“Ionesco. He’s a French playwright who writes absurd plays, and this is absurd.”
“I know, but I have to do it the way he wants me to. He’s insistent.”
“Who’s insistent?”
“My supervisor,” Joyce whispered, as if the empty chairs had ears, “and he’s really strict. I don’t want to get in trouble. I have to do what he asks me to do.”
“Even if it makes no sense?”
“We’re here to learn, right? Maybe there’s something to it. Please go away.”
“OK, I’m sorry. Didn’t mean to interrupt—” I almost said “interrupt your group,” but stopped myself because I didn’t want to sound sarcastic. Joyce was what my family would have called a really good egg, so I didn’t want to annoy her more than I already had.
Being the good student she was, Joyce told her supervisor about my interrupting “the group,” and her supervisor took her to task for talking to me, telling her that she had “let the group down” by allowing me to violate the boundaries of the group and allowing me to “upset the group’s integrity.” It seems I had denied Joyce the opportunity to feel “the full existential tension,” as the supervisor put it, of running a group with no one in it but the leader.
After I apologized to Joyce, she laughed it off. She had a mature approach. “I never know what to expect. I just try to take the best of what each supervisor has to offer and then make up my own mind later on.”
Thank God, our supervisor had given us no such rigid rules by which to run our group. “Just jump in.” The more formal side of me wondered if we should make interpretations. Interpretations were the bread and butter of therapy.
“Interpretation” is a word out of psychoanalysis. A therapist interprets the foreign language of unconscious material, group dynamics, connections between seemingly disconnected events, the meaning hidden in what appears to lack meaning, or the emotion buried in a blank stare. Making interpretations is like detective work, gathering disparate clues to find the cause or significance in a certain statement, behavior, dream, action, or event. Making interpretations is a lot like what I did as an English major while analyzing a poem or a novel, which is one reason majoring in English helped me become a good psychiatrist. Same with being a writer. Professor Alfred had told me becoming a doctor would help me as a writer. As he put it, “Writers and doctors are always on the lookout for the telling detail.”
We got zero training in making interpretations in medical school or internship, so college or residency was the time to learn how to do it. But even in residency, we were more or less on our own, learning from whatever books and articles we chose to read, and from our various supervisors.
For example, after starting the group with Jennifer, an obvious interpretation we could make might be that if a member arrived late, that meant they were avoiding the group because the old leaders had left. As far as psychodynamic thinking went, you were never just late—or early, for that matter. Every action had its cause. The time you arrived was a reflection of an unconscious, or maybe conscious, motive.
We didn’t learn this stuff from a textbook, although there were many such books for us to peruse. The psychologists got the book learning. Psychiatrists sat with patients. We also learned from case conferences, from seminars in which we read papers from academic journals, and from supervision sessions, as well as from talking with each other. I love this way of learning, and I loved being a resident. To this day I am still learning in the same ways, even though I long ago completed my formal training.
There were a host of axioms and unwritten rules we absorbed pretty quickly. “Every gift is a bribe,” which meant we should not accept gifts from patients, nor should we offer gifts. “No PC,” which meant no personal contact, or touching of patients. Shaking hands was OK, but that was it. “Every relationship is ambivalent,” which meant people never love or hate anyone a hundred percent.
And then there were the many Semrad sayings we heard from supervisors. Some of my favorites: “Is there any other way to learn than the hard way?” … “If you have somebody to be mad at, then there’s a place for all the energy to go.” … “What one feels is a part of life not amenable to reason.” … “Sorrow is the vitamin of growth.” … “Pretending that it can be when it can’t is how people break their hearts.” … “It hurts to think straight.” … “You can have definite opinions only when you don’t know anything about a subject.” … “This is one of the eternal questions: How much are you going to pay for what you get?” Susan Rako and Harvey Mazer, two of his former students, collected some of his quotes in a book called Semrad: The Heart of a Therapist. A slim volume, it is the only written record we have of Semrad.
