Becoming Myself: A Psychiatrist's Memoir

by Irvin D. Yalom

  Marilyn returned to France for a conference in 1964 and wanted very much for the whole family to take a trip to Europe. What turned out was even better: a whole year in London.

  CHAPTER EIGHTEEN

  A YEAR IN LONDON

  In 1967, I received a career teaching award from the National Institute of Mental Health that permitted me to spend a year at the Tavistock Clinic in London. I planned to study the Tavistock approach to group therapy and begin working in earnest on a group therapy textbook. We found a house on Reddington Road in Hampstead close to the clinic, and our family of five (Ben, our youngest son, was not yet born) began a heavenly and memorable year abroad.

  I had swapped offices with John Bowlby, an eminent British psychiatrist from the Tavistock Clinic who was spending the year at Stanford. His London office was in the center of the clinic, allowing me much contact with the faculty. During that year I would walk each morning from our house to the clinic, ten blocks away, passing a fine eighteenth-century church. The small churchyard inside its grounds contained a score of headstones, several of them askew and so worn that the names were unreadable. The larger cemetery across the street was the resting place of a few prominent nineteenth- and twentieth-century figures, such as the writer Daphne du Maurier. Nearby I passed a stately, pillared mansion in which General Charles de Gaulle had lived during the German occupation of France. It was for sale for 100,000 pounds, and Marilyn and I often wished and fantasized that we had the funds to purchase it. A block farther was the huge mansion that had been used in the Mary Poppins film for the Julie Andrews and Dick Van Dyke rooftop dance scenes. Then, I continued down Finchley Road to Belsize Lane and entered a four-story nondescript building that housed the Tavistock Clinic.

  John Sutherland, the head of the Tavistock, was a kind and most genial Scotsman. He greeted me graciously on my first day, introduced me to his staff, and invited me to attend all clinic seminars and to observe the staff-led therapy groups. I was introduced to the psychiatrists involved with group work, and throughout the year I had ongoing contact with Pierre Turquet, Robert Gosling, and Henry Ezriel. Though I found them to be astute and welcoming, their approach to group leadership struck me as bizarrely distant and unengaged. Tavistock group leaders never spoke directly to any particular member, but directed 100 percent of their comments to the ceiling, limiting themselves only to remarks about the “group.” I recall a meeting one evening when one of the leaders, Pierre Turquet, said, “If all the members of this group have come in this ghastly rain from the far corners of London and choose to talk about cricket, well then, that’s all right with me.” The Tavistock group leaders followed the ideas of Wilfred Bion, which focused on the unconscious processes in groups as a whole and had little interest in the interpersonal realm, except as it related to leadership and authority. This was why comments were always made about the group as a whole and therapists never addressed an individual patient.

  Though I liked some of the psychiatrists personally, especially Bob Gosling, who invited us to his home in London as well as to his country home, I concluded after a few months that this approach to group therapy was highly ineffective, noting that a great many patients voted with their feet: attendance was exceptionally poor. They had a rule that unless four members attended, the meeting would be canceled and, indeed, that was the case all too often.

  Later that year I attended a weeklong Tavistock group conference at Leeds, with one hundred others from the fields of education, psychology, and business. I remember clearly how it began: the attendees were instructed to divide themselves up into five groups using five designated rooms. At the ringing of the starting bell, the attendees charged into the rooms. Some members vied for leadership, some demanded that the doors be closed lest the group get too large, and some insisted on rules for procedure. The workshop continued with ongoing meetings of the small groups, each assigned a faculty adviser who reflected on group process, and large group meetings, attended by all faculty and attendees, so that a study could be made of mass group dynamics.

  Although Tavistock groups continue to be used as a training tool to help individuals learn about group dynamics and organizational behavior, the Tavistock approach in group psychotherapy has, to the best of my knowledge, mercifully faded away.

