certain times of the month. Anyway, she thought, maybe she was pregnant. She and her new husband, Matt, had been together for three years and both had talked about wanting to start a family as soon as they got married. In the weeks before the wedding, they hadn’t been vigilant about birth control. It was a good time to have a baby too. Julie had just gotten tenure at her university, and after years of hard work, she could finally take a breath. Now there would be more time for her passions: running marathons and climbing mountains and baking silly cakes for her nephew. There would also be time for marriage and parenthood. When Julie got back from her honeymoon, she peed on a stick and showed it to Matt, who picked her up and danced around the room with her. They decided that the song that happened to be on the radio—“Walking on Sunshine”—would be their baby’s theme song. Excited, they went to the obstetrician for their first prenatal appointment, and when her doctor felt the “gland” that Julie had noticed on her honeymoon, his smile faded slightly. “It’s probably nothing,” he said, “but let’s get it checked out.” It wasn’t nothing. Young, newly married, and pregnant, with no family history of breast cancer, Julie had been struck by the randomness of the universe. Then, while grappling with how to handle the cancer treatment and the pregnancy, she had a miscarriage. This was when Julie landed in my office. It was an odd referral, given that I wasn’t a therapist who specialized in treating people with cancer. But my lack of expertise was exactly why Julie wanted to see me. She had told her physician that she didn’t want a therapist from “the cancer team.” She wanted to feel normal, to be part of the living. And since her doctors seemed confident that she’d be fine after surgery and chemo, she wanted to focus on both getting through the treatment and being newly married. (What should she say in her wedding-gift thank-you notes? Thanks so much for the lovely bowl . . . I keep it by my bed to vomit in?) The treatment was brutal but Julie got better. The day after her doctors declared her “tumor-free,” she and Matt went on a hot-air balloon ride with their closest friends and family. It was the first week of summer, and as they joined arms and watched the sunset from a thousand feet above the earth, Julie no longer felt cheated, as she had during the treatment, but lucky. Yes, she’d gone through hell. But it was behind her, and her future lay ahead. In six months, she would get a final scan, a sign-off, to clear her for pregnancy. That night, she dreamed that she was in her sixties and holding her first grandchild. Julie was in good spirits. Our work was done. I didn’t see Julie between the hot-air balloon ride and the scan. But I did start getting calls from other cancer patients who’d been referred by Julie’s oncologist. There’s nothing like illness to take away a sense of control, even if we often have less of it than we imagine. What people don’t like to think about is that you can do everything right—in life or in a treatment protocol—and still get the short end of the stick. And when that happens, the only control you have is how you deal with that stick—your way, not the way others say you should. I’d let Julie do it her way—I was so inexperienced that I didn’t have a strong sense of what a “way” should look like—and it seemed to help. “Whatever you did with her,” Julie’s oncologist said, “she seemed pleased with the outcome.” I knew that I hadn’t done anything brilliant with Julie. Mostly, I worked hard not to flinch from her rawness. But that rawness went only so far because we weren’t even thinking about death then. Instead, we discussed wigs versus scarves, sex and postsurgery body image. And I helped her think through how to manage her marriage, parents, and work, much the way I might with any patient. Then one day I checked my messages and heard Julie’s voice. She wanted to see me right away. She came in the next morning, ashen. The scan that was supposed to show nothing had instead found a rare form of cancer, different from the original. In all likelihood, this cancer was going to kill her. It might take a year or five or, if things went very well, ten. Of course, they would explore experimental treatments, but they were just that—experimental. “Will you stay with me until I die?” Julie asked, and though my instinct was to do what people tend to do whenever somebody brings up death, which is to deny death completely (Oh, hey, let’s not go there yet. Those experimental treatments might work), I had to remember that I was there to help Julie, not comfort myself. Still, at the moment she asked, I was stunned, still absorbing the news. I wasn’t sure I was the best person for this. What if I said or did the wrong thing? Would I offend her if my feelings—discomfort, fear, sadness—came across in my facial expressions or body language? She was going to get only one chance at doing this the way she wanted. What if I let her down? She must have seen my hesitation. “Please,” she said. “I know it’s not a picnic, but I can’t go to those cancer people. It’s like a cult. They call everyone ‘brave,’ but what choice do we have, and besides, I’m terrified and still cringe at the sight of the needles like I did as a kid getting my shots. I’m not brave and I’m not a warrior fighting a battle. I’m just an ordinary college professor.” She leaned forward on the couch. “They have affirmations on their walls. So, please?” Looking at Julie, I couldn’t say no. More important, now I didn’t want to. And right then, the nature of our work together changed: I was going to help her come to terms with her death. This time, my inexperience might matter. 6 Finding Wendell “Maybe you should talk to someone,” Jen suggests two weeks after the breakup. She has just called to check on me at work. “You need to find a place where you’re not being a therapist,” she adds. “You need to go where you can completely fall apart.” I look at myself in the mirror that hangs by the door in my office, the one I use to make sure I don’t have lipstick on my teeth when I’m about to retrieve a patient from the waiting room after a quick snack between sessions. I appear normal, but I feel dizzy and disoriented. I’m fine with patients—seeing patients is a relief, a full fifty minutes of respite from my own life—but outside of sessions, I’m losing it. In fact, as each day goes by, I seem worse, not better. I can’t sleep. I can’t concentrate. Since the breakup, I’ve left my credit card at Target, driven out of the gas station with my tank’s cap hanging off, and fallen off a step in my garage, badly bruising my knee. My chest hurts as if my heart has been crushed, though I know it hasn’t been, because if anything, my heart is working harder, beating rapidly 24/7—a sign of anxiety. I obsess about Boyfriend’s state of mind, which I imagine is calm and unconflicted, while I lie on my bedroom floor at night and miss him. Then I obsess about whether I really miss him—did I even know him? Do I miss him, or do I miss the idea of him? So when Jen says I should see a therapist, I know she’s right. I need someone to help me through this crisis. But who? Finding a therapist is a tricky thing. It’s not like looking for, say, a good internist or dentist because pretty much everyone needs an internist or dentist. A therapist, though? Consider: 1.If you ask somebody for a therapist recommendation and that person isn’t seeing a therapist, he or she might be offended that you’d made that assumption. Similarly, if you ask somebody for a therapist recommendation and that person is seeing a therapist, he or she might be upset that it was so apparent to you. Of all the people she knows, this person might wonder, why did she think to ask me? 2.When you inquire, you risk this person asking why you want to see a therapist. “What’s wrong?” this person might say. “Is it your marriage? Are you depressed?” Even if people don’t ask this aloud, every time they see you, they might be silently wondering, What’s wrong? Is it your marriage? Are you depressed? 3.If your friend does give you her therapist’s name, there might be unexpected checks and balances to what you say in the therapy room. If, for instance, your friend recounts to this therapist a not-so-flattering incident that involves you, and you give a different version of this same incident—or omit it altogether—the therapist will see you in a way you haven’t chosen to present. But you won’t know what the therapist knows about you, because the therapist can’t mention anything said in somebody else’s session. These caveats notwithstanding, word of mouth is often an effective way to find a therapist. You can also go on PsychologyToday.com and sort through profiles in your area. But however you do it, you may need to meet with a few before you find the right one. That’s because clicking with your therapist matters in a way that it doesn’t with other clinicians (as another therapist said: “It’s not the same as choosing a good cardiologist who sees you maybe twice a year and will never know about your massive insecurity”). Study after study shows that the most important factor in the success of your treatment is your relationship with the therapist, your experience of “feeling felt.” This matters more than the therapist’s training, the kind of therapy they do, or what type of problem you have. But I have unique constraints in finding a therapist. To avoid an ethical breach known as a dual relationship, I can’t treat or receive treatment from any person in my orbit—not a parent of a kid in my son’s class, not the sister of my coworker, not a friend’s mom, not my neighbor. The relationship in the therapy room needs to be its own, distinct and apart. These rules don’t hold for other health-care clinicians. You can play tennis or be in a book club with your surgeon, dermatologist, or chiropractor, but not with your therapist. This narrows my prospects dramatically. I’m friendly with, refer patients to, go to conferences with, or otherwise associate with numerous therapists in town. On top of that, my friends who are therapists, like Jen, know many of the same therapists I do. Even if Jen referred me to one of her colleagues that I don’t know, there would be something awkward about her being friendly with my therapist—it’s too close. And as for my asking my colleagues? Well, there’s this: I don’t want my colleagues to know I’m seeking urgent therapy. Might they hesitate, consciously or not, to send referrals my way? So while I’m surrounded by therapists, my predicament conjures that Coleridge line “Water, water, everywhere?/?Nor any drop to drink.” But by the end of the day, I have an idea. My colleague Caroline isn’t in my suite, or even in my building. She’s not a friend, although we’re professionally friendly. Sometimes we share cases—I’ll see a couple, and she’ll see one of the members of the couple individually, or vice versa. Any referral she’d have, I’d trust. I dial her cell at ten to the hour, and she picks up. “Hi, how are you?” she asks. I say I’m great. “Absolutely great,” I repeat enthusiastically. I don’t mention the fact that I’ve barely slept or eaten and feel like I might faint. I ask how she is, then get right to the point. “I need a referral,” I say, “for a friend.” I quickly explain that this “friend” is looking specifically for a male therapist to keep Caroline from wondering why I’m not referring my friend to her. Through the phone, I can almost hear the gears turning in her head. About three-fourths of clinicians who do therapy (as opposed to research, psychological testing, or medication management) are women, so it takes some thought for her to find a man. I add that the one male therapist in my office suite, who happens to be one of the most talented therapists I know, won’t work out for this friend because this friend doesn’t feel comfortable doing therapy at my office, where we share a waiting room. “Hmm,” Caroline says. “Let me think. It’s a male patient who wants the referral?” “Yes, he’s in his forties,” I say. “High-functioning.” High-functioning is therapist code for “a good patient,” the kind most therapists enjoy working with, often to balance out the patients we also want to work with but who are less high-functioning. High-functioning patients are those who can form relationships, manage adult responsibilities, and have a capacity for self-reflection. The kind who don’t call daily between sessions with emergencies. Studies show, and common sense dictates, that most therapists prefer to work with patients who are verbal, motivated, open, and responsible—these are the patients who improve more quickly. I include the high-functioning bit with Caroline because it broadens the range of therapists who might be interested in this case, and, well, I consider myself to be relatively high-functioning. (At least, I did until recently.) “I think he’d feel more comfortable with a male therapist who’s also married with kids,” I continue. I add this for a reason too. I know this isn’t a fair assumption, but I’m afraid that a female therapist might be predisposed to empathize with me post-breakup and that a male therapist who’s neither married nor a father won’t understand the nuances of the kid part of the situation. In short, I want to see if an objective male professional who has firsthand experience of marriage and kids—a man just like Boyfriend—will be as appalled at Boyfriend’s behavior as I am, because then I’ll know that my reaction is normal and I’m not going insane after all. Yes, I’m seeking objectivity, but only because I’m convinced that objectivity will rule in my favor. I hear Caroline clicking away on her keyboard. Tap, tap, tap. “How about—no, scratch that, he thinks much too highly of himself,” she says of some unnamed therapist. She goes back to her keyboard. Tap, tap, tap. “There’s a colleague who used to be in my consultation group,” she begins. “But I’m not sure. He’s great. Very skilled. He always has insightful things to say. It’s just—” Caroline hesitates. “Just what?” “He’s so happy all the time. It feels . . . unnatural. Like, what the hell is he so happy about? But some patients like that. Do you think your friend would do well with him?” “Definitely not,” I say. I, too, am suspicious of chronically happy people. Next Caroline names a good therapist I also know relatively well, so I tell her that he won’t work out for my friend because there’s a conflict—therapist shorthand for “Their worlds collide, but I can’t reveal more.” She clicks around again—tap, tap, tap—then stops. “Oh, hey, there’s a psychologist named Wendell Bronson,” Caroline says. “I haven’t talked to him in years, but we trained together and he’s smart. Married with kids. Late forties or so, been doing this a long time. Do you want his info?” I say I do. I mean, “my friend” does. We exchange some pleasantries and then hang up. At this point, all I know about Wendell is what Caroline has just told me and that there’s two-hour free parking in the lot across the street from his office. I know about the parking because when Caroline texts me his phone number and address a minute after our call, I realize that my bikini-wax place happens to be on the same street (Not that I’ll be needing those services for the foreseeable future, I think, which makes me start crying again). I pull it together long enough to dial Wendell’s number, and of course I get voicemail. Therapists rarely answer their office phones so that patients won’t feel rebuffed if they call in a crisis and their therapists have only a few minutes between sessions to speak. Colleague-to-colleague calls are made via cell phone or pager. I hear a generic outgoing recording (“Hi, you’ve reached the office of Wendell Bronson. I return my calls during business hours Monday through Friday. If this is an emergency, please call . . .”), and after the beep I leave a concise message with exactly the information a therapist wants—name, one-liner about why I’m calling, and return phone number. I’m doing well until, thinking it might get me in to see him sooner, I add that I’m also a therapist, but my voice cracks as I say the word therapist. Mortified, I cover with a cough and quickly hang up. When Wendell calls me back an hour later, I try to sound as together as possible as I explain that I just need a little crisis management, a few weeks to “process” an unexpected breakup, and then I’ll be good to go. I’ve done therapy before, I say, so I come “preshrunk.” He doesn’t laugh at my joke so I’m pretty sure he has no sense of humor, but it doesn’t matter because I don’t need a sense of humor for crisis management. This is, after all, just about getting me back on my feet. Wendell says about five words the entire call. I use the term words loosely because it’s more like a bunch of Uh-huhs before he offers a nine o’clock appointment the next morning. I accept and we’re done. Although Wendell didn’t say much, our conversation provides me with immediate relief. I know this is a common placebo effect: patients often feel hopeful after making that first appointment, before even setting foot in the therapy room. I’m no different. Tomorrow, I think, I’ll get help with this. Yes, I’m a mess now because this whole thing is a shock, but soon I’ll make sense of it (that is, Wendell will confirm that Boyfriend is a sociopath). When I look back, this breakup will be a blip on the radar screen of my life. It will be a mistake that I will have learned from, the kind of mistake my son calls “a beautiful oops.” That night before I go to sleep, I gather up Boyfriend’s things—his clothes, toiletries, tennis racket, books, and electronics—and pack them in a box that I’ll give back to him. I take the Costco pajamas out of my drawer and find a Post-it with a flirtatious note that Boyfriend had stuck on one of them. When he wrote that, I wonder, did he already know he was leaving? At a case consultation I went to the week before the breakup, a colleague brought up a patient who found out that her husband had been leading a double life. Not only had he been having an affair for years, but he’d gotten the woman pregnant and she was about to have his baby. When his wife discovered all of this (was he ever going to tell her?), she no longer knew what to make of her life with him. Were her memories real? For example, that romantic vacation—was her version of the trip accurate or was it some fiction, given that he was having his affair at that time? She felt robbed of her marriage but also of her memories. Likewise, when Boyfriend put the Post-it on my pajamas—when he bought me the pajamas in the first place—was he also secretly planning his kid-free life? I frown at the note. Liar, I think. I walk the box out to the car and place it on the front seat so I’ll remember to drop it off. Maybe I’ll even do it in the morning, on the way to my appointment with Wendell. I can’t wait for him to tell me what a sociopath Boyfriend is. 7 The Beginning of Knowing I’m standing in the doorway of Wendell’s office, trying to figure out where to sit. I see a lot of therapy offices in my profession—my supervisors’ offices during training, my colleagues’ offices that I visit—but I’ve never seen one like Wendell’s. Yes, there are the usual diplomas on the walls and therapy-related books on the shelves, along with the conspicuous absence of anything that might give away his personal life (no family photos on the desk, for instance; just a lone laptop). But instead of the standard setup of the therapist’s chair in the middle of the room with seating against the walls (during internship, we learned to sit close to the door in case “things escalated” and we needed an escape route), Wendell’s office has two long sofas on the far walls arranged in an L-shape with a side table between them—and no therapist chair at all. I’m flummoxed. Here’s a diagram of my office: And here’s a diagram of Wendell’s office. Wendell, who is very tall and very thin with a balding head and the stooped posture of our profession, stands there waiting for me to take a seat. I consider the possibilities. I assume we won’t sit side by side on the same sofa, but which sofa does he typically take? The one by the window (so he can escape through that if things escalate)? Or the one by the wall? I decide to take a seat by the window, position A, before he closes the door, walks across the room, and relaxes into position C. Generally when I see a new patient, I’ll open the conversation with an icebreaker like “So, tell me what brings you here today.” Wendell, however, says nothing. He just looks at me, his green eyes questioning. He’s wearing a cardigan, khakis, and loafers, like he came straight from Therapist Central Casting. “Hi,” I say. “Hi,” he replies. And he waits. About a minute passes, which is longer than it sounds, and I try to gather my wits so that I can clearly lay out the Boyfriend situation. The truth is, every day since the breakup has been worse than the night of the breakup itself because now a glaring void has opened up in my life. For the past couple of years, Boyfriend and I had been in constant contact throughout our days, had said good night every bedtime. Now what was he doing? How had his day gone? Did his presentation at work go well? Was he thinking about me? Or was he glad to have gotten the truth off his chest so he could go search for somebody who was kid-free? I’ve felt his absence in every cell of my body, so by the time I get to Wendell’s office this morning, I’m a wreck—but I don’t want that to be his first impression of me. Or, to be honest, his second or hundredth. An interesting paradox of the therapy process: In order to do their job, therapists try to see patients as they really are, which means noticing their vulnerabilities and entrenched patterns and struggles. Patients, of course, want to be helped, but they also want to be liked and admired. In other words, they want to hide their vulnerabilities and entrenched patterns and struggles. That’s not to say that therapists don’t look for a patient’s strengths and try to build on those. We do. But while we aim to discover what’s not working, patients try to keep the illusion going to avoid shame—to seem more together than they really are. Both parties have the well-being of the patient in mind but often work at cross-purposes in the service of a mutual goal. As calmly as possible, I begin to tell Wendell the Boyfriend story, but almost immediately, my dignity’s gone and I’m sobbing. I go through the entire story play-by-play and by the time I’m done, my hands are covering my face, my body is shaking, and I think about what Jen said on the phone when she called to check on me yesterday: “You need to find a place where you’re not being a therapist.” I’m definitely not being a therapist right now. I’m making the case for why Boyfriend must be blamed for all of this: If he hadn’t been so avoidant (?Jen’s diagnosis), I wouldn’t have been so blindsided. And, I add, he must be a sociopath (again quoting Jen; this is exactly the reason therapists can’t see their friends for therapy), because I had no idea that he felt this way—he was such a good actor! And even if he’s not a certifiable sociopath, he’s clearly missing a few marbles, because who keeps something this big to himself for God knows how long? After all, I know what normal communication looks like, especially because I see so many couples in my practice, and besides . . . I look up and I think I see Wendell suppress a smile (I imagine his thought bubble: This wacko’s a therapist . . . who treats couples?) but it’s hard to tell because I can’t see very well. It’s like looking through the windshield of a car without its wipers on during a rainstorm. In a strange way, I’m relieved to be able to cry this hard in front of another person, even if that person is a stranger who doesn’t say much. After a bunch of empathetic Mmms, Wendell asks a question: “Is this a typical breakup reaction for you?” His tone is kind, but I know what he’s getting at. He’s trying to determine what’s known as my attachment style. Attachment styles are formed early in childhood based on our interactions with our caregivers. Attachment styles are significant because they