Becoming Myself: A Psychiatrist's Memoir

by Irvin D. Yalom

  Traditional NTL T-groups

  Encounter (or personal growth) groups

  Gestalt therapy groups

  Esalen (sensory awareness groups)

  TA (transactional analytic) groups

  Psychodrama groups

  Synanon (confrontational “hot seat”) groups

  Psychoanalytically oriented groups

  Marathon groups

  Leaderless, tape-led groups

  Next we recruited two well-known expert group leaders from each of these modalities. Mort Lieberman developed a large battery of instruments to measure changes in the members and to assess the leaders’ behavior, and we enlisted and trained a team of observers to study members and leaders during each meeting. Once the university human research panel approved our research plan, we embarked on this memorable project—it would be the largest and most rigorous study of such groups ever conducted.

  At the end of the study we wrote a five-hundred-page monograph published by Basic Books, Encounter Groups: First Facts. The overall findings were impressive: about 40 percent of students taking a one-quarter college course underwent significant positive personal change that endured for at least six months. However, there were also sixteen “casualties”—students who reported feeling worse six months after their group experience.

  I wrote the chapters describing the clinical development and evolution of each group, the behavior of the leaders, and the effects on the “high-learners” and the “casualties.” The casualty chapter received enormous attention from opponents of the encounter group movement and was cited in hundreds of newspapers across the country. It provided the conservative right exactly the ammunition they wanted. On the other hand, my chapter on high-learners, the large number of students who reported substantial personal change as a result of twelve group meetings, received no attention whatsoever. This was most unfortunate, for I’ve always felt keenly that such groups, properly led, have much to offer.

  Ten years later, the encounter group movement had faded away—it had been replaced by Bible groups in many of the Stanford dorms. And, with the demise of encounter groups, our book Encounter Groups: First Facts lost its readership, aside from scholars, who found many of the research instruments useful. Of all my books, it alone has gone out of print. My wife was never a friend of this project because it demanded so much of my time, and because a crucial staff meeting prevented me from driving her home from the Stanford Hospital after she delivered our fourth child, Benjamin Blake. She recalls that one of the reviewers of the book commented, “These authors must have worked very hard because the prose was so tired.”

  I continued working on my group textbook (The Theory and Practice of Group Psychotherapy) for two more years, and when I finished the final draft I flew to New York to meet publishers whom David Hamburg had contacted on my behalf. I lunched with Arthur Rosenthal, the impressive founder of Basic Books, and chose to publish with him despite offers from other presses. Reviewing my life in these pages reminds me of the extent to which David Hamburg not only supported my research but also facilitated my publishing career.

  The Theory and Practice of Group Psychotherapy was immediately successful, and within a year or two it was adopted as a textbook by most of the psychotherapy training programs in the country; later, it was adopted in many other countries as well. Instrumental in the training of group therapists, the textbook has gone through five revised editions and sold over 1 million copies, which, over time, gave Marilyn and me a new degree of financial security. Like most of the young psychiatry faculty, I had augmented my income by consulting on weekends at various psychiatric hospitals, but once the textbook was published, I stopped my weekend consulting and instead accepted invitations to lecture on group therapy.

  My entire approach to remuneration was radically altered one day about five years after publication of my textbook, when I addressed a large audience at Fordham University in New York City. As usual, I brought with me a videotape of a group therapy meeting I had held the previous week, which I intended to use in my teaching. However, the Fordham videotape player malfunctioned and the technicians finally threw up their hands, leaving me with the daunting and stressful task of improvising for the entire morning. I gave my two prepared lectures in the afternoon and had a lengthy Q-and-A session with the audience, and by the end of the day I was entirely exhausted. As the audience was filing out, I happened to peruse the printed program and took note that the fee for the workshop was $40 (this was in 1980). I looked around the auditorium and estimated that there were upward of six hundred attendees. A quick calculation indicated that the sponsors of the talk had made over $20,000, and they were paying me $400! From that time on I contracted for a fair share of the funds raised at each conference, and my speaking income soon dwarfed my university salary.

