by The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases
I smiled. “Have you ever seen a psychiatrist before?”
“No,” he said, “but my family is so nuts that I probably could have used one for years.”
“I’d like to hear about that.” As always, I enjoyed working with patients like Bruce who had a sense of humor, but I wondered how much of it had to with his anxiety about meeting with me.
“Really, right now I just need your help with my insomnia. I can’t seem to get through the night.”
“Are you having trouble falling asleep or staying asleep?” I asked. Typically people with clinical depression wake up in the middle of the night and can’t fall back to sleep, whereas patients with anxiety disorders have trouble settling down when they go to bed.
“I fall asleep fine. It’s staying asleep that’s my problem. My dreams wake me up, and I feel tired the next day, especially during long procedures.” He rubbed his face and eyes for a moment, then said defensively, “Look, it’s not affecting my work, thank God, but I want to deal with it before it gets worse. I could have written myself some Dalmane or Valium, but as a rule, I think it’s a bad idea to prescribe for yourself.”
Bruce’s comment about self-medicating suggested that he was ethical and had a sense of right and wrong. On the other hand, he could be protesting too much and covering up a drug-dependency problem. Many doctors, because of convenience, tend to prescribe medicines for themselves and their family members, which can get them into trouble if they dole out the wrong drugs or dosages for conditions outside their expertise. It can also be the first step to prescription-drug dependence and addiction.
As a group, doctors are less likely to use illicit drugs like cocaine or heroin but more likely to abuse prescription medicines, such as opiates or tranquilizers. Plastic surgeons, anesthesiologists, and dentists tend to have painkillers and sedatives stored right in their office, and the ready availability increases the risk for self-medication and addiction. I made a note to explore Bruce’s medication history in more detail, but for now it seemed best to focus on his chief complaint.
“Tell me about your dreams, Bruce.”
“Is that really necessary? I thought we could just discuss the best sleep medication for me. I don’t want any hangovers or side effects.”
“We’ll get to that before we finish today, but sometimes understanding what’s waking us up can help us sleep better.”
“I don’t know how talking about my dreams is going to help me sleep. Besides, they’re complicated, and it would take longer than fifty minutes.” He stood up, took off his jacket, placed it next to him on the couch, and sat back down.
“We have plenty of time,” I said. “Let’s give it a try.”
“Well, what do you want to know?”
“When did you first start having these dreams?”
“I think I’ve had them off and on since I was a kid, but they’ve kicked up a little since I met my fiancée.”
“Are the dreams connected to your fiancée in some way?” I asked.
“Well, she has a somewhat peculiar obsession.”
“Really,” I said, my mind racing with dozens of unusual titillating possibilities. “Care to elaborate?”
“Look, Christina is an amazing woman. My parents were ready to give up on me ever getting married. But when they met her, they knew she was the one—even though she’s not Jewish. She’s beautiful, poised, intelligent…and she has this incredible energy. We have a lot of fun together. We travel, play golf, go to the theater.”
“She sounds great, but what does she have to do with the dreams?”
Bruce crossed his arms and slumped. “There is this one little quirk of hers, and it’s starting to get under my skin.”
“Okay…what is it?” I was becoming frustrated.
“Christina has this fascination with Disneyland and everything Disney.” He went silent and I waited.
“The first time I went to her condo in Santa Monica, I was blown away—the entire place was decorated in Disney themes. Snow White living room, Mickey Mouse kitchen, Little Mermaid bathroom…And she has this Pinocchio den. It’s so bizarre, I don’t even want to go in there.”
“Sounds intense,” I said.
“You have no idea.” He shook his head. “I mean, everybody has hobbies, but this is ridiculous.”
“What’s ridiculous about it?” I asked.
“There’re people who wear Mickey Mouse watches and stuff, it’s kind of kitsch, whatever. But I think Christina’s hobby borders on obsession. And here’s the potential deal breaker: she’s actually planning our wedding at Disneyland. Oh, there’ll be no chuppah, we’ll be exchanging our vows in front of the Sleeping Beauty Castle, and Christina will be wearing a replica of Snow White’s gown.”
Struggling to keep a straight face and restraining myself from asking if he was going as Goofy or Pluto, I said, “I see.”
“And did you know that they actually have people who arrange all this at Disneyland? My parents are okay with my marrying a shiksa, but this? It’ll kill them.”
“So you haven’t told them?”
“God no,” he said.
Bruce’s humor made his narrative entertaining, but he was avoiding any discussion about the dreams that were fueling his insomnia by focusing on Christina’s issues rather than his own. I wondered if there had been a deal breaker in his prior relationships that kept him from making a commitment.
“It’s certainly an unusual wedding plan,” I said. “But maybe you should tell me about the dreams so I can understand the connection.”
“Well, they’re nightmares really…I mean, they start out as nothing special. I might be at work, or back at school when I was a kid, but they all seem to end up the same…”
“And how’s that?” I urged him on.
“No matter how the dream begins, I somehow become Pinocchio, my nose is growing, and I start turning into a donkey. I wake up in a sweat and I can’t go back to sleep. That’s it.”
