by The Naked Lady Who Stood on Her Head: A Psychiatrist's Stories of His Most Bizarre Cases
Clearly, it’s impossible to pay full attention all the time. Gigi loved me and was interested in my life, but at that moment she was focused on something else. If I had asked her to put her computer down and listen, I’m sure she would have. I tried to imagine how it would feel to live with someone who didn’t care about me or was unable to focus on my emotional life.
For some people, it’s a personality disorder such as narcissism that makes it difficult for them to experience empathy. They get so wrapped up in their own needs that they never learn to respond to the needs of those around them. For others, it can be a psychotic illness, depression, or a variety of other personal problems that keep them from getting close to other people.
After Bruce’s realization about the traumatic events surrounding his seeing the movie Pinocchio, his nightmares began to subside. As I continued to work with him, I learned that his father was not only a narcissistic personality but also an alcoholic, although a high-functioning one. He didn’t drink during the day, but at night the booze helped him escape from his personal demons and kept him from having to connect with his family. Although Bruce’s father only hit him that one time, he had unpredictable rages that perpetuated Bruce’s fears. In Bruce’s mind, his father was a powerful, judgmental, and emotionally distant figure. Bruce craved the love and caring that his father seemed to give to his clients, and felt that he was a disappointment as a son, not the real boy that his father probably wanted. The fact that Bruce saw the Disney movie right after his father beat him unconsciously linked Pinocchio to this traumatic event. And the theme of the movie seemed to capture many of Bruce’s personal struggles that haunted him in his dreams—Pinocchio too wished to be a “real boy” that his father would pay attention to.
I suspected that these unresolved issues had kept Bruce from getting too close to other people and making a commitment, until now, at age forty-eight. Perhaps it was no coincidence that his fiancée had an obsession with everything Disney. Often in life we seek out what we fear the most as a way to overcome that fear and resolve our underlying conflicts.
I turned to Gigi and said, “Honey, if you can take a break, I’d like to talk to you. I need your advice.”
She smiled. “Sure,” she said, and put her computer aside.
THE FOLLOWING THURSDAY I GOT INTO THE office early to proofread a research paper before my session with Bruce. I got so caught up in the task that I lost track of time and suddenly my assistant buzzed me—Bruce was there.
I opened the door and saw Bruce standing with a pretty woman in her mid-thirties, wearing a pink, lightweight Chanel suit and low heels. Bruce said, “This is my fiancée, Christina.”
“I’m delighted to meet you, Dr. Small,” she said, smiling.
“Nice to meet you too,” I said.
“Sweetie, meet me back here in about fifty minutes, okay? Then we’ll go shopping,” Bruce said.
“Oh, can’t I come in and just chitchat for a few minutes? I’ve never been in a psychiatrist’s office.” Before Bruce or I could say anything, she glided into the room and sat on the couch. Bruce, apprehensive, joined her. Christina’s cheerfulness was infectious, and I wasn’t sure if she was hypomanic or just had an incredibly upbeat personality. She certainly brightened a room. “Bruce tells me that you’re an excellent doctor,” she chirped.
“Thank you. I understand you do charity work, Christina.”
She described how she had become involved in her family’s foundation after graduating college back East and was now chairing its board. The foundation gave away about five million dollars a year to nonprofits in music and the arts. Bruce listened, his admiration apparent.
“Is there anything you wanted to talk about in particular?” I asked Christina.
“First, I wanted to tell you how thrilled I am that Bruce is in therapy,” she said. “It’s wonderful—he’s sleeping better, and he’s been in such a good mood.”
“It’s true,” Bruce injected. “It’s amazing what a good night’s sleep can do for you.”
“So, how are the wedding plans going?” I asked.
Christina brightened. “We’re so excited! It’s going to be a fairy-tale wedding. Has Bruce filled you in on the details?”
Bruce leaned forward and clasped his hands, “Of course I’ve told Gary about the Disneyland thing.”
She politely turned to him. “What do you mean by ‘Disneyland thing’?”