play out in people’s adult relationships too, influencing the kinds of partners they pick (stable or less stable), how they behave during the course of a relationship (needy, distant, or volatile), and how their relationships tend to end (wistfully, amiably, or with a huge explosion). The good news is that maladaptive attachment styles can be modified in adulthood—this, in fact, is a lot of the work of therapy. “No, this isn’t typical,” I insist, using my sleeve to dry my tears. I let him know that I’ve had long-term relationships and I’ve gone through breakups but not like this. And, I reiterate, the only reason I’m having this reaction is that this particular breakup was such a shock, so out of left field, and isn’t what Boyfriend did the most confusing and bizarre and . . . UNETHICAL thing to do to someone? I’m sure that this married professional with kids is going to say something supportive right now about how painful it is to be blindsided but that in the long run, thank goodness this happened, because I dodged a bullet—not just for me, but for my son. I sit back, take a breath, and wait for the validation to pour in. But Wendell doesn’t offer any. Of course, I didn’t expect him to call Boyfriend trash, as Allison had; a therapist would use more neutral language, such as “It sounds like he had a lot of feelings that he didn’t communicate directly to you.” Still, Wendell says nothing. My tears are starting to spill onto my pants again when out of the corner of my eye, I see an object flying through the air toward me. At first it looks like a football, and I wonder if I’m hallucinating (from the zero hours of restful sleep I’ve gotten since the breakup), but then I realize that it’s a brown box of tissues—the one that was on the end table between the sofas, next to the seat I didn’t take. Instinctively, my hands fly up to catch it, but I miss. It lands with a thud on the cushion next to me, and I grab a bunch of tissues and blow my nose. Having the box there seems to narrow the space between Wendell and me, as if he just threw me a lifeline. Over the years, I’ve handed tissue boxes to patients countless times, but I’d forgotten how cared for that simple gesture can make someone feel. A phrase I first heard in graduate school pops into my head: “the therapeutic act, not the therapeutic word.” I take more tissues and wipe my eyes. Wendell is watching me, waiting. I continue talking about Boyfriend and his avoidance issues, building a case using details from his past, including the way his marriage ended, which wasn’t dissimilar to how our relationship ended in terms of shock value for his wife and kids. I’m telling Wendell everything I knew about Boyfriend’s history of avoidance without realizing that what I’m unintentionally illustrating is my avoidance of his avoidance—about which apparently I knew quite a bit. Wendell tilts his head slightly, a questioning smile on his face. “It’s curious, isn’t it, given what you knew about his history, that this is such a shock to you?” “But it is a shock,” I say. “He’d never said anything about not wanting a kid in the house! In fact, he’d just talked to HR at his firm to make sure that he could put my son on his benefits policy once we were married!” I go over the entire chronology again, adding more evidence to support my story, then notice that Wendell’s face is starting to cloud over. “I know I’m being repetitive,” I say. “But you have to understand, I was expecting that we would spend the rest of our lives together. This was how things were supposed to go, and now it’s all up in the air. Half my life is over, and I have no idea what’s going to happen. What if Boyfriend was the last person I fall in love with? What if he was the end of the line?” “The end of the line?” Wendell perks up. “Yeah, the end of the line,” I say. He waits for me to continue, but instead my tears return. Not the wild sobs of the past week, but something both calmer and deeper. Quieter. “I know that you feel caught by surprise,” Wendell says. “But I’m also interested in something else you said. Half your life is over. Maybe what you’re grieving isn’t just the breakup, though I know this experience feels devastating.” He pauses, and when he speaks again, his voice is softer. “I wonder if you’re grieving something bigger than the loss of your boyfriend.” He looks at me meaningfully, like he just said something incredibly important and profound, but I kind of want to punch him. What a load of garbage, I think. I mean, really? I was fine—more than fine; I was fine-plus—before this turn of events. I have a child I adore beyond measure. I have a career I enjoy immensely. I have a supportive family and amazing friends whom I care about and who care about me. I’m grateful for this life . . . okay, sometimes I’m grateful. I certainly try to be grateful. And now I’m frustrated. I’m paying this therapist to help me with a painful breakup and this is what he has to offer? Grieving something bigger, my ass. Before I can say this, I notice that Wendell is looking at me in a way I’m not used to being looked at. His eyes are like magnets, and every time I glance away, they seem to find me. His expression is intense but gentle, a combination of a wise elder and a stuffed animal, and it comes with a message: In this room, I’m going to see you, and you’ll try to hide, but I’ll still see you, and it’s going to be okay when I do. But I’m not here for that. As I told Wendell when I called to schedule the appointment, I just need some crisis management. “I’m really just here to get through the breakup,” I say. “I feel like I’ve been tossed in a blender and can’t get out, and that’s all I’m here for—to find a way out.” “Okay,” Wendell says, graciously backing off. “Help me understand more about the relationship.” He’s trying to establish what’s known as a therapeutic alliance, a trust that has to develop before any work can get done. In the early sessions, it’s always more important for patients to feel heard and understood than it is for them to gain any insight or make any changes. Relieved, I go back to talking about Boyfriend, rehashing the whole thing. But he knows. He knows what all therapists know: That the presenting problem, the issue somebody comes in with, is often just one aspect of a larger problem, if not a red herring entirely. He knows that most people are brilliant at finding ways to filter out the things they don’t want to look at, at using distractions or defenses to keep threatening feelings at bay. He knows that pushing aside emotions only makes them stronger, but that before he goes in and destroys somebody’s defense—whether that defense is obsessing about another person or pretending not to see what’s in plain sight—he needs to help the patient replace the defense with something else so that he doesn’t leave the person raw and exposed with no protection whatsoever. As the term implies, defenses serve a useful purpose. They shield people from injury . . . until they no longer need them. It’s in this ellipsis that therapists work. Meanwhile, back on my couch, clutching the tissue box, a small part of me knows something too. As much as I want validation, somewhere inside, I know that Wendell’s load of garbage is precisely what I’m paying him for, because if I just want to complain about Boyfriend, I can do that for free, with my family and friends (at least until their patience runs out). I know that often people create faulty narratives to make themselves feel better in the moment even though it makes them feel worse over time—and that sometimes, they need somebody else to read between the lines. But I also know this: Boyfriend is a goddamn motherfucking selfish sociopath. I’m in that space between knowing and not knowing. “That’s all we can do with this today,” Wendell says, and following his gaze, I notice for the first time that his clock has been resting on the windowsill over my shoulder. He lifts his arms and gives his legs two loud pats as if to punctuate the session’s end, a gesture that I’ll soon come to recognize as his signature sign-off. Then he rises and escorts me to the door. He says to let him know if I’d like to come back next Wednesday. I think about the week ahead, the void where Boyfriend used to be, and the comfort of, as Jen said, having a place to completely fall apart. “Sign me up,” I say. I walk across the street to the lot where I used to park for my bikini waxes, and I feel both lighter and like I might vomit. A supervisor once likened doing psychotherapy to undergoing physical therapy. It can be difficult and cause pain, and your condition can worsen before it improves, but if you go consistently and work hard when you’re there, you’ll get the kinks out and function so much better. I check my phone. A text from Allison: Remember, he’s trash. An email from a patient needing to move her session. A voicemail from my mom wondering if I’m okay. No message from Boyfriend. I’m still hoping he’ll call. I can’t understand how he could be fine while I’m suffering so much. At least, he seemed fine when we coordinated my returning his belongings this morning. Had he gotten through his sadness months ago, knowing that eventually he was going to end things? If so, how could he have kept talking about our future together? How could he send I love you emails just hours before what was to become our last conversation, at the start of which we made movie plans for the weekend? (Did he go see the movie? I wonder.) I start to stew again on the drive to the office. By the time I pull into my building’s parking garage, I’m thinking about the fact that not only has Boyfriend wasted two years of my life, but now I’m going to have to deal with the fallout by going to therapy, and I don’t have time for any of this because I’m in my forties now and half my life is over and . . . oh my God, there it is again! Half my life is over. I’ve never said that to myself or anyone else before. Why does it keep popping up? You’re grieving something bigger, Wendell had said. But I forget all about this as soon as I step into the elevator at work. 8 Rosie “Well, it’s official,” John says after slipping off his shoes and sitting cross-legged on the sofa. “I’m surrounded by idiots.” His phone vibrates. As he reaches for it, I raise my eyebrows. In return, John gives me an exaggerated eye roll. It’s our fourth session together, and I’ve started to form some initial impressions. I get the sense that, despite all the people surrounding him, John is desperately isolated—and that this is by design. Something in his life has made getting close seem dangerous, so dangerous that he does everything in his power to prevent it. His arsenal is effective: He insults me, goes on long tangents, changes the subject, and interrupts whenever I attempt to speak. But unless I can find a way to get past his defenses, we’ll have no chance of making headway. One of these defenses is his cell phone. Last week, after John began texting in session, I brought his attention to my experience of feeling dismissed when he texts. This is called working in the here-and-now. Instead of focusing on a patient’s stories from the outside world, the here-and-now is about what’s occurring in the room. You can bet that whatever a patient does with his therapist, he also does with others, and I wanted John to begin to see the impact he had on people. I knew I ran the risk of pushing too far too soon, but I remembered a detail about his earlier therapy: It had lasted just three sessions, exactly where we were. I didn’t know how long I’d have with him. I was guessing that John had left his previous therapist for one of two reasons: either she didn’t call him on his bullshit, which makes patients feel unsafe, like children whose parents don’t hold them accountable; or she did call him on his bullshit, but she moved too fast and committed the same mistake I was potentially about to make. I was willing to risk it, though. I wanted John to feel comfortable in therapy but not so comfortable that I wasn’t helping him. Above all, I didn’t want to fall into the trap that Buddhists call idiot compassion—an apt phrase, given John’s worldview. In idiot compassion, you avoid rocking the boat to spare people’s feelings, even though the boat needs rocking and your compassion ends up being more harmful than your honesty. People do this with teenagers, spouses, addicts, even themselves. Its opposite is wise compassion, which means caring about the person but also giving him or her a loving truth bomb when needed. “You know, John,” I’d said the week before as he texted away, “I’m curious if you have any reaction to my feeling dismissed when you do this.” He held up a finger—Hang on—but continued to text. When he finished, he looked up at me. “Sorry, what was I saying?” I loved that. Not “What were you saying” but “What was I saying.” “Well—” I began, but his phone pinged, and off he went, responding to another text. “See, this is what I mean,” he grumbled. “I can’t delegate anything if I want it done right. Just a sec.” Judging by the pings coming in, he seemed to be having multiple conversations. I wondered if we were reenacting a scene that played out with his wife. Margo: Pay attention to me. John: Who, you? It was profoundly annoying. What to do with my annoyance? I could sit and wait (and become more irritated), or I could do something else. I stood up, walked over to my desk, searched through a file, picked up my cell phone, walked back to my chair, and started texting. It’s me, your therapist. I’m over here. John’s phone pinged. I watched him read my text, surprised. “Jesus Christ! You’re texting me now?” I smiled. “I wanted to get your attention.” “You have my attention,” he said, but he kept on texting. I don’t feel like I have your attention. I feel ignored, and a bit insulted. Ping. John sighed dramatically, then resumed his texting. And I don’t think I can help you unless we’re able to give each other our full attention. So if you’d like to try to work together, I’m going to ask that you not use your phone in here. Ping. “What??” John said, looking up at me. “You’re banning my cell phone? Like I’m on an airplane? You can’t do that. It’s my session!” I shrugged. “I don’t want to waste your time.” I didn’t tell John that our sessions aren’t, in fact, his alone. Every therapy session belongs to both patient and therapist, to the interaction between them. It was the psychoanalyst Harry Stack Sullivan who, in the early twentieth century, developed a theory of psychiatry based on interpersonal relationships. Breaking away from Freud’s position that mental disorders were intrapsychic in origin (meaning “in one’s mind”), Sullivan believed that our struggles were interactional (meaning “relational”). He went so far as to say, “It’s the mark of a senior clinician that he or she is the same person in their living room that they are in their office.” We can’t teach patients to be relational if we aren’t relational with them. John’s phone pinged again, but this time it wasn’t me. He looked between me and his phone, deliberating. As his internal battle waged, I waited it out. I was half prepared for him to get up and leave, but I also knew that if he didn’t want to be here, he wouldn’t have come. Whether he understood it or not, he was getting something out of this. I was likely the only person in his life right now who would listen to him. “Oh, for God’s sake!” he said, tossing his cell onto the chair across the room. “Okay, I’ll put down the goddamned phone.” Then he changed the subject. I expected his anger, but for a second it looked as if his eyes had moistened. Was that sadness? Or was that a reflection from the sun streaming in the window? I toyed with inquiring, but there was only a minute left in the session, a time usually reserved for putting people back together rather than opening them up. I decided to file it away for a more opportune moment. Like a miner spotting a glimmer of gold, I suspected that I’d hit on something. Today, with much restraint, John stops mid-reach, leaving his vibrating phone alone and continues his story about being officially surrounded by idiots. “Even Rosie’s being idiotic,” he says. I’m surprised to hear him talk this way about his daughter, who’s four. “I tell her not to go near my laptop, and what does she do? She jumps on the bed, which is fine, but it’s not fine to jump on the laptop that’s on the bed. Idiot! And then as soon as I yell, ‘No!?’ she pees on the bed. Ruined the mattress. She hasn’t peed on anything since she was a baby.” This story concerns me. There’s a myth that therapists are trained to be neutral, but how can we be? We’re humans, not robots. In fact, instead of being neutral, we therapists strive to notice our very un-neutral feelings and biases and opinions (what we call countertransference), so that we can step back and figure out what to do with them. We use, rather than suppress, our feelings to help guide the treatment. And this story about Rosie raises my hackles. Many parents have yelled at their kids in their less-than-glorious parenting moments, but I wonder about John’s relationship with his daughter. When working with couples on empathy, often I’ll say, “Before you speak, ask yourself, What is this going to feel like to the person I’m speaking to??” I make a mental note to share this with John one day. “That sounds frustrating,” I say. “Do you think you might have scared her? A loud voice can be frightening.” “Nah, I yell at her all the time,” he says. “The louder the better. Only way she listens.” “The only way?” I ask. “Well, when she was younger I would go outside and run around with her, let her blow off some steam. Sometimes she just needed to be outside. But lately she’s been a real pain in the ass. She even tried to bite me.” “Why?” “She wanted to play with me, but . . . oh, you’ll love this.” I know what’s coming. “I was texting, so she had to wait, and she just lost her shit. Margo was out of town, so Rosie was spending her days with her Danny, and—” “Remind me, who’s Danny?” “Not Danny. Her danny. You know, a dog nanny?” I stare back blankly. “A dog sitter. A nanny for the dog. A danny.” “Oh, so Rosie is your dog,” I say. “Well, who the hell did you think I was talking about?” “I thought your daughter’s name was—” “Ruby,” he says. “The little one is Ruby. Wasn’t it obvious that I was talking about a dog here?” He sighs and shakes his head as if I’m the biggest idiot in his kingdom of idiots. He never mentioned having a dog before. The fact that I remembered the first letter of his daughter’s name, which was referenced only in passing two sessions ago, feels like a victory to me. But more than John’s entitlement, what strikes me is this: he’s showing me a softer side I haven’t seen yet. “You really love her,” I say. “Of course I do. She’s my daughter.” “No, I mean Rosie. You care about her deeply.” I’m trying to touch him in some way, to bring him closer to his emotions, which I know are there but atrophied, like a neglected muscle. He waves me away with his hand. “She’s a dog.” “What kind of dog is she?” His face brightens. “A mix. She’s a rescue dog. She was a mess when we got her because of those idiots who were supposed to be taking care of her, but now she’s—I’ll show you a photo if you’ll let me use my goddamned phone.” I nod. As he scrolls through his pictures, he smiles to himself. “I’m looking for a good one,” he says. “So you can see how cute she really is.” With each photo, he beams a bit more, and I glimpse his perfect teeth again. “Here she is!” he says proudly, handing me the phone. I look down at the picture. I happen to love dogs, but Rosie, God bless her, is one of the ugliest dogs I’ve ever seen. She has sagging jowls, uneven eyes, multiple bald patches, and a missing tail. John is still beaming, smitten. “I can see how much you love her,” I say, handing back the phone. “I don’t love her. She’s a fucking dog.” He sounds like a fifth-grade boy denying a crush on a classmate. John and Rosie sitting in a tree . . . “Oh,” I say gently. “The way you talk about her, I hear a lot of love there.” “Would you stop saying that?” His tone is irritated, but I see pain in his eyes. I think back to our previous session—something about love or caring must feel painful for him. With a different patient, I might ask why what I’m saying is so upsetting. But I know that John will avoid the topic by arguing with me about whether he loves his dog. Instead, I say, “Most people who have pets care about them deeply.” I lower my voice so that he almost has to lean in to hear me. Neuroscientists discovered that humans have brain cells called mirror neurons that cause them to mimic others, and when people are in a heightened state of emotion, a soothing voice can calm their nervous systems and help them stay present. “Whether it’s called love or something else, it doesn’t really matter.” “This is a ridiculous conversation,” John says. He’s looking down at the floor, but I can see that I’ve got his full attention. “You brought up Rosie for a reason today. She matters to you, and now she’s acting in a way that concerns you—because you care.” “People matter to me,” John says. “My wife, my kids. People.” He glances toward his cell, which is vibrating again, but I don’t follow his gaze. I stay with him, trying to hold on so he won’t get pulled away whenever an unwanted feeling appears and go numb. People often mistake numbness for nothingness, but numbness isn’t the absence of feelings; it’s a response to being overwhelmed by too many feelings. John looks from his cell back to me. “You know what I love about Rosie?” he says. “She’s the only one who doesn’t ask things of me. The only one who isn’t, in one way or another, disappointed with me—or at least, she wasn’t before she bit me! Who wouldn’t love that?” He laughs loudly, like we’re at a bar and he’s just tossed out a breezy one-liner. I try to talk about the disappointment—who’s disappointed with him and why?—but he claims it was just a joke and can’t I take a joke? And though we get nowhere with this today, we both know what he told me: he has a heart under those quills, and the capacity for love. For starters, he adores that hideous dog. 9 Snapshots of Ourselves People who come to therapy present snapshots of themselves, and from these snapshots, a therapist has to extrapolate. Patients arrive, if not at their worst, then certainly not at their best. They might be despairing or defensive, confused or chaotic. Generally, they’re in very bad moods. So they sit on the therapist’s couch and look up expectantly, hoping to find some understanding and, eventually (but preferably immediately), a cure. But therapists don’t have an immediate cure because these people are complete strangers to us. We need time to acquaint ourselves with their hopes and dreams, their feelings and behavior patterns, sometimes more deeply than even they have. If it takes from birth to the day they arrive in our offices to develop whatever is troubling them or if a problem has been incubating for many months, it makes sense that they might need more than a couple of fifty-minute sessions to attain the desired relief. But when people are in extremis, they want their therapists, these professionals, to do something. Patients want our patience but may not have much patience themselves. Their demands can be overt or tacit, and—especially in the beginning—they can weigh heavily on the therapist. Why would we choose a profession that requires us to meet unhappy, distressed, abrasive, or unaware people and sit with them, one after the other, alone in a room? The answer is this: Because therapists know that at first, each patient is simply a snapshot, a person captured in a particular moment. It’s like a photo of you taken from an unfortunate angle and with a sour expression on your face. There might also be a photo in which you’re glowing, caught opening a present or mid-laugh with a lover. Both are you in that fraction of time, and neither is you in your entirety. So therapists listen, suggest, nudge, guide, and occasionally cajole our patients to bring other snapshots into view, to shift their experience of what’s happening inside and around them. We sort through the snapshots, and before long it becomes apparent that these seemingly discrete images all revolve around a common theme, one that might not have been in our patients’ fields of vision when they decided to come in. Some snapshots are disturbing, and glimpsing them reminds me that we all have a dark side. Others are blurry. People don’t always remember events or conversations clearly, but they do remember with great accuracy how an experience made them feel. Therapists have to be interpreters of these blurry snapshots, aware that patients need to be fuzzy to some extent, because those first snapshots help to gloss over painful feelings that might be invading their peaceful inner territory. In time, they find out that they aren’t at war after all, that the path to peace is to call a truce with themselves. Which is why when people first come in, we’re imagining them down the line. We do this not just on that first day but in every single session, because that image allows us to hold for them the hope that they can’t yet muster themselves, and it informs how the treatment unfolds. I once heard creativity described as being the ability to grasp the essence of one thing and the essence of some very different thing and smash them together to create some entirely new thing. That’s what therapists do too. We take the essence of the initial snapshot and the essence of an imagined snapshot and smash them together to create an entirely new one. I have this in mind each time I meet a new patient. I hope that Wendell does too, because in those early sessions, my snapshots are, well—not flattering. 