  I generally observed one or two small group meetings a week and attended lectures or conferences, but for the most part during that year, I was completely on my own, fully engaged writing my group therapy textbook. The Tavistock faculty found my approach to groups as distasteful as I found theirs. When I presented my research work on “therapeutic factors” based on my interviews with a large number of successful group therapy patients, the British staff scoffed at the typical American fixation on the “satisfied customer.” As the only American, I felt isolated and unsupported. A year later, when I met John Bowlby face-to-face, he told me that he had had similar experiences with the Tavistock staff, and at times had fantasized setting off a bomb in the audience. I felt so isolated, unappreciated, and uneasy in my skin that year that I decided to find a therapist for myself, as I’ve done at various difficult points throughout my life.

  There were a great many schools of therapy in the United Kingdom at that time. The well-known British psychiatrist R. D. Laing came immediately to mind. From his writing, he seemed to be an arresting and original thinker. He had recently established Kingsley Hall, a site where psychotic patients and their therapists lived together in a healing community. Moreover, he treated patients in an egalitarian manner, which was very different from the Tavistock approach. When I attended a lecture he gave at Tavistock, I was impressed by his intelligence and rather enjoyed how his iconoclastic views ruffled the feathers of the establishment. But I also found him a bit disorganized, and I could easily understand why many members of the audience suggested that he was on LSD, his then-current drug of choice. Nonetheless, I chose to meet individually with him to discuss entering therapy. I recall asking him about his experience at Esalen in Big Sur, California, and his comments in his lecture about nude marathon groups being conducted there. He responded enigmatically, “I paddle my canoe and others paddle their canoes.” I concluded that he was too unfocused for me. (Little did I think I would be attending a nude marathon group at Esalen a few years later.)

  Next I consulted with the head of the Kleinian analytic school in London. I recall questioning his intense dredging for information about my first two years of life and asking why Kleinian analysis generally lasted seven to ten years. At the end of our two-hour consultation, he concluded (and I concurred) that my skepticism about his approach was too great. As he put it, “the volume of your background music [i.e., my resistance] will obscure the true chords of the analysis.” You have to admire the Brits for their eloquence!

  Eventually I chose to work with Charles Rycroft, who had been Laing’s analyst. He was a leading London psychiatrist of the “middle school” influenced by the British analysts Fairbairn and Winnicott. For the next ten months, I met with Rycroft two times a week. He was in his mid-fifties, and quite thoughtful and kind, if a bit detached. Each time I entered his Harley Street office, which had a Dickensian air about it and was furnished with a thick Persian carpet, a couch, and two comfortable upholstered armchairs, he hurriedly snuffed out the cigarette he had been smoking between sessions, greeted me with a handshake, and politely invited me to take my chair (not the couch) that faced his. He treated me collegially. I especially recall him recounting his role in the psychoanalytic society’s eviction of Masud Khan—an account I later re-created in my novel Lying on the Couch.

  I profited from our sessions, but wished he would be more active and interactional. His complex interpretations almost never struck me as helpful, but even so, after a few weeks, my anxiety was ameliorated and I felt able to write more effectively. Why? Perhaps because of his reliable acceptance and empathy. It was extremely important for me to know I had someone on my side. In later years when I visi
ted London, I paid him social visits, and we often reviewed our therapy together. When he said he regretted his adherence to the doctrine of offering only interpretations, I much appreciated his candor.

  My work time in London was entirely devoted to writing the group therapy textbook. Since this was my first book, I had to invent my method and ended up drawing heavily from three major sources: my lecture notes from the courses I had given to the residents during the previous years, the hundreds of group summaries I had written and mailed to group members, and the group therapy research literature, much of it accessible through the Tavistock Clinic’s excellent library. I didn’t know how to type (most professionals did not type in those years). Each day I handwrote my three or four pages and gave them to a Tavistock typist, whom I hired privately to type my day’s work each evening, to be ready for my revision the following morning.

