Contrapuntal views are essential, as I learned in my psychiatric training and in my first few years of practice. After my residency I made arrangements to obtain supervision on my most difficult cases from a controversial, older colleague. He was a brilliant man, a wunderkind who had graduated from high school at fifteen and Harvard at nineteen, a veritable Doogie Howser of his generation. Now in his fifties and in the twilight of his career, he was delighted to share his knowledge and insights with me, and he also invited me to assist him in leading psychotherapy groups. A wonderful opportunity for me since it allowed me to solidify my identity as a psychiatrist early in my career, and it allowed me to see in the flesh how a seasoned professional dealt with the most troubling psychiatric crises in real time—not just in supervision a few days later, ex post facto, in hindsight.
What also made this experience a special treat was the fact that this psychiatrist was more than a bit loony, but he came by it honestly. “Listen, Paul,” he told me, “anyone who has a particular kind of intelligence that is at least two standard deviations above the norm has a capacity that sets him apart from virtually everyone else. In a sense I am like a frog who can see in color, whereas all the other frogs can only see in black and white. It can leave me with unusual perceptions and insights that others cannot understand, and it can leave me feeling different and alienated.”
Not unlike the Wang sisters in China, he could see things that other mere mortals could not see.
Adding to this unique worldview was an alienation spawned by his childhood experiences. “My mother was incredibly crazy and erratic. I couldn’t trust anything she said or did, and I couldn’t wait to get away from the Midwest and head to college. My experiences with my mother, though, have given me a very healthy distrust of authority.
“Look at Three Mile Island a few years ago. We here in Washington were only a hundred miles from the reactor. I refused to believe anything that was coming out of the mouths of the ‘authorities.’ To my mind all they wanted to do was avoid any mass panic. I got on the first plane I could find and headed out to Minnesota to visit a long-lost cousin.” He returned only when he could determine on his own that the Potomac coast was clear.
He continued, “if and when we do have a true nuclear disaster, I’ll be one of the few survivors while the rest of you guys go through your normal wishful thinking. You’ll assume that the pronouncements from the White House and the rest of the government are accurate.”
Unfortunately because of his distrust of others, this psychiatrist was unable to forge meaningful long-term relationships. His pessimism and distrust and excessive self-reliance were an unmitigated detriment to survival, except under the most extreme circumstances. But he was a perfect sentinel. He had a perspective that needed to be heard, a perspective that provided a crucial counterpoint to our optimism bias, to our Pollyanna-ish worldview.
This brilliant yet daft psychiatrist taught me that a steadying hand can come from even the loopiest of sources. Just to have another perspective, a perspective that is reasonably objective and detached—though not too detached—is essential in providing a stabilizing presence in our lives. This perspective—a realistic pessimism to our excessive optimism, or vice versa—can curb our unknowing excesses. This kind of sentinel can question our headlong jumps into oxygen-depleted coal mines, and our solipsistic ruminations that have grown more fervent and bizarre with each passing day of isolation caused by illness. So what if the therapist is a flawed human being like ourselves? So what if the therapist has his own struggles and problems? Who among us does not have something overwhelming to deal with? Each of us is loopy and flawed in our own peculiar idiosyncratic ways. Should these flaws disqualify us from being able to help others overcome their flaws and wounds and diseases? There’s a crack, a crack in everything; that’s how the light gets in.
The healing powers may flow, not through those who have known only health, but through those who have been ill and been drawn to near death—and have then recovered. The wounded healer, from Aesculapius to Jesus.
The myth and the archetype: Aescalapius, according to Greek mythology, was plucked from death as a premature infant by his father Apollo after Apollo had killed the infant’s mother for infidelity. As an adult Aescalapius became a master of the mysteries of illness and healing, of death and life. And his three daughters, Iaso, Panacea, and Hygeia became significant figures in the myths of healing as well. Their names live on in English words like “iatrogenic,” “panacea,” and “hygiene.”
