by Irvin Yalom
One afternoon he tried to attain some sense of mastery by reading the melanoma literature in the medical school library, but that proved futile. Worse than futile—it made things more horrendous. As Julius apprehended the truly ghastly nature of his disease, he began to think of melanoma as a voracious creature sinking ebony tendrils deep into his flesh. How startling it was to realize that suddenly he was no longer the supreme life form. Instead he was a host; he was nourishment, food for a fitter organism whose gobbling cells divided at a dizzying pace, an organism that blitzkrieged and annexed adjacent protoplasm and was now undoubtedly outfitting clusters of cells for cruises into the bloodstream and colonization of distant organs, perhaps the sweet friable feeding grounds of his liver or the spongy grassy meadows of his lungs.
Julius put aside the reading. Over a week had gone by, and it was time to move past distraction. The hour had come to face what was really happening. Sit down, Julius, he told himself. Sit down and meditate upon dying. He closed his eyes.
So death, he thought, has finally made its appearance on stage. But what a banal entrance—the curtains jerked open by a roly-poly dermatologist with a cucumber nose, magnifying glass in hand, and costumed in white hospital coat with his name stitched in dark blue letters upon his upper breast pocket.
And the closing scene? Destined, most likely, to be equally banal. His costume would be his wrinkled pinstriped New York Yankees night-shirt with DiMaggio’s number 5 on the back. The stage set? The same queen-sized bed in which he had slept for thirty years, crumpled clothes on the chair beside the bed and, upon his bedside table, a stack of unread novels unaware that their time would now never come. A whim-pering, disappointing finale. Surely, Julius thought, the glorious adventure of his life deserved something more…more…more what?
A scene he had witnessed a few months ago on a Hawaiian vacation came to mind. While hiking he had quite by chance come upon a large Buddhist retreat center and saw a young woman walking though a circular labyrinth, constructed of small lava stones. Reaching the center of the labyrinth she stopped and remained motionless in a lengthy standing meditation. Julius’s knee-jerk reaction to such religious ritual was not charitable, generally falling somewhere in the territory between ridicule and revulsion.
But, now, as he thought about that meditating young woman, he experienced softer feelings—a flood of compassion for her and for all his fellow humans who are victims of that freakish twist of evolution that grants self-awareness but not the requisite psychological equipment to deal with the pain of transient existence. And so throughout the years, the centuries, the millennia, we have relentlessly constructed makeshift denials of finiteness. Would we, would any of us, ever be done with our search for a higher power with whom we can merge and exist forever, for God-given instruction manuals, for some sign of a larger established design, for ritual and ceremony?
And yet, considering his name on death’s roster, Julius wondered whether a little ceremony might not be such a bad thing. He jerked away from his own thought as if scorched—so thoroughly dissonant was it with his lifelong antagonism to ritual. He had always despised the tools by which religions strip their followers of reason and freedom: the ceremonial robes, incense, holy books, mesmerizing Gregorian chants, prayer wheels, prayer rugs, shawls and skullcaps, bishop’s miters and crosiers, holy wafers and wines, last rites, heads bobbing and bodies swaying to ancient chants—all of which he considered the paraphernalia of the most powerful and longest-running con game in history, a game which empowered the leaders and satisfied the congregation’s lust for submission.
But now, with death standing next to him, Julius noted that his vehemence had lost its bite. Maybe it was simply imposed ritual he disliked. Perhaps a good word could be found for a little personal creative ceremony. He was touched by the newspaper descriptions of the firemen at ground zero in New York, stopping, standing, and removing hats to honor the dead as each pallet of newly discovered remains was brought to the surface. Nothing wrong with honoring the dead…no, not the dead, but honoring the life of the one who died. Or was it something more than honoring, more than sanctifying? Wasn’t the gesture, the ritual of the firemen, also signifying connectivity? The recognition of their relationship, their unity with each victim?
Julius had a personal taste of connectivity a few days after his fateful meeting with his dermatologist when he attended his support group of fellow psychotherapists. His fellow doctors were stunned when Julius revealed the news of his melanoma. After encouraging him to talk himself out, each group member expressed his shock and sorrow. Julius couldn’t find any more words, nor could anyone else. A couple of times someone started to talk but did not, and then it was as if the group agreed nonverbally that words were not necessary. For the final twenty minutes all sat in silence. Such prolonged silences in groups are almost invariably awkward, but this one felt different, almost comforting. Julius was embarrassed to admit, even to himself, that the silence felt “sacred.” Later it occurred to him that the members not only were expressing grief but were also removing their hats, standing at attention, joining and honoring his life.
