“Maybe you’d like to get some caring from the group, but how can you get it when you come on so tough? You haven’t yet talked about having cancer.” (I had been urging Carlos to reveal to the group that he had cancer, but he was procrastinating: he said he was afraid he’d be pitied, and didn’t want to sabotage his sexual chances with the women members.)
Carlos grinned at me. “Good try, Doc! It makes a lot of sense. You’ve got a good head. But I’ll be honest—the thought of my cancer never entered my mind. Since we stopped chemotherapy two months ago, I go days at a time without thinking of the cancer. That’s goddamn good, isn’t it—to forget it, to be free of it, to be able to live a normal life for a while?”
Good question! I thought. Was it good to forget? I wasn’t so sure. Over the months I had been seeing Carlos, I had discovered that I could chart, with astonishing accuracy, the course of his cancer by noting the things he thought about. Whenever his cancer worsened and he was actively facing death, he rearranged his life priorities and became more thoughtful, compassionate, wiser. When, on the other hand, he was in remission, he was guided, as he put it, by his pecker and grew noticeably more coarse and shallow.
I once saw a newspaper cartoon of a pudgy lost little man saying, “Suddenly, one day in your forties or fifties, everything becomes clear. . . . And then it goes away again!” That cartoon was apt for Carlos, except that he had not one, but repeated episodes of clarity—and they always went away again. I often thought that if I could find a way to keep him continually aware of his death and the “clearing” that death effects, I could help him make some major changes in the way he related to life and to other people.
It was evident from the specious way he was speaking today, and a couple of days ago in the group, that his cancer was quiescent again, and that death, with its attendant wisdom, was far out of mind.
I tried another tack. “Carlos, before you started the group I tried to explain to you the basic rationale behind group therapy. Remember how I emphasized that whatever happens in the group can be used to help us work in therapy?” He nodded.
I continued, “And that one of the most important principles of groups is that the group is a miniature world—whatever environment we create in the group reflects the way we have chosen to live? Remember that I said that each of us establishes in the group the same kind of social world we have in our real life?”
He nodded again. He was listening.
“Now, look what’s happening to you in the group! You started with a number of people with whom you might have developed close relationships. And when you began, the two of us were in agreement that you needed to work on ways of developing relationships. That was why you began the group, remember? But now, after only six weeks, all the members and at least one of the co-therapists are thoroughly pissed at you. And it’s your own doing. You’ve done in the group what you do outside of the group! I want you to answer me honestly: Are you satisfied? Is this what you want from your relationships with others?”
“Doc, I understand completely what you’re saying, but there’s a bug in your argument. I don’t give a shit, not one shit, about the people in the group. They’re not real people. I’m never going to associate with losers like that. Their opinion doesn’t mean anything to me. I don’t want to get closer to them.”
I had known Carlos to close up completely like this on other occasions. He would, I suspected, be more reasonable in a week or two, and under ordinary circumstances I would simply have been patient. But unless something changed quickly, he would either drop out of the group or would, by next week, have ruptured beyond repair his relationships with the other members. Since I doubted very much, after this charming incident, whether I’d ever be able to persuade another group therapist to accept him, I persevered.
“I hear those angry and judgmental feelings, and I know you really feel them. But, Carlos, try to put brackets around them for a moment and see if you can get in touch with anything else. Both Sarah and Martha were in a great deal of pain. What other feelings did you have about them? I’m not talking about major or predominant feelings, but about any other flashes you had.”
“I know what you’re after. You’re doing your best for me. I want to help you, but I’d be making up stuff. You’re putting feelings into my mouth. Right here, this office, is the one place I can tell the truth, and the truth is that, more than anything else, what I want to do with those two cunts in the group is to fuck them! I meant it when I said that if rape were legal, I’d do it! And I know just where I’d start!”
Most likely he was referring to Sarah, but I did not ask. The last thing I wanted to do was enter into that discourse with him. Probably there was some important oedipal competition going on between the two of us which was making communication more difficult. He never missed an opportunity to describe to me in graphic terms what he would like to do to Sarah, as though he considered that we were rivals for her. I know he believed that the reason I had earlier dissuaded him from inviting Sarah out was that I wanted to keep her to myself. But this type of interpretation would be totally useless now: he was far too closed and defensive. If I were going to get through, I would have to use something more compelling.
The only remaining approach I could think of involved that one burst of emotion I had seen in our first session—the tactic seemed so contrived and so simplistic that I could not possibly have predicted the astonishing result it would produce.
“All right, Carlos, let’s consider this ideal society you’re imagining and advocating—this society of legalized rape. Think now, for a few minutes, about your daughter. How would it be for her living in the community—being available for legal rape, a piece of ass for whoever happens to be horny and gets off on force and seventeen-year-old girls?”
Suddenly Carlos stopped grinning. He winced visibly and said simply, “I wouldn’t like that for her.”