“Can you pinpoint the emotion you experience when you wake up?” I asked.
“I feel like an ass.” He laughed and I smiled with him. “Seriously, I feel utter terror. It’s insane. I’m forty-eight years old, and I wake up in the middle of the night afraid of a cartoon.”
“Dreams can be bizarre and make no sense,” I said. “What this dream means to you on an emotional level may not be obvious, and may be only partly connected to the actual content of the dream.”
The understanding of dreams has been a focus of psychoanalytic theory and practice since the end of the nineteenth century. In Freud’s book The Interpretation of Dreams, he argued that the actual content of a dream could reveal its hidden meaning. He believed that all dreams were expressions of wish fulfillment. When trying to understand a dream, a psychotherapist often explores the events of the preceding day that might have triggered it. But the dream’s actual content is often illusive, disguised or distorted by years of experience and repressed feelings—fear, anger, anxiety, guilt, and more. These distortions can take many forms, such as condensation—the dream stands for several ideas or experiences; displacement—a dream shifts a person’s unacceptable emotions or desires to more acceptable ones; or symbolism—an event or character in the dream stands for something else of importance.
“My dreams don’t make any sense, that’s for sure,” Bruce said.
“Let’s try to make sense of it and look at last night’s dream systematically. What happened yesterday that might have stirred it up?”
“Nothing much. I had dinner at Christina’s.”
“Anything out of the ordinary happen?” I asked.
“No, not that I recall. I didn’t stay over, though. I had an early surgery this morning.”
“Did you go into the Pinocchio den?” I asked.
“I generally avoid it. It gives me the creeps,” he said. “I mean, look at my dreams.”
“So, what did you talk about at dinner?”
“I was describing a procedure I’m developing, a
noninvasive face-lift. But Christina kept changing the subject. She wanted to talk about the Mad Hatter wedding cake and her ridiculous idea for the centerpieces.”
“Did you tell her how you felt when she changed the subject?” I asked.
“No. I didn’t want to upset her. I mean, I love her, and if this Disneyland wedding means that much to her, I guess I’ll do it.” He looked down, resigned.
“Bruce, this is your wedding too.”
“I know, but women are more hung up on the details of all this wedding stuff.”
“But it’s important that this wedding means something to you too,” I said.
He looked up. “You think it has something to do with my dreams?”
It was the perfect moment for the standard psychiatrist question. “What do you think?”
Bruce was pensive for a moment, then spoke. “I’m not sure, but from what I know, I suppose that Pinocchio and the donkey represent some fear of mine, since I wake up in a cold sweat.”
“Perhaps you’re lying to yourself about something. Lying like Pinocchio did when his nose would grow,” I added.
“Are you saying I’m lying to myself about wanting to get married?” he asked, worried.
I thought that was a big jump, but maybe right on the nose, so to speak. “I don’t know, Bruce. Maybe you just don’t want to have the wedding at Disneyland.”
“Well, that’s for sure. And I suppose I am sort of lying to Christina by not telling her.”
“I think as we get a better handle on what your dreams mean, it will be easier for you to talk about those kinds of feelings with Christina.”
“It’s not like we don’t talk about things,” he said. “It’s just that I’d rather avoid certain topics than cause a scene.”
Despite his initial defensiveness, Bruce was warming up to the idea that talking about dreams and feelings could help. He had made a lot of progress in just this first session. His initial reason for seeing me was to get a sleep prescription, but now he was willing to explore possible psychological causes for his problems. He was even able to come up with a plausible interpretation for his recurring dreams, but I suspected that he had deeper emotional issues stirring them up.
Before our session ended, I wrote Bruce a prescription for a short-acting benzodiazepine, since his sleep problems sounded more like an anxiety disorder than a depression. I suggested that he only use the medication if he really needed it to sleep before a long procedure the next day. I encouraged him to not only let himself have his dreams but to also jot down notes about them when he woke up—that way he’d remember the details better and we could discuss them at the next session.
The rain stopped on the weekend, and Gigi and I took the kids to our favorite breakfast place in Studio City, just down the hill from our house. After having our fill of pancakes and eggs—every way but thrown at us—we were walking to the perfect parking space I had found only four and a half blocks from the restaurant, to avoid the three-dollar parking charge.
Gigi and our five-year-old, Rachel, were up ahead, looking in shop windows, and I was walking with Harry, our three-year-old. He must have been two steps ahead of me—just out of my grasp—when he tripped on a crack in the sidewalk and fell down, hard. He started wailing. He had bloody knees, hands, and elbows, and much to Gigi’s horror, on his forehead was a “definite scar for life” (which completely disappeared in two months).
As we drove home to get him cleaned up and bandaged (no stitches necessary), I realized how lucky it was that this first bad fall had happened in front of us. If he had fallen while under the care of one of our mothers or a babysitter, we probably wouldn’t have left either of the kids with anyone for the next twenty years. Even though I got defensive about it not being my fault that Harry hurt himself on my watch, we made sure not to argue in front of the kids. We both knew from Gigi’s voluminous library of child-rearing books that remaining calm and united was key to minimizing any psychological trauma for the kids when they got hurt or during a crisis.