10 The Future Is Also the Present Today I’m early for my appointment, so I sit in Wendell’s waiting room and take a look around. Turns out his waiting room is as unusual as his therapy room. Instead of professional-looking furniture and the usual art—a framed poster of an abstract painting; maybe an African mask—the aesthetic in here is Grandma’s hand-me-downs. There’s even a musty smell to go with it. In a corner are two worn, high-backed dining chairs in an outdated paisley gold-brocade fabric, an equally worn and outdated rug on top of the beige wall-to-wall carpet, and a credenza covered by a stained lace tablecloth topped with doilies—doilies!—and a vase of fake flowers. On the floor between the chairs is a white-noise machine, and in front of them, in lieu of a coffee table, is what probably used to be a living-room side table now nicked and chipped and covered by a mess of magazines. A paper folding screen shields this seating area from the path leading in and out of Wendell’s office so that patients have some privacy, but you can still see clearly through the hinged openings. I know I’m not here for the d?cor, but I find myself wondering: Can somebody with such bad taste help me? Is this a reflection of his judgment? (An acquaintance told me that she’d been profoundly distracted by the crooked pictures hanging in her therapist’s office; why wouldn’t she just straighten the damn things?) For about five minutes, I glance at the magazine covers—Time, Parents, Vanity Fair—and then the door to the therapy room opens and out walks a woman. She whizzes behind the screen, but I can tell in the split second I see her that she’s pretty, well dressed, and tearful. Then Wendell appears in the waiting area. “I’ll just be a minute,” he says, and he heads into the hallway, presumably to use the restroom. As I wait, I wonder what the pretty woman was crying about. When Wendell returns, he gestures for me to enter his office. There’s no hesitation at the doorway now. I go straight to position A, by the window, he to position C, by the side table, and I launch right in. “Blah-blah-blah-blah,” I begin. “And if you can believe this, Boyfriend said, ‘Blah-blah-blah-blah-blah,’ so I said, ‘Well, blah-blah-blah?’” Or at least, that’s what I’m sure it sounds like to Wendell. This goes on for a while. I’ve brought in pages of notes for this session, numbered, annotated, and in chronological order, just like I organized the interviews I did as a journalist before I became a therapist. I confess to Wendell that I’d caved and phoned Boyfriend and that he’d let it go to voicemail. Humiliated, I had to wait a full day for him to call me back, knowing the entire time that the last thing anyone wants to do is talk to the person he’s just broken up with but who still wants to be together. “You’re probably going to ask what I wanted to get out of calling him,” I say, anticipating his next question. Wendell raises his right eyebrow—just the one, I notice, and I wonder how he does that—but before he can respond, I plow ahead. First, I explain, I wanted Boyfriend to tell me that he missed me and this was all a big mistake. But barring that “unlikely possibility” (added so that Wendell knows I have self-awareness, even though I’d believed that Boyfriend would tell me he’d reconsidered), I wanted to get clear on how we had arrived at this point. If I could just get my questions answered, I’d stop going over the breakup in my head ad nauseam, in an infinite loop of confusion. Which is why, I tell Wendell, I subjected Boyfriend to a several-hour interrogation—I mean conversation—in which I tried to solve the mystery of What the Fuck Led to Our Sudden Breakup. “And then he says, ‘Being around a kid is limiting and distracting,’” I go on, reading verbatim quotes. “‘It never would have been enough alone time with you. And I realized that no matter how great the kid, I’m never going to want to live with any child other than my own.’ So then I said, ‘Why did you hide all this from me?’ and he said, ‘Because I needed to figure it out before I said anything.’ And then I said, ‘But don’t you think we should have discussed this?’ and he said, ‘What’s to discuss? It’s binary. Either I could live with a kid or I couldn’t, and only I could figure that out.’ And just as my brain is about to burst, he says, ‘I really love you, but love doesn’t conquer all.’ “It’s binary!” I say to Wendell, shaking my papers in the air. I’d put an asterisk next to this word in my notes. “Binary! If it’s so binary, why get into the binary situation in the first place?” I’m insufferable and I know it, but I can’t stop. For the next several weeks, I come to Wendell’s office and report the details of my circular conversations with Boyfriend (admittedly, there are several more) while Wendell tries to interject something useful (that he’s not sure how this is helping me; that this feels masochistic; that I keep telling the same story hoping for a different outcome). He says that I want Boyfriend to explain himself to me—and that he is explaining himself to me—but that I keep going back because his explanation isn’t what I want to hear. Wendell says that if I’ve been taking such copious notes during our phone calls, I probably haven’t been able to listen to Boyfriend, and if my goal is to be open to understanding his perspective, that’s hard to do when I’m trying to prove a point rather than have an interaction in earnest. And, he adds, I’m doing the same thing to him in our sessions. I agree, then go right back to railing against Boyfriend. In one session, I explain with excruciating specificity the arrangements for getting Boyfriend’s belongings returned to him. In another, I repeatedly ask, Am I crazy or is he? (Wendell says neither of us is crazy, which infuriates me.) Another consists of an analysis of what kind of person says, “I want to marry you, just not you with a kid.” For this session, I’ve created an infographic on gender differences. A man can say “I don’t want to have to look at the Legos” and “I’ll never love a kid who’s not mine” and get away with it. A woman who said that would be crucified. I also pepper our sessions with reports of what I’ve discovered in my daily Google-stalking: the women Boyfriend must be dating (based on elaborate stories I create from social media Likes); how fabulous his life is without me (based on his Tweets about his business trip); how he isn’t even sad about the breakup (because he photographs salads in restaurants—how can he even eat?). I’m convinced that Boyfriend has quickly transitioned into his post-me life completely unscathed. It’s a refrain I recognize from divorcing couples I see in which one person is struggling mightily and the other seems fine, happy even, to be moving on. I tell Wendell that, like these patients, I want some sign of the scar tissue left behind. I want to know, in the end, that I mattered. “Did I matter?” I ask over and over. I continue like this, letting my freak flag fly, until finally Wendell kicks me. One morning, as I drone on about Boyfriend, Wendell scoots to the edge of his couch, stands up, walks over to me, and, with his very long leg, lightly kicks my foot. Smiling, he returns to his seat. “Ouch!” I say reflexively, even though it didn’t hurt. I’m startled. “What was that?” “Well, you seem like you’re enjoying the experience of suffering, so I thought I’d help you out with that.” “What?” “There’s a difference between pain and suffering,” Wendell says. “You’re going to have to feel pain—everyone feels pain at times—but you don’t have to suffer so much. You’re not choosing the pain, but you’re choosing the suffering.” He goes on to explain that all of this perseverating I’m doing, all of this endless rumination and speculation about Boyfriend’s life, is adding to the pain and causing me to suffer. So, he suggests, if I’m clinging to the suffering so tightly, I must be getting something out of it. It must be serving some purpose for me. Is it? I think about why I might be obsessively Google-stalking Boyfriend despite how bad I know it makes me feel. Is it a way to stay connected to Boyfriend and his daily routine, even if it’s only one-sided? Maybe. Is it a way to numb out so I don’t have to think about the reality of what happened? Possibly. Is it a way of avoiding what I should be paying attention to in my life but don’t want to? Earlier, Wendell had pointed out that I’d kept my distance from Boyfriend—ignoring clues that would have made his revelation less shocking—because if I’d inquired about them, Boyfriend might have said something I didn’t want to hear. I told myself it meant nothing that he seemed irritated by kids in public places, that he’d happily run errands for us rather than attend my son’s basketball games, that he said it was more important to his ex-wife than to him to have children when they were having fertility problems, and that his brother and sister-in-law stayed in a hotel when they came to visit because Boyfriend didn’t want the commotion of their three kids in his house. And yet, neither he nor I had ever discussed our feelings about children directly. I figured: He’s a dad, he likes kids. Wendell and I talked about my pretending away certain parts of Boyfriend’s history and comments and body language to quiet the alarm that might have gone off if I’d paid them heed. And now Wendell wonders if I’ve been keeping my distance from him as well, obsessing over my notes and sitting far away from him in order to protect myself here too. I glance at the L-shaped sofa configuration. “Don’t most people sit here?” I ask from my seat under the window. I’m certain that nobody shares a sofa with him, so that rules out position D. And as for position B, catty-corner to him, who would sit that close to the therapist? Again, nobody. “Some do,” Wendell says. “Really? Where?” “Anywhere along here.” Wendell gestures from where I’m sitting all the way to position B. Suddenly the distance between us seems vast, but I still can’t believe that people sit that close to Wendell. “So somebody walks into your office for the very first time, scans the room, and then plops down right there, even though you’re going to be sitting just inches away?” “They do,” Wendell says simply. I think about the tissue box that Wendell had tossed to me and how he kept it on the table next to position B because, it occurs to me now, most people must sit there. “Oh,” I say. “Should I move?” Wendell shrugs. “It’s up to you.” I get up and sit down perpendicular to Wendell. I have to adjust my legs to the side so that they don’t touch his. I notice a bit of gray at the roots of his dark hair. The wedding ring on his finger. I remember asking Caroline to refer me—or my “friend”—to a married male therapist, but now that I’m here, I realize it doesn’t really matter. He hasn’t sided with me or declared Boyfriend a sociopath. I adjust the pillows and try to get comfortable. This feels strange. I look down at my notes, but I have no interest in reading them right now. I feel exposed, and I have the urge to run. “I can’t sit here,” I say. Wendell asks why, and I tell him I don’t know. “Not knowing is a good place to start,” he says, and this feels like a revelation. I spend so much time trying to figure things out, chasing the answer, but it’s okay to not know. We’re both quiet for a while, then I get up and move farther away, about midway between positions A and B. I can breathe again. I think of a Flannery O’Connor quote: “The truth does not change according to our ability to stomach it.” What am I protecting myself from? What do I not want Wendell to see? All along, I’d been telling Wendell that I didn’t wish ill upon Boyfriend—like having his next girlfriend blindside him—I just wanted our relationship back. I said with a straight face that I didn’t want revenge, that I didn’t hate Boyfriend, that I wasn’t angry, just confused. Wendell listened but said he wasn’t buying it. Obviously, I did want revenge, I did hate Boyfriend, I was furious. “Your feelings don’t have to mesh with what you think they should be,” he explained. “They’ll be there regardless, so you might as well welcome them because they hold important clues.” How many times had I said something similar to my own patients? But here I feel as if I’m hearing this for the first time. Don’t judge your feelings; notice them. Use them as your map. Don’t be afraid of the truth. My friends, my family—like me, they’ve had trouble considering the possibility that Boyfriend is a decent guy who was confused and conflicted. Instead, he was either selfish or a liar. They’ve also never considered that, even though Boyfriend told himself that he couldn’t live with a kid, maybe he also couldn’t live with me. Maybe, in ways he didn’t realize, I reminded him too much of his parents or ex-wife or the woman he once mentioned who had hurt him deeply in graduate school. “I made a decision never to go through anything like that again,” he had said early in our relationship. I’d asked him to explain more, but he didn’t want to talk about it, and I, colluding with his avoidance, didn’t push it. Wendell, though, has been asking me to look at the ways we avoided each other by hiding behind romance and banter and plans for our future. And now I’m in pain and creating my own suffering—and my therapist is literally trying to kick some sense into me. He switches his crossed legs from right over left to left over right, something therapists do when their legs start to fall asleep. His striped socks match his striped cardigan today, as if they came as a set. He points with his chin to the papers in my hand. “I don’t think you’re going to get the answers you’re looking for from these notes.” You’re grieving something bigger pops into my head, like a song lyric I can’t shake. “But if I don’t talk about the breakup, I won’t have anything to say,” I insist. Wendell tilts his head. “You’ll have the important things to say.” I hear him and I don’t. Whenever Wendell implies that this is bigger than Boyfriend, I push back, so I suspect that he must be onto something. The things we protest against the most are often the very things we need to look at. “Maybe,” I say. But I feel antsy. “Right now I feel like I need to finish telling you what Boyfriend said. Can I just tell you one last thing?” He takes in a breath and then stops, hesitating, like he was about to say something but decided against it. “Sure,” Wendell says. He’s pushed me enough and knows it. He’s taken away my drug—talking about Boyfriend—for a minute too long, and I need another fix. I start rifling through the pages, but now I can’t remember where I was. I’m scanning the notes to see which damning quote I should share next, but there are so many asterisks and so many notes, and I can feel Wendell’s eyes on me. I wonder what I would be thinking if somebody like me were sitting in my therapy room right now. Actually, I know. I’d be thinking of the laminated sign that my office mate posted inside the files at work: There is a continuing decision to be made as to whether to evade pain, or to tolerate it and therefore modify it. I put down the notes. “Okay,” I say to Wendell. “What did you want to say?” Wendell explains that my pain feels like it’s in the present, but it’s actually in both the past and the future. Therapists talk a lot about how the past informs the present—how our histories affect the ways we think, feel, and behave and how at some point in our lives, we have to let go of the fantasy of creating a better past. If we don’t accept the notion that there’s no redo, much as we try to get our parents or siblings or partners to fix what happened years ago, our pasts will keep us stuck. Changing our relationship to the past is a staple of therapy. But we talk far less about how our relationship to the future informs the present too. Our notion of the future can be just as powerful a roadblock to change as our notion of the past. In fact, Wendell continues, I’ve lost more than my relationship in the present. I’ve lost my relationship in the future. We tend to think that the future happens later, but we’re creating it in our minds every day. When the present falls apart, so does the future we had associated with it. And having the future taken away is the mother of all plot twists. But if we spend the present trying to fix the past or control the future, we remain stuck in place, in perpetual regret. By Google-stalking Boyfriend, I’ve been watching his future unfold while I stay frozen in the past. But if I live in the present, I’ll have to accept the loss of my future. Can I sit through the pain, or do I want to suffer? “So,” I say to Wendell, “I guess I should stop interrogating Boyfriend—and Google-stalking him.” He smiles indulgently, the way one would at a smoker who announces that she’ll quit cold turkey but doesn’t realize how overly ambitious that is. “Or at least try,” I say, backtracking. “Spend less time on his future, more on my present.” Wendell nods, then pats his legs twice and stands. The session is over but I want to stay. I feel like we just got started. 11 Goodbye, Hollywood My first week working at NBC, I was assigned to two shows that were about to premiere: ER, a medical drama, and Friends, a sitcom. These shows would catapult the network to number one and establish its Thursday-night dominance for years to come. The series were set to air in the fall, following a much faster cycle than in the film world. Within months, casts and crews were hired, sets were built, and production began. I was in the room when Jennifer Aniston and Courteney Cox auditioned for starring roles in Friends. I weighed in on whether Julianna Margulies’s character in ER should die at the end of episode one, and I was on the set with George Clooney before anyone knew how famous this series would make him. Energized by this new job, I watched less TV at home. I had stories I was passionate about and colleagues who were equally passionate about those stories, and I felt connected to my work again. One day ER’s writers called up a local emergency department with a medical question, and a physician named Joe happened to take the call. It seemed like kismet—in addition to his medical degree, he had a master’s in film production. When the writers learned of Joe’s background, they began to consult him regularly. Before long, they hired him as a technical adviser to block out the highly choreographed trauma-bay scenes, teach the actors how to pronounce medical terms, and make the procedures look as accurate as possible (flush out the syringe; wipe the skin with alcohol before starting an IV; hold the patient’s neck in this position when inserting a breathing tube). Of course, sometimes we skipped the surgical masks the characters should have worn, because everyone wanted to see George Clooney’s face. On set, Joe was a study in competence and calm, the same qualities that served him in a real ER. During breaks, he would talk about patients he’d seen recently, and I’d want to hear every detail. What stories! I thought. One day I asked Joe if I could visit him on the job—“Research,” I said—and he offered me access to his ER, where, in borrowed baggy scrubs, I followed him around during his shift. “The drunk drivers and gang shootings don’t start pouring in until dark,” he explained when I arrived on a Saturday afternoon and not much was going on. But soon we were rushing from room to room, patient to patient, as I tried to keep the names and charts and diagnoses straight. In the span of an hour, I watched Joe do a lumbar puncture, see inside a pregnant woman’s uterus, and hold the hand of a thirty-nine-year-old mother of twins as she was told that her migraine was really a brain tumor. “No, you see, we just wanted more migraine medicine” was her only response—denial that would soon give way to a rush of tears. Her husband excused himself to go to the restroom but vomited on the way. For a second I pictured this drama on TV—an ingrained instinct when your work is coming up with stories—but I had a sense that finding TV material wasn’t only what being here was about for me. And Joe sensed that, too. Week after week, I kept going back to the ER. “You seem more interested in what we’re doing here than in your day job,” Joe said one evening months later as we looked at an x-ray together and he showed me where the fracture was. Then, almost as an afterthought, he said, “You could still go to medical school, you know.” “Medical school?” I said. I looked at him like he was nuts. I was twenty-eight years old and had been a language major in college. It was true that in high school I’d competed in math and science tournaments, but outside of school, I’d always been drawn to words and stories. And now my work was a great job at NBC that I felt incredibly lucky to have. Even so, I kept sneaking away from tapings to go back to the ER—not just with Joe but with other doctors who let me shadow them too. I knew that my being there had gone from research to hobby, but so what? Didn’t everyone have hobbies? And, okay, sure, maybe spending my evenings in the ER had become the new equivalent of obsessively watching TV every night when I was restless in my film job. Again, so what? I certainly wasn’t about to give all this up and start over in medical school. Besides, I wasn’t bored by the work at NBC. I just felt that something real and big and meaningful was happening in the ER that couldn’t happen in the same way on television. And my hobby could fill in those blanks—that’s what hobbies were for. But sometimes I’d be standing in the ER, and, during a lull in the action, I’d realize how at home I felt, and more and more I wondered if Joe was onto something. Before long, my hobby led me out of the ER and into a neurosurgery suite. The case I’d been invited to see was that of a middle-aged man with a pituitary tumor that was likely benign but had to be removed to keep it from pressing on his cranial nerves. Gowned and masked and wearing running shoes for comfort, I stood over Mr. Sanchez, peering into his skull. After sawing through the bone (using a tool like something you’d buy at Home Depot), the surgeon and his team meticulously pulled aside layer after layer of fascia until they reached his naked brain. Finally, there it was, looking just like the images I’d seen in a book the night before, but as I stood there, my own brain inches from Mr. Sanchez’s, I felt a sense of awe. Everything that made this man himself—his personality, his memories, his experiences, his likes and dislikes, his loves and losses, his knowledge and abilities—was contained in this three-pound organ. You lose a leg or a kidney, you’re still you, but lose a part of your brain—literally, lose your mind—and who are you then? I had a perverse thought: I’ve gotten inside a person’s head! Hollywood tried to get into people’s heads all the time via market research and ads, but I was actually there, deep inside this man’s skull. I wondered if those slogans the network bombarded viewers with ever made it to their destinations: It’s Must See TV! As classical music played softly in the background and two neurosurgeons picked away at the tumor, carefully depositing pieces of it onto a metal tray, I thought of the frenetic sets in Hollywood with all of their commotion and commands. “Come on, people! Let’s go!” An actor would be rushed down a hallway on a stretcher, red liquid drenching his clothes, but then someone would turn the corner too quickly. “Shit!” the director would say. “Jesus, people, let’s get it right this time!” Burly men with cameras and lights would rush around in a frenzy, resetting the scene. I’d see a producer pop a pill—Tylenol or Xanax or Prozac?