“You know, the Snow White thing, the Sleeping Beauty Castle, all of it,” Bruce said.
Christina looked hurt. “You said you were fine with it.”
“I am, sort of, but there’re so many other options we haven’t even considered,” he said.
“So you’re not pleased with how I’m planning this wedding, Bruce?”
He hesitated, then said with trepidation. “I just think my parents were hoping for something a little more traditional…maybe more Jewish?”
She was surprised. “You never mentioned a word of this before.”
“I didn’t want to hurt your feelings,” he said. “I know how important this wedding is to you.”
“And it’s not important to you?” she snapped.
He took her hand. “Of course it is. I love you.”
I spoke up. “It’s clear that the wedding is important to both of you, but it’s also important to be able to discuss your feelings about the details.”
“Dr. Small, since I was a little girl, I’ve always wished for a perfect Snow White wedding.”
“Why do you think that is?” I asked.
“I guess because it was so special to go to Disneyland with my father. I can remember him walking me through the Sleeping Beauty Castle and holding my hand. It was magical. I know he would want this for me.”
“Did your father pass away?” I asked.
Christina looked away sadly. “When I was ten he got pancreatic cancer and was gone in three months.” Bruce leaned over and wrapped her in his arms to comfort her.
“That’s a young age to lose your father,” I said.
She pulled herself together. “Yes, it was hard, but Mom remarried, and he’s a wonderful man. And I’ve got my Bruce.” She smiled at Bruce and gave him a kiss on the cheek.
I wondered if Christina had become emotionally stuck at age ten when her father took her to Disneyland for the last time. Her attempt to create the perfect fairy-tale wedding could be an expression of an unfulfilled wish to reexperience the closeness she felt with her father. It also could partly explain why she was marrying a man nearly fifteen years her senior.
“I can see why getting married at Disneyland might be important to you,” I said.
“It was just a dream of mine; my life doesn’t depend on it. I’m more concerned that Bruce never told me he was unhappy about the idea.”
I looked at Bruce. “What about sharing some of your dreams with Christina?”
“Yeah. How about it?” she asked him, growing annoyed.
Bruce stood and looked out the window. “Sweetie, one of the things I’ve been discussing with Gary is a recurring nightmare I keep having.”
She softened as soon as she sensed him starting to open up. “Really, sweetheart? Tell me about it.”
“They’re kind of crazy and embarrassing,” Bruce said.
“You don’t have to be embarrassed with me. I love you.”
“I know…Well, at the end of every dream, no matter how it starts, I become Pinocchio and I’m turning into a donkey. Then I wake up and can’t get back to sleep.”
“Wow,” Christina said. “I had no idea…I’m so sorry, darling. No wonder you hate my den.” They both laughed.
Bruce went on, “The whole thing is complicated and has to do with my father.”
“What happened with your father?” she asked.
“It’s sort of a long story, but the one day that he hit me when I was a kid happened to be the day I saw the movie Pinocchio. The movie scared the hell out of me. But now thanks to therapy I can see that somehow in
my mind, there’s a weird connection between these events.”
“Bruce, getting married at Disneyland has been a dream of mine since I was little, but you know what?” she paused and sat forward, “I’m grown-up now, and you mean much more to me than some Fantasyland Castle or Snow White dress. All you had to do was tell me how you really felt.” Bruce moved next to her on the couch and they hugged.
For any psychotherapist, dream interpretation can be a powerful tool. The actual Pinocchio story is rich with metaphors relating to Bruce’s life. His relationship with his father stirred up a lifelong wish to be seen and treated as a real person and not a wooden puppet without feelings. He never learned from his father how to deal with the complexity of a close relationship, and as in most Disney stories, there was no strong mother figure in the picture. Bruce’s mother stayed in the background and always took his father’s side, no matter what.