  Where to begin? I started with the very first questions faced by a group therapist: how to select patients and compose a group.Selection consists of determining whether a particular patient is suitable for a particular type of group therapy. Composing the group addresses another question: If the patient is suitable and there are a number of groups with space for a new member, then which group would be best for that patient? Or consider yet another (extremely unlikely) scenario: Imagine a roster of a hundred patients, enough to form twelve groups. How should therapists go about composing these twelve groups so they will be maximally effective? With these questions in mind, I surveyed the research literature and wrote two scholarly, dense, highly detailed, and exceedingly boring chapters.

  Just after I had completed the two chapters on patient selection and group composition, my chairman, David Hamburg, visited us in London and gave me the stunning, unexpected news that the tenure board of Stanford had met and granted me early tenure. I was not scheduled to be considered for tenure for another year and was, of course, overjoyed to have been spared the anxiety of waiting for the decision. In later years, as I saw colleagues and patients pass through that tortured ordeal, I grew to appreciate even more my own good fortune.

  This news of my tenure dramatically affected my book project. No longer was I writing for the stern, empirically oriented, pinched-faced professors I imagined sitting on my tenure board. I felt joyfully emancipated and now began to write a textbook for an entirely different audience: for student practitioners struggling to learn how to be helpful to their patients. Hence, all subsequent chapters of the book are far livelier and are studded with clinical vignettes, some of them only a few lines, some of them three or four pages. But those first two chapters were like cement; they stuck in my craw and I never could find a way to enliven them. Twenty-five years later I published the fifth edition of The Theory and Practice of Group Psychotherapy, and even after four major revisions, each one requiring two years of intense literature review and editing, those two pre-tenure chapters (now chapters eight and nine) written in London seem misfits, written by a different person in stilted, deadly prose. When I write a sixth edition I am determined to renovate these two chapters.

  THE AUTHOR AND FAMILY, LONDON, WINTER 1967–1968.

  My three children, aged nine, twelve, and thirteen, had been, naturally, reluctant to leave their Palo Alto school friends, but ultimately came to love their year in London. Our daughter, Eve, was dejected when she was turned down by the nearby Parliament Hill School because of poor penmanship, but she came to value the one she did attend, the Hampstead Heath School for Girls, where she made several good friends and ended the year with excellent, if evanescent, penmanship. Our son Reid went to the nearby University College School, where he proudly wore a red-and-black-striped jacket and cap. His poor penmanship, even worse than Eve’s, had been duly noted but entirely overlooked because, as the school principal told me on several occasions, he was “a jolly good rugby player.” Eight-year-old Victor thrived at the local British school. He was unhappy having to take daily naps there, but took much delight in visiting the penny sweet shop on his way home.

  Though we had bought a car in Europe, we rarely used it in London and took the Tube everywhere: to the Royal National Theatre, to local poetry readings, to the British Museum and the Royal Albert Hall. Through Marilyn’s contacts at a Franco-American literary magazine called Adam, we met Alex Comfort, with whom we remained close friends until his death in 2000. Alex was one of two geniuses I’ve been close to—the other was Josh Lederberg, a Stanford Nobel Prize–winning molecular biologist. At that time, Alex was splitting his time between a wife and a mistress and had a full wardrobe in each of their homes. With an encyclopedic mind, he could, and did, discourse endlessly on any and every subject—British and French literature, Indian mythology and art, worldwide sexual practices, his professional field of gerontology, seventeenth-century opera. He once told us that he had asked his wife what she wanted for Christmas and she had replied, “Anything but information!”

  I always enjoyed speaking to Alex—such a rare, fertile, engaging mind. I knew that he was strongly drawn to Marilyn, but he and I also formed a friendship, not only in London, but also later when he came to our house in Palo Alto.

