Becoming Myself: A Psychiatrist's Memoir

by Irvin D. Yalom

  Think of it! A Schopenhauer clone enters a therapy group, creates turmoil, challenges the leader, and infuriates the other members, but ultimately undergoes dramatic change. Think of the message I would send to my field: If group therapy could help Arthur Schopenhauer, the arch pessimist and most dedicated misanthropist of the ages, then group therapy could help anyone!

  Later, looking back on the finished novel, I realized that it might be a good teaching tool for training group therapists, and in many sections of the fifth edition of my group therapy textbook, I refer student readers to various pages of the novel where they might read dramatic portrayals of therapy principles.

  I wrote the novel in an unusual manner, alternating chapters depicting the meetings of the therapy group with a psychobiography of Schopenhauer. I suspect many readers have been puzzled by this format and, even in the midst of writing, I knew it made for an awkward amalgam. Nevertheless, I believed that a résumé of Schopenhauer’s life would help the reader understand Philip, Schopenhauer’s double. But that’s only part of the reason: I confess that I had become so fascinated with Schopenhauer’s work, life, and psyche that I couldn’t pass up the opportunity of speculating on his character formation. Nor could I resist exploring the ways in which Schopenhauer had anticipated Freud and set the stage for psychotherapy.

  I believe this book is the best demonstration of effective group therapy I have written. Julius was the therapist I had always endeavored to be. In the book, however, he develops an untreatable malignant melanoma. Despite his illness, he continues to find meaning, even near his death, by enhancing the lives of all the members of his group. He is open, generous, focused on the here-and-now, and gives all his remaining energy to helping the members explore their relationships with each other and learn about themselves.

  Selecting the novel’s title was unusually painless: as soon as The Schopenhauer Cure coasted into my mind, I embraced it. I liked its double entendre: Schopenhauer the person is offered a cure, and Schopenhauer the thinker offers a cure to all of us.

  Twelve years after publication, the novel is very much alive. A Czech film company is working on a film version. The Schopenhauer Cure also anticipated the field of clinical philosophy, as I have learned from leaders in that discipline.

  Several years ago at the annual convention of the American Group Psychotherapy Association in San Francisco, a large audience of group therapists watched Molyn Leszcz, a former student of mine and coauthor of the fifth edition of my textbook on group therapy, lead a half-day meeting of actors playing the group members in the novel. My son Ben selected the actors, directed the production, and played one of the characters. The actors had no script, but they were instructed to imagine themselves in a therapy group, to stay within their character, and to interact spontaneously with the other members. I was the discussant for segments of the interaction. Another of my sons, Victor, edited a film of the event and has made the video available on his educational website. It was a great delight for me to sit back and watch my imagined characters interact in the flesh.

  CHAPTER THIRTY-FIVE

  STARING AT THE SUN

  My sister, Jean, died as I was writing this book. Seven years older than I, Jean was a gentle soul and I loved her dearly. During our adult lives she lived on the East Coast, I on the West, but we always phoned one another weekly, and whenever I was in Washington I stayed with her and her husband, Morton, a cardiologist, who was always generous and welcoming.

  Jean developed aggressive dementia and at my last visit to Washington, a few weeks before she died, she no longer recognized me. Because I felt I had already lost her, I was not shaken by the news of her death—not consciously. Instead, I welcomed it as a release for her and her family, and the following day Marilyn and I flew to Washington to attend her funeral.

  I had intended to begin my eulogy by telling a story about our mother’s funeral in Washington fifteen years earlier. On that occasion, I tried to honor my mother by baking kichel, an old-world pastry, to be served at the family gathering after the funeral. My kichel looked good, and smelled wonderful, but, alas, were entirely tasteless: I had followed her recipe but forgotten to put in the sugar! Jean was always gracious and generous and my point in telling this story was to highlight my sister’s sweetness by saying that, if I were baking kichel for her, I could never have forgotten the sugar. But, though I had arrived at the funeral feeling composed and unaware of deep grief, I broke down completely during my remarks, and returned to my seat without finishing.