Havens’s office, which used to be Semrad’s office, had ten chairs of various shapes and sizes, all upholstered and much more comfortable than the straight chairs in Joyce’s group room. There was an attractive, albeit worn, oriental rug on the floor, bookcases along one wall, and Havens’s desk at the far end of the office. There were a couple of small coffee-table-type furnishings, some standing lamps so we didn’t have to use the antiseptic overhead light, and three large windows (with much larger panes than those in my office) looking out onto Fenwood Road in the dusk of early evening in Boston in October.
The group was set to start at six o’clock, but Jennifer and I arrived early, about 5:45, and made a decision to sit opposite each other rather than side by side. “I don’t want them to feel like we’re king and queen,” Jennifer said, and I agreed.
We waited. I thought of Joyce. “What if nobody comes?” I asked. “What if they’re so pissed that they got handed off to us that they boycott?”
“You think they will?” Jennifer asked.
She was beautiful, with long auburn hair and a slightly freckled face. I was very drawn to her, and we even dated for a while after the group ended, but it was not to be. She had her eye on another guy.
By six, no one had arrived. I felt like a host when no one comes to the party. Maybe they’re fashionably late, I thought to myself. Five past six, still no one.
“Are we in the right room?” Jennifer asked.
“We have to be. This is Havens’s office, and this group has been meeting here since before the last leaders took over, like forever.”
At that, as if beckoned by the ghosts of groups past, three members arrived and took the seats they must have been taking before, as there was no hesitation in their choice of where to sit. Over the next five minutes, the other five members arrived, causing me no end of relief.
The group was kind to Jennifer and me. They introduced themselves and thanked us for picking up where the old leaders had left off. “Don’t worry,” one named Maxwell, a thin bearded man, said. “We’ll give you a nice honeymoon before we start to chew you up.”
“Shut up, Maxwell,” another said. He was named Bernie, and looked like an ex-football player. “You’re gonna scare them off.”
“We’re tame,” said a third member, Francie. She looked as if she had once been utterly beautiful, a bit like Lauren Bacall, but the meds, cigarettes, booze, and years had taken their toll. It’s a look I came to recognize easily and see often, a face’s pentimento. “We’re chronically mentally ill,” Francie continued. “What could be tamer than that? No matter what we do, we don’t know what we’re doing and you have the right to lock us up any time if you want to.”
“That’s not correct,” George piped up. “We have certain unalienable rights.” He said this with great mock pride, clearly ironic. George had the red nose of a drinker, but also dressed very well.
Despina was supportive. “George, you know you always undercut yourself. We do have certain unalienable rights. How are we ever going make progress if we can’t take ourselves seriously?”
“You still think you’re Greek nobility, so it’s easy for you to feel pride,” George replied. “What am I but a chronic drunk with a brutal past and no future?”
Jennifer and I sat a little dumbfounded
as the group took off. I wondered if they did this every week. What did they need us for? Once again, as usual at MMHC, the clinicians needed the patients more than the patients needed the clinicians. I was smart enough not to interrupt the process, and thankful that Jennifer was as well.
“Have you had a bad week, George?” asked Despina. Despina did indeed look like royalty, Greek or otherwise, dressed in a flowing blue gown and bedecked with paste jewelry.
“You could say that. I got laid off. So what else is new? But my boss was a real asshole so I’m just as glad.”
“Fuck him!” Alice jumped in. “It’s not right they just fire you like that. What reason did he give?”
“Thanks,” George said, “but I had it coming. I’m always late. Why does this world make such a big deal about being on time? I hope these leaders aren’t like that.”
Seeing an opening, I asked, “Were the leaders before us sticklers about time?”
“Oh, yes,” George said. “ ‘We start on time. We don’t want to reward lateness,’ they would say. What they didn’t know is that we knew that that line came from Dr. Gutheil, their supervisor, so when they’d say it, we’d say ‘Thanks, Dr. Gutheil.’ They’d get embarrassed and not admit they were stealing his line, but we knew, and they knew we knew.”
