Maybe You Should Talk to Someone

by Lori Gottlieb

“You’re going to miss Matt a lot,” I say.

  “I am,” she squeaks out. “Everything about him. The way he gets so excited about little things, like a latte or a line in a book. The way he kisses me, and the way his eyes take ten minutes to open if he wakes up too early. How he warms my feet in bed and looks at me when we’re talking, like his eyes are soaking up everything I’m saying as much as his ears are.” Julie pauses to catch her breath. “And you know what I’m going to miss most of all? His face. I’m going to miss looking at his beautiful face. It’s my favorite face in the entire world.”

  Julie is crying so hard that no sound comes out. I wish that Matt could have been here for this.

  “Have you told him?” I ask.

  “All the time,” Julie says. “Every time he holds my hand, I say, ‘I’m going to miss your hands.’ Or when he’s whistling around the house—he’s an amazing whistler—I’ll tell him how much I’m going to miss that sound. And he always used to say, ‘Jules, you’re still here. You can hold my hands and hear me whistle.’ But now—” Julie’s voice cracks. “Now he says, ‘I’m going to miss you just as much.’ I think he’s starting to accept the fact that I’m really dying this time.”

  Julie wipes her upper lip.

  “You want to hear something?” she continues. “I’m also going to miss myself. All those insecurities I’d spent my life wanting to change? I was just getting to a place where I really like myself. I like me. I’m going to miss Matt, and my family, and my friends, but I’m also going to miss me.”

  She goes on to name all the things she wishes she’d appreciated more before she got sick: Her breasts, which she used to think weren’t perky enough until she had to give them up; her strong legs, which she often thought were too thick, even though they served her well in marathons; her quiet way of listening, which she feared some might find boring. She’s going to miss her distinctive laugh that a boy in fifth grade called “a squawk,” a comment that somehow stuck like a burr inside her for years until that laugh made Matt glance her way in a crowded room and then make a beeline for her to introduce himself.

  “I’m going to miss my freaking colon!” she says, laughing now. “I didn’t appreciate it enough before. I’m going to miss sitting on a toilet and shitting. Who thinks they’ll miss shitting?” Then come the tears—angry ones.

  Every day is another loss of something she took for granted until it was gone, like what happens to the couples I see who take each other for granted and then miss each other when the marriage seems to be dying. Many women, too, have told me that they loathed getting their menstrual periods but grieved the loss of them when they reached menopause. They missed bleeding the way Julie will miss shitting.

  Then, in almost a whisper, Julie adds, “I’m going to miss life.

  “Fuck, fuck, fuck, fuck, fuck!” she says, starting soft and getting louder, surprising herself with her volume. She looks at me, embarrassed. “Sorry, I didn’t mean—”

  “It’s okay,” I say. “I agree. It fucking sucks.”

  Julie laughs. “And now I got my therapist to say fuck! I never used to swear like this. I don’t want my obituary to read, ‘She swore like a sailor.’”

  I wonder what she does want her obituary to say, but time is almost up and I make a mental note to come back to this next time.

  “Oh, who cares, that felt good. Let’s do it again,” Julie says. “Will you do it with me? We’ve got a minute left, right?”

  At first I don’t know what she’s talking about—do what? But she has that mischievous look again, and then it clicks.

  “You want us to—”

  Julie nods. The rule-follower is asking me to yell obscenities with her. Recently in my consultation group, Andrea had said that while we need to hold hope for our patients, we have to hope for the right thing. If I can no longer hold hope for Julie’s longevity, Andrea said, I have to hold hope for something else. “I can’t help her in the way that she wants,” I’d said. But sitting here now, I see that maybe I can, at least for today.

  “Okay,” I say. “Ready?”

  We both yell, “FUCK, FUCK, FUCK, FUCK, FUCK, FUCK, FUCK!” When we’re done, we catch our breath, exhilarated.

  Then I walk her to the door, where, as usual, she hugs me goodbye.

  In the hallway, other patients are leaving their sessions, doors opening at ten to the hour like clockwork. My colleagues look at me questioningly as Julie leaves. Our voices must have carried into the corridor. I shrug, close my door, and start laughing. That was a first, I think.

  Then I feel the tears well up. Laughter to tears—grief. I’m going to miss Julie and I’m having a hard time with this myself.

  Sometimes the only thing to do is yell, “Fuck!”

  36

  The Speed of Want

  After completing my traineeship year, I began my internship at a nonprofit clinic located in the basement of a sleek office building. Upstairs, the light-filled suites had views of Los Angeles’s mountains to one side and beaches to the other, but downstairs was another story. In cramped, cave-like, windowless consultation rooms furnished with decades-old chairs, broken lamps, and torn sofas, we interns thrived on patient volume. When a new case came in, we all vied for it, because the more people we saw, the more we learned and the closer we came to finishing our hours. Between back-to-back sessions, clinical supervision, and mounds of paperwork, we didn’t pay much attention to the fact that we were living underground.