I wondered about Bruce’s early-childhood traumas and what experiences might be contributing to his current nightmares and apparent fear of commitment. After all, he was forty-eight and had never married, although he told me he had been close to getting engaged several times. I knew that to help Bruce, I needed to explore his early memories and discover how they might be connected to his dreams.
The following week, I had my geriatric-psychiatry training-committee meeting at lunch just before Bruce’s scheduled appointment. I was in charge of recruiting and training the young psychiatrists who wanted additional experience in geriatrics. There were always challenges in finding good candidates for these much needed positions, in part because of ageism—many doctors avoid treating older patients because they’re often complicated, time-consuming, and more likely to die during treatment than younger patients. The faculty had some good ideas on how to attract candidates that year, and I was happy to have time to eat a decent lunch without ruining my tie before Bruce showed up.
I returned to my office and found Bruce sitting in the waiting area. The fact that he was early could have been a sign of his eagerness to get back into his dream work. I figured he had the afternoon off because he was dressed in country-club casual, including sweater carefully draped around the shoulders. I opened the office door, and he went for the couch while I took my chair.
“So, how did your week go, Bruce?”
“I only took the medicine a couple of nights, when I thought I might really need it. It worked great—no hangover, nothing.”
“That’s good,” I said. “What about the other nights?”
He reached into his pocket and pulled out a small spiral notebook. “I made some notes on my dreams.”
From what I could see, the pad looked completely filled with illegible surgeon scribbles.
Bruce continued, “You were right. When I jotted down my thoughts as soon as I woke up, I remembered more details. And the dreams don’t all end exactly the same.”
“Let’s start with last night’s dream. What do you remember?”
“It was a bit strange. I was in the operating room, but instead of being the lead surgeon, I was assisting my father, who’s not even a doctor.”
“What does, or did, your father do?” I asked.
“He’s an investment banker who just retired a couple of years ago. So it was weird that he was in the O.R. with me.”
“Anything else strange about the dream?”
“Yes. I was handing Dad a sponge, and he slapped my hand really hard.”
“How did you react?”
“I got furious. I was only doing what I was supposed to do, and he attacked me out of nowhere. And I never meant to get him angry.”
“What happened next?”
“He threw me out of the O.R., and my nose started growing.”
“What were you feeling just as your nose began growing?” I asked.
“I felt like a kid again—as if I had never been to med school and had lied my way into the O.R. My nose kept growing, and I began turning into a donkey. Then I woke up.” Bruce seemed upset as he put away his notebook.
“Have you dreamt about your father before?”
“Probably, but I don’t remember anything specific.”
“Does this dream remind you of any early experiences with your father?” I asked.
Bruce took a deep breath and settled back on the couch. After a moment he replied. “Dad only hit me once in my life. The rest of the time he really didn’t pay much attention to me.”
“What do you mean?” I asked.
“His clients loved him—he was charming and attentive, but when he got home, he’d have a couple of drinks at dinner, then just watch TV and fall asleep.”
“So when did he hit you?” I asked.
“I must have been in kindergarten. He was supposed to pick me up from school, but it was pouring rain and he didn’t show up.” Bruce looked tense and rubbed the back of his neck. “M
y friend’s mother offered me a ride—she said it was silly for me to stand outside in the rain. So I got in her car and she took me home.”
“Then what happened?” I asked.
“He came home about a half hour later, furious. He had been driving around in the rain, frantic that someone had kidnapped me.” Bruce paused, somewhat choked up, then regained his composure. “I can remember him standing over me, yelling that I was an idiot. He grabbed me and threw me over his knee, pulled off his belt, and whipped the crap out of me.”
“That must have been terrifying.” Bruce didn’t seem to hear me—his mind was elsewhere. “Bruce, are you okay?” I asked.
“I just remembered something else. I don’t think I’ve ever recalled this before…”
“Go on,” I said encouraging him.
“That night, our family went to the temple for some event. My parents dropped my sister and me off at the rec room, where all the kids gathered to watch a movie.”
“Where did your parents go?”
“I think they went to a lecture in the chapel.”
“So what happened after your parents dropped you off?” I asked. He looked upset. “Take your time, Bruce.”
“I can remember sitting there with my sister, kind of nervous—I’d never been to the movies before. I remember the folding chairs they had set up were uncomfortable and my butt was still sore from the beating. And the movie really scared me.”
“Do you recall what movie it was?” I asked.
“Pinocchio!” he blurted out.
LATER THAT EVENING AFTER THE KIDS WENT to bed, Gigi and I were hanging out in the den. The TV news was on low, and Gigi was working on her laptop. I was ruminating about the difficulty I was having recruiting geriatric trainees. Gigi was giving me an occasional “uh-huh” or “mm-hmm.” I found myself getting annoyed because she wasn’t paying full attention to me. I immediately thought of Bruce’s father, whose clients adored him because he always gave them his full attention, but at night he tuned out and paid little or no attention to his family.