“How did you know?” Jennifer asked.
“You’re very pretty,” George said. “Much prettier than the lady you replaced.”
“Don’t talk like that,” said Lucas. “It’s not respectful. Remember, we all agreed that respect is the main rule of the group.” Lucas, who had once been a schoolteacher, still talked and looked the part.
“OK. So are you now the policeman?”
“We’re all the police,” Lucas said. “That’s what we’re trying to learn here, how to police ourselves. I wasn’t putting you down, just reminding you that you agreed, with the rest of us, that being respectful was a good rule to stick to.”
“Why isn’t it respectful to tell her she’s pretty?” George asked.
“It’s not exactly what you say right off the bat to a new leader, but the really disrespectful part was your dissing Dr. Kathy.”
“I didn’t like Dr. Kathy. I never got to tell her that.”
“What held you back from telling her you didn’t like her when she was leading the group?” Jennifer asked.
“I guess I felt intimidated,” George said. “Let’s face it, you guys, the group leaders, the docs, all the people in charge here, you’re on a totally different status level than the patients. In your eyes, we’re inferior beings. In the eyes of the world, we’re inferior beings.”
“That’s not right,” Alice said sharply. “We are not inferior. If we can’t stand up for ourselves, who will?”
“That’s why we’re here, to help each other do that, out in the world,” Lucas said. “It begins here, then we take it outside. But we gotta respect each other in here.”
Francie started to cry, and Despina offered her a box of Kleenex—Kleenex was always in great demand at MMHC.
“What’s wrong, Francie?” Alice asked.
“It’s just so hard,” Francie said. “Everything you say is so right, Alice, but what George said is right, too. The world really is against us. It is so hard out there. I don’t know why I even get up in the morning. I get a little bit of hope and try to make myself look presentable, even look pretty, like I used to be, you know, like I don’t have a mental illness, but I just can’t do it. I don’t know how to do it anymore, I lost that somewhere, I used to be a normal person, a normal woman, a pretty woman, if you can believe that. And when I get up, if I don’t think twice, I can actually imagine I am that person that I used to be. But then I start to try and make myself look like her and I just don’t know how to anymore. That face is gone, even though I can almost see it in the mirror. But I know when I finish dressing and putting on makeup, I know the world can still tell I’m a crazy. I walk out the door and say to myself, ‘Hold your head up high, Francie, just like Mom told you to do, just like she always did no matter what.’ And she’d tell me, ‘Always remember you have dignity, and no one can take that from you except you.’ I give myself this pep talk as I walk out the door, and then the first person who walks past me gives me that horrible, horrible second look, and I feel it like a slap in the face, all my dignity goes to hell and I know I’m just a piece of garbage, like where do you get off, Francie, you’re just a total nobody, a piece of garbage. Living like this, it’s just so hard.”
“Oh, shut up, Francie,” said Maxwell. “Stop being a crybaby.”
“She’s not being a crybaby,” George spoke up. “She’s speaking for every single one of us in this room, including you, Maxwell. Maybe not the leaders, but all of the rest of us feel that way.”
“Don’t think we don’t have our moments of feeling pretty shitty,” I said.
“But, Doc,” George said, “look at you, and look at Lady Doc over there—”
“I’m not a doctor,” Jennifer corrected. “I’m an occupational therapist.”
“Whatever,” George said, “you’re on one level, you and Doc here, and us in the group, we’re on the garbage heap, like Francie said.”
“I am not on a garbage heap!” Despina stated indignantly.
“Don’t you tell me what to say,” Maxwell interjected.
“Oh, stop it, Maxwell,” George replied. “We all know you can’t stand to be sad, so you try to turn sad moments into fights. You’ve been with us long enough, we’re wise to your tricks.”
“Fuck you.”
“Back atcha,” George replied with a smile.