  CHAPTER TWENTY

  SOJOURN IN VIENNA

  Vienna had always loomed large in my consciousness because it was the birthplace of Freud and the cradle of psychotherapy. Having read through many biographies of Freud, I had a great sense of familiarity with the storied city that had housed so many of my favorite writers, including Stefan Zweig, Franz Werfel, Arthur Schnitzler, Robert Musil, and Joseph Roth. Thus, in 1970, I quickly accepted Stanford’s offer to teach undergraduate students for a summer quarter at the Stanford campus in Vienna. The move was not without complications: I had four children, then aged fifteen, fourteen, eleven, and one. We brought with us a twenty-year-old neighbor and friend of my daughter’s, who would live with us in the students’ dorm and help care for Ben, our youngest child. I welcomed the opportunity to work with Stanford undergraduates, and Marilyn, as always, loved the possibility of a European sojourn.

  It was wondrous to live in the center of Vienna, where Freud had lived. I plunged into his world, walking the streets he had walked, visiting his cafés, and gawking at a large unmarked five-story apartment building at Berggasse 19, Freud’s home for forty-nine years. Years later, the Sigmund Freud Foundation bought this building, turned it into the Freud Museum, prominently marked it with a large red banner, and opened it to visitors, but at the time of my visit, there was no indication whatsoever that he had ever lived and worked there. The city had placed scores of brass plaques marking the homes of prominent and not-so-prominent Viennese, including several for Mozart’s residences, but nothing to signal the lifetime dwelling of Sigmund Freud.

  Seeing Freud’s home and walking through the streets of his Vienna served me well thirty years later when I wrote my novel When Nietzsche Wept. I drew on these memories and the photos I took that year to create a credible visual setting for my imagined meetings of Nietzsche and the famed Viennese physician Josef Breuer, who had been Freud’s mentor.

  My primary teaching assignment in Vienna was a course for Stanford undergraduates on the life and work of Sigmund Freud. The forty lectures I prepared became the basis of a “Freud Appreciation” course that I taught to psychiatric residents for the next fifteen years. I always emphasized to my students that Freud was not just the creator of psychoanalysis (accounting for less than 1 percent of all the therapy offered today), but that he invented the entire field of psychotherapy: it did not exist in any form prior to Freud. Though I have my criticisms of contemporary orthodox Freudian analysis, I have always felt great respect for Freud’s creativity and courage. He is very often in my mind when I do therapy. Recently, for example, I met with a new patient who was plagued with obscene obsessions about members of his family, and I immediately thought of Freud’s observation that behind such persistent obsessions there is often rage. I regret that Freud has fallen so far out of fashion. As one of my chapter titles in The Gift of Therapy declares, “Freud wasn’t always wrong.”

  Just before leaving Stanford for Vienna, I suffered two significant traumatic events. First, I was jolted by the death from adrenal cancer of a close friend, Al Weiss, whom I had met when he was a resident at Stanford. Amon
g other things, Al and I were spearfishing buddies and had taken trips together to Baja.

  Then, at a dental appointment the day before my departure, my dentist found a suspicious lesion on my gums. He took a biopsy and told me I would receive the pathology report after my arrival in Vienna. I was reading at the time about Freud’s fatal oral cancer, likely caused by heavy cigar smoking, and grew alarmed at my own smoking habits: I smoked a pipe much of the day, choosing a different pipe each day from my collection, and reveling in the aroma of Balkan Sobranie tobacco. As I waited in Vienna for the report, I grew extremely anxious at the thought that I might soon learn I had the same cancer that killed Freud.

  I quit smoking cold turkey that first week in Vienna and consequently had difficulty sleeping, and sucked bag after bag of coffee-flavored hard candies to ease my oral cravings. Finally I received a wire from my dentist informing me that my biopsy was negative. Still, however, I was left to mourn my friend as I awaited my family’s arrival. I tried to force myself to work—I had come to Vienna a week early to prepare forty lectures—but remained so anxious that I decided to seek help. I attempted to consult with an eminent Viennese therapist, Viktor Frankl, author of the widely read Man’s Search for Meaning, but was informed by his telephone answering service that he was overseas on a lecture trip.

  When my wife and children arrived, I settled down and grew more comfortable, and our three-month stay in Vienna with the Stanford students ended up to be an unforgettably positive experience for all of us. The two older children were especially thrilled by all the daily contact with Stanford students. We took all our meals with the students, including one dinner when our son Ben celebrated his first birthday. A large cake appeared at our table and the entire student body sang “Happy Birthday” while my daughter, Eve, held him up to the audience. Marilyn took each of the children individually to the Sacher Hotel for one of the rightfully famed Sachertorte, the best pastry I have ever tasted.

  We accompanied the students on two class trips. The first was a boat trip down the Danube, which was lined with millions of dazzling, fully alert sunflowers that turned their faces toward the sun as it moved across the sky. The day ended with a tour of Budapest, gray and austere under Russian occupation, but still charming. Then, at the very end of the quarter, we accompanied the class on a train trip to Zagreb, where we said our final farewells. Having left our children at the Stanford dorm with their nanny, Marilyn and I rented a car for a few days and drove down the unforgettably beautiful Dalmatian coast to Dubrovnik, and from there through the peaceful Serbian countryside.

  Though my time in Vienna was heavily focused on coursework and the students, it was impossible to resist the cultural treasures. Marilyn guided me through the Belvedere Museum and introduced me to the work of Gustav Klimt and Egon Schiele, who have since become, along with Vincent van Gogh, my favorite painters. Though I never mentioned Klimt to my German publishers, years later they chose to use his work for the covers of almost all my books in German translation.

  The children took walks in the verdant city parks, careful not to step on the grass—lest elderly Viennese woman scold them—and they hiked in the woods around the city, where people greeted each other with a friendly “Grüss Gott.” And, of course, we went to the opera for an unforgettable performance of The Tales of Hoffmann. Vienna offered us an opulent vista on a legendary world that had only recently recovered from its Nazi past. Not in my wildest dreams could I have imagined that, forty years later, the city would award a prize to one of my books, distribute 100,000 free copies, and honor me with weeklong festivities.

  Toward the end of our stay I finally reached Viktor Frankl on the phone and introduced myself as a Stanford professor of psychiatry troubled by some personal issues and in need of help. He said he was extremely busy, but he agreed to see me in the late afternoon of the same day.

  Frankl, a short, attractive, white-haired man, greeted me genially at the door and took an immediate interest in my eyeglasses, asking me right away about the manufacturer. I had no idea and took them off and handed them to him. They were cheap frames purchased from a California chain called Four Eyes and, after a brief inspection, he found them of little interest. His own thick steel-gray frames were quite handsome and I told him so. He smiled and guided me to his living room, pointing out, by a wave of his hand, an enormous bookcase filled with translations of his book Man’s Search for Meaning.

  We sat in a sunny corner of the living room and Frankl began by saying he might not be able to meet too long, as he had just arrived home the previous day from a trip to the UK and had answered his fan mail until 4 in the morning. I found that odd: it seemed as if he was attempting to impress me. Moreover, he didn’t ask my reasons for contacting him, but instead expressed great interest in the psychiatric community at Stanford. He asked many questions, and then immediately segued into a description of the rigidity of the Viennese psychiatric community, which had refused to recognize his contributions. I began to feel I was at the Mad Hatter’s tea party: I had sought him out for a therapy consultation, but he was seeking consolation from me about the disrespectful treatment he had received from the Viennese professional community. His complaints continued for the rest of our session, during which he asked me nothing at all about my reasons for coming. In our next meeting, the following day, he raised the question of whether he might be invited to address the Stanford psychiatric staff and students in California. I promised I would try to arrange it.

  Man’s Search for Meaning, a moving and inspiring book written in 1946, has been read by millions of people worldwide and even today remains a bestseller in psychology. In it Frankl tells the story of his experience during the Holocaust and how his determination to share his story with the entire world was responsible for his survival. I have heard his primary lecture on meaning in life several times: he was an excellent speaker and never failed to deliver an inspiring talk.

  His visit to Stanford a few months later, however, was highly problematic. It was clear during his visit to our home with his wife that he was not comfortable with the informal California culture. On one occasion my au pair, a young woman from Switzerland, who lived with us and helped care for our children, came to us in tears because of the scolding she had received from him: he had requested tea, and she had served it in a ceramic rather than a porcelain cup.

  A clinical demonstration he offered to Stanford residents took a catastrophic turn. His logotherapy demonstration consisted, for the most part, of his determining, in a ten- to fifteen-minute inquiry, what the patient’s life meaning should be, and prescribing it to the patient in authoritarian fashion. At one point during a demonstration interview, one of the more obstreperous, long-haired, sandal-wearing psychiatric residents stood up in protest and stalked out of the room, muttering, “This is inhuman!” It was a terrible moment for all, and no amount of apology would soothe Viktor, who repeatedly demanded that the resident be dismissed from the program.

  There were times I tried to offer him feedback, but he almost always interpreted it as hurtful criticism. We corresponded a good bit after he left California, and a year later he sent me a manuscript, seeking my critique. One passage described, in great detail, a lecture he had given at Harvard, during which the audience had stood and applauded loudly five times. I was in a quandary: he had asked for my commentary, though, so, after agonizing over my response, I decided to be genuine. I replied, as gently as possible, that such heavy focus on the applause deterred from his presentation and might lead some readers to conclude that he was overinvested in the applause. He wrote back immediately, saying, “Irv, you just won’t understand—you weren’t there: they DID rise and applaud five times.” Even the best of us are sometimes blinded by our wounds and our need for praise.

  Very recently, I read an autobiographical account of student days at the Medical University of Vienna in the 1960s written by Professor Hans Steiner, a Stanford colleague and friend, who offered anoth
er perspective. As a student in Vienna, Hans had had an extremely positive experience with Viktor Frankl: he described him as an excellent teacher, whose creative approach felt like a breath of fresh air in contrast to the rigidity of the other psychiatric faculty in Vienna.

  Years later Viktor Frankl and I both spoke at a large psychotherapy conference and I attended his lecture on Man’s Search for Meaning. As always, he enthralled the audience and received a thunderous ovation. We met afterward and I got a warm hug from him and his wife, Eleanor. Years later, when writing Existential Psychotherapy, I reviewed his work thoroughly and realized, more than ever, the importance of his innovative and fundamental contributions to our field. More recently, I visited a psychotherapy graduate school institute in Moscow that offered a PhD in logotherapy, and I was captivated by a life-sized photograph of Viktor. While gazing at it, I suddenly became aware of the magnitude of his courage as well as the depth of his pain. I knew from his book how the horrors of his stay in Auschwitz had traumatized him, but in those early encounters with him in Vienna and Stanford I was not ready to empathize fully with him or offer the support I might have given. Later, in my relationship with other leading figures in the field, such as Rollo May, I would not repeat that error.

  CHAPTER TWENTY-ONE

  EVERY DAY GETS A LITTLE CLOSER

  Writing this memoir has caused me to look back over the arc of my life’s work as a writer. At some point, I made a transition from writing research-oriented articles and books for other academics to writing about therapy for a more general public, and I trace the first stirrings of this metamorphosis to a strange book with a bizarre title, Every Day Gets a Little Closer, published in 1974. In this book I moved away from quantitative research language and sought to emulate the storytellers I had been reading all my life. I had no idea at that time that I would go on to teach about psychotherapy through four novels and three collections of stories.