  My seat was in the front row, close enough to touch my sister’s plain wooden casket. When gusts of strong wind arose and buffeted the cemetery, I saw, out of the corner of my eye, my sister’s casket begin to shake. Despite all my rationality, I could not get the bizarre thought out of my mind that my sister was trying to get out of her casket, and I had to fight the instinct to bolt from the gravesite. All the experience I’ve had with death, all the patients I’ve escorted to the very end, all my supreme detachment and rationality in prose about the topic of death—all of it evaporated in the presence of my own terror.

  This incident shocked me. I had been trying for decades to understand and ameliorate my personal anxiety about death. I had played these fears out in my novels and stories and projected them onto fictional characters. In The Schopenhauer Cure, Julius, the group leader, announces that he has been diagnosed with a fatal illness, and the group members attempt to console him. One member of the group, Pam, tries to offer comfort by citing a passage from Vladimir Nabokov’s memoir, Speak, Memory, describing life as a spark between two identical pools of darkness—the one before birth and the one after death.

  Immediately, Philip, the Schopenhauer clone and acolyte, responds in his usual condescending manner, saying, “Nabokov undoubtedly lifted the idea from Schopenhauer, who said that after death we will be as before our birth and then proceeded to prove the impossibility of there being more than one kind of nothingness.”

  Pam, furious with Philip, says, “You think Schopenhauer once said something vaguely similar. Big fucking deal.”

  Philip closes his eyes and begins reciting: “ ‘A man finds himself, to his great astonishment, suddenly existing after thousands and thousands of years of nonexistence; he lives for a little while: and then, again, comes an equally long period when he must exist no more.’ I quote from Schopenhauer’s essay, ‘Additional Remarks on the Doctrine of the Vanity of Existence.’ Is that vague enough for you, Pam?”

  I cite this passage because of what it did not include: namely, that Schopenhauer’s and Nabokov’s statements both trace back to Epicurus, an ancient Greek philosopher who held that the primary source of human misery was our omnipresent fear of death. To ease that fear, Epicurus developed a series of potent secular arguments for the students in his school in Athens and stipulated that they learn them just as they might memorize a catechism. One of these arguments was the renowned “symmetry argument” positing that our state of nonbeing after death is identical to our state before our birth, and yet the thought of our “pre-being” state is never associated with anxiety. Philosophers throughout the ages have attacked this argument, and yet to my mind it is beautiful in its simplicity and still holds considerable power. It has offered comfort to many of my patients, and to me as well.

  As I read more about Epicurus’s arguments to dispel death terror, a bombshell of an idea for my next book occurred to me and held me enthralled for a great many months. Here’s the idea. A horrific nightmare terrorizes a man: In a forest at nightfall he is pursued by some terrifying beast. He runs until he can run no farther; he stumbles, feels the creature pouncing upon him, and realizes this is his death. He awakens screaming, heart pounding, soaked in sweat. He jumps out of bed, quickly dresses, bolts from his bedroom and from his home, and sets off to find someone—an elder, a thinker, a healer, a priest, a doctor—anyone who can help with this death terror.

  I imagined a book con
sisting of eight or nine chapters, each beginning with the same first paragraph: the nightmare, the awakening, and the setting out to seek help for his death terror. Yet each chapter would be set in a different century! The first would take place in the third century BC in Athens, and the dreamer would rush to the Agora, the section of Athens where many of the important schools of philosophy were located. He would walk past the Academy, founded by Plato and now led by his nephew, Speusippus; past the Lyceum, the school of Aristotle; past the schools of the Stoics and the Cynics; and finally would reach his destination, the Garden of Epicurus, where, at sunrise, he would be permitted to enter.

  Another chapter might be set in the time of St. Augustine, another during the Reformation, another in the late eighteenth century at the time of Schopenhauer, another in the days of Freud, perhaps another at the time of Sartre or Camus, and perhaps others in a Muslim and a Buddhist country.