—and down it with sparkling water. “I’m gonna have a heart attack if we don’t get this shot today.” He’d sigh. “I swear, I’m gonna die.” In the OR with Mr. Sanchez, there was no yelling, no one feeling as if a coronary was imminent. Even Mr. Sanchez, with his head sawed open, seemed less stressed out than the people on the set. As the surgical team worked, “Please” and “Thank you” peppered each request, and if it weren’t for the steady stream of blood dripping out of a man’s head and into a bag near my leg, I might have mistaken this place for fantasy. And in a way it was. It was at once more real than anything I had ever seen and also galaxies away from what I considered to be my actual life back in Hollywood, a place I had no intention of leaving. But months later, everything changed. I’m following an ER doctor in a county hospital on a Sunday. As we approach a curtain, he says, “Forty-five-year-old with complications from diabetes.” He pulls back the curtain and I see a woman lying on the table under a sheet. That’s when the smell hits my nostrils—an assault so vile I worry I might faint. I can’t identify the odor because I’ve never smelled anything this nauseating in my life. Has she defecated? Vomited? I see no signs of either, but the smell becomes so powerful that I feel the lunch I ate an hour ago rise into my throat, and I swallow hard to keep it down. I hope she can’t see how pale I must be or sense the queasiness taking over my gut. I’m thinking: Maybe it’s coming from the next bed over. Maybe if I move more to this side of the room, I won’t smell it so strongly. I concentrate on the woman’s face—watery eyes, reddish cheeks, bangs over her sweaty forehead. The doctor is asking her questions and I can’t understand how he manages to breathe. I’ve been trying to hold my breath this entire time, but I have to come up for air. Okay, I tell myself. Here goes. I take in some air and the smell seizes my body. Steadying myself against the wall, I look on as the doctor lifts the sheet covering the woman’s legs. Only there are no lower legs. Her diabetes has caused severe vasculitis, and all that remain are two stumps above the knees. One has gangrene, and I can’t decide if the sight of this infected stump, all black and moldy like a rotten fruit, is worse than its smell. The space is small, and I move closer to the woman’s head, as far away from the infected stump as possible, and that’s when something extraordinary happens. This woman takes my hand and smiles at me as if to say, I know this is hard to watch, but it’s okay. Even though I’m the one who should be holding her hand, even though she’s the one with the missing appendages and a massive infection, she’s reassuring me. And though this could make a great story line on ER, in that millisecond, I know I won’t be working on that show much longer. I am going to medical school. Maybe that’s an impulsive reason to change careers—the fact that this graceful stranger with a blackened stump is holding my hand as I try not to barf—but something is happening inside me that I’ve never felt at any of my Hollywood jobs. I still love TV, but there’s something about the real stories I’m experiencing in person that seduce me and make the imaginary ones feel thin. Friends is about community, but a fake one. ER is about life and death, but they’re fictional. Instead of taking these stories I witness and folding them back into my world at the network, I want real life—real people—to be my world. As I drive home from the hospital that day, I don’t know how or when this might happen or what kind of medical-school loans I can get or even if I can get in. I don’t know how many science classes I’ll have to take to meet the requirements and prepare for the MCAT or where to take those courses, since I graduated from college six years ago. But somehow, I decide, I’m going to make this happen, and I can’t do that while working sixty-hour weeks on Must See TV. 12 Welcome to Holland After Julie learned that she was dying, her best friend, Dara, wanting to be helpful, sent her the well-known essay “Welcome to Holland.” Written by Emily Perl Kingsley, the parent of a child with Down syndrome, it’s about the experience of having your life’s expectations turned upside down: When you’re going to have a baby, it’s like planning a fabulous vacation trip—to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It’s all very exciting. After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The flight attendant comes in and says, “Welcome to Holland.” “Holland?!?” you say. “What do you mean Holland?? I signed up for Italy! I’m supposed to be in Italy. All my life I’ve dreamed of going to Italy.” But there’s been a change in the flight plan. They’ve landed in Holland and there you must stay. The important thing is that they haven’t taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It’s just a different place. So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met. It’s just a different place. It’s slower-paced than Italy, less flashy than Italy. But after you’ve been there for a while and you catch your breath, you look around . . . and you begin to notice that Holland has windmills . . . and Holland has tulips. Holland even has Rembrandts. But everyone you know is busy coming and going from Italy . . . and they’re all bragging about what a wonderful time they had there. And for the rest of your life, you will say “Yes, that’s where I was supposed to go. That’s what I had planned.” And the pain of that will never, ever, ever, ever go away . . . because the loss of that dream is a very, very significant loss. But . . . if you spend your life mourning the fact that you didn’t get to Italy, you may never be free to enjoy the very special, the very lovely things . . . about Holland. “Welcome to Holland” made Julie furious. After all, there was nothing special or lovely about her cancer. But Dara, whose son had severe autism, said that Julie was missing the point. She agreed that Julie’s prognosis was devastating and unfair and a complete departure from how her life was supposed to go. But she didn’t want Julie to spend the time she had remaining—perhaps as long as ten years—missing out on what she might still have while alive: Her marriage. Her family. Her work. She could still have a version of those things in Holland. To which Julie thought, Screw you. And also, You’re right. Because Dara would know. I’d already heard about Dara from Julie, the same way I hear about all of my patients’ close friends. I knew from Julie that when Dara was at her wits’ end with worry and grief over her son’s endless hitting and head-banging, his tantrums, his inability to have a conversation or feed himself at four years old, his need for multiple weekly therapies that had taken over her life but also didn’t seem to be helping, Dara would call Julie, despondent. “Now, I’m embarrassed by this,” Julie said after she explained her initial anger toward Dara, “but when I saw what Dara was going through with her son, my biggest fear was to end up in her situation. I love her so much, and I also felt like any hope for the life she wanted had died.” “Like you feel now,” I said. Julie nodded. She told me that for a long while, Dara would say, “I didn’t sign up for this!” and catalog all the ways in which her life had been irrevocably changed. She and her husband would never have cuddles and carpools and reading stories before bed. They would never have a child who would grow into an independent adult. Dara would look at her husband, Julie said, and think, He’s an amazing father to our son, but she couldn’t help contemplate the amazing father he would have been to a child who could fully interact with him. She couldn’t help the sadness that would descend when she let herself think about the kinds of experiences they wouldn’t be able to have with their child, ever. Dara felt selfish and guilty for her sadness, because she wished most of all that her son’s life could be easier for his sake, that he could live a fulfilling life, one with friends and lovers and work. She felt enveloped by both pain and envy when she saw other moms playing with their four-year-olds at the park, knowing that in that situation, her son would likely lose control and be asked to leave. That her son would continue to be shunned as he grew older, and so would she. The looks she got from the other moms, the ones who had typical kids with typical problems, added to her sense of isolation. Dara phoned Julie often that year, each call more hopeless than the previous one. Depleted financially, emotionally, and practically, she and her husband decided not to add a sibling to the mix—how could they afford and have time for another, and what if that child also had autism? She’d already stopped working in order to manage their son’s life while her husband took on an extra job, and she didn’t know how to cope. Until one day she came across “Welcome to Holland” and realized that she would have to not only cope in this strange land but find joy there where she could. There were still pleasures to be had, if she could let them in. In Holland, Dara found friends who understood her family’s situation. She found ways to connect with her son, to enjoy him and love him for who he was and not focus on who he wasn’t. She found ways to stop obsessing about what she did and did not know about tuna and soy and chemicals in cosmetics during her pregnancy that might have harmed her developing baby. She got care for her son so that she could care for herself and do meaningful part-time work and have meaningful downtime too. She and her husband found each other and their marriage again while also struggling with the challenges they couldn’t change. Instead of sitting in their hotel room the whole trip, they decided to venture out and see the country. Now Dara was inviting Julie to do the same, to look at the tulips and Rembrandts. And after Julie’s anger about “Welcome to Holland” subsided, it occurred to her that there would always be somebody whose life seemed more—or less—enviable. Would Julie trade places with Dara now? Her first instinct: yes, in a heartbeat. Her second: maybe not. She’d come up with various scenarios: If she could have ten great years with a healthy child, would she take that over a longer life? Is it more difficult to be sick yourself or to have a child who is? She felt horrible even having these thoughts, but she couldn’t deny them either. “Do you think I’m a bad person?” she’d ask, and I’d assure her that everyone who comes to therapy worries that what they think or feel might not be “normal” or “good,” and yet it’s our honesty with ourselves that helps us make sense of our lives with all of their nuances and complexity. Repress those thoughts, and you’ll likely behave “badly.” Acknowledge them, and you’ll grow. In this way, Julie started to see that we’re all in Holland, because most people don’t have lives that go exactly as planned. Even if you’re lucky enough to be traveling to Italy, you might experience canceled flights and horrible weather. Or your spouse might have a fatal heart attack in the shower ten minutes after the two of you have glorious sex in a luxurious Rome hotel room during a trip to celebrate your anniversary, as happened to an acquaintance of mine. So Julie was going to Holland. She didn’t know how long her stay would be, but we were booking her trip for ten years and would change the itinerary as needed. Meanwhile, we’d work together to figure out what she wanted to do there. Julie had just one stipulation. “Will you promise to tell me if I’m doing something crazy? I mean, now that I’m going to die sooner than I ever imagined, I don’t have to be so . . . sensible, right? So if I’m going overboard, and things get a little over-the-top, you’ll tell me?” I said I would. Julie had spent her entire life being conscientious and responsible, doing everything by the book, and I couldn’t imagine what her version of over-the-top would look like. I figured if anything, it would be the equivalent of the goody-goody student who went a little crazy by having one too many beers at a party. But I’d forgotten that people are often at their most interesting when they’ve got a proverbial gun to their head. “Bucket list,” Julie said in session as we tried to envision her Holland. “It’s such a funny term, isn’t it?” I had to agree. What do we want to do before we kick the bucket? Often people think about bucket lists when somebody close to them dies. That’s what happened for Candy Chang, an artist who, in 2009, created a space on a public wall in New Orleans with the prompt Before I die _____. Within days the wall was completely filled. People wrote things like Before I die, I want to straddle the international dateline. Before I die, I want to sing for millions. Before I die, I want to be completely myself. Soon the idea spawned over a thousand such walls all over the world: Before I die, I would like to have a relationship with my sister. Be a great dad. Go skydiving. Make a difference in someone’s life. I don’t know if people followed through, but based on what I’ve seen in my office, a good number may have had momentary awakenings, done a little soul-searching, added more to their lists—and then neglected to tick things off. People tend to dream without doing, death remaining theoretical. We think we make bucket lists to ward off regret, but really they help us to ward off death. After all, the longer our bucket lists are, the more time we imagine we have left to accomplish everything on them. Cutting the list down, however, makes a tiny dent in our denial systems, forcing us to acknowledge a sobering truth: Life has a 100 percent mortality rate. Every single one of us will die, and most of us have no idea how or when that will happen. In fact, as each second passes, we’re all in the process of coming closer to our eventual deaths. As the saying goes, none of us will get out of here alive. I’ll bet right now you’re glad that I’m not your therapist. Who wants to think about this? How much easier it is to become death procrastinators! Many of us take for granted the people we love and the things we find meaningful, only to realize, when our deadline is announced, that we’d been skating by on the project: our lives. But now Julie needed to grieve all the things she’d have to leave off her list. Unlike older people, who grieve for what they’ll be losing and leaving behind, Julie was grieving for what she would never have—all of the milestones and firsts that people in their thirties just assume will happen. Julie had, as she put it, “a concrete deadline” (“Dead being the operative part of the word,” she said), a deadline so unforgiving that most of what she’d expected would never come to pass. One day Julie told me that she’d begun to notice how often in casual conversation people talked about the future. I’m going to lose weight. I’m going to start exercising. We’re going to take a vacation this year. In three years, I’ll get that promotion. I’m saving to buy a house. We want to have a second baby in a couple of years. I’ll go to my next reunion in five years. They plan. It was hard for Julie to plan a future not knowing how much time there was. What do you do when the difference between a year and ten is enormous? Then something miraculous happened. Julie’s experimental treatment seemed to be shrinking her tumors. In a matter of weeks, they were almost gone. Her doctors were optimistic—maybe she had longer than they’d thought. Maybe these drugs would work not just now or for a few years but for the long term. There were a lot of maybes. So many maybes that when the tumors disappeared completely, she and Matt began, very tentatively, to become the kind of people who plan. When Julie examined her bucket list, she and Matt talked about having a baby. Should they have their own child if Julie might not be around for middle school—or, if things went very badly, preschool? Was Matt up for that? What about the child? Was it fair for Julie to become a mother under these circumstances? Or would Julie’s greatest motherly act be the decision not to become one, even if it would be the hardest sacrifice she’d ever make? Julie and Matt decided that they had to live their lives, even in the face of such uncertainty. If they had learned anything, it was that life is the very definition of uncertainty. What if Julie remained cautious and they didn’t have a baby because they were waiting for the cancer to return—but it never did? Matt assured Julie that he would be a committed father no matter what happened with Julie’s health. He would always be there for their child. So it was decided. Looking death in the eye would force them to live more fully—not in the future, with some long list of goals, but right now. Julie kept her bucket list lean: they were going to start their family. It didn’t matter if they ended up in Italy or Holland or someplace else entirely. They would hop on a plane and see where they landed. 13 How Kids Deal with Grief Shortly after the breakup, I told Zach, my eight-year-old, the news. We were eating dinner, and I tried to keep it simple: Boyfriend and I had both decided (poetic license) that we weren’t going to be together after all. His face fell. He looked both surprised and confused. (Welcome to the club! I thought.) “Why?” he asked. I told him that before two people got married, they needed to figure out if they’d make good partners, not just for the moment, but for the rest of their lives, and even though Boyfriend and I loved each other, both of us realized (again, poetic license) that we wouldn’t and that it was better for us to find other people who would. This was, basically, the truth—minus some details and plus a few pronoun changes. “Why?” Zach asked again. “Why wouldn’t you be good partners?” His face was a wrinkle. My heart ached for him. “Well,” I said. “You know how you used to hang out with Asher and then he got really into soccer and you got really into basketball?” He nodded. “You guys still like each other, but now you spend more time with people who have similar interests.” “So you like different things?” “Yeah,” I said. I like kids, and he’s a Kid Hater. “What things?” I took a breath. “Well, things like I want to be home more and he wants to travel more.” Kids and freedom are mutually exclusive. If the queen had balls . . . “Why can’t you both compromise? Why can’t sometimes you stay home and sometimes you go traveling?” I mulled this over. “Maybe we could, but it’s like that time you were assigned to work with Sonja on that poster and she wanted to put pink butterflies all over it, and you wanted it to have Clone troopers, and in the end, you ended up with yellow dragons, which was pretty cool, but not really what either of you wanted. Then on the next project you worked with Theo and even though you had different ideas, they were similar enough, and you still both compromised, but not as much as you had to do with Sonja.” He was staring at the table. “Everyone has to compromise to get along,” I said, “but if you have to compromise too much, it might be hard to be married to each other. If one of us wanted to travel a lot and one of us wanted to stay home a lot, we both might get frustrated a lot. Does that make sense?” “Yeah,” he said. We sat together for a minute, and then suddenly he looked up and blurted out, “Are we killing a banana if we eat it?” “What?” I said, thrown by the non sequitur. “You know how you kill a cow to get the meat and that’s why vegetarians don’t eat meat?” “Uh-huh.” “Well,” he continued, “if we pull the banana off the tree, aren’t we also killing the banana?” “I guess it’s like hair,” I said. “Hair falls off our heads when it’s ready to die, and then new hair grows in its place. New bananas grow where the old ones used to be.” Zach leaned forward in his chair. “But we pull the bananas before they fall off, when they’re still alive. What if somebody PULLED YOUR HAIR OUT before it was ready to fall off? So doesn’t it kill the banana? And doesn’t it hurt the tree when we pull the banana off?” Oh. This was Zach’s way of dealing with the news. He was the tree here. Or the banana. Either way, he was hurting. “I don’t know,” I said. “Maybe we don’t intend to hurt the tree or the banana, but it’s possible that sometimes we hurt it anyway, even though we really, really don’t want to.” He went quiet for a while. Then: “Am I going to see him again?” I told him I didn’t think so. “So we’re not going to play Goblet anymore?” Goblet was a board game that belonged to Boyfriend’s kids when they were young, and Zach and Boyfriend sometimes played it together. I told him no, not with Boyfriend. But if he felt like it, I’d play it with him. “Maybe,” he said quietly. “But he was really good at it.” “He was really good at it,” I agreed. “I know this is a big change,” I added, and then I stopped talking because nothing I said would help him right then. He was going to have to feel sad. I knew that over the next few days and weeks and even months, we’d have many conversations to help him through this (the upside of being a therapist’s child is that nothing gets shoved under the rug; the downside is that you’ll be totally screwed up anyway). Meanwhile, the news would have to marinate. “Okay,” Zach mumbled. Then he got up from the table, went over to the fruit bowl on the counter, picked up a banana, ripped it open, and with dramatic flair, sunk his teeth into it. “Yummmm,” he said, a strangely gleeful look on his face. Was he murdering the banana? He devoured the entire thing in three big bites and then went to his room. Five minutes later, he came out carrying the Goblet game. “Let’s give this to Goodwill,” he said, placing the box by the door. Then he walked over to me for a hug. “I don’t like it anymore anyway.” 