  Alex finally divorced his wife, married his mistress, and wrote The Joy of Sex, one of the all-time bestsellers. Then, mainly to escape British taxes, he moved to a Santa Barbara think tank, the Center for the Study of Democratic Institutions, only a few hours away from Palo Alto. Though The Joy of Sex was his best-known work, Alex wrote fifty other books, from works in gerontology to poetry and novels. He wrote quickly and with great ease. I was amazed and daunted by his fluency: his first draft was often his last, whereas I have written between ten and twenty drafts of every book I’ve published. My children knew his name before they ever met him, because several of Alex’s poems were included in an anthology of modern poetry that was their textbook in their Palo Alto school. Walking with him down the street in our neighborhood was a treat, as Alex would immediately recognize birdcalls, name the bird, and effortlessly reproduce the sound.

  Even though London entranced us, we were dedicated Californians and greatly missed the sun. A helpful travel agent sent our entire family off for a week’s vacation to Djerba, a large island off the coast of Tunisia, that, legend has it, was the island of the Lotus Eaters where Odysseus was stranded. We visited bazaars, Roman ruins, and a 2,000-year-old synagogue. As I entered, a caretaker dressed in Arab garb asked if I was one of the tribe, and when I nodded, he took my arm and walked me arm in arm to the Bimah, the altar in the center of the synagogue. He put an ancient Bible in my hand but, thankfully, did not test my Hebrew.

  CHAPTER NINETEEN

  THE BRIEF, TURBULENT LIFE OF ENCOUNTER GROUPS

  In California and in many other parts of the country during the mid-1960s and early 1970s, the encounter group movement exploded. Encounter groups were everywhere—and some of them so closely resembled therapy groups that they interested me enormously. The Free University in Menlo Park, a community adjoining Stanford University, posted advertisements for dozens of personal growth groups. The living rooms of Stanford dorms hosted a variety of encounter groups: twenty-four-hour marathon groups, psychodrama groups, T-groups, human potential groups. Moreover, many Stanford students sought group experiences in nearby growth centers like Esalen, or, like hundreds of thousands across the country, joined EST or Lifespring, which both had large meetings that often broke out into smaller encounter-type groups.

  I was as puzzled as anyone. Were these groups, as many feared, a menace, a harbinger of social disintegration? Or were they just the opposite? Was it possible that they effectively enhanced personal growth? The more extravagant the claims, the more raucous the zealots and the more shrill the conservative response. I observed T-groups led by well-trained leaders, and it seemed to me that many members profited. I also attended rather wild drop-in psychodrama groups that concerned me, causing me to wonder whether members might have been psychologically damaged. I attended a twenty-four-hour nude
marathon group at Esalen, but had no follow-up on the effects of the experience on the group. It seemed to me that some of the fifteen members of the group profited, but I had no way of knowing the effects on less vocal members. Many praised these new experimental groups; many others damned them. The situation begged for some empirical evaluation.

  I heard a talk by Mort Lieberman, a University of Chicago professor, at a group therapy conference in Chicago and was much impressed with his work. We spoke for hours well into the night and agreed to undertake an ambitious inquiry into the effects of encounter groups. Our interests overlapped: not only was he an esteemed social science researcher, but he had also been trained as a T-group leader and as a group therapist. He made plans to spend a full year at Stanford, and we soon enlisted Matt Miles, a professor of education and psychology at Columbia University as well as a researcher and expert statistician, to join our team. The three of us designed an ambitious study of the effectiveness of encounter groups. Encounter groups were much in evidence on the Stanford campus, and many faculty members were concerned that students might suffer harm from the forceful confrontations, the uncensored feedback, and the antiestablishment posture of the groups. In fact, the university administration was so concerned about these groups on campus that they immediately granted us permission to conduct research on them. To ensure a large sample, the university even permitted us to offer college credit for encounter group participation.

  Our final research design called for a sample of 210 students who were randomly assigned to a control sample or to one of twenty groups, each group meeting for a total of thirty hours. The students would receive three credits for the course. We selected ten currently popular methodologies and offered two groups from each methodology: