Becoming Myself: A Psychiatrist's Memoir

by Irvin D. Yalom

  The detailed account of an analyst being banished from the psychoanalytic institute was loosely based on Masud Khan’s ejection from the British Psychoanalytic Society in 1988. Charles Rycroft, my British analyst, witnessed the event and described it to me in detail. Even the “Smokey the Bear” dream is my own, from the night after Rollo May died. Many of the characters’ names had personal meaning for me—for example, the protagonist’s name, Ernest Lash. While writing about Ernest, who was indeed very earnest, and his seductive patient, I often thought of Odysseus, who had himself lashed to the mast of his ship to escape the lusty calls of the sirens—hence, “Ernest Lash.” Another character, a figure in my fictional psychoanalytic institute, is Terry Fuller, a name I derived from a former student, Fuller Torrey, who became an eminent figure in psychiatry. Marshal Streider, patterned after one of my Johns Hopkins supervisors, strides firmly and staunchly upholds the law (except for one egregious lapse of judgment).

  Though I personally champion the idea of therapist genuineness, I decided to present an enormous challenge to Ernest Lash. For reasons explained in the novel, Ernest boldly undertakes an experiment: he will be entirely transparent with the next new patient entering his door. Alas, by sheer novelistic coincidence, Ernest’s next new patient, an attorney, has her own hidden agenda: she, unbeknownst to him, is the revenge-seeking wife of one of Ernest’s patients, and believes that Ernest has persuaded her husband to divorce her. To retaliate, she is planning to seduce and, thereby, ruin him. I’ve never had so much fun writing as when I embarked on this tale about a therapist committed to authenticity encountering a patient committed to entrapment. And writing one of the subplots was even more fun, when I described how the novel’s version of the British Psychoanalytic Society drums out an offending analyst for heretical interpretations and elects to send out a public recall notice—like those sent by automobile manufacturers—to all his patients who had been treated with damaging interpretations.

  Several filmmakers have wanted to turn Lying on the Couch into a film. Harold Ramis, the late actor and film director of Groundhog Day, Ghostbusters, and Analyze This, bought the film option, and we had a good deal of contact with one another when he was filming Bedazzled, shot on the streets of San Francisco. Alas, Bedazzled failed at the box office and the film studio refused to finance Lying on the Couch until he first made a surefire big profit movie, Analyze That—a sequel to his highly successful Analyze This. Unfortunately, Analyze That also bombed. Although Harold Ramis continued to purchase film options on the book for several years, he was never able to obtain sufficient financing for the project. I liked Harold Ramis very much and was saddened by the news of his death in 2014.

  Another near-life film experience occurred with Wayne Wang, the director of such fine movies as The Joy Luck Club, Smoke, and Maid in Manhattan. He, too, bought the option, but was also unable to find financial backing. Later he made a film called Last Holiday about a woman (Queen Latifah) with a fatal illness and asked me to lead a two-day T-group with the cast in New Orleans to sensitize them to the issues around dealing with a fatal illness. I had a lark working with Queen Latifah, LL Cool J, and Timothy Hutton, all of whom I found refreshingly open, well-informed, serious about their work, and interested in my observations.

  Finally, Ted Griffin, a talented screenwriter (Ocean’s Eleven, Matchstick Men), entered the scene, and he has had the film rights for the past several years. Having written a screenplay, he approached actor Anthony Hopkins—one of my screen idols, with whom I enjoyed conversing by phone. Alas, nothing has yet materialized. Moreover, there’s a part of me dreading a film version, which might ignore the serious messages of the novel and focus excessively, perhaps exclusively, on the conning and sexual parts. I now feel a bit embarrassed by the protagonist’s erotic exuberance. My wife, always my first reader, wrote in caps on the last page of the manuscript: “ISN’T THERE ANYTHING ELSE YOU WANT TO TELL AMERICA ABOUT YOUR SEXUAL FANTASIES?”

  CHAPTER THIRTY-ONE

  MOMMA AND THE MEANING OF LIFE

  Every year at departmental graduation, the psychiatry residents put on a skit lampooning some aspect of their Stanford experience. One year I was the target, and the resident lampooning me always appeared caressing a stack of books with “Yalom” on the spine. But I took no offense: instead, I found myself rather pleased at the sight of all those books I had written.

  At that time I was working on a publisher-generated book, The Yalom Reader, beautifully edited by my son Ben, that contains excerpts from my prior work and new essays. After finishing the final essay, I had a powerful, unforgettable dream about my mother that I described in the title story of my next book, Momma and the Meaning of Life.

  Dusk. Perhaps I am dying. Sinister shapes surround my bed: cardiac monitors, oxygen canisters, dripping intravenous bottles, coils of plastic tubing—the entrails of death. Closing my lids, I glide into darkness.

  But then, springing from my bed, I dart out of the hospital room smack into the bright, sunlit Glen Echo Amusement Park where, in decades past, I spent many summer Sundays. I hear carousel music. I breathe in the moist, caramelized fragrance of sticky popcorn and apples. And I walk straight ahead—not hesitating at the Polar Bear Frozen Custard stand or the double-dip roller coaster or the Ferris wheel—to take my place in the ticket line for the House of Horrors. My fare paid, I wait as the next cart swivels around the corner and clanks to a halt in front of me. After stepping in and pulling down the guardrail to lock myself snugly into place, I take one last look about me—and there, in the midst of a small group of onlookers, I see her.

  I wave with both arms and call, loud enough for everyone to hear, “Momma! Momma!” Just then the cart lurches forward and strikes the double doors, which swing open to reveal a black gaping maw. I lean back as far as I can and, before being swallowed by the darkness, call again, “Momma! How’d I do, Momma? How’d I do?”

  Could the dream’s message be—and this possibility staggers me—that I have been conducting my entire life with this lamentable woman as my primary audience? All my life I have sought to escape, to climb away from my past—the ghetto, the grocery store—yet can it be that I have escaped neither my past nor my mother?

  My mother had a conflictual relationship with her mother, who spent the last years of her life in a New York nursing home. In addition to cleaning and cooking and working in the store, my mother regularly took a four-hour train ride to bring home-baked pastries to her mother, who instead of thanking her, raved about Simon, my mother’s brother. He never brought her anything but a bottle of 7-Up.

  My mother told me that story so many times that I stopped listening—I was tired of her ranting. But now I feel differently. Obviously my mother felt wholly unappreciated by her only son. I often ask myself: Why didn’t I sympathize with her? Why couldn’t I have said, “How unfair! You do all that work and baking and travel to see your mother and all she does is praise Simon for his 7-Up. How grating that must have felt!” Really, how hard would it have been for me to say that? Oh, how I wish I could have been kind enough to utter those words. That simple act of appreciation would have meant so much to her. And perhaps, if I had said this, she wouldn’t still be haunting my dreams.

  And, of course, the dream staggers me with the idea that as I move toward my death, that dark house of horrors, I am still looking for validation. But not from my wife, my children, my friends, colleagues, students, or patients, but from my mother! That mother whom I disliked so thoroughly and felt so ashamed of. Yes, in my dream, I turn to her. It was to her that I posed my final question, “How’d I do?” What better proof for the lasting power of early life attachments?

  Such regret played a role in the therapy of a young woman I’m currently seeing. She had asked for a few consultation sessions on Skype, and in our second meeting I asked about her relationship with her parents. “My mother is a saint, and I’ve always had a warm, wonderful relationship with her. But m
y father . . . well, that’s a different story.”

  “Tell me about your relationship with him.”

  “The best description I can give is that it is very much like your relationship to your mother in Momma and the Meaning of Life. My father worked hard and supported the family but he was a tyrant. I’ve never heard a complimentary or pleasant word from him to anyone in the family, nor to the people who work in his company. Then, about eight years ago, his older brother and business partner committed suicide; the business went under, and my father went bankrupt. He lost everything. Now he’s angry and depressed and does nothing but look out the window all day. I’ve been supporting him financially since the bankruptcy, but not one word of thanks. Yesterday at breakfast we got into a big fight and he threw his plate on the floor and walked out.”

  My patient and I have only had three meetings, but since my patient had read my story, I decided to share with her my regrets for never having empathized with my mother. “I wonder,” I said to her, “if, someday, you’ll have such regrets about your father.”

  She nodded slowly, saying, “Maybe I will.”

  “I’m only guessing, but I imagine that your father, who was so entirely invested in his role as provider, and who ran a big company and exercised such power in the world and in the family, might be feeling great humiliation at being supported by his daughter.”

  She nods. “We’ve never talked about it.”

  “Are you up to it?”

  “I’m not sure. It’s something to think about.”

  The following week she described an encounter with her father. “I own a large clothing store, and we were having a special event to showcase the new collection. I had extra entry tickets and thought my father might enjoy it. He came, but then, without discussing it with me, went to the staff area and jollied up to them, letting them know he was my father. When I heard about this, I lost it and said, ‘How could you have done that? I don’t appreciate your not checking with me first. I want to keep my business and personal life separate.’ He started yelling at me and I yelled back and finally he went to his room and slammed his door.”

  “And then?”

  “I started to leave, but then I started thinking of what a miserable evening this was going to be for my mother . . . and, yes, for my father, as well, and I thought about what you had said about your mother. So I took a breath and knocked on his door and talked to him. ‘Look, Dad, I’m sorry. But here’s my point. I invited you to see one of my events, but I didn’t want you to go and cozy up with my employees—what I wanted was to share the event with you. How often do we ever do that?’ ”

  “What a wonderful thing to say. And then?”

  “For once he was silent. Almost dumbfounded. And he came over to me and hugged me and he cried. I’ve never, ever, seen him cry before. And I cried, too. We cried together.”

  Yes, this is a true story—almost word-for-word.

  Momma and the Meaning of Life contains the most effective teaching tale I have ever written, “Seven Advanced Lessons in the Therapy of Grief,” that was meant to serve as a primer for therapists using an existential approach.

  Irene, an esteemed surgeon, called upon me for assistance. Her husband was dying of cancer at a young age, and Irene’s grief was understandably acute. Several years before, I had spent two years leading a group for people who had recently lost a spouse, and as a result of this project, I considered myself expert in working with bereaved patients and agreed to work with Irene. Extraordinarily intelligent, but frosty and severe with herself and others, Irene became my patient for two years. Our work together showed me how much I still had to learn about loss: hence the title of the story, “Seven Advanced Lessons in the Therapy of Grief.”

  My first lesson occurred in our very first session, when she described the dream she had had the night before.

  I’m still a surgeon, but I’m also a grad student in English. My preparation for a course involves two different texts, an ancient and a modern text, each with the same name. I am unprepared for the seminar because I haven’t read either text. I especially haven’t read the old, first text, which would have prepared me for the second.

  I asked her if she remembered anything about the name of the texts. “Oh, yes, I remember it clearly. Each book, the old and the new, was titled The Death of Innocence.” For a therapist with my interests and background, this was a great gift. Imagine, two texts—an ancient and a new one—and the ancient text (i.e., one’s earliest years) was needed to understand the new.

  It wasn’t only that Irene’s dream promised an intellectual treasure hunt of the highest order; it was also a first dream. As I explain in “Seven Advanced Lessons,” ever since 1911, when Freud first discussed it, a mystique has surrounded the initial dream that a patient reports in therapy. Freud believed that the first dream is unsophisticated and highly revealing because beginning patients still have their guard down. Later in therapy, once they have worked through different dreams with the therapist, the dream-weaver residing in the unconscious grows cautious, taking care thereafter to manufacture more complex and obfuscating dreams.

  Following Freud, I often imagined the dream-weaver as a plump, jovial homunculus, living the good life in a forest of dendrites and axons. He sleeps by day, but at night, lying on a cushion of buzzing synapses, he drinks honeyed nectar and lazily spins out dream sequences for his host. On the night before the first therapy visit, the patient falls asleep full of conflicting thoughts about the upcoming therapy, and the homunculus within goes about his nighttime job weaving those fears and hopes into a dream. Then, after the therapy session, the homunculus learns that the therapist has deftly interpreted his dream, and from that time forward he takes care to bury the meaning ever deeper in nocturnal disguise. Of course, this is all just a foolish fairy tale—if only I didn’t believe it!

  I remember with eerie clarity my own dream, on the night before the first session of my personal analysis over fifty years ago, which I also describe in “Seven Advanced Lessons.”

  I am lying on a doctor’s examining table. The sheet is too small to cover me properly. I can see a nurse inserting a needle into my leg—my shin. Suddenly there’s an explosive hissing, gurgling sound—WHOOOOOSH.

  The center of the dream—the loud whoosh—was immediately clear to me. As a child I had been plagued with chronic sinusitis, and every winter my mother took me to Dr. Davis, an otolaryngologist, for a sinus draining and flushing. I hated his yellow teeth and his fishy eye, which peered at me through the center of the circular mirror attached to the headband otolaryngologists used to wear. As he inserted a cannula into my sinus foramen, I felt a sharp pain and then heard a loud whooooosh—the same whooooosh I heard in the dream—as the injected saline flushed out my sinus. Looking at the quivering, disgusting mess of pus in the chrome drainage pan, I thought some of my brain had been washed out. In my first dream in analysis, that real-life horror had blended with my fear that shameful and disgusting thoughts would come out of me on the analytic couch.

  Irene and I worked hard on her first dream. “So you hadn’t read either text,” I began, “especially not the old one.”

  “Yes, yes, I expected you to ask about that. I hadn’t read either text, but I especially hadn’t read the ancient one.”

  “Any hunches about the meaning of the two texts in your life?”

  “Hardly a hunch,” Irene replied. “I know exactly what they mean.”

  I waited for her to go on but she simply sat in silence, looking out the window. I had not yet gotten used to Irene’s irritating trait of not volunteering a conclusion unless I explicitly requested it.

  Annoyed, I let the silence last a minute or two. Finally I obliged: “And the meaning of the two texts, Irene, is—”

  “My brother’s death, when I was twenty, was the ancient text. My husband’s death to come is the modern text.”

  “So the dream
is telling us that you may not be able to deal with your husband’s death until you deal first with your brother’s.”

  “You got it. Precisely.”

  The content that we dealt with was illuminating, but the process (that is, the nature of the relationship between us) was confrontational and highly charged, and ultimately the work on our relationship was to be the true source of healing. In one session, our discussion of a dream about a wall of bodies separating the two of us led to an anguished outburst:

  “What I mean is, how can you understand me? Your life’s unreal—warm, cozy, innocent. Like this office.” She pointed to my packed bookshelves behind her and to the scarlet Japanese maple blazing just outside the window. “The only thing missing are some chintz cushions, a fireplace, and a crackling wood fire. Your family surrounds you—all in the same town. An unbroken family circle. What can you really know of loss? Do you think you’d handle it any better? Suppose your wife or one of your children was to die right now? How would you do? Even that smug striped shirt of yours—I hate it. Every time you wear it, I wince. I hate what it says.”