14 Harold and Maude At medical school, my cadaver’s name was Harold. Or, rather, that’s what my lab partners and I named him after the group next to us named theirs Maude. We were in gross anatomy, the traditional first-year human-dissection course, and each student team at Stanford worked on the cadaver of a generous person who had donated his or her body to science. Our professors gave us two instructions before we set foot in the lab. One: Pretend that the bodies belonged to our grandmothers and show respect accordingly. (“Do normal people slice up their grandmothers?” one freaked-out student replied.) Two: Pay attention to any emotions that came up during what we were told would be an intense process. We weren’t given any information about our cadavers—names, ages, medical histories, causes of death. The names were withheld for privacy, and the rest because the goal was to solve a mystery, not a whodunnit but a whydunnit. Why did this person die? Was he a smoker? A red-meat lover? A diabetic? Over the semester, I discovered that Harold had had a hip replacement (clue: the metal staples in his side); his mitral valve had been leaky (clue: enlargement on the left side of the heart); he’d been constipated, probably from lying in a hospital bed, at the end of his life (clue: the backed-up feces in his colon). He had pale blue eyes, straight yellowing teeth, a circle of white hair, and the muscular fingers of a builder, pianist, or surgeon. Later, I learned that he’d died of pneumonia at ninety-two, which surprised us all, including our professor, who declared, “He had the organs of a sixty-year-old.” Maude, however, had lungs full of tumors, and her nicely painted pink nails belied the nicotine stains on her fingers from her habit. She was the opposite of Harold; her body had aged prematurely, making her organs seem like those of someone much older. One day, the Maude Squad, as we called Maude’s lab group, carved out her heart. One of the students lifted it gingerly and held it up for the others to examine, but it slipped off her glove, fell to the floor with a thud, and split apart. We all gasped—a broken heart. How easy it is, I thought, to break someone’s heart, even when you take great care not to. Pay attention to your emotions, we’d been instructed, but it was far more convenient to close them off as we scalped our cadaver and sawed open his skull like a cantaloupe. (“It’s another Black and Decker day,” our professor said when he greeted us on the second morning of that unit. A week later, we’d do a “gentle dissection” of the ear—meaning chisels and hammers, but no saws.) We opened each lab session by unzipping the bag containing our cadaver and pausing as a class for a minute of silence to honor the people who were letting us take their bodies apart. We started below the neck, keeping their heads covered as a sign of respect, and when we moved up to their faces, we kept their eyelids closed, again out of respect, but also to make them seem less human to us—less real. Dissection showed us that living is a precarious thing, and we did our best to distance ourselves from this fact by lightening the mood with obscene mnemonics passed down from class to class, like the one for the cranial nerves (olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal): Oh, Oh, Oh, To Touch And Feel Virginia’s Greasy Vagina, AH. While dissecting the head and neck, the class would shout this out in unison. Then we’d hit the books and prepare for the next day’s lab. Our hard work paid off. We aced each unit, but I’m not sure that any of us were paying attention to our emotions. When exams rolled around, we did our first walkabout. A walkabout is just that—you walk about a roomful of skin and bone and viscera as if examining the wreckage from a horrific plane crash, except your job is to identify not the victims but the individual parts. Instead of “I think this is John Smith,” you try to figure out if the fleshy thing sitting by itself on a table is part of a hand or a foot, then say, “I think this is extensor carpi radialis longus.” But even that wasn’t the goriest experience we had. The day we dissected Harold’s penis—cold, leathery, lifeless—the students at Maude’s table, having a cadaver with female organs, joined us to observe. Kate, my lab partner, was meticulous in her dissections (her focus, the professor liked to say, was as “sharp as a nine blade”) but now she was distracted by shouts from the Maude Squad watching her work. The deeper she sliced, the louder the shouts became. “Ouch!” “Eww!” “I think I’m gonna puke!” More classmates came over to watch, and a bunch of male students started dancing in circles and guarding their crotches with their plastic-protected textbooks. “Drama queens,” Kate muttered. She had no patience for squeamishness—she was going to be a surgeon. Refocusing, Kate used a probe to locate the spermatic cord, then grabbed the scalpel again and made a vertical incision along the entire base of the penis, so that it split open into two neat halves, like a hotdog. “Okay, that’s it, I’m outta here!” one of the guys announced, and then he and several of his friends ran from the room. The final day of the course, there was a ceremony in which we paid our respects to the people who had let us learn from their bodies. We all read personal thank-you notes to them, played music, and offered blessings, hoping that even though their bodies had been dismantled, their souls were intact and open to receiving our gratitude. We talked a lot about the vulnerability of our cadavers, exposed and at our mercy, cut open and scrutinized, millimeter by millimeter, samples of them literally put under a microscope as we removed their tissues. But we were the truly vulnerable ones, made more so by our unwillingness to admit it—we were first-years wondering if we could hack it in this field; young people seeing death up close; students not knowing what to make of the tears we’d sometimes shed at the most unexpected moments. They had told us to pay attention to our emotions, but we weren’t sure what our emotions were or what to do with them, anyway. Some people took meditation classes offered by the medical school. Some thrived on exercise. Others buried themselves in their studies. One student on the Maude Squad took up smoking, sneaking out for quick cigarette breaks and refusing to believe he’d end up tumor-ridden like his cadaver. I volunteered for a literacy program and read to kindergartners—how healthy they were! How alive! How intact their body parts!—and when I wasn’t doing that, I wrote. I wrote about my experiences, and I became curious about other people’s experiences, and then I started writing about these experiences for magazines and newspapers. At one point, I wrote about a class called Doctor-Patient that taught us how to interact with the people we would one day treat. As part of our final exam, each student was videotaped taking a medical history, and my professor commented that I was the only student who’d asked the patient how she was feeling. “That should be your first question,” he told the class. Stanford emphasized the need to treat patients as people, not cases, but at the same time, our professors would say, this was becoming harder to do because of the way the practice of medicine was changing. Gone were the long-term personal relationships and meaningful encounters, replaced by some newfangled system called “managed care” with its fifteen-minute visits, factory-like treatment, and restrictions on what a doctor could do for each patient. As I moved on from gross anatomy, I thought a lot about what specialty I might choose—was there one in which the older model of the family doctor survived? Or would I not know the names of many of my patients, much less anything about their lives? I shadowed doctors in various specialties, ruling out the ones with the least amount of patient interaction. (Emergency medicine: exciting, but you rarely see your patients again. Radiology: you see pictures, not people. Anesthesiology: your patients are asleep. Surgery: ditto.) I liked internal medicine and pediatrics, but the physicians I followed warned me that those practices were becoming far less personal—to stay afloat, they had to cram in thirty patients each day. If they were starting out now, a few even said, they might consider another field. “Why become a doctor if you can write?” one professor asked after he had read something I’d written for a magazine. When I was at NBC, I worked with stories but wanted real life. Now that I had real life, I wondered if, in the modern daily practice of medicine, there’d be no room for people’s stories. What was satisfying, I discovered, was immersing myself in other people’s lives, and the more I wrote as a journalist, the more I found myself doing just that. One day, I talked to a professor about my dilemma, and she suggested that I do both—journalism and medicine together. If I could bring in extra income as a writer, she said, I could have a smaller practice and see patients the way doctors used to. But, she added, I’d still have to answer to insurance companies with their time-consuming mounds of paperwork, which would take me away from patient care. Has it really come to this? I thought. Writing as a way to support a living as a doctor? Didn’t it used to be the other way around? I considered her idea anyway. At that point, though, I was thirty-three years old, with two more years of medical school, at least three years of residency, maybe a fellowship after that—and I knew that I wanted a family. The more I saw the effects of managed care up close, the less I could imagine myself taking the years-long risk of finishing my training and then trying to find out if it was possible to concoct the kind of practice I wanted while also being a writer. Besides, I wasn’t sure I could do both—not well, at least—and also have room for a personal life. By the end of the term, I felt like I had to choose: journalism or medicine. I chose journalism, and over the next several years, I published books and wrote hundreds of magazine and newspaper stories. Finally, I thought, I’ve found my professional calling. As for the rest of my life—the family—that, too, would fall into place. At the time I left medical school, I was absolutely sure of it. 15 Hold the Mayo “Seriously? Is that all you shrinks care about?” John is back on my couch, sitting cross-legged and barefoot. He’s come in wearing flip-flops because the pedicurist was at the studio today. His toenails, I notice, are as perfect as his teeth. I’ve just asked something about his childhood, and he’s not happy about it. “How many times do I have to tell you? I had a great childhood,” he continues. “My parents were saints. Saints!” Whenever I hear about saintly parents, I get suspicious. It’s not that I’m looking for problems. It’s just that no parent is a saint. Most of us end up being the “good-enough” parents that Donald Winnicott, the influential English pediatrician and child psychiatrist, believed was sufficient to raise a well-adjusted child. Even so, the poet Philip Larkin put it best: “They fuck you up, your mum and dad, / They may not mean to, but they do.” It wasn’t until I became a parent that I could truly understand two crucial things about therapy: 1.The purpose of inquiring about people’s parents isn’t to join them in blaming, judging, or criticizing their parents. In fact, it’s not about their parents at all. It’s solely about understanding how their early experiences inform who they are as adults so that they can separate the past from the present (and not wear psychological clothing that no longer fits). 2.Most people’s parents did their absolute best, whether that “best” was an A-minus or a D-plus. It’s the rare parent who, however limited, deep down doesn’t want his or her child to have a good life. That doesn’t mean people can’t have feelings about their parents’ limitations (or mental-health challenges). They just need to figure out what to do with them. Here’s what I know about John so far: He’s forty years old, married for twelve years, and has two daughters, ages ten and four, and a dog. He writes and produces popular television shows, and when I learn which ones, I’m not surprised; he’s won Emmys precisely because his characters are so brilliantly wicked and insensitive. He complains that his wife is depressed (although, as the saying goes, “Before diagnosing people with depression, make sure they’re not surrounded by assholes”), his kids don’t respect him, his colleagues waste his time, and everyone demands too much of him. His father and two older siblings live in the Midwest, where John grew up; he was the only one to move away. His mother died when he was six and his brothers were twelve and fourteen. She was a drama teacher, and she had been leaving the high school after rehearsal when she saw one of her students in the path of a speeding car. She ran and pushed the student out of the way, but she was hit herself and died at the scene. John told me this part with no emotion, as if he were matter-of-factly recounting the plot of one of his TV shows. His father, an English professor with aspirations to be a writer, took care of the boys alone until he married a widowed neighbor with no children three years later. John described his stepmom as “vanilla, but I have nothing against her.” While John has had a lot to say about the various idiots in his life, his parents have been largely absent from our conversations. During my internship, a supervisor suggested that with very defended patients, one way to get a sense of their pasts is by asking them, “Without thinking about it, what three adjectives come immediately to mind in relation to your mom’s [or dad’s] personality?” These off-the-cuff answers have always given me (and my patients) helpful insights into their parental relationships. But nothing comes of this with John. “Saint, saint, and saint—that’s three words for both of them!” he replies, using nouns instead of adjectives despite his writerly facility with words. (I’ll learn later that his father “might have” had a drinking problem after his wife died and “possibly” still does and that John’s oldest brother once told John that their mother “might have” had “a light version of bipolar disorder,” but, John said, his brother was just “being dramatic.”) I’m curious about John’s childhood because of his narcissism. His self-involvement, defensiveness, demeaning treatment of others, need to dominate the conversation, and sense of entitlement—basically, his being an asshole—all fall under the diagnostic criteria for narcissistic personality disorder. I noticed these traits at our very first session, and while some therapists might have referred John out (narcissistic personalities aren’t considered good candidates for introspective, insight-oriented therapy due to their struggle to see themselves and others clearly), I was game. I didn’t want to lose the person behind the diagnosis. Yes, John had likened me to a prostitute, acted as though he were the only person in the room, and felt that he was better than everyone else. But underneath all that, how different, really, was he from the rest of us? The term personality disorder evokes all kinds of associations, not just for therapists, who consider these patients to be a handful, but in the popular culture as well. There’s even a Wikipedia entry that catalogs movie characters and the personality disorders they exemplify. The most recent version of the Diagnostic and Statistical Manual of Mental Disorders, the clinical bible of psychological conditions, lists ten types of personality disorders, broken into three groups, called clusters: Cluster A (odd, bizarre, eccentric): Paranoid PD, Schizoid PD, Schizotypal PD Cluster B (dramatic, erratic): Antisocial PD, Borderline PD, Histrionic PD, Narcissistic PD Cluster C (anxious, fearful): Avoidant PD, Dependent PD, Obsessive-Compulsive PD In outpatient practice, we mostly see patients in cluster B. People who are untrusting (paranoid), loners (schizoid), or oddballs (schizotypal) don’t tend to seek out therapy, so there goes cluster A. People who shun connection (avoidant), struggle to function like adults (dependent), or are rigid workaholics (obsessive-compulsive) also don’t look for help very often, so there goes cluster C. The antisocial folks in cluster B generally won’t be calling us either. But the people who experience difficulty in relationships and are either extremely emotional (histrionics and borderlines) or married to people like this (narcissists) do make their way to us. (Borderline types tend to couple up with narcissists, and we see that pairing often in couples therapy.) Until very recently, most mental-health practitioners believed that personality disorders were incurable because unlike mood disorders, such as depression and anxiety, personality disorders consist of long-standing, pervasive patterns of behavior that are very much a part of one’s personality. In other words, personality disorders are ego-syntonic, which means the behaviors seem in sync with the person’s self-concept; as a result, people with these disorders believe that others are creating the problems in their lives. Mood disorders, on the other hand, are ego-dystonic, which means the people suffering from them find them distressing. They don’t like being depressed or anxious or needing to flick the lights on and off ten times before leaving the house. They know something’s off with them. But personality disorders lie on a spectrum. People with borderline personality disorder are terrified of abandonment, but for some, that might mean feeling anxious when their partners don’t respond to texts right away; for others, that might mean choosing to stay in volatile, dysfunctional relationships rather than being alone. Or consider the narcissist. Who doesn’t know somebody who fits the bill to varying degrees—accomplished, charismatic, smart, and witty but alarmingly egocentric? Most important, having traits of a personality disorder doesn’t necessarily mean that a person meets the criteria for an official diagnosis. From time to time—on a doozy of a bad day or when pushed until a fragile nerve is struck—everyone exhibits a tad of this or that personality disorder, because each is rooted in the very human wish for self-preservation, acceptance, and safety. (If you don’t think this applies to you, just ask your spouse or best friend.) In other words, just as I always try to see the whole person and not just the snapshot, I also try to see the underlying struggle and not just the five-digit diagnosis code I can put on an insurance form. If I rely on that code too much, I start to see every aspect of the treatment through this lens, which interferes with forming a real relationship with the unique individual sitting in front of me. John may be narcissistic, but he’s also just . . . John. Who can be arrogant and, to use a nonclinical description, incredibly fucking annoying. And yet. Diagnosis has its usefulness. I know, for example, that people who are demanding, critical, and angry tend to suffer from intense loneliness. I know that a person who acts this way both wants to be seen and is terrified of being seen. I believe that for John, the experience of being vulnerable feels pathetic and shameful—and I’m guessing that he somehow got the message not to show “weakness” at six years old when his mother died. If he spends any time at all with his emotions, they likely overwhelm him, so he projects them onto others as anger, derision, or criticism. That’s why patients like John are especially challenging: they’re masters at getting your goat—all in the service of deflection. My job is to help both of us understand what feelings he’s hiding from. He’s got fortresses and moats to keep me out, but I know that part of him is in the turret calling for help, hoping to be saved—from what, I don’t know yet. And I’ll apply my knowledge of diagnosis without getting lost in it to help John see that the way he acts in the world might be causing more problems for him than the so-called idiots around him are. “Your light is on.” John and I are discussing his irritation with my questions about his childhood when he announces that the green light on the wall near my door that’s connected to a button in the waiting room is illuminated. I glance at the light, then at the clock. It’s just five minutes past the hour, so I figure that my next patient must be uncharacteristically early. “It is,” I say, wondering if John is trying to change the subject or if he might even have some feelings about the fact that he’s not my only patient. Many patients secretly wish to be their therapist’s only patient. Or, at least, the favorite—the funniest, most entertaining and, above all, most beloved. “Can you get it?” John says, nodding toward the light. “It’s my lunch.” I’m confused. “Your lunch?” “The food delivery guy is out there. You said no cell phones, so I told him to press the button. I haven’t had time for lunch yet, and now I have a free hour—I mean, fifty minutes. I need to eat.” I’m floored. People don’t generally eat in therapy, but if they do, they’ll say something along the lines of “Is it okay if I eat in here today?” And they bring their own food. Even my patient with hypoglycemia brought food into this room only once, and that was to avoid going into shock. “Don’t worry,” John says, registering the look on my face. “You can have some if you want.” Then he gets up, walks down the hall, and retrieves his lunch from the delivery person in the waiting room. When John comes back, he unpacks the bag, puts a napkin on his lap, unwraps his sandwich, takes a bite, then loses it. “Jesus Christ, I said no mayo! Look at this!” He opens up the sandwich to show me the mayonnaise, and with his free hand he reaches for his cell phone—presumably to call about his order—but I give him a look reminding him of the no-cell-phone policy. His face turns bright red, and I wonder if he might yell at me too, but instead he just explodes with “Idiot!” “Me?” I ask. “You what?” “I remember you once described your last therapist as nice, but an idiot. Am I also nice, but an idiot?” “No, not at all,” he says, and I’m pleased that he’s able to acknowledge that somebody in his life isn’t an idiot. “Thank you,” I say. “For what?” “For saying I’m not an idiot.” “That’s not what I meant,” he replies. “I meant no, you’re not nice. You won’t let me use my phone to call the idiot who put mayonnaise on my sandwich.” “So I’m mean and an idiot?” He grins, and when he does, his eyes twinkle and his dimples appear. For a second I can see how some people might find him charming. “Well, you’re mean, that’s for sure. I don’t know about the idiot part yet.” He’s being playful, and I smile back. “Phew,” I say. “At least you’re giving me the benefit of getting to know me first. I appreciate that.” He begins fidgeting, uncomfortable with my attempt to engage. He’s so desperate to escape from this moment of human contact that he starts munching on his mayonnaise-y sandwich and looks away. But he’s not fighting me, and I’ll take it. I sense a microscopic opening. “I’m sorry that you experience me as being mean,” I say. “Is that why you made that comment about the fifty minutes?” The mistress insult—that I’m more like his hooker—was more complicated, but I’m guessing he made the fifty-minutes crack for the same reason most people do—they wish they could stay longer but don’t know how to say this directly. Acknowledging their attachment makes them feel too vulnerable. “No, I’m glad it’s fifty minutes!” he says. “God knows, if I stayed for an hour, you’d keep asking me about my childhood.” “I just want to get to know you better,” I say. “What’s to know? I’m anxious and I can’t sleep. I’m juggling three shows, my wife’s complaining all the time, my ten-year-old is acting like a teenager, my four-year-old misses the nanny who left for graduate school, the fucking dog is acting out, and I’m surrounded by idiots who make my life harder than it needs to be. And, frankly, I’m pissed off at this point!” “That’s a lot,” I say. “You’re dealing with a lot.” John says nothing. He’s chewing his food and studying a spot on the floor near his flip-flops. “Damn right,” he says finally. “What’s so hard to understand about three words? Hold. The. Mayo. That’s it!” “You know, about those idiots,” I say. “I have a thought about that. What if the people who are pissing you off aren’t trying to piss you off? What if these people aren’t idiots but reasonably intelligent people who are just doing the best they can on a given day?” John lifts his eyes slightly, as if considering this. “And,” I add softly, thinking that as hard as he is on others, he’s probably triply hard on himself, “what if you are too?” John starts to say something, then stops. He looks back toward his flip-flops, lifts a napkin, and pretends to wipe the crumbs from his mouth. But I see it happen anyway. He quickly maneuvers the napkin upward and below his eye. “Goddamn sandwich,” he says, stuffing the napkin into the food bag along with the rest of the meal before tossing the whole thing into the trash can under my desk. Swish. A perfect shot. He looks at the clock. “This is nuts, you know. I’m starving, it’s my one break to eat, and I can’t even use my phone to order a proper lunch. You call this therapy?” I want to say Yes, this is therapy—face-to-face, without phones or sandwiches, so that two people can sit together and connect. But I know John will just offer a sardonic rebuttal. I think about what Margo must go through and wonder what her own