“You all know each other pretty well,” I said.
“We do, we do,” George said. “But we don’t know you and Princess Grace over there.”
“You’ll get to know us,” I said. “But don’t you think we should stick with what Francie was saying? All of you live out in the world, and you’ve learned how to live with what you have, but it’s hard.”
George responded. “Thanks for the support, Doc. But you couldn’t possibly know what it’s like to be one of us. Have you ever suffered from, let’s say, manic depressive illness? Or had anyone close to you come down with that? Have you seen your family ruined, like Despina has? She used to be like a queen in Greece, then it fell apart because her family went nuts. I know you’re trying to help us, Doc, but how can you possibly understand what Francie feels when she’s getting dressed in the morning to go out into the world?”
61.
Havens looked like Jack Paar, the first host of The Tonight Show. Handsome, trim, an avid tennis player (I don’t know why, but many psychoanalysts love tennis). He was also at heart a humanist. He quoted literature all the time. Joseph Conrad was one of his favorites.
I never got to know him well. Not many people did. He allowed me to develop a personal relationship with him at the distance he felt comfortable with. My hunch is that he sensed how needy I was (am), and so he kept a distance lest he be asked to give more than he wanted to or could.
Back when I was a first-year resident, one of Les’s sons died. Even though I didn’t know Les well, I’d read his classic book, Approaches to the Mind, and already revered him, so I sent a note of sympathy. To my surprise, he wrote back a kind note of gratitude, even though we’d never met.
You could say that note sealed the deal for me. I felt a bond with Les ever after. I was hardly alone. Many people felt they had a special bond with Les even though they spent almost no time with him one on one. He noticed the little things. Walking through the corridors of MMHC, for example, when he and I would pass each other, he always said, “There he is.”
There he is. How to take a puny little resident and make him feel like he’s on top of the world. He did this so naturally and with so many people. Was it manipulation? No, I don’t think so. It was empathy. Les knew we residents were starved for recognition. In three simple words he gave me that, many times.
He liked to supervise residents in group
s rather than individually, and he often talked with us about the history of MMHC and the field. “The Viennese took over psychoanalysis in Boston faster than the British dispersed the Indians. The embodiment of all they stood for you could see in Grete Bibring. She was a brilliant woman, a graduate of Harvard Medical School and a top student there. I knew her well because she supervised one of my cases at the Institute for four years. She and her tribe—the classical Viennese analysts—held Boston in a stranglehold for years—feeling they had to protect their leader, Sigmund Freud, at all costs.”
Havens had an animated, engaging way of speaking, even to a small group like the three of us he supervised. “They were right to do so, no doubt, because without their strict authority cowing everyone into submission, people might notice the great king was missing some clothes.
“The kind of analysis and training Grete Bibring insisted upon could be summed up in a story she told on herself,” Havens said to us. “She recounted that one day her little daughter said, ‘Mommy, my friend says her mother is like a soft, fluffy doll.’ But then Bibring’s daughter pointed to a porcelain figurine standing on a table across the room, beautifully painted but hard and metallic. ‘Mommy, you’re more like that.’ ‘And it’s true,’ Bibring said. ‘I am more like that. That is how an analyst ought to be.’ ”
I asked, “Grete Bibring actually told that story on herself? Like she was proud of it?”
“Yes,” Les said. “The Austrian contingent felt a deep loyalty to their leader, and what they perceived to be the method Freud recommended. If you wanted to get ahead in this town, you had to go to the Institute and do it their way. The development of emotion in conducting a psychoanalysis took a back seat to clarification, interpretation, and intellectualization. It was all about being smart.”
Les stretched his arms, rubbed his shoulders, put his feet up on his desk, and leaned back in his swivel chair. “And then we had Elvin,” he said with a smile. “Elvin put emotion first. He would say, ‘If you have to tell somebody something, it’s already too late.’
Because I Come from a Crazy Family Page 27