  But one thing at a time. I decided to write the entire episode in Epicurus’s Greece in 300 BC, and then turn to each of the later time periods. For months I researched the details of daily life in Greece in that era, the clothing, the type of breakfast, the customs of daily life. I studied ancient and current historical and philosophical texts, read novels set in ancient Greece (by Mary Renault and others), and eventually arrived at the sad realization that the research required to write this and the chapters in the other time periods would consume the rest of my life. With great regrets I abandoned the project. It’s the only book I’ve ever started and did not finish.

  Instead, I decided to discuss the work of Epicurus in a nonfiction book on death anxiety, and that book gradually morphed into Staring at the Sun, published in 2008. Staring at the Sun traces my thoughts about death that emerged from my clinical practice with healthy as well as terminally ill patients. The book’s title comes from a seventeenth-century maxim by François de La Rochefoucauld: “One cannot stare straight into the face of the sun or death.” Though I use the maxim for my title, I challenge its truth in the text by emphasizing that much good may come from staring directly at death.

  I illustrate that idea not only with clinical but also with literary vignettes. For example, Ebenezer Scrooge in Dickens’s Christmas Carol begins the story as a miserly, isolated creature, but by the end he is a kind, generous, and beloved man. Whence the transformation? Dickens gave Scrooge a strong dose of existential shock therapy when the Ghost of Christmas Yet to Come allows Scrooge to view his own gravesite and read his name on the headstone.

  Throughout Staring at the Sun, the confrontation with death serves as an awakening experience, one that teaches us how to live more fully. Therapists sensitized to this process see it often. As I mentioned earlier, in my clinical practice I often suggest that patients draw a line on a sheet of paper and imagine that one end of the line represents their birth and the other end their death. I ask them to indicate where they are now situated on the line, and meditate on that for a few moments. The film Yalom’s Cure begins with my voice suggesting this exercise.

  During my training as a psychiatrist, I never once heard death discussed in therapy seminars or in case discussions. It was as though the field still followed the advice of Adolf Meyer, the longtime dean of American psychiatrists: “Don’t scratch where it doesn’t itch”—in other words, don’t raise troublesome topics unless the patient does, especially in areas that might be beyond our capacity to assuage. I’ve taken the contrary position: since death itches all the time, there is much to be gained by helping patients explore their posture toward it.

  I agree entirely with the Czech existential novelist Milan Kundera, who wrote that the act of forgetting offers us a foretaste of death. In other words, what terrifies us about death is not only loss of the future but also loss of the past. As I reread my own books, I often fail to remember the faces and names of the patients I have written about: I’ve disguised them so well I cannot recognize who they were. I ache sometimes to think of all the intimate and wrenching hours I spent with individuals who are now lost to memory.

  I believe that death anxiety lies behind the presenting complaints of many patients. Consider, for example, the discomfort that accompanies big birthdays (age thirty or forty or fifty), which remind us of the inexorable passage of time. I saw a patient recently who described several nights of terrifying nightmares. In one, an intruder had threatened her life; in another, she had felt herself falling through space. She mentioned that her fiftieth birthday was approaching, and she dreaded the party her family was giving. I urged her to explore all the connotations of being fifty. She said that she felt fifty was truly old and recalled how old her mother had looked at fifty. Both her parents had died in their late sixties, and thus she knew she was now two-thirds through her life. Before we met, she had never spoken openly about how she might die, about her funeral, or about her religious beliefs, and though our sessions were painful, I believe that demystifying the process ultimately offered her relief. Death anxiety lurks in many of our milestones—in the empty nest syndrome, retirement, the midlife crisis, and high school and college reunions—as well as in our grief at the deaths of others. I believe that most nightmares are driven by death anxiety that has escaped its corral.

  Now, as I write these lines, ten years after writing Staring at the Sun—ten years closer to my own death—I don’t believe I could write as dispassionately about the subject as I did then. In the past year, I have not only lost my sister, but also lost three of my oldest and closest friends—Herb Kotz, Larry Zaroff, and Bob Berger.

  Larry and Herb were my classmates in college and medical school. We were anatomy partners in dissecting a cadaver and roomed together during our internships. The three of us with our wives vacationed together in many places: the Poconos, the Eastern Shore of Maryland, the Hudson Valley, Cape May, and Napa Valley. We loved the days and nights we spent together talking, biking, playing games, and sharing meals.