psychological history must be for her to have chosen John. “I’ll make you a deal,” John says. “I’ll tell you something about my childhood if I can order some lunch from the place up the street. I’ll order for both of us. Let’s just be civilized and have a conversation over a goddamn Chinese chicken salad, okay?” He looks at me, waiting. Normally I wouldn’t do this, but therapy isn’t by the numbers. We need professional boundaries, but if they’re too open, like an ocean, or too constricting, like a fishbowl, we run into trouble. An aquarium seems just right. We need space for spontaneity—which is why when Wendell kicked me, it was effective. And if John needs some distance between us in the form of food to feel comfortable talking to me right now, so be it. I tell him we can order lunch but he doesn’t have to talk about his childhood. It’s not a quid pro quo. He ignores me and dials a restaurant to place the order, a process that, of course, frustrates him. “Right, no dressing. Not drinks, dressing!?” He’s yelling into the phone, which is on speaker. “D-r-e-s-s-i-n-g.” He sighs loudly, rolls his eyes. “Extra dressing?” the guy at the restaurant says in broken English, and John becomes apoplectic as he tries to communicate that the dressing should be on the side. Everything’s a problem—they have Diet Pepsi, not Diet Coke; they can be here in twenty minutes, not fifteen. I watch, horrified and bemused. It must be so hard to be John, I think. As they wrap up, John says something in Chinese, and the guy doesn’t understand. John doesn’t understand why the guy doesn’t understand his “own language” and the guy explains that he speaks Cantonese. They hang up and John looks at me, incredulous. “What, they don’t use Mandarin?” “If you know Chinese, why didn’t you use it to place the order?” I ask. John gives me a withering look. “Because I speak English.” Yikes. John grumbles until lunch arrives, but once we set out our salads, he lets down the drawbridge a bit. I’ve already had lunch but I eat some salad anyway to join him; there’s something innately bonding about sharing a meal together. I hear some stories about his father and older brothers and how he thinks it’s strange that while he doesn’t remember much about his mom, he began dreaming about her a few years ago. He keeps having versions of the same dream, like Groundhog Day, and he can’t make it stop. He wants it to stop. Even in his sleep, he says, he’s being bothered. He just wants peace. I inquire about the dream but he says it will upset him to talk about it and he’s not paying me to upset him. Didn’t he just tell me that he wanted peace? Don’t they teach “listening skills” to therapists? I want to talk about what he just said—to challenge his beliefs that he shouldn’t be uncomfortable in therapy and that he can find peace without also experiencing discomfort—but I need time for that, and there are just a couple of minutes left. I ask when he has peace. “Walking the dog,” he says. “Until Rosie started acting out. That used to be peaceful.” I think about how he doesn’t want to bring the dream into this room. Could it be that this room has become something of a sanctuary for him, away from his job, wife, kids, dog, the world’s idiots, and the ghost of his mom that appears in his sleep? “Hey, John,” I try. “Are you feeling peaceful right now?” He chucks his chopsticks into the bag where he’s just packed away the remains of his salad. “Of course not,” he says, adding an impatient eye roll. “Oh,” I say, letting it go. But John hasn’t. Our time is up and he stands to leave. “Are you kidding?” he continues as he heads to the door. “In here? Peace?” His eye roll has been replaced by a smile now—not a condescending smirk, but a secret he’s sharing with me. It’s a lovely smile, luminous, and not because of those dazzling teeth. “I thought so,” I say. 16 The Whole Package Spoiler: After I left medical school, the rest of my life did not fall into place as planned. Three years later, when I was nearly thirty-seven, a two-year relationship ended. It was sad but amicable and not a surprise the way the breakup with Boyfriend later turned out to be. But still, it was the worst timing imaginable for someone who wanted to have a baby. I’d always known, in the surest possible way, that I wanted to be a parent. I’d spent my adulthood volunteering with kids and assumed that I would one day have my own. Now, though, with forty looming, I was dying to have a baby, but not so much that I would just marry the next guy who came along. This left me in a tricky predicament—desperate, but picky. It was then that a friend suggested I could do things in reverse order: baby first, partner later. One night, she emailed me links for some sperm-donor sites. I’d never heard of such a thing and wasn’t sure at first how I felt about it, but after considering my options, I made the decision to move forward. Now I just needed to choose a donor. Of course I wanted a donor with a good health history, but on these sites there were other qualities to consider, and not just things like hair color or height. Did I want a lacrosse player or a literature major? A Truffaut buff or a trombonist? An extrovert or an introvert? I was surprised to see that in many ways, these donor profiles resembled dating profiles—except that most of the candidates were college students and provided their SAT scores. And there were a few other key differences, chief among them the comments of the so-called lab girls. These were the women (they all seemed to be female) who worked at the banks and met the donors when they came in to give a “release.” (Not in the sense of “contract.”) The lab girls would then write what they termed staff impressions and add them to the donors’ profiles, but there was no rhyme or reason as to what kinds of impressions they’d share. Their comments varied wildly from He has amazing biceps! to He tends to procrastinate, but eventually gets his stuff done. (I was wary of any male college student whose procrastination extended to masturbation.) I relied heavily on these staff impressions because the more profiles I read, the more I realized that I wanted to feel some intangible connection to the donor who would have a connection to my child. I wanted to like him, whatever that meant—to feel that if he were sitting at our family dinner table, I would enjoy his company. But as I read the staff impressions and listened to the audio of the interviews that the lab girls conducted with the donors (“What’s the funniest thing that’s ever happened to you?,” “How would you describe your personality?,” and, weirdly, “What’s your idea of a romantic first date?”), it still felt clinical, impersonal. Then one day I called up the sperm bank with a question about a donor’s health history and was transferred to a lab girl named Kathleen. As Kathleen looked up his medical records, I began chatting with her and learned that she had been the lab girl who’d met this particular donor. I couldn’t help myself. “Is he cute?” I asked, trying to sound casual. I didn’t know if I was allowed to be asking. “Well . . .” Kathleen hedged, drawing out the word in her thick New York accent. “He’s not unattractive. But I wouldn’t look twice at him on the subway.” After that, Kathleen became my sperm concierge, suggesting donors and answering my questions. I trusted her because while some of the lab girls inflated their assessments—they were trying to sell sperm, after all—Kathleen was honest to a fault. Her standards were very high, and so were mine, which was a problem, because nobody made it through our filters. To be fair, it seemed reasonable to assume that my future child would want me to be picky. And there were multiple factors to juggle. If I found a donor who seemed to share my sensibilities, there would be other problems, like his family’s health history wasn’t a good match with mine (breast cancer under age sixty, kidney disease). Or I’d find a donor with a pristine health history but who was a six-foot-four Danish guy with Nordic features, a look that would stick out—and might make my child feel self-conscious—in my family of short, brown-haired Ashkenazi Jews. Other donors seemed to have good health, intelligence, and similar physical features, but something else would raise a red flag, like the donor who wrote that his favorite color was black, his favorite book Lolita, and his favorite movie A Clockwork Orange. I tried to imagine my child reading this profile one day and looking at me like, “And you chose this one?” I had the same reaction if the donor couldn’t spell or use punctuation correctly. This process continued for three exhausting months, during which I began to lose hope that I’d find a healthy donor I’d be proud to tell my child about. And then—finally!—I found him. I came home late one evening to a message on my voicemail from Kathleen. She told me to check out a donor she described as looking like “a young George Clooney.” She added that she especially liked this donor because he was always friendly and in a great mood when he arrived at the bank to donate. I rolled my eyes. After all, if you’re a guy in his twenties who’s about to go watch porn and have an orgasm—and you’re getting paid for that—what’s not to be in a great mood about? But Kathleen gushed about this guy—he had good health, good looks, strong intelligence, and a winning personality. “He’s the whole package,” she said confidently. Kathleen had never sounded so enthusiastic, so I logged on to take a look. I clicked on his profile, pored over his health history, read his essays, listened to his audio interview, and instantly knew, in the same way that people talk about love at first sight, that I’d found The One. Everything about him—his likes and dislikes, his sense of humor, his interests and values—felt like family. Elated but exhausted, I figured I’d get some sleep and handle the details in the morning. The next day happened to be my birthday, and overnight I had vivid dreams about my baby for what felt like eight hours straight. For the first time, I pictured an actual baby coming from two specific people instead of some hazy idea of a baby with half its heritage blank. In the morning, I jumped out of bed with a burst of excitement, the song “Child of Mine” playing in my head. Happy birthday to me! I’d been wanting a baby for the past several years, and finding a donor I felt so comfortable with seemed like the best birthday present ever. Heading to the computer, I smiled at my good fortune—I was really going to do this. I typed in the sperm bank’s URL, found the donor’s profile, and read it all over again. I was just as certain as I’d been the night before that he was The One—the one that would make sense to my child when he or she asked why, of all the possible donors, I chose this guy. I placed the donor in my online shopping cart—just as I might with a book on Amazon—double-checked the order, then clicked Purchase Vials. I’m having a baby! I thought. The moment felt monumental. As the order processed, I planned what I had to do next: Make an appointment for the insemination, buy prenatal vitamins, put together a baby registry, get the baby’s room set up. Between thoughts, I noticed that my order was taking a while to complete. The rotating circle on my screen, known as the “spinning wheel of death,” seemed to be spinning for an unusually long time. I waited, waited some more, and finally tried using the back button in case my computer was crashing. But nothing happened. Finally, the spinning wheel of death disappeared and a message popped up: Out of stock. Out of stock? I figured there must be some computer glitch—maybe when I pressed the back button?—so I speed-dialed the sperm bank and asked for Kathleen, but she was out and I got transferred to a customer-service rep named Barb. Barb looked into the matter and determined that this was no glitch. I’d selected a very popular donor, she said. She went on to explain that popular donors went quickly and that, while the company tried to “restock” their “inventory” often, there was a six-month hold for it so it could get quarantined and tested. Even when the inventory was made available, she said, there still might be a long wait, because some people had placed it on back order. As Barb spoke, I thought of how Kathleen had called just yesterday. Now it occurred to me that maybe she’d suggested this donor to several women. Like me, maybe many women had bonded with Kathleen over her honest appraisals of semen. Barb placed me on the waitlist (“Don’t be foolish and waste your time waiting,” she’d said ominously), then I put down the phone and felt numb. After months of fruitless searching, I’d found my donor, and my future baby had finally seemed like a reality, more than just an idea in my head. But now, on my birthday, I had to let that baby go. I was all the way back at square one. I slumped over my laptop, staring into space. I sat there for a long while until I noticed, on the corner of my desk, a business card that I’d gotten the week before at a professional networking event. It was from a twenty-seven-year-old filmmaker named Alex. I’d spoken to Alex for only about five minutes, but he was kind and smart and seemed healthy, and I thought, with the impulsivity of somebody running out of options, that maybe I could skip the online banks and try to find my donor out in the real world. Alex fit the profile of the kind of donor I sought. Why not ask if he’d consider it? After all, the worst he could say was no. I chose my subject line carefully (An Unusual Question) and left the email vague (Hey, remember me, from that networking event?). Then I invited him to meet for coffee so that I could ask my “unusual question.” Alex responded, wondering if I could email him the question. I replied that I’d prefer to discuss it in person. He wrote, Sure. And the next thing I knew, we were set to meet for coffee Sunday at noon. I was, to put it mildly, nervous when I arrived at Urth Caff?. After sending my impulsive email, I was certain that Alex would say no and then tell ten of his friends what I’d done, leaving me so humiliated that I’d never be able to go to a networking event again. I’d considered backing out, but I wanted a baby so badly that I felt I had to do this, just in case. The answer to an unasked question is always no, I repeated to myself over and over. Alex greeted me warmly and the small talk came easily—so easily that, before I knew it, we were having a great time. After about an hour, in fact, I’d almost forgotten what we were doing there when Alex leaned across the table, looked me in the eye, and asked flirtatiously, as if he’d concluded we were on a date, “So, what was your ‘unusual question’?” Instantly my face felt hot and my palms sweaty, and I did what any normal person would do under the circumstances—I went mute. The gravity and lunacy of what I was about to do rendered me speechless. Alex waited until I began forming words, flailing, using incoherent analogies to explain my request. I was saying things like “I don’t have all the ingredients for the recipe” and “It’s like donating a kidney, but without removing the organ.” The second I said the word organ, I got even more flustered and tried changing course. “It’s like giving blood,” I said, “except there’s sex instead of needles!” With that, I willed myself to shut up. Alex was staring back with a strange look on his face, and I thought, Life does not get more humiliating than this. But then it did. Because it quickly became apparent that Alex had no idea what I was trying to ask. “Look,” I managed to say. “I’m thirty-seven years old and I want to have a baby. I’m not having luck with the sperm banks, and I’m wondering if you’d consider—” This time Alex clearly got it, because his entire body froze; even his mocha chai latte stayed suspended in midair. Other than one catatonic patient in medical school, I’d never seen a person sit so still before in my life. Finally Alex’s lips moved and out came one word: “Wow.” Then, slowly, more words came out. “I wasn’t expecting that at all.” “I know,” I said. I felt terrible for having put him in such an awkward situation, for bringing this up at all, and I was just about to say so when, to my amazement, Alex added: “But I’d be willing to talk about it.” Now it was my turn to freeze before eventually saying “Wow.” The next few hours flew by: Alex and I discussed about everything from our childhoods to future dreams. It seemed that talking about sperm had broken down all the emotional walls, the way having sex with somebody for the first time can open the emotional floodgates. When we finally got up to leave, Alex said that he needed to do some thinking, and I said okay, and he said he’d be in touch. I was sure, though, that once he actually thought this through, I’d never hear from him again. But that night, Alex’s name appeared in my inbox. I clicked on his message, expecting a nice rejection. Instead he wrote: So far I am a yes, but with more questions. So we set up another meeting. Over the next couple of months we met at Urth so often that I started calling the caf? my “sperm office,” and my friends started calling it simply Spurth. At Spurth, we talked about everything from semen samples and medical histories to contracts and contact with the child. Eventually we got to the point where we talked about how to do the transfer—whether we should have the doctor do the insemination or have sex to increase the odds of conception. He picked sex. Honestly, I had no objection. And more honestly? I was thrilled with this development! After all, I imagined that in my future life as a mom, there wouldn’t be much opportunity to have sex with a gorgeous twenty-seven-year-old like Alex, with his ripped abs and chiseled cheekbones. Meanwhile, I began obsessively monitoring my menstrual cycles. One day at Spurth, I mentioned to Alex that I was about to ovulate, so if we were going to try this month, he had exactly one week to make a decision. In other circumstances that might have seemed like a lot of pressure to put on a guy, but by now it felt like a done deal and I didn’t have time to waste. We’d already looked at our plan from every possible angle: legal, emotional, ethical, practical. By this point, too, we had inside jokes and nicknames for each other and had bonded over what a blessing this child would be. The week before, he had even asked if, like any other business opportunity, I had “gone out to others” or if this was an exclusive offer. I had the fleeting impulse to invent a bidding war to seal the deal (Pete is circling and there’s also interest from Gary, so you better get back to me by Friday. There’s a lot of heat around this). But I wanted our relationship to be based in complete truthfulness, and anyway, I was sure that Alex would say yes. The day after I issued the deadline, we decided to take a walk on the beach to discuss one last time the final details in the contract we’d had drawn up. As we strolled along the shore, drizzle appeared out of nowhere. We looked at each other—should we head back?—but then the drizzle turned into a veritable storm. We were both in short sleeves, and Alex took the jacket from around his waist and placed it over my shoulders, and as we faced each other, getting drenched in the rain on the beach, he gave me the official green light. After all the negotiations, all the getting to know each other, all the questions about what this would mean for us and the child, we were ready. “Let’s make you a baby!” he said, and there we were, hugging and smiling, me in an oversize jacket that went down to my knees, embracing this man who was going to give me his sperm, and I thought about how I couldn’t wait to tell my child this story one day. When we got back to his car, Alex gave me his executed copy of the contract. And then he disappeared. I didn’t hear from him for another three days. This might not seem long, but if you’re in your late thirties and about to ovulate and your only other baby option is on indefinite back order, three days is an eternity. I tried not to read into it (stress is bad for conception), but when Alex finally resurfaced, he left me a message saying, “We need to talk.” I sank to the floor. Like every adult on the planet, I knew exactly what that meant: I was about to be dumped. The next morning, as we sat at our regular table at Spurth, Alex looked away and began issuing the usual breakup clich?s: “It’s not you, it’s me”; “I’m so unsettled in my life right now that I don’t know if I can commit, so for your sake, I don’t want to string you along.” And the perennial favorite “I hope we can still be friends.” “It’s okay, there are other fish in the sea,” I said, protecting myself with a bad pun. I hoped to lighten the mood, to let Alex know that the rational part of me understood why he felt that he couldn’t go through with the donation. But inside I was gutted, because now this was the second baby I’d so clearly imagined and that I would never get to hold in my arms. A friend who had her second miscarriage around this time said that she felt exactly the same way. I went home and decided to take a break from the sperm-donor search because the heartbreak was too much to bear. And like my friend who had miscarried, I avoided babies as much as possible. Even diaper commercials sent me lunging for the remote so I could change the channel. After a few months, I knew I had to get back online and resume my search. But just as I was about to sign on again, I got an unexpected call. It was Kathleen, my lab girl at the sperm bank. “Lori, good news!” she announced in her heavy Brooklyn accent. “Somebody returned a vial of the Clooney kid.” The Clooney kid . . . my guy. The one who was “the whole package.” “Returned?” I asked. I wasn’t sure how I felt about returned semen. I thought about how at Whole Foods, you couldn’t return any personal-hygiene items, even with a receipt. But Kathleen assured me that the vial hadn’t left its sealed nitrogen tank and that there was nothing wrong with the “product.” Somebody had simply gotten pregnant some other way and no longer needed the backup. If I wanted it, I had to buy it now. “Clooney has a waiting list, you know—” she began, but before she finished her sentence, I had already said yes. Late that fall, I was out to dinner with a group of people after my baby shower when my mother noticed the real George Clooney sitting at a table nearby. Everyone at our table knew about Kathleen’s “young George Clooney” description, and one by one, my friends and family pointed at my enormous belly, then turned their heads toward the movie star. He looked much more grown up than he had as a young actor starring in ER. I, too, felt much more grown up than I’d been as a young executive working at NBC. So much had happened in both of our lives. He was about to win an Oscar. I was about to have my son. A week later, “the Clooney kid” got a new name: Zachary Julian. ZJ. He is love and joy and wonder and magic. He is, as Kathleen might say, “the whole package.” Flash-forward eight years: a d?j? vu, of sorts. When Boyfriend says, “I can’t live with a kid under my roof for the next ten years,” I’ll be transported back to that day at Urth when Alex told me he couldn’t be my donor after all. I’ll remember how shattered I was, but also how Kathleen called soon after, resurrecting what had felt like the death of a dream. The situations will seem similar enough—the blindsiding twist, plans dashed—that underneath my pain in the wake of Boyfriend’s announcement, I might expect to have hope that things will work themselves out again. But something feels very different this time. 17 Without Memory or Desire In the mid-twentieth century, the British psychoanalyst Wilfred Bion posited that therapists should approach their patients “without memory or desire.” In his view, therapists’ memories were prone to subjective interpretation, morphing over time, while their desires might run counter to what their patients wanted. Taken together, memories and desires can create biased notions that therapists hold about the treatment (known as formulated ideas). Bion wanted clinicians to enter each session committed to hearing the patient in the present moment (rather