The life and after-death of Jesus followed the same trajectory as the archetypal wounded healer—death followed by a descent into the underworld, followed by a restoration to a heavenly position of healing the sick and distraught.
Not everyone who has recovered from a life-threatening illness becomes a wounded healer. Only some people, according to the myths and archetypes, are “chosen” by the gods to be healers. They are “destined” for illness so that through their illness and recovery they might be able to function as healers to a desperate and troubled mankind. That notion of a chosen people, again.
In more primitive cultures the shamanistic traditions reflect the invariable exposure that the shaman has had to the night-side of life. These experiences with a deadly or debilitating illness followed by recovery allow a person to bear witness to the mysteries and essences of life.
Men and women who have not gone through any significant reconciliation and transformation after a brush with a deadly illness—and those who have been fortunate enough to have no exposure to major illness or injury—can still be decent healers and doctors. They can follow the protocols and the appropriate algorithms, and provide not an insignificant benefit to their patients.
Some healers, though, can be special. Take the case of Bill W. and Dr. Bob, the cofounders of Alcoholics Anonymous (A.A.) in the 1930s. The ultimate wounded healers, these guys barely snatched themselves from death and then transformed themselves through their restoration to health.
As Dr. Bob said of Bill W., “He gave me information about the subject of alcoholism which was undoubtedly helpful. Of far more importance was the fact that he was the first living human with whom I had ever talked, who knew what he was talking about in regard to alcoholism from actual experience. In other words, he talked my language.” Ah, the simple wisdom of A.A. How did these two guys, a broken-down broker and a potted proctologist pull these ideas out of their butts? Just as youth is wasted on the young, A.A. may be wasted on alcoholics.
How did these guys recognize the ultimate paradox of life—that we only gain some semblance of control in our lives when we admit we have absolutely no control? A modest variation of Step One tells us, “We have admitted we are powerless over our pasts and our past traumas, that our lives have become unmanageable.” To emphasize this remarkable paradox, Bill W. goes on to say, “We shall find no enduring strength until we first admit complete defeat.”
Take some of the traditions from the Twelve Traditions and Twelve Steps of Alcoholics Anonymous:
Tradition Two: Our leaders are but trusted servants; they do not govern.
Tradition Six: An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
Tradition Seven: Every A.A. group ought to be fully self-supporting, declining outside contributions.
In these few sentences these two guys and their collaborators wiped out money and greed and pride and power and pathological narcissism—often the driving forces behind the destructiveness of human groups. Our one and only goal, they noted, is for members of A.A. to achieve sobriety—without any diverting and distracting forces.
When one adds in the efforts at making a “searching and fearless moral inventory,” efforts at making “amends” to all those “we have harmed,” and efforts at an altruistic “carrying” of “this message” to other fellow alcoholics, one realizes that he is in the
midst of a healing brilliance. Not a literary brilliance by any means—check out Philip Roth’s Sabbath’s Theater to see a critique of the miserable literary quality—but an unusual intelligence that is as rare as that of the Wang sisters.
Their language and the program work. George Vaillant has shown that A.A. works 100 percent of the time, but slightly less than 20 percent of alcoholics avail themselves of the program in a committed way. No one with a drinking problem wants to stop drinking; with the help of alcohol, they feel no pain. All the pain is felt by spouses and partners and friends and family.
Bill W. and Dr. Bob—two schlumps who were pedestrian drunks, guys that most of us would step right over if we happened upon them at the local bus station. Hardly legendary, hardly the stuff of “Bill W. and Dr. Bob Superstars.” Yet their transformation is worthy of the best transformations in all of literature. And their wounded healing is more real, less illusory and mythic, than the healing of Aescalapius and Jesus. A true life resurrection for Bill W. and Dr. Bob—and a true life resurrection for anyone who commits to the program.
The two greatest healers of the twentieth century. Contrast them with some of the twentieth-century Nobel prizewinners in Medicine or Physiology. The guy who invented the prefrontal lobotomy? How about the inventor of an alleged treatment for syphilis, by infecting the syphilitic patient with malaria? Wounded wounding, not wounded healing.