“But where would she fit, then, in this world you’re building? Locked up in a convent? You’ve got to make a place where she can live: that’s what fathers do—they build a world for their children. I’ve never asked you before—what do you really want for her?”
“I want her to have a loving relationship with a man and have a loving family.”
“But how can that happen if her father is advocating a world of rape? If you want her to live in a loving world, then it’s up to you to construct that world—and you have to start with your own behavior. You can’t be outside your own law—that’s at the base of every ethical system.”
The tone of the session had changed. No more jousting or crudity. We had grown deadly serious. I felt more like a philosophy or religious teacher than a therapist, but I knew that this was the proper trail. And these were things I should have said before. He had often joked about his own inconsistency. I remember his once describing with glee a dinner-table conversation with his children (they visited him two or three times a year) when he informed his daughter that he wanted to meet and approve any boy she went out with. “As for you,” pointing to his son, “you get all the ass you can!”
There was no question now that I had his attention. I decided to increase my leverage by triangulation, and I approached the same issue from another direction:
“And, Carlos, something else comes to my mind right now. Remember your dream of the green Honda two weeks ago? Let’s go back over it.”
He enjoyed working on dreams and was only too glad to apply himself to this one and, in so doing, to leave the painful discussion about his daughter.
Carlos had dreamed that he went to a rental agency to rent a car, but the only ones available were Honda Civics—his least favorite car. Of several colors available, he selected red. But when he got out to the lot, the only car available was green—his least favorite color! The most important fact about a dream is its emotion, and this dream, despite its benign content, was full of terror: it had awakened him and flooded him with anxiety for hours.
Two weeks ago we had not been able t
o get far with the dream. Carlos, as I recall, went off on a tangent of associations about the identity of the female auto rental clerk. But today I saw the dream in a different light. Many years ago he had developed a strong belief in reincarnation, a belief that offered him blessed relief from fears about dying. The metaphor he used in one of our first meetings was that dying is simply trading in your body for another one—like trading in an old car. I reminded him now of that metaphor.
“Let’s suppose, Carlos, that the dream is more than a dream about cars. Obviously renting a car is not a frightening activity, not something that would become a nightmare and keep you up all night. I think the dream is about death and future life, and it uses your symbol of comparing death and rebirth to a trade of cars. If we look at it that way, we can make more sense of the powerful fear the dream carried. What do you make of the fact that the only kind of car you could get was a green Honda Civic?”
“I hate green and I hate Honda Civics. My next car is going to be a Maserati.”
“But if cars are dream symbols of bodies, why would you, in your next life, get the body, or the life, that you hate above all others?”
Carlos had no option but to respond. “You get what you deserve, depending on what you’ve done or the way you’ve lived your present life. You can either move up or down.”
Now he realized where this discussion was leading, and began to perspire. The dense forest of crassness and cynicism surrounding him had always shocked and dissuaded visitors. But now it was his turn to be shocked. I had invaded his two innermost temples: his love for his children and his reincarnation beliefs.
“Go on, Carlos, this is important—apply that to yourself and to your life.”
He bit off each word slowly. “The dream is saying that I’m not living right.”
“I agree, I think that is what the dream is saying. Say some more on your thoughts about living right.”
I was going to pontificate about what constitutes a good life in any religious system—love, generosity, care, noble thoughts, pursuit of the good, charity—but none of that was necessary. Carlos let me know I had made my point: he said that he was getting dizzy, and that this was a lot to deal with in one day. He wanted time to think about it during the week. Noting that we still had fifteen minutes left, I decided to do some work on another front.
I went back to the first issue he had raised in the hour: his belief that he had missed a golden opportunity with Ruth, the woman he had met briefly at a church social, and his subsequent head pounding and self-recrimination for not having walked her to her car. The function that his irrational belief served was patent. As long as he continued to believe that he was tantalizingly close to being desired and loved by an attractive woman, he could buttress his belief that he was no different from anyone else, that there was nothing seriously wrong with him, that he was not disfigured, not mortally ill.
In the past I hadn’t tampered with his denial. In general, it’s best not to undermine a defense unless it is creating more problems than solutions, and unless one has something better to offer in its stead. Reincarnation is a case in point: though I personally consider it a form of death denial, the belief served Carlos (as it does much of the world’s population) very well; in fact, rather than undermine it, I had always supported it and in this session buttressed it by urging that he be consistent in heeding all the implications of reincarnation.
But the time had come to challenge some of the less helpful parts of his denial system.
“Carlos, do you really believe that if you had walked Ruth to her car you’d have a ten- to fifteen-percent chance of marrying her?”
“One thing could lead to another. There was something going on between the two of us. I felt it. I know what I know!”
“But you say that every week—the lady in the supermarket, the receptionist in the dentist’s office, the ticket seller at the movie. You even felt that with Sarah. Look, how many times have you, or any man, walked a woman to her car and not married her?”