Bruce’s choice to become a plastic surgeon might have been an attempt to create perfection in his own life, what Freud would have called sublimation, or a way to redirect his unconscious feelings of imperfection into something constructive. Had Bruce not opened up to Christina about his struggles and fears, he might have used the Disney wedding as a “deal-breaker” excuse to flee yet another relationship. As he stopped lying to himself and Christina, the dreams of Pinocchio’s growing nose subsided, along with the bad-boy image of becoming a donkey.
Christina’s desire to have her wedding at Disneyland might have been an attempt to repair the abandonment and loss she experienced when her father died. In her mind, she was trying to re-create the closeness and magical feelings she recalled having with her father.
It seemed to me that Christina’s interest in everything Disney was more of an obsession than a hobby. But how many of us have pastimes that border on obsession, whether it’s poker, golf, or collections of cherished possessions from baseball cards to shoes? Sometimes we embrace these passions and even define ourselves by them; other times we might feel ashamed and keep them a secret. The key to feeling comfortable with ourselves and others is to accept our idiosyncrasies and enjoy them without becoming obsessed.
The next week Bruce returned for his solo session. He looked well rested and upbeat.
“The session last week with Christina made a huge difference in our relationship,” he said. “We got out of the Disneyland contract, she hired a wedding planner, and we’re even having a rabbi perform the ceremony.”
“So, where are you going to have it?” I asked.
Bruce grinned. “At my parents’ temple!”
“And Christina is okay with all of these changes?”
“She’s more than okay. She’s been a doll. Ever since I opened up to her about my feelings, we’re so much closer.”
THE WEDDING WENT SMOOTHLY, AND BRUCE CONTINUED in psychotherapy for the next year. They bought a new house and hired a decorator known for her minimalist style. Christina put her Disney paraphernalia into storage, and Pinocchio made only an occasional appearance in Bruce’s dreams.
A few months into the marriage, Christina got pregnant. Bruce was thrilled, but his nightmares returned. During therapy we discovered that his dreams were now triggered by anxiety that his child would not be raised as a Jew. After a few couples sessions, he finally expressed his feelings to Christina. And true to their dynamic, once he revealed his hidden fears and worries, she felt closer to him. She agreed to send their children to Hebrew school, as long as they could still have a tree at Christmas.
CHAPTER TWELVE
Gaslight
Summer 1999
OUR FAMILY HAD MOVED FROM THE San Fernando Valley to a house in Bel Air, overlooking UCLA. I was enjoying the shorter commute, as well as living up in the hills. It was beautiful and quiet, and you didn’t feel like you were in the city. And since it was so close to campus, many of our neighbors worked at the university as well.
Early on a crisp Sunday morning, I took our dog, Jake, for a walk up the street to get a view of the ocean. Jake was panting as we approached the top of the hill, so I slowed our pace, not for a moment acknowledging that I was completely out of breath myself. As we rested, I saw Bob Martin, another UCLA psychiatrist, planting hydrangeas in his front garden. He waved, and I went over to say hello.
Bob was an expert in cognitive-behavioral therapy or CBT, a goal-oriented form of treatment based on the idea that a patient’s own thoughts, rather than external events, situations, and relationships, cause their feelings and behaviors. By systematically changing how the patient thinks, the therapist can improve how the patient feels and behaves. During sessions, the therapist uses a structured approach that can be applied to several different psychiatric disorders.
It often seemed that a psychiatrist’s style of therapy reflected his personality, and Bob’s perfectly organized and meticulous garden was no exception. As Jake leaped into Bob’s flowers and shrubs to sniff around, I could see the terror on Bob’s face. I quickly pulled Jake’s leash and brought him back to me, and Bob relaxed.
After discussing tulips and petunias more than I could bear, I shifted the conversation to psychiatry. We got into a friendly debate about the pros and cons of different forms of psychotherapy.
“I know that CBT helps a lot of patients,” I said. “But don’t you ever wonder if those thoughts you alter or even extinguish so quickly might be better off explored and understood?”
Bob laughed. “That’s what I love about you, Gary. You think therapy should last forever.”
“No, I just think it should last as long as it takes.”