than being influenced by memory) and remaining open to various outcomes (rather than being influenced by desire). Early in my internship, I trained under a Bion enthusiast, and I challenged myself to start each session with “no memory, no desire.” I loved the idea of not getting sidetracked by preconceived notions or agendas. There also seemed to be a Zen flavor to this kind of relinquishment, similar to the Buddhist notion of letting go of attachment. In practice, though, it felt more like trying to emulate the neurologist Oliver Sacks’s famous patient H.M., whose brain injury confined him to live only in the moment, with no ability to remember the immediate past or conceptualize the future. With my frontal lobes intact, I couldn’t will myself into that kind of amnesia. I know, of course, that Bion’s concept was more nuanced and that there’s value in checking the distracting aspects of memory and desire at the door. But I bring up Bion here because when I drive to my sessions with Wendell, I think about how, from the patient’s side of the room—from my side—“no memory (of Boyfriend), no desire (for Boyfriend)” would be close to grace. It’s Wednesday morning and I’m on Wendell’s couch, sitting halfway between positions A and B, having just arranged the pillows behind my back. I fully intend to open with what happened at work the day before when I was in the communal kitchen and spotted a copy of Divorce magazine on top of a pile of reading material that was to be placed in the waiting room. I pictured the people who subscribed to this magazine coming home at the end of the day and finding, among all the bills and store catalogs, this magazine with the word DIVORCE in bright yellow letters on the cover. Then I imagined these people walking into their empty houses, each one turning on the lights, heating up a frozen dinner or ordering takeout for one, sitting down to eat, and flipping through this magazine’s pages, wondering, How did this become my life? I figured the people who had moved on from their divorces were doing something other than reading this magazine and that the majority of subscribers would be people like me, newly smarting and trying to make sense of it all. Of course, I hadn’t married Boyfriend, so this wasn’t a divorce. But we were supposed to get married, which, according to my thinking at that moment, put me in a similar category. I even felt that this breakup might be worse than a divorce in one particular aspect. In a divorce, things have gone badly already, thus leading to the split. If you’re going to mourn a loss, isn’t it better to have an arsenal of unpleasant memories—stony silences, screaming fights, infidelity, massive disappointment—to temper the good ones? Isn’t it harder to let go of a relationship filled with happy memories? It seemed to me the answer was yes. So I was sitting at the table eating a yogurt and scanning the magazine’s headlines (“Healing from Rejection”; “Managing Negative Thoughts”; “Creating the New You!”) when my phone beeped, indicating that an email had come in. It was not, as I still (delusionally) hoped, from Boyfriend. The subject line read Prepare for the best night ever! Spam, I assumed—but if it wasn’t, who was I to turn down the best night ever, given how bad I felt? I clicked on it and saw that the email was a confirmation for the concert tickets I’d ordered months in advance as a surprise for Boyfriend’s upcoming birthday. We both loved this band, and their music had been like a soundtrack to our relationship. On our first date, we discovered that we had the same all-time-favorite song. I couldn’t imagine going to this concert with anyone but Boyfriend—especially on his birthday. Should I go? With whom? And wouldn’t I be thinking about him on his birthday? Which raised the questions: Would he be thinking about me? And if not, didn’t I mean anything to him? I looked back at the Divorce headline: “Managing Negative Thoughts.” I was finding it hard to manage my negative thoughts because, outside of Wendell’s office, they didn’t have much of an outlet. Breakups tend to fall into the category of silent losses, less tangible to other people. You have a miscarriage, but you didn’t lose a baby. You have a breakup, but you didn’t lose a spouse. So friends assume that you’ll move on relatively quickly, and things like these concert tickets become an almost welcome external acknowledgment of your loss—not only of the person but of the time and company and daily routines, of the private jokes and references, and of the shared memories that now are yours alone to carry. I fully intend to say all this to Wendell as I get comfortable on the couch, but instead all that comes out is a torrent of tears. Through the blur, I see the tissue box soaring toward me. Once again, I miss the catch. (In addition to being dumped, I think, I’ve become uncoordinated.) I’m both surprised by and ashamed of my outburst—we haven’t even greeted each other yet—and every time I try to pull it together, I get in a quick “I’m sorry” before I lose it again. For about five minutes, my session goes like this: Cry. Try to stop. Say, I’m sorry. Cry. Try to stop. Say, I’m sorry. Cry. Try to stop. Say, Oh God, I’m really sorry. Wendell wants to know what I’m apologizing for. I point to myself. “Look at me!” I make loud honking noises into a tissue. Wendell shrugs as if to say, Well, yeah—and so what? And then I don’t even pause to say “I’m sorry”; it’s just cry. Try to stop. Cry. Try to stop. Cry. Try to stop. This goes on for another few minutes. While I’m crying, I think about how the morning after the breakup, after a sleepless night, I got out of bed and went on with my daily life. I remember how I dropped Zach off at school and said, “Love you,” as he jumped out of the car, and he looked around to make sure nobody could hear and then said, “Love you!” before running off to join his friends. I think about how on the drive to work, I replayed Jen’s comment over and over in my mind: I don’t know that this is the end of the story. I think about how, riding up to my office in the elevator, I actually laughed when I remembered the old pun Denial is not a river in Egypt—and how even so, I went right back into denial: Maybe he’ll change his mind, I thought. Maybe this is all a big misunderstanding. Of course it wasn’t all a big misunderstanding because here I am, crying in front of Wendell and telling him again how lame I am to be doing this, to still be such a wreck. “Let’s make a deal,” Wendell says. “How about we agree that you’ll be kind to yourself while you’re in here? You can go ahead and beat yourself up all you want as soon as you leave, okay?” Be kind to myself. This hadn’t occurred to me. “But it’s just a breakup,” I say, immediately forgetting to be kind to myself. “Or I could just leave a pair of boxing gloves at the door so you could hit yourself with them all session. Would that be easier?” Wendell smiles, and I feel myself take in some air, let it out, relax into the kindness. I flash on a thought I often have when seeing my own self-flagellating patients: You are not the best person to talk to you about you right now. There is a difference, I point out to them, between self-blame and self-responsibility, which is a corollary to something Jack Kornfield said: “A second quality of mature spirituality is kindness. It is based on a fundamental notion of self-acceptance.” In therapy we aim for self-compassion (Am I human?) versus self-esteem (a judgment: Am I good or bad?). “Maybe not the boxing gloves,” I say. “It’s just that I was doing better and now I can’t stop crying again. I feel like I’m going backward, like I’m back where I was the week of the breakup.” Wendell tilts his head. “Let me ask you something,” he says, and, assuming it’s going to be about my relationship, I wipe my eyes and wait expectantly. “In your work as a therapist,” he begins, “have you ever sat with somebody who’s grieving?” His question stops me cold. I have sat with people dealing with all kinds of grief—the loss of a child, the loss of a parent, the loss of a spouse, the loss of a sibling, the loss of a marriage, the loss of a dog, the loss of a job, the loss of an identity, the loss of a dream, the loss of a body part, the loss of youth. I’ve sat with people whose faces close in on themselves, whose eyes become slits, whose open mouths resemble the image in Munch’s The Scream. I’ve sat with patients who describe their grief as “monstrous” and “unbearable”; one patient, quoting something she had heard, said it made her feel “alternately numb and in excruciating pain.” I’ve also seen grief from afar, like the time in medical school when I was transporting blood samples in the emergency room and heard a sound so startling that I almost dropped the tubes. It was a wail, more animal-like than human, so piercing and primal that it took me a minute to find its source. Out in the hallway was a mother whose three-year-old had drowned after running out the back door and falling in the swimming pool during the two minutes in which the mother had gone upstairs with her infant to change his diaper. As I listened to the wail, I saw her husband arrive and receive the news, heard his shock erupting into shrieks as if in chorus with his wife’s roar-moan. It was my first time hearing this particular music of sorrow and anguish, but I have heard it countless times since. Grief, not surprisingly, can resemble depression, and for this reason, until a few years ago, there was something termed the bereavement exclusion in our profession’s diagnostic manual. If a person experienced the symptoms of depression in the first two months after a loss, the diagnosis was bereavement. But if those symptoms persisted past two months, the diagnosis became depression. This bereavement exclusion no longer exists, partly because of the timeline: Are people really supposed to be done grieving after two months? Can’t grief last six months or a year or, in some form or another, an entire lifetime? Then there’s the fact that losses tend to be multilayered. There’s the actual loss (in my case, of Boyfriend), and the underlying loss (what it represents). That’s why for many people the pain of a divorce is only partially about the loss of the other person; often it’s just as much about what the change represents—failure, rejection, betrayal, the unknown, and a different life story than the one they’d expected. If the divorce happens at midlife, the loss might involve coping with the limitations of knowing someone and being known again with the same degree of intimacy. I remember reading a divorced woman’s experience of getting to know a new lover after her decades-long marriage ended: “I will never lock eyes in the delivery room with David,” she wrote. “I’ve never met his mother.” And that’s also why Wendell’s question is so important. In asking me to remember what it’s like to sit with people who are grieving, he’s showing me what he can do for me right now. He can’t fix my broken relationship. He can’t change the facts. But he can help because he knows this: We all have a deep yearning to understand ourselves and be understood. When I see couples in therapy, often one or the other will complain, not “You don’t love me” but “You don’t understand me.” (One woman said to her husband, “You know what three words are even more romantic to me than ‘I love you’?” “You look beautiful?” he tried. “No,” his wife said. “I understand you.”) My tears start again, and I’m thinking about what it might be like for Wendell to sit here with me. Everything we therapists do or say or feel as we sit with our patients is mediated by our histories; everything I’ve experienced will influence how I am in any given session at any given hour. The text I just received, the conversation I had with a friend, the interaction I had with customer service while trying to resolve a mistake on my bill, the weather, how much sleep I’ve gotten, what I dreamed of before my first session of the day, a memory inspired by a patient’s story, will all influence my behavior with my patient. Who I was before Boyfriend is different from who I am now. Who I was when my son was an infant is different from who I am in sessions now, including in this one with Wendell. And he is different in this session with me because of whatever has happened in his life up to this point. Maybe my tears are bringing up whatever grief he’s experienced and it’s painful for him to sit through this too. He’s as mysterious to me as I am to him, and yet here we are, joining forces to unravel the story of how I ended up here. It’s Wendell’s job to help me edit my story. All therapists do this: What material is extraneous? Are the supporting characters important or a distraction? Is the story advancing or is the protagonist going in circles? Do the plot points reveal a theme? The techniques we use are a bit like the type of brain surgery in which the patient remains awake throughout the procedure; as the surgeons operate, they keep checking in with the patient: Can you feel this? Can you say these words? Can you repeat this sentence? They’re constantly calibrating how close they are to sensitive regions of the brain, and if they hit one, they back off so as not to damage it. Therapists delve into a mind rather than a brain, and we can see from the subtlest gesture or expression if we’ve hit a nerve. But unlike neurosurgeons, we gravitate toward the sensitive area, pressing delicately on it, even if it makes the patient feel uncomfortable. That’s how we get to the deeper meaning of the story, and often at the core is some form of grief. But a lot of plot stands in between. A patient named Samantha came to therapy in her twenties to understand the story of her beloved father’s death. She’d been told as a child that he had died in a boating accident, but as an adult, she began to suspect that he had killed himself. Suicide often leaves the survivors with an unsolved mystery: Why? What could have been done to prevent this? Meanwhile, Samantha was always looking for problems in her relationships, searching for issues that would inevitably provide her with a reason to leave. In not wanting her boyfriends to be the enigma that her father was, she’d unwittingly re-create a story of abandonment—only in this version, she was the one doing the abandoning. She had control, but ended up alone. In therapy, she learned that the mystery she was trying to solve was larger than whether or not her father committed suicide. It was also the mystery of who her father was when he was alive—and who she became as a result of that. People want to be understood and to understand, but for most of us, our biggest problem is that we don’t know what our problem is. We keep stepping in the same puddle. Why do I do the very thing that will guarantee my own unhappiness over and over again? I cry and cry, wondering how it’s possible that I can cry so long. I wonder if I’ve become massively dehydrated. And still more tears appear. Before I know it, Wendell is patting his legs to indicate that our session is over. I take a breath and notice that I feel strangely calm now. Sobbing freely in Wendell’s office was like being wrapped in a blanket, warm and safe and separate from everything happening out there. I think about the Jack Kornfield quote again, the part about self-acceptance, but still I start to judge: Did I just pay somebody to watch me cry for forty-five minutes straight? Yes and no. Wendell and I had a conversation, even if no words were exchanged. He watched me grieve, and he didn’t try to make things more comfortable by interrupting or analyzing the issue. He let me tell my story in whatever way I needed to today. As I dry my tears and stand to leave, I think about how whenever Wendell has asked about other aspects of my life—what else was happening while Boyfriend and I were dating, what my life was like before I met Boyfriend—I’ve given a pat response (family, work, friends; nothing to see here, folks!), always returning the topic to Boyfriend. But now, tossing my tissues in the trash can, I realize that what I’ve told Wendell isn’t really complete. I haven’t lied, exactly. But I haven’t told the whole story either. Let’s just say that I left out some details. Part Two Honesty is stronger medicine than sympathy, which may console but often conceals. —Gretel Ehrlich 18 Fridays at Four We’re in my colleague Maxine’s office—skirted chairs, distressed wood, vintage fabrics, and soft shades of cream. It’s my turn to present a case in today’s consultation group, and I want to talk about a patient I can’t seem to help. Is it her? Is it me? That’s what I’m here to find out. Becca is thirty years old, and she came to me a year ago because of difficulty with her social life. She did well at her work but felt hurt that her peers excluded her, never inviting her to join them for lunch or drinks. Meanwhile, she’d just dated a string of men who seemed excited at first but broke it off after two months. Was it her? Was it them? That’s what she’d come to therapy to find out. This isn’t the first time I’ve brought up Becca on a Friday at four, when our weekly group meets. Though not required, consultation groups are a fixture of many therapists’ lives. Working alone, we don’t have the benefit of input from others, whether that’s praise for a job well done or feedback on how to do better. Here we examine not just our patients but ourselves in relation to our patients. In our group, Andrea can say to me, “That patient sounds like your brother. That’s why you’re responding that way.” I can help Ian manage his feelings about the patient who begins her sessions by reporting her horoscope (“I can’t stand this woo-woo shit,” he says). Group consultation is a system—imperfect, but valuable—of checks and balances to ensure that we’re maintaining objectivity, homing in on the important themes, and not missing anything obvious in the treatment. Admittedly, there’s also banter on these Friday afternoons—often along with food and wine. “It’s the same dilemma,” I tell the group—Maxine, Andrea, Claire, and Ian, our lone male. Everyone has blind spots, I add, but what’s notable about Becca is that she seems to have so little curiosity about herself. The members of the group nod. Many people begin therapy more curious about others than about themselves—Why does my husband do this? But in each conversation, we sprinkle seeds of curiosity, because therapy can’t help people who aren’t curious about themselves. At some point I might even say something like “I wonder why I seem to be more curious about you than you are about yourself?” and see where the patient takes this. Most people will start to get curious about my question. But not Becca. I take a breath and go on. “She’s not satisfied with what I’m doing, she’s not moving forward, and instead of seeing somebody else, she comes each week—almost to show that she’s right and I’m wrong.” Maxine, who’s been in practice for thirty years and is the matriarch of the group, swirls the wine in her glass. “Why do you keep seeing her?” I consider this as I slice some cheese from the wedge on the tray. In fact, all of the ideas the group has offered in the past several of months have fallen flat. If, for instance, I asked Becca what her tears were about, she’d shoot back with “That’s why I’m coming to you—if I knew what was going on, I wouldn’t need to be here.” If I talked about what was happening between us in the moment—her disappointment in me, her feeling misunderstood by me, her perception that I wasn’t helpful—she’d go off on a tangent about how this kind of impasse didn’t happen with anybody else, just me. When I attempted to keep the conversation focused on us—did she feel accused of something, or criticized?—she’d get angry. When I tried to talk about the anger, she’d shut down. When I wondered if the shutting down was a way of keeping out what I had to say for fear it might hurt her, she’d say again that I misunderstood. If I asked why she kept coming to see me if she felt so misunderstood, she’d say I was abandoning her and that I wished she would leave—just like her boyfriends or her peers at work. When I tried to help her consider why those people pulled away from her, she’d say the boyfriends were commitment-phobes and her coworkers were snobby. Generally what happens between therapist and patient also plays out between the patient and people in the outside world, and it’s in the safe space of the therapy room that the patient can begin to understand why. (And if the dance between therapist and patient doesn’t play out in the patient’s outside relationships, it’s often because the patient doesn’t have any deep relationships—precisely for this reason. It’s easy to have smooth relationships on a surface level.) It seemed that Becca was reenacting with me and everyone else a version of her relationship with her parents, but she wasn’t willing to discuss that either. Of course, there are times when something just isn’t right between therapist and patient, when the therapist’s countertransference is getting in the way. One sign: having negative feelings about the patient. Becca does irritate me, I tell the group. But is it because she reminds me of somebody from my past, or because she’s genuinely difficult to interact with? Therapists use three sources of information when working with patients: What the patients say, what they do, and how we feel while we’re sitting with them. Sometimes a patient will basically be wearing a sign around her neck saying I REMIND YOU OF YOUR MOTHER! But as a supervisor drilled into us during training, “What you feel on the receiving end of an encounter with a patient is real—use it.” Our experiences with this person are important because we’re probably feeling something pretty similar to what everyone else in this patient’s life feels. Knowing that helped me empathize with Becca, to see how deep her struggles were. The late reporter Alex Tizon believed that every person has an epic story that resides “somewhere in the tangle of the subject’s burden and the subject’s desire.” But I couldn’t get there with Becca. I felt increasingly fatigued in our sessions—not from mental exertion, but from boredom. I made sure to have chocolate and do jumping jacks before she came in to wake myself up. Eventually, I moved her evening session to first thing in the morning. The minute she sat down, though, the boredom set in and I felt helpless to help her. “She needs to make you feel incompetent so she can feel more powerful,” Claire, a sought-after analyst, says today. “If you fail, then she doesn’t have to feel like such a failure.” Maybe Claire is right. The hardest patients aren’t the ones like John, people who are changing but don’t seem to realize it. The hardest patients are the ones, like Becca, who keep coming but don’t change. Recently Becca had started dating someone new, a guy named Wade, and last week, she told me about an argument they’d had. Wade had noticed that Becca seemed to complain about her friends quite a bit. “If you’re so unhappy with them,” he said, “why do you keep them as friends?” Becca “couldn’t believe” Wade’s response. Didn’t he understand that she was just venting? That she wanted to talk it through with him and not be “shut down”? The parallels here seemed obvious. I asked Becca if she was just trying to vent with me and that, as with her friends, she found some value in our relationship, even though sometimes she also felt frustrated. No, Becca said, I’d gotten it wrong again. She was here to talk about Wade. She couldn’t see that she had shut Wade down just as she had shut me down, which left her feeling shut down herself. She wasn’t willing to look at what she was doing that made it difficult for people to give her what she wanted. Though Becca came to me wanting aspects of her life to change, she didn’t seem open to actually changing. She was stuck in a “historical argument,” one that predated therapy. And just as Becca had her limitations, so did I. Every therapist I know has come up against theirs. Maxine asks again why I’m still seeing Becca. She points out that I’ve tried everything I know from my training and experience, everything I’ve gleaned from the therapists in my consultation