“O.K., O.K., maybe it’s closer to a one-percent or half-percent chance, but there was still a chance—if I hadn’t been such a jerk. I didn’t even think of asking to walk her to the car!”
“The things you pick to beat yourself up about! Carlos, I’m going to be blunt. What you’re saying doesn’t make any sense at all. All you’ve told me about Ruth—you only talked to her for five minutes—is that she’s twenty-three with two small kids and is recently divorced. Let’s be very realistic—as you say, this is the place to be honest. What are you going to tell her about your health?”
“When I get to know her better, I’ll tell her the truth—that I’ve got cancer, that it’s under control now, that the doctors can treat it.”
“And—?”
“That the doctors aren’t sure what’s going to happen, that there are new treatments discovered every day, that I may have recurrences in the future.”
“What did the doctors say to you? Did they say may have recurrences?”
“You’re right—will have recurrences in the future, unless a cure is found.”
“Carlos, I don’t want to be cruel, but be objective. Put yourself in Ruth’s place—twenty-three years old, two small children, been through a hard time, presumably looking for some strong support for herself and her kids, having only a layman’s knowledge and fear of cancer—do you represent the kind of security and support she’s looking for? Is she going to be willing to accept the uncertainty surrounding your health? To risk placing herself in the situation where she might be obligated to nurse you? What really are the chances she would allow herself to know you in the way you want, to become involved with you?”
“Probably not one in a million,” Carlos said in a sad and weary voice.
I was being cruel, yet the option of not being cruel, of simply humoring him, of tacitly acknowledging that he was incapable of seeing reality, was crueler yet. His fantasy about Ruth allowed him to feel that he could still be touched and cared for by another human. I hoped that he would understand that my willingness to engage him, rather than wink behind his back, was my way of touching and caring.
All the bluster was gone. In a soft voice Carlos asked, “So where does that leave me?”
“If what you really want now is closeness, then it’s time to take all this heat off yourself about finding a wife. I’ve been watching you beat yourself up for months about this. I think it’s time to let up on yourself. You’ve just finished a difficult course of chemotherapy. Four weeks ago you couldn’t eat or get out of bed or stop vomiting. You’ve lost a lot of weight, you’re regaining your strength. Stop expecting to find a wife right now, it’s too much to ask of yourself. Set a reasonable goal—you can do this as well as I. Concentrate on having a good conversation. Try deepening a friendship with the people you already know.”
I saw a smile begin to form on Carlos’s lips. He saw my next sentence coming: “And what better place to start than in the group?”
Carlos was never the same person after that session. Our next appointment was the day following the next group meeting. The first thing he said was that I would not believe how good he had been in the group. He bragged that he was now the most supportive and sensitive member. He had wisely decided to bail himself out of trouble by telling the group about his cancer. He claimed—and, weeks later, Sarah was to corroborate this—that his behavior had changed so dramatically that the members now looked to him for support.
He praised our previous session. “The last session was our best one so far. I wish we could have sessions like that every time. I don’t remember exactly what we talked about, but it helped me change a lot.”
I found one of his comments particularly droll.
“I don’t know why, but I’m even relating differently to the men in the group. They are all older than me but, it’s funny, I have a sense of treating them as though they were my own sons!”
His having forgotten the content of our last session troubled me l
ittle. Far better that he forget what we talked about than the opposite possibility (a more popular choice for patients)—to remember precisely what was talked about but to remain unchanged.
Carlos’s improvement increased exponentially. Two weeks later, he began our session by announcing that he had had, during that week, two major insights. He was so proud of the insights that he had christened them. The first, he called (glancing at his notes), “Everybody has got a heart.” The second was “I am not my shoes.”
First, he explained “Everybody has got a heart.” “During the group meeting last week, all three women were sharing a lot of their feelings, about how hard it was being single, about loneliness, about grieving for their parents, about nightmares. I don’t know why, but I suddenly saw them in a different way! They were like me! They were having the same problems in living that I was. I had always before imagined women sitting on Mount Olympus with a line of men before them and sorting them out—this one to my bedroom, this one not!
“But that moment,” Carlos continued, “I had a vision of their naked hearts. Their chest wall vanished, just melted away leaving a square blue-red cavity with rib-bar walls and, in the center, a liver-colored glistening heart thumping away. All week long I’ve been seeing everyone’s heart beating, and I’ve been saying to myself, ‘Everybody has got a heart, everybody has got a heart.’ I’ve been seeing the heart in everyone—a misshapen hunchback who works in reception, an old lady who does the floors, even the men I work with!”
Carlos’s comment gave me so much joy that tears came to my eyes. I think he saw them but, to spare me embarrassment, made no comment and hurried along to the next insight: “I am not my shoes.”
He reminded me that in our last session we had discussed his great anxiety about an upcoming presentation at work. He had always had great difficulty speaking in public: excruciatingly sensitive to any criticism, he had often, he said, made a spectacle of himself by viciously counterattacking anyone who questioned any aspect of his presentation.
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