And perhaps this was a way of honoring their own lives, Julius thought. What else do we have? What else other than this miraculous blessed interval of being and self-awareness? If anything is to be honored and blessed, it should simply be this—the priceless gift of sheer existence. To live in despair because life is finite or because life has no higher purpose or embedded design is crass ingratitude. To dream up an omniscient creator and devote our life to endless genuflection seems pointless. And wasteful, too: why squander all that love on a phantasm when there seems too little love to go around on Earth as it is? Better to embrace Spinoza’s and Einstein’s solution: simply bow one’s head, tip one’s hat to the elegant laws and mystery of nature, and go about the business of living.
These were not new thoughts for Julius—he had always known of finiteness and the evanescence of consciousness. But there is knowing and knowing. And death’s presence on the stage brought him closer to really knowing. It was not that he had grown wiser: it was only that the removal of distractions—ambition, sexual passion, money, prestige, applause, popularity—offered a purer vision. Wasn’t such detachment the Buddha’s truth? Perhaps so, but he preferred the path of the Greeks: everything in moderation. Too much of life’s show is missed if we never take off our coats and join in the fun. Why rush to the exit door before closing time?
After a few days, when Julius felt calmer with fewer sweeps of panic, his thoughts turned to the future. “One good year” Bob King had said, “no guarantees, but it would not be unreasonable to hope for at least a year of good health.” But how to spend that year? One thing he resolved was not to make that one good year a bad year by grieving that it was not more than a year.
One night, unable to sleep and craving some comfort, he restlessly browsed in his library. He could find nothing written in his own field that seemed even remotely relevant to his life situation, nothing pertaining to how should one live, or find meaning in one’s remaining days. But then his eye fell upon a dog-eared copy of Nietzsche’s Thus Spake Zarathustra. Julius knew this book well: decades ago he had thoroughly studied it while writing an article on the significant but unacknowledged influence of Nietzsche on Freud. Zarathustra was a brave book which more than any other, Julius thought, teaches how to revere and celebrate life. Yes, this might be the ticket. Too anxious to read systematically, he flipped the pages randomly and sampled some of the lines he had highlighted.
“To change ‘it was’ into ‘thus I willed it’—that alone shall I call redemption.”
Julius understood Nietzsche’s words to mean that he had to choose his life—he had to live it rather than be lived by it. In other words he should love his destiny. And above all there was Zarathustra’s oft-repeated question whether we would be willing to repeat the precise life we have lived again and again throughout eternity. A curious thought experiment—yet, the more he thought
about it, the more guidance it provided: Nietzsche’s message to us was to live life in such a way that we would be willing to repeat the same life eternally.
He continued flipping the pages and stopped at two passages highlighted heavily in neon pink: “Consummate your life.” “Die at the right time.”
These hit home. Live your life to the fullest; and then, and only then, die. Don’t leave any unlived life behind. Julius often likened Nietzsche’s words to a Rorschach exam; they offered so many opposing viewpoints that the readers’ state of mind determined what they took from them. Now he read with a vastly different state of mind. The presence of death prompted a different and more enlightened reading: in page after page, he saw evidence of a pantheistic connectedness not previously appreciated. However much Zarathustra extolled, even glorified solitude, however much he required isolation in order to give birth to great thoughts, he was nonetheless committed to loving and lifting others, to helping others perfect and transcend themselves, to sharing his ripeness. Sharing his ripeness—that hit home.
Returning Zarathustra to its resting place, Julius sat in the dark staring at the lights of cars crossing the Golden Gate Bridge and thinking about Nietzsche’s words. After a few minutes Julius “came to”: he knew exactly what to do and how to spend his final year. He would live just the way he had lived the previous year—and the year before that and before that. He loved being a therapist; he loved connecting to others and helping to bring something to life in them. Maybe his work was sublimation for his lost connection to his wife; maybe he needed the applause, the affirmation and gratitude of those he helped. Even so, even if dark motives played their role, he was grateful for his work. God bless it!
Strolling over to his wall of file cabinets, Julius opened a drawer filled with charts and audiotaped sessions of patients seen long ago. He stared at the names—each chart a monument to a poignant human drama that had once played itself out in this very room. As he surfed through the charts, most of the faces immediately sprang to mind. Others had faded, but a few paragraphs of notes evoked their faces, too. A few were the truly forgotten, their faces and stories lost forever.
Like most therapists, Julius found it difficult to seal himself off from the unremitting attacks on the field of therapy. Assault came from many directions: from pharmaceutical companies and managed care, which sponsored superficial research orchestrated to validate the effectiveness of drugs and briefer therapies; from the media, which never tired of ridiculing therapists; from behaviorists; from motivational speakers; from the hordes of new age healers and cults all competing for the hearts and minds of the troubled. And, of course, there were doubts from within: the extraordinary molecular neurobiological discoveries reported with ever-increasing frequency caused even the most experienced therapists to wonder about the relevance of their work.