group, and Becca is making no progress. “I don’t want her to feel emotionally stranded,” I say. “She already feels emotionally stranded,” Maxine says. “By everyone in her life, including you.” “Right,” I say. “But I’m afraid that if I end therapy with her, it’s going to further cement her belief that nobody can help her.” Andrea raises her eyebrows. “What?” I say. “You don’t need to prove your competence to Becca,” she says. “I know that. It’s Becca I’m worried about.” Ian coughs loudly, then pretends to gag. The entire group bursts out laughing. “Okay, maybe I do.” I put some cheese on a cracker. “It’s like this other patient I have who’s in a relationship with a guy who doesn’t treat her very well, and she won’t leave because on some level, she wants to prove to him that she deserves to be treated better. She’s never going to prove it to him, but she won’t stop trying.” “You need to concede the fight,” Andrea says. “I’ve never broken up with a patient before,” I say. “Breakups are awful,” Claire says, popping some grapes in her mouth. “But we’d be negligent if we didn’t do them.” A collective Mm-hmm fills the room. Ian watches, shaking his head. “You’re all going to jump down my throat over this”—Ian’s famous in our group for making generalizations about men and women—“but here’s the thing. Women put up with more crap than men do. If a girlfriend’s not treating a guy well, he has an easier time leaving. If a patient isn’t benefiting from what I have to offer, and I’ve made sure I’m doing my very best but nothing’s working, I’ll break it off.” We give him our familiar stare-down: Women are just as good at letting go as men are. But we also know there might be a grain of truth here. “To breaking it off,” Maxine says, raising her glass. We clink glasses but not in a joyful way. It’s heartbreaking when a patient invests hope in you and, in the end, you know you’ve let her down. In those cases, a question stays with you: If I’d done something differently, if I’d found the key in time, could I have helped? The answer you give yourself: Probably. No matter what my consultation group says, I wasn’t able to reach Becca in just the right way, and in that sense, I failed her. Therapy is hard work—and not just for the therapist. That’s because the responsibility for change lies squarely with the patient. If you expect an hour of sympathetic head-nodding, you’ve come to the wrong place. Therapists will be supportive, but our support is for your growth, not for your low opinion of your partner. (Our role is to understand your perspective but not necessarily to endorse it.) In therapy, you’ll be asked to be both accountable and vulnerable. Rather than steering people straight to the heart of the problem, we nudge them to arrive there on their own, because the most powerful truths—the ones people take the most seriously—are those they come to, little by little, on their own. Implicit in the therapeutic contract is the patient’s willingness to tolerate discomfort, because some discomfort is unavoidable for the process to be effective. Or as Maxine said one Friday afternoon: “I don’t do ‘you go, girl’ therapy.” It may seem counterintuitive, but therapy works best when people start getting better—when they feel less depressed or anxious, or the crisis has passed. Now they’re less reactive, more present, more able to engage in the work. Unfortunately, sometimes people leave just as their symptoms lift, not realizing (or perhaps knowing all too well) that the work is just beginning and that staying will require them to work even harder. Once, at the end of a session with Wendell, I told him that sometimes, on days when I left more upset than when I came in—tossed out into the world, having so much more to say, holding so many painful feelings—I hated therapy. “Most things worth doing are difficult,” he replied. He said this not in a glib way but in a tone and with an expression that made me think he spoke from personal experience. He added that while everyone wants to leave each session feeling better, I, of all people, should know that that’s not always how therapy works. If I wanted to feel good in the short term, he said, I could eat a piece of cake or have an orgasm. But he wasn’t in the short-term-gratification business. And neither, he added, was I. Except that I was—as a patient, that is. What makes therapy challenging is that it requires people to see themselves in ways they normally choose not to. A therapist will hold up the mirror in the most compassionate way possible, but it’s up to the patient to take a good look at that reflection, to stare back at it and say, “Oh, isn’t that interesting! Now what?” instead of turning away. I decide to take my consultation group’s advice and end my sessions with Becca. Afterwards, I feel both disappointed and liberated. When I tell Wendell about it at my next session, he says he knows exactly how it felt to be with her. “You have patients like her?” I ask. “I do,” he says, and he smiles broadly, holding my gaze. It takes a minute, but then I get it: He means me. Yikes! Does he do jumping jacks or down caffeine before our sessions too? Many patients wonder if they bore us with what feels to them like their unremarkable lives, but they’re not boring at all. The patients who are boring are the ones who won’t share their lives, who smile through their sessions or launch into seemingly pointless and repetitive stories every time, leaving us scratching our heads: Why are they telling me this? What significance does this have for them? People who are aggressively boring want to keep you at bay. It’s what I’ve done with Wendell when talking incessantly about Boyfriend; he can’t quite reach me because I’m not allowing him to. And now he’s laying it out there: I’m doing with him what Boyfriend and I did with each other—and I’m not so different from Becca after all. “I’m telling you this by way of invitation,” Wendell says, and I think about how many invitations of mine Becca had rebuffed. I don’t want to do that with Wendell. If I wasn’t able to help Becca, maybe she’ll be able to help me. 19 What We Dream Of One day, a twenty-four-year-old woman I’d been seeing for a few months came in and told me about the previous night’s dream. “I’m at the mall,” Holly began, “and I run into this girl, Liza, who was horrible to me in high school. She didn’t tease me to my face, like some other girls did. She just completely ignored me! Which would have been okay, except that if I ran into her outside of school, she’d pretend she had no idea who I was. Which was crazy, because we’d been at the same school for three years, and we had several classes together. “Anyway, she lived a block away, so I’d run into her a lot—you know, around the neighborhood—and I’d have to pretend I didn’t see her, because if I said hi or waved or acknowledged her in any way, she’d scrunch up her forehead and give me this look like she was trying to place me but couldn’t. And then she’d say, in this fake-sweet voice, ‘I’m sorry, do I know you?’ or ‘Have we met before?’ or, if I was lucky, ‘This is so embarrassing, but what’s your name again?’” Holly’s voice faltered for a second, then she continued. “So in the dream, I’m at the mall, and Liza is there. I’m no longer in high school and I look different—I’m thin, wearing the perfect outfit, blow-dried hair. I’m flipping through some clothes on a rack when Liza comes over to browse through the same rack, and she starts making small talk about the clothes, the way you might with a stranger. At first I’m pissed, like here we go again—she’s still pretending not to recognize me. Except then I realize that now it’s real—she doesn’t recognize me because I look so good.” Holly shifted on the couch, covering herself with the blanket. We’ve talked in the past about how she uses that blanket to cover up her body, to hide her size. “So I play innocent, and we start chatting about the clothes and what our jobs are, and as I’m talking, I see this look of recognition dawning on her face. It’s like she’s trying to reconcile her image of me from twelfth grade—you know, pimply, fat, frizzy hair—with me now. I see her brain connecting the dots, and then she says, ‘Oh my God! Holly! We went to high school together!’” Holly was starting to laugh now. She was tall and striking, with long chestnut hair and eyes the color of a tropical ocean, and she was still a good forty pounds overweight. “So,” she continued, “I scrunch up my forehead and say, in the same fake-sweet voice she used to use on me, ‘Wait, I’m so sorry. Do I know you?’ And she says, ‘Of course you know me—it’s Liza! We had geometry and ancient history and French together—remember Ms. Hyatt’s class?’ And I say, ‘Yeah, I had Ms. Hyatt, but, gosh, I don’t remember you. You were in that class?’ And she says, ‘Holly! We lived a block away from each other. I used to see you at the movies and the yogurt place and that one time in Victoria’s Secret by the dressing rooms—’” Holly laughed some more. “She’s totally giving away that she did know me all those times. But I say, ‘Wow, how weird, I don’t remember you, but it’s nice to meet you.’ And then my phone rings and it’s her high-school boyfriend telling me to hurry up, we’ll be late for our movie. So I give her that condescending smile she used to give me, and I walk away, leaving her feeling how I felt in high school. And then I realize that the ringing phone is actually my alarm and it was all a dream.” Later, Holly would call this her “poetic-justice dream,” but to me it was about a common theme that comes up in therapy, and not just in dreams—the theme of exclusion. It’s the fear that we’ll be left out, ignored, shunned, and end up unlovable and alone. Carl Jung coined the term collective unconscious to refer to the part of the mind that holds ancestral memory, or experience that is common to all humankind. Whereas Freud interpreted dreams on the object level, meaning how the content of the dream related to the dreamer in real life (the cast of characters, the specific situations), in Jungian psychology, dreams are interpreted on the subject level, meaning how they relate to common themes in our collective unconscious. It’s no surprise that we often dream about our fears. We have a lot of fears. What are we afraid of? We are afraid of being hurt. We are afraid of being humiliated. We are afraid of failure and we are afraid of success. We are afraid of being alone and we are afraid of connection. We are afraid to listen to what our hearts are telling us. We are afraid of being unhappy and we are afraid of being too happy (in these dreams, inevitably, we’re punished for our joy). We are afraid of not having our parents’ approval and we are afraid of accepting ourselves for who we really are. We are afraid of bad health and good fortune. We are afraid of our envy and of having too much. We are afraid to have hope for things that we might not get. We are afraid of change and we are afraid of not changing. We are afraid of something happening to our kids, our jobs. We are afraid of not having control and afraid of our own power. We are afraid of how briefly we are alive and how long we will be dead. (We are afraid that after we die, we won’t have mattered.) We are afraid of being responsible for our own lives. Sometimes it takes a while to admit our fears, especially to ourselves. I’ve noticed that dreams can be a precursor to self-confession—a kind of pre-confession. Something buried is brought closer to the surface, but not in its entirety. A patient dreams that she’s lying in bed hugging her roommate; initially she thinks it’s about their strong friendship but later she realizes she’s attracted to women. A man has a recurring dream that he’s been caught speeding on the freeway; a year into this dream, he begins to consider that his decades of cheating on his taxes—of positioning himself above the rules—might catch up with him. After I’ve been seeing Wendell for a few months, my patient’s dream about her high-school classmate seeps into mine. I’m at the mall, looking through a rack of dresses, when Boyfriend appears at the same rack. Apparently, he’s shopping for a birthday gift for his new girlfriend. “Oh, which birthday?” I ask in the dream. “Fiftieth,” he says. At first I’m relieved in the pettiest way—not only is she not the clich?d twenty-five-year-old, but she’s actually older than I am. It makes sense. Boyfriend wanted no kids in the house, and she’s old enough to have kids in college. Boyfriend and I are having a pleasant conversation—friendly, innocuous—until I happen to catch a glimpse of myself in the mirror adjacent to the rack. That’s when I see that I’m actually an old lady—late seventies, maybe eighties. It turns out that Boyfriend’s fifty-year-old girlfriend is, in fact, decades younger than I am. “Did you ever write your book?” Boyfriend asks. “What book?” I say, watching my wrinkled, prune-like lips move in the mirror. “The book about your death,” he replies matter-of-factly. And then my alarm goes off. All day, as I hear other patients’ dreams, I can’t stop thinking about mine. It haunts me, this dream. It haunts me because it’s my pre-confession. 20 The First Confession Allow me to get defensive for a minute. You see, when I told Wendell that everything was just fine until the breakup, I was telling the absolute truth. Or, rather, the truth as I knew it. Which is to say, the truth as I wanted to see it. And now let me remove the defense: I was lying. One thing I haven’t told Wendell is that I’m supposed to be writing a book—and that it hasn’t been going very well. By “not going very well,” I mean that I haven’t actually been writing it. This wouldn’t be a problem if I weren’t under contract and therefore legally obligated to either produce a book or return the advance that I no longer have in my bank account. Well, it would still be a problem even if I could return the money, because in addition to being a therapist, I am a writer—it’s not just what I do but who I am—and if I can’t write, then a crucial part of me goes missing. And if I don’t turn in this book, my agent says that I won’t get the opportunity to write another. It isn’t that I haven’t been able to write at all. In fact, during the time I was supposed to be writing my book, I was crafting fabulously witty and flirtatious emails to Boyfriend, all while telling friends and family and even Boyfriend that I was busy writing my book. I was like the closet gambler who gets dressed for work and kisses his family goodbye each morning and then drives to the casino instead of the office. I’ve been meaning to talk to Wendell about this situation, but I’ve been so focused on getting through the breakup that I haven’t had a chance. Obviously that, too, is a big fat lie. I haven’t told Wendell about the book-I’m-not-writing because every time I think about it, I’m filled with panic, dread, regret, and shame. Whenever the situation pops into my head (which is constantly; as Fitzgerald put it, “In a real dark night of the soul, it is always three o’clock in the morning, day after day”), my stomach tightens and I feel paralyzed. Then I question every bad decision I’ve made at various forks in the road because I’m convinced that I’m in this current situation due to what ranks as one of the most colossally bad decisions of my life. Perhaps you’re thinking, Really? You were lucky enough to get a book contract, and now you’re not writing the book? Boo-hoo! Try working twelve hours a day in a factory, for God’s sake! I understand how this comes across. I mean, who do I think I am, Elizabeth Gilbert at the beginning of Eat, Pray, Love when she’s crying on the bathroom floor as she thinks about leaving the husband who loves her? Gretchen Rubin in The Happiness Project who has the loving, handsome husband, the healthy daughters, and more money than most people will ever see but still has that niggling feeling of something missing? Which reminds me—I left out an important detail about the book-I’m-not-writing. The topic? Happiness. No, the irony hasn’t been lost on me: the happiness book has been making me miserable. I should never have been writing a happiness book in the first place, and not just because, if Wendell’s grieving-something-bigger theory holds water, I’ve been depressed. When I made the decision to write this book, I’d recently begun my private practice, and I’d just written a cover story for the Atlantic called “How to Land Your Kid in Therapy: Why Our Obsession with Our Kids’ Happiness May Be Dooming Them to Unhappy Adulthoods,” which, at the time, was the most emailed piece in the hundred-plus-year history of the magazine. I talked about it on national television and radio; media from around the world called me for interviews; and overnight, I became a “parenting expert.” Next thing I knew, publishers wanted the book version of “How to Land Your Kid in Therapy.” By wanted, I mean they wanted it for—I don’t know how else to say this—a dizzying sum of money. It was the kind of money that a single mom like me only dreamed of, the kind of money that would provide our one-income family with some financial room to breathe for a long time. A book like this would have led to speaking engagements (which I enjoy) at schools across the country and a steady flow of patients (which would have helped, as I was starting out). The article was even optioned for a television series (which might have gotten made had there also been a best-selling book to go along with it). But when given the opportunity to write the book version of “How to Land Your Kid in Therapy,” a book that could potentially change the entire landscape of my professional and financial future, I said, with an astonishing lack of forethought: Thanks very much, that’s so kind, but . . . I’d rather not. I hadn’t had a stroke. I just said no. I said no because something felt wrong about it. Mainly, I didn’t think that the world needed another helicopter-parenting book. Dozens of smart, thoughtful books had already covered overparenting from every conceivable angle. After all, two hundred years ago, the philosopher Johann Wolfgang von Goethe succinctly summarized this sentiment: “Too many parents make life hard for their children by trying, too zealously, to make it easy for them.” Even in recent history—2003, to be exact—one of the early modern overparenting books, aptly named Worried All the Time, put it this way: “The cardinal rules of good parenting—moderation, empathy, and temperamental accommodation with one’s child—are simple and are not likely to be improved upon by the latest scientific findings.” As a mom myself, I wasn’t immune to parental anxiety. I wrote my original article, in fact, with the hope that it would be useful to parents in the way that a therapy session might be. But if I eked a book out of it in order to jump on the commercial bandwagon and join the ranks of insta-experts, I thought I’d be part of the problem. What parents needed, I believed, wasn’t another book about how they had to calm down and take a break. What they needed was an actual break from the deluge of parenting books. (The New Yorker later ran a humor piece about the proliferation of parenting manifestos, saying that “another book at this point would just be cruel.”) So like Bartleby the Scrivener (and with similarly tragic results), I said, “I would prefer not to.” Then I spent the next several years watching more and more overparenting books hit the market and beating myself up with a rotating roster of self-flagellating questions: Had I been a responsible adult by turning down that kind of money? I’d recently finished an unpaid internship, I had graduate-school loans to repay, and I was the sole provider for my family; why couldn’t I have just written the parenting book quickly, reaped the professional and financial benefits, and gone my merry way? After all, how many people have the luxury of working only on what matters most to them? The regret I felt about having not done the parenting book was compounded by the fact that I continued to get weekly reader mail and speaking-engagement queries about the “How to Land Your Kid in Therapy” article. “Will there be a book?” person after person asked. No, I wanted to reply, because I’m a moron. I did feel like a moron, because in the interest of not selling out and cashing in on the parenting craze, I agreed instead to write the now-dreaded, depression-inducing happiness book. To make ends meet as I launched my practice, I still had to write a book, and I thought at the time that I could provide a service to readers. Instead of showing how we parents were trying too hard to make our kids happy, I was going to show how we were trying too hard to make ourselves happy. This idea seemed closer to my heart. But whenever I sat down to write, I felt as disconnected from the topic as I had from the subject of helicopter parenting. The research didn’t—couldn’t—reflect the subtleties of what I was seeing in the therapy room. Some scientists had even come up with a complex mathematical equation to predict happiness based on the premise that happiness stems not from how well things go but whether things go better than expected. It looks like this: Happiness (t) = w0 w1 ?t?jCRj w2 ?t?jEVj w3 ?t?jRPEj Which all boils down to: Happiness equals reality minus expectations. Apparently, you can make people happy by delivering bad news and then taking it back (which, personally, would just make me mad). Still, I knew I could put together some interesting studies, but I felt I’d just be scratching the surface of something else I wanted to say but couldn’t quite put my finger on. And in my new career, and in my life more generally, scratching the surface no longer felt satisfying. You can’t go through psychotherapy training and not be changed in some way, not become, without even noticing, oriented toward the core. I told myself it didn’t matter. Just write the book and be done with it. I’d already botched things up with the parenting book; I couldn’t botch up this happiness book too. And yet, day after day, I couldn’t get myself to write it. Just like I couldn’t get myself to write the parenting book. How had I gotten here again? In graduate school, we used to watch therapy sessions through one-way mirrors, and sometimes when I’d sit down to write the happiness book, I’d think about a thirty-five-year-old patient I’d observed. He’d come to therapy because he very much loved and was attracted to his wife but he couldn’t stop cheating on her. Neither he nor his wife understood how his behavior could be so at odds with what he believed he wanted—trust, stability, closeness. In his session, he explained that he hated the turmoil his cheating put his wife and their marriage through and knew that he wasn’t the husband or father he wanted to be. He talked for a while about how desperately he wanted to stop cheating and how he had no idea why he kept doing it. The therapist explained that often different parts of ourselves want different things, and if we silence the parts we find unacceptable, they’ll find other ways to be heard. He asked the guy to sit in a different chair, across the room, and see what happened when the part of him that chose to cheat wasn’t shoved aside but got to say its piece. At first the poor guy was at a loss, but gradually, he began to give voice to his hidden self, the part that would goad the responsible, loving husband into engaging in self-defeating behavior. He was torn between these two aspects of himself, just as I was torn between the part of me that wanted to provide for my family and the part of me that wanted to do something meaningful—something that touched my soul and hopefully others’ souls as well. Boyfriend appeared on the scene just in time to distract me from this internal battle. And once he was gone, I filled the void by Google-stalking him when I should have been writing. So many of our destructive behaviors take root in an emotional void, an emptiness that calls out for something to fill it. But now that Wendell and I have talked about not Google-stalking Boyfriend, I feel accountable. I have no excuse not to sit down and write this misery-inducing happiness book. Or at least tell Wendell the truth about the mess I’m in.