So, if we cannot trust our judgments about whom we choose as gods, if we cannot trust our judgments about who are the genuine healers in the medical sciences, how the hell can we trust our judgment in choosing a therapist?
All we can do is base it on the “fit”—our comfort level with that therapist and the confidence level we have in that therapist. Or, as Dr. Bob said, does the therapist “talk my language”?
All we can do is acknowledge our own significant flaws in judgment and the significant flaws in any and all therapists. Just as in the way we choose a god, we are all too likely to choose a punitive therapist if we have grown up with punitive parenting, or too detached and analytic a therapist if we have grown up with detached parenting.
Here in my hospital bed, four days after surgery in October 1984, I was realizing I needed someone, anyone—beyond my friends and family—to provide palpable therapeutic support and encouragement for my near-impossible medical mess. A psychiatric friend back in Washington, DC recognized my predicament and called the head of consultation-liaison psychiatry at the hospital I was in to come see me.
A kindly older man, the consultation-liaison psychiatrist got right to the point, knowing that he was speaking to a fellow psychiatrist. “Are you clinically depressed?” he asked bluntly after some initial pleasantries.
“Depression is not the right word for it,” I muttered. “Try despair. In the past eighteen hours since my conversation with the radiation-oncologist, even the best Chinese food brought in by my family and friends disgusts me. I cannot eat anything; I can barely sleep. All I can think about is the very recent mutilation of my pelvis and genital region with surgery. And all I can look forward to is the upcoming burning of my prostate bed through radiation—followed then by a likely death within five years, delayed only briefly and temporarily by castration. It’s not a sunny scenario.
“How the hell will I ever be able to keep a morsel of food down ever again?” I added, with a few other expletives appended for good measure.
The psychiatrist was amiable and supportive; he provided a reasonable counterpoint to my despair and urged me to get some treatment upon my return to Washington, DC. I had already beaten him to the punch. I had called my colleague who was well-versed in the Simonton approach, to empower me in dealing with this cancer. And I called around to other colleagues to help me figure out who might be a good fit, as a plain old therapist or psychiatrist, in providing a steadying hand in my facing this cancer.
Over the years the psychiatrist whom I consulted with in Washington, DC has continued to be a genuine stabilizing and motivating presence in my life. Sure, he is a flawed mere mortal, but that mere mortalness beats a flawless, otherworldly, and illusory god any time. He has been a good fit; and, unlike the gods, he has been seeable and knowable. And he counterbalances my flawed projections and illusions, my faulty hopes and yearnings even though he, no doubt, has had his own counterprojections and illusions.
So, why did Anthony Sattilaro, in his otherwise inspiring book about his prostate cancer, not make any reference to his psychotherapy, his “analysis”—a therapy which, he acknowledged to me over the phone, had been crucial to his emotional survival after castration? Shame and stigma can be hopelessly powerful forces.
The wisdom of A.A.: “We are not responsible for our illness, but we are responsible for getting help for that illness.” No self-blame, no shame, no guilt. No rational reason for us to feel we are being weak and self-indulgent in getting help. We are not being whiners and complainers; we are not wimping out. If our body has been ravaged, our mind will be ravaged. If our mind has been ravaged, it will have an effect on the viability of our body.
No need for the Cartesian mind-body dichotomy. The roots of the tree—its brains—are fully and intimately connected to the trunk and the branches and the crown and the canopy. No need for excessive and faulty self-reliance that reinforces our tendency to stay away from “shrinks.” Genuine self-reliance—not the kind fostered by stereotypes of Horatio Alger and the Wild West—recognizes the human need to turn to others whenever life’s forces overwhelm us. We cannot always pick ourselves up by the bootstraps.
Here transference again plays a role. If we have grown up with parents or others who could not help us, how can we ever assume that some veritable stranger can actually help us? Ironically, the people who are the least jaded end up receiving many of the benefits of psychotherapy, whereas the most untrusting and the most troubled human beings steer clear of the psychiatrist’s consulting room.