  Larry had a long career as a cardiac surgeon in Rochester, New York, but then, after thirty years of practice, switched fields, obtaining a PhD in the history of medicine at Stanford. In his final years he taught literature to undergraduates and medical students before dying suddenly of a ruptured aortic aneurism. In my brief eulogy at his funeral, I tried to add a lighter note by describing a vacation trip the six of us had taken in the Poconos at a time when Larry was in his bad-clothes phase and had worn a beaten-up, wrinkled T-shirt to a fancy restaurant. We all harangued him about his appearance until he stood up and left the table. He returned ten minutes later looking quite dapper: he had just bought the shirt off our waiter’s back! (The waiter, fortunately, had a spare one in his locker.) Though I wanted to lighten the atmosphere with this tale at the funeral, I choked up and struggled to get the words out.

  Herb, who had trained as a gynecologist and then as an oncologist, gradually developed dementia. He lived his last years in a state of such confusion and physical pain that I felt, as with my sister, that I had lost him long before he died. I was too ill with the flu to travel to Washington, DC, for his funeral, but sent my remarks with a friend to be read at the graveside.

  I felt relief for him and for his family, and yet, at the precise time of his funeral, I grew agitated, took a brief walk in San Francisco, and unexpectedly broke into tears, recalling a scene I hadn’t thought of in many years. When Herb and I were in college and medical school, we had often played pinochle on Sundays with his Uncle Louie, a bachelor who lived with Herb’s family. Louie, an endearing man with a tendency toward hypochondriasis, always started the evening by announcing that he wasn’t sure he could play well that night because there was “something wrong upstairs,” pointing to his head. That was the cue for each of us to whip out our brand new stethoscopes and blood pressure cuffs and, for a five-dollar fee, take his blood pressure, listen to his heart, and pronounce him healthy. Louie was such a good player that we didn’t hang on to our five dollars very long: almost always, by the end of the evening, he had reco
uped his money and then some.

  I loved those evenings. But Uncle Louie is long dead, and now, with Herb gone as well, I experienced a staggering loneliness as I realized I no longer had a witness to that scene of so long ago. It now existed only in my mind, somewhere in the mysteries of my crackling neural circuits, and when I died it would vanish entirely. Of course, I’ve known these things in the abstract for decades, and emphasized them in books and lectures and many therapeutic hours, but I am feeling them now, feeling that when we perish, every one of our precious, joyful, unique memories vanishes with us.

  I’m also grieving Bob Berger, my dear friend of over sixty years, who died a few weeks after Herb. After a cardiac arrest, Bob was unconscious for several hours before being resuscitated, and during a brief interval of lucidity he called me on the phone. Jocular as ever, he rasped, “I bring you a message from the other side.” That was all he said: his condition quickly worsened. He slumped back into a coma and died two weeks later.

  Bob and I first met in Boston in my second year of medical school. Though we subsequently lived on different coasts, we remained lifelong friends, and kept in touch frequently by phone and visits. Fifty years after our first meeting, he asked me to help him write about his life as an adolescent when the Germans overran his native Hungary. He told me about passing as a Christian and participating in the Resistance during the Nazi occupation of Budapest. He related hair-raising stories, one after the other. For example, at the age of sixteen, he and a fellow Resistance fighter, on motorcycle, had followed lines of Jews who had been tied together and were being forced to walk through the woods to the Danube, where they were to be thrown into the river and drowned. There was no hope of saving any of the captives, but Bob and his friend drove by and threw grenades to kill the Nazi guards. Later, when Bob was away for a few days, trying, unsuccessfully, to find his mother, their landlord had turned his roommate, another close friend, over to the Nazis, who had dragged him into the street and pulled down his pants. When they saw he was circumcised, they shot him in the abdomen and left him to die, warning onlookers to offer no help, not even a drink of water. I heard such horrific tales, one after another—all for the first time—and at the end of the evening I said to him, “Bob, we’ve been so close. We’ve known each other for fifty years. Why have you never told me any of this before?” His answer stunned me: “Irv, you weren’t ready to hear it.”