  Sitting in the break room (aroma: microwaved popcorn and ant spray), we would scarf down some food (lunch was always eaten “al desco”) and commiserate about our lack of time. But despite our gripes, our initiation as therapists felt exhilarating—partly because of the steep learning curve and our wise supervisors (who gave us advice like “If you’re talking that much, you can’t be listening” and its variant “You have two ears and one mouth; there’s a reason for that ratio”), and partly because we knew this phase was blessedly temporary.

  The light at the end of the years-long tunnel was licensure, when we imagined we could improve people’s lives by doing the work we loved but with reasonable hours and a less frenetic pace. As we hunkered down in that basement, doing our charts by hand and searching for reception on our phones, we didn’t realize that upstairs, a revolution was under way, one of speed, ease, and immediate gratification. And that what we were being trained to offer—gradual but lasting results that required some hard work—was becoming increasingly obsolete.

  I’d seen hints of these developments in my patients at the clinic but, focused on my own harried existence, I failed to see the bigger picture. I thought: Of course these people have trouble slowing down or paying attention or being present. That’s why they’re in therapy.

  My life wasn’t much different, of course, at least during this phase. The faster I finished my work, the sooner I’d get to spend time with my son, and then the quicker we could do the bedtime routine, the quicker I could get to bed so that I could wake up the next day and hurry all over again. And the quicker I moved, the less I saw, because everything became a blur.

  But this would end soon, I reminded myself. Once I finished my internship, my real life would begin.

  One day I was in the break room with some fellow interns, and we once again started counting our required number of hours and calculating how old we’d be when we finally got licensed. The higher the number, the worse we felt. A supervisor in her sixties walked by and overheard the conversation.

  “You’ll turn thirty or forty or fifty anyway, whether your hours are finished or not,” she said. “What does it matter what age you are when that happens? Either way, you won’t get today back.”

  We all went quiet. You won’t get today back.

  What a chilling idea. We knew that our supervisor was trying to tell us something important. But we didn’t have time to think about it.

  Speed is about time, but it’s also closely related to endurance and effort. The faster the speed, the think
ing goes, the less endurance or effort required. Patience, on the other hand, requires endurance and effort. It’s defined as “the bearing of provocation, annoyance, misfortune, or pain without complaint, loss of temper, irritation, or the like.” Of course, much of life is made up of provocation, annoyance, misfortune, and pain; in psychology, patience might be thought of as the bearing of these difficulties for long enough to work through them. Feeling your sadness or anxiety can also give you essential information about yourself and your world.

  But while I was down in that basement rushing toward licensure, the American Psychological Association published a paper called “Where Has All the Psychotherapy Gone?” It noted that 30 percent fewer patients received psychological interventions in 2008 than they had ten years earlier and that since the 1990s, the managed-care industry—the same system that my medical-school professors had warned us about—had been increasingly limiting visits and reimbursements for talk therapy but not for drug treatment. It went on to say that in 2005 alone, pharmaceutical companies spent $4.2 billion on direct-to-consumer advertising and $7.2 billion on promotion to physicians—nearly twice what they spent on research and development.

  Of course, it’s a lot easier—and quicker—to swallow a pill than to do the heavy lifting of looking inside yourself. And I had nothing against patients using medication to feel better. Just the opposite; I was, in fact, a strong believer in the tremendous good it often did in the right situations. But did 26 percent of the general population in this country really need to be on psychiatric medications? After all, it wasn’t that psychotherapy didn’t work. It was that it didn’t work fast enough for today’s patients, who were now, tellingly, called “consumers.”

  There was an unspoken irony to all of this. People wanted a speedy solution to their problems, but what if their moods had been driven down in the first place by the hurried pace of their lives? They imagined that they were rushing now in order to savor their lives later, but so often, later never came. The psychoanalyst Erich Fromm had made this point more than fifty years earlier: “Modern man thinks he loses something—time—when he does not do things quickly; yet he does not know what to do with the time he gains except kill it.” Fromm was right; people didn’t use extra time earned to relax or connect with friends or family. Instead, they tried to cram more in.

  One day, as we interns begged to be given more new cases despite our full caseloads, our supervisor shook her head.

  “The speed of light is outdated,” she said dryly. “Today, everybody moves at the speed of want.”

  Indeed, I sped through. Before long, I completed my internship, passed my board exams, and moved upstairs into an airy office with a view of the world around me. After two false starts—Hollywood, medical school—I was ready to begin a career I felt passionate about, and my being older also gave it a sense of urgency. I had taken a circuitous route, arriving late to the game, and though now I could finally slow down and appreciate the hard-won fruits of my labor, I still felt as rushed as I had in my internship—this time, I felt rushed to enjoy it. I sent out an email announcement introducing my practice and did some networking. After six months, I had a smattering of patients, but then the number seemed to plateau. Everyone I spoke to was having a similar experience.

  I joined a consultation group for new therapists, and one night, after we’d discussed our cases, the conversation turned to the state of our practices—were we imagining things, or was our generation of therapists doomed? Somebody said she had heard about branding specialists specifically for therapists, professionals who could help to bridge the gap between the culture’s need for speed and ease and what we were trained to do.

  We all laughed—branding consultants for therapists? How ludicrous. The influential therapists of the past that we admired would be turning in their graves! But secretly, she got my attention.