We are all hurtling through space on a planet on which we have never lived before. It is all new to us. We cannot do it alone.
Yes, it takes a village to deal with and manage prostate cancer, and psychotherapy indeed has been a critical part of my earthly village.
If, in the wisdom of A.A., we are only as sick as our secrets, let me sing from the highest mountaintop, from the highest steeple: I would not be alive today; I would not have my testicles today if I had not gotten myself into psychotherapy.
CHAPTER 16
A Clichéd Deliverance
“We are all born for love . . . It is the principle of existence and its only end.”
Benjamin Disraeli, Sybil
“There is no fear in love; but perfect love casteth out fear.”
I John IV.18
“He who for love hath undergone
The worst that can befall,
Is happier thousandfold than one
Who never loved at all.”
Richard Monckton Milnes, “To Myrzha”
“Love—a grave mental disease.”
Plato
Time to sashay with a cliché. Yes, as Jorge Louis Borges has pointed out, the best metaphors are clichéd dead metaphors. Time is a river; life is a dream. And love and marriage are a union between hands and hearts.
Many writers focus on flings, brief passionate affairs, even one-night stands—unions that have not become tired and boring over time. Passion is exotic, a last tango in Paris. Grounding and stability are pedestrian and quotidian, a never-ending waltz in Topeka.
Yet how exciting is it to find a love that does not alter “when it alteration finds” as Shakespeare wrote! How exciting is it to find a partner who tackles the alterations created by prostate cancer in a marriage! How exciting is it to follow the clichés of marriage, to sustain a love through better or worse, through sickness and in health—not said just in a wedding ceremony but in the course of four decades! How exciting is it to maintain and share passions in some new and startling ways!
Is it possible to get this excitement across w
ithout exclamation points?
Enough of infatuations and flings and orgies. Enough of opera plots and so-called serious literature—none of it containing long-standing true love. Hell, in operas the love barely gets consummated. The star-crossed lover or lovers die at the end before any true relationship is realized; then the fat lady sings. Enough of the time of his or her time, the human stain going every which way, the fling that culminates in divorce and misery. Yes, all a prominent part of life—but let’s see the other part: the marriage vows and marriage clichés that culminate in ongoing passion combined with a real grounding and stability.
Ups and downs to be sure, profound adjustments to be sure, passions and grounding that come and go, go and come, to be sure.
Singer-songwriters can get away with clichés. The music dilutes the clichéd wordings and allows the songs to sound more profound and idiosyncratic and exotic than they really are. But can I as a prostate cancer sufferer get away with these same clichés?
Our favorite novelists have hardly been role models for loving and long-standing relationships. Passions sell—not grounding and stability.
But clichés are valuable and real and truthful. That’s why they are clichés, expressing a real human sentiment that has a universality, a relevance, a meaning for much of humanity.
So many stars have to be perfectly aligned for a long-term relationship and marriage to work—especially under intense crises. Three elements, besides luck, pulse through any ongoing relationship—desire and vulnerability and bravery. How we muster and manage all three is crucial. And when prostate cancer strikes thirteen years into a marriage, the equilibrium in those desires, in that vulnerability, in that bravery, gets smashed.
So, hats off to Helen. She has managed her desire even in the face of my months-long periods of lack of desire. What bravery—leaving herself vulnerable with me, her partner, in so many ways. In a long-standing relationship we let ourselves go, we open ourselves more fully to our partner, we put ourselves at risk for losing ourselves and losing our sense of identity. Our boundaries become more fluid as we focus on not just pleasing ourselves but also pleasing our partner. We run the risk of being swallowed up; we have put all our eggs into one basket. We become super vulnerable to losing that partner, to abandonment, especially in the face of a sex-destroying illness. No hedging our bets—so, bravery is essential. No lily-white pure Madonna partitioned off from the immodest whore—or the male equivalents, the paterfamilias partitioned off from the bad boy, the roguish gigolo, the lothario. A synthesis of the two that requires real bravery.
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