While we were talking, I lost track of Jake, who was now inspecting Bob’s lawn, having just left a large present. I pulled out my handy blue bag to scoop up the specimen, and Bob nearly swallowed his tongue as he ran for the garden hose.
“I’m really sorry, Bob, but a beautiful, well-groomed lawn like yours is hard for Jake to resist.”
Bob hosed down the offending area. Just then, Jake spotted a white poodle coming toward us and yanked the leash, pulling me up the hill. I managed to say good-bye as I yelled “Heel!” to Jake while he dragged me along.
The next day Bob called me at the office. He couldn’t still be upset about his lawn, could he?
“Bob, I’m so sorry about my dog’s behavior in your garden yesterday.”
He laughed. “Don’t worry about it, Gary. It was nice to get a chance to talk. I’m calling because I know a couple who could use some help, and I think you might be the right person for them to see.”
“I appreciate it. What can you tell me about them?” I asked.
“Well, I know the wife,” he said. “She’s a psychologist with a busy practice in Brentwood. She’s married to a businessman. Now with their kids grown up and out of the house, she’s complaining that something’s not right in the marriage.”
“I’d be glad to see them. Have them call me.”
The next week I had an appointment to see Susan and Raymond Wagner. They came a few minutes late, and as they entered the office, Ray complained about the parking. He was lean, in his early fifties, with salt-and-pepper hair; he wore yachting attire. Except for the clothes, he looked like he could be my older brother. Susan appeared a few years younger. They sat at opposite ends of the couch and stared, waiting for me to take the lead.
I began. “Bob Martin said I might be able to help you. Why don’t you tell me what’s going on?”
“We got married when Susan was an undergrad and I was getting my M.B.A.,” Ray said. “Our youngest just left for college last fall, and as far as I’m concerned, we’re having a great time.”
I looked at Susan and said, “So, how does it feel to have an empty nest?”
“Not bad. We’re both busy with our careers and have a very nice life, but for the last couple of years, I’ve felt some distance between us. I just don’t feel as happy in the marriage as I used to.”
Ray shook his head. “Whoa…honey, I don’t know where all this is coming from,” Ray said, and
then turned to me. “Frankly, I don’t see why we both have to be here. Susan’s not happy, I get that, but shouldn’t she be seeing someone rather than the two of us?”
Susan looked at him, frustrated. “Ray, we have a marriage problem. That involves both of us. Why do you insist on being in denial about it?”
Ray raised his arms in resignation. “If you say so, sweetheart, then tell the doctor what you think the problem is.”
“Fine,” she said. “First of all, Ray spends all his free time on that stupid boat of his—”
“It’s a yacht, dear,” Ray interrupted.
“Whatever. You know I get seasick just looking at it.” She turned toward me. “I mean, when he first got the thing, he’d take it out for a few hours on Sundays, and it was no big deal. But now he’s gone all weekend for yacht races and whatnot. And the weekends spill over to Monday nights.”
He balked. “You know I do business on the yacht. I close deals up and down the coast—it’s how I make my living. Besides, it isn’t every weekend.”
“Yes, lately it is,” she said. “And when you’re away, you hardly ever call and I feel lonely. It seems like that yacht is more important to you than I am.”
“That’s ridiculous. When I’m in town, don’t we have a great time together? Don’t we feel close?” He moved toward her on the couch and took her hand.
She softened. “It’s true. When you are home, it’s good.” She shook her head. “I hate when I hear myself complain—I sound like one of those disgruntled housewives I see in my practice. They’re always bitching about not getting enough attention from their husbands.” She paused and looked away. “I feel embarrassed.”
“Why is that?” I asked.
She looked at me. “I shouldn’t be so insecure. I’m a psychologist—I treat people with these kinds of problems all the time.”
“But therapists are people. We both know that a degree on the wall doesn’t make us immune to personal problems,” I said.
“Look, I realize that after thirty years of marriage, getting some space and having separate interests can be healthy for a couple. But something just doesn’t feel right to me.”