  A week later, I found myself on the phone with a branding consultant for therapists.

  “Nobody wants to buy therapy anymore,” the consultant said matter-of-factly. “They want to buy a solution to a problem.” She made some suggestions about positioning myself for this new marketplace—even proposing that I should offer “text therapy”—but the whole thing made me uncomfortable.

  Still, she was right. The week before Christmas, I got a call from a man in his early thirties about coming in for therapy. He explained that he wanted to figure out whether to marry his girlfriend, and he hoped we could “resolve this” quickly because Valentine’s Day was coming up and he knew he had to produce a ring or she’d bail. I explained that I could help him with clarity but couldn’t guarantee his timeline. It was a big life question, and I didn’t know anything about him yet.

  We set up an appointment, but the day before he was to come in, he called and told me he’d found someone else to help sort things out. She’d given him a guarantee that they’d resolve the issue in four sessions, which would meet his Valentine’s Day deadline.

  Another patient who genuinely wanted to find a life partner told me that she was going through people on the dating apps so fast that several times she had contacted a guy only to have him reply that they’d already met. She’d actually spent an hour having coffee with this person, but she was cycling through her options so quickly that she couldn’t keep track.

  Both of these patients were examples of, as my supervisor had put it, “the speed of want”—want in the sense of a desire. But I also began to think of the term slightly differently, as referring to the other sort of want—a lack or deficit.

  If you’d asked me when I started as a therapist what most people came in for, I would have replied that they hoped to feel less anxious or depressed, to have less problematic relationships. But no matter the circumstances, there seemed to be this common element of loneliness, a craving for but a lack of a strong sense of human connection. A want. They rarely expressed it that way, but the more I learned about their lives, the more I could sense it, and I felt it in many ways myself.

  One day at my new practice, in the long lull between patients, I found a video online of MIT researcher Sherry Turkle talking about this loneliness. In the late 1990s, she said, she had gone to a nursing home and watched a robot comfort an elderly woman who had lost a child. The robot looked like a baby seal, with fur and large eyelashes, and it processed language well enough to respond appropriately. The woman was pouring her heart out to this robot, and it seemed to follow her eyes, to be listening to her.

  Turkle went on to say that while her colleagues considered this seal robot to be great progress, a way to make people’s lives easier, she felt profoundly depressed.

  I gasped in recognition. Just the day before, I’d joked to a colleague, “Why not have a therapist in your iPhone?” I didn’t know then that soon there would be therapists in smartphones—apps through which you could connect with a therapist “anytime, anywhere . . . within seconds” to “feel better now.” I felt about these options the way Turkle felt about the woman with the robotic seal.

  “Why are we essentially outsourcing the thing that defines us as people?” Turkle asked in the video. Her question made me wonder: Was it that people couldn’t tolerate being alone or that they couldn’t tolerate being with other people? Across the country—at coffee with friends, in meetings at work, during lunch at school, in front of the cashier at Target, and at the family dinner table—people were texting and Tweeting and shopping, sometimes pretending to make eye contact and sometimes not even bothering.

  Even in my therapy office, people who were paying to be there would glance at their phones when they buzzed just to see who it was. (These were often the same people who later admitted that they also glanced at pinging phones during sex or while sitting on the toilet. Upon learning this, I placed a bottle of Purell in my office.) To avoid distraction, I’d suggest turning off their phones during sessions, which worked well, but I noticed that before patients even reached the door at the end of the session, they’d grab their phones and start scroll
ing through their messages. Wouldn’t their time have been better spent allowing themselves just one more minute to reflect on what we had just talked about or to mentally reset and transition back to the world outside?

  The second people felt alone, I noticed, usually in the space between things—leaving a therapy session, at a red light, standing in a checkout line, riding the elevator—they picked up devices and ran away from that feeling. In a state of perpetual distraction, they seemed to be losing the ability to be with others and losing their ability to be with themselves.

  The therapy room seemed to be one of the only places left where two people sit in a room together for an uninterrupted fifty minutes. Despite its veil of professionalism, this weekly I-thou ritual is often one of the most human encounters that people experience. I was determined to establish a flourishing practice, but I wasn’t willing to compromise this ritual in order to make that happen. It may have seemed quaint, if not downright inconvenient, but for those patients I did have, I knew there was a tremendous payoff. If we create the space and put in the time, we stumble upon stories that are worth waiting for, the ones that define our lives.

  And my own story? Well, I wasn’t really allowing the time and the space for that—gradually, I became too busy listening to the stories of others. But beneath the hectic bustle of therapy sessions and school drop-offs, of doctor appointments and romance, a long-repressed truth was percolating beneath the surface and just beginning to make itself felt when I arrived in Wendell’s office. Half my life is over, I would say, seemingly out of nowhere, in our very first session—and Wendell would jump right on this. He was picking up where my internship supervisor had left off years earlier.

  You won’t get today back.

  And the days were flying by.

  37

  Ultimate Concerns

  I’m soaked when I get to Wendell’s office this morning. During my short walk across the street from the parking lot to his building, the winter’s first downpour began unannounced. Having no umbrella or coat, I threw my cotton blazer over my head and ran.