Julius was not immune to these attacks and often entertained doubts about the effectiveness of his therapy and just as often soothed and reassured himself. Of course he was an effective healer. Of course he offered something valuable to most, perhaps even all, of his patients.
Yet the imp of doubt continued to made its presence known: Were you really, truly, helpful to your patients? Maybe you’ve just learned to pick patients who were going to improve on their own anyway.
No. Wrong! Wasn’t I the one who always took on great challenges?
Huh, you’ve got your limits! When was the last time you really stretched yourself—took a flagrant borderline into therapy? Or a seriously impaired schizophrenic or a bipolar patient?
Continuing to thumb through old charts, Julius was surprised to see how much posttherapy information he had—from occasional follow-up or “tune-up” visits, from chance encounters with the patient, or from messages delivered by new patients they had referred to him. But, still, had he made an enduring difference to them? Maybe his results were evanescent. Maybe many of his successful patients had relapsed and shielded that information from him out of sheer charity.
He noted his failures, too—folks, he had always told himself, who were not ready for his advanced brand of deliverance. Wait, he told himself, give yourself a break, Julius. How do you know they were really failures? permanent failures? You never saw them again. We all know there are plenty of late bloomers out there.
His eye fell upon Philip Slate’s thick chart. You want failure? he said to himself. There was failure. Old-time major-league failure. Philip Slate. More than twenty years had passed, but his image of Philip Slate was crisp. His light brown hair combed straight back, his thin graceful nose, those high cheekbones that suggested nobility, and those crisp green eyes that reminded him of Caribbean waters. He remembered how much he disliked everything about his sessions with Philip. Except for one thing: the pleasure of looking at that face.
Philip Slate was so alienated from himself that he never thought to look within, preferring to skate on the surface of life and devote all his vital energy to fornication. Thanks to his pretty face, he had no end of volunteers. Julius shook his head as he rifled through Philip’s chart—three years of sessions, all that relating and support and caring, all those interpretations without a whisper of progress. Amazing! Perhaps he wasn’t the therapist he thought he was.
Whoa, don’t jump to conclusions, he told himself. Why would Philip continue for three years if he had gotten nothing? Why would he continue to spend all that money for nothing? And God knows Philip hated to spend money. Maybe those sessions had changed Philip. Maybe he was a late bloomer—one of those patients who needed time to digest the nourishment given by the therapist, one of those who stored up some of the therapist’s good stuff, took it home, like a bone, to gnaw on later, in private. Julius had known patients so competitive that they hid their improvement just because they didn’t want to give the therapist the satisfaction (and the power) of having helped them.
Now that Philip Slate entered his mind, Julius could not get him out. He had burrowed in and taken root. Just like the melanoma. His failure with Philip became a symbol embodying all his failures in therapy. There was something peculiar about the case of Philip Slate. From where had it drawn all that power? Julius opened his chart and read his first note written twenty-five years before.
PHILIP SLATE—Dec. 11, 1980
26 yr old single white male chemist working for DuPont—develops new pesticides—strikingly handsome, carelessly dressed but has a regal air, formal, sits stiffly with little movement, no expression of feelings, serious, absence of any humor, not a smile or grin, strictly business, no social skills whatsoever. Referred by his internist, Dr. Wood.
CHIEF COMPLAINT: “I am driven against my will by sexual impulses.”
Why now? “Last straw” episode a week ago which he described as though by rote.
I arrived by plane in Chicago for a professional meeting, got off the plane, and charged to the nearest phone and went down my list of women in Chicago looking for a sexual liaison that evening. No luck! They were all busy. Of course they were busy: it was a Friday evening. I knew I was coming to Chicago; I could have phoned them days, even weeks earlier. Then, after calling the last number in my book, I hung up the phone and said to myself, “Thank God, now I can read and get a good night’s sleep, which is what I really wanted to do all along.”
Patient says that phrase, that paradox—“which is what I really wanted to do all along”—haunted him all week and is the specific impetus for seeking therapy. “That’s what I want to focus on in therapy,” he says. “If that is what I want—to read and to get a good night’s sleep—Dr. Hertzfeld, tell me—why can’t I, why don’t I, do it?”
Slowly more details of his work with Philip Slate coasted into mind. Philip had intellectually intrigued him. At the time of their first meeting he had been working on a paper on psychotherapy and the will, and Philip’s question—why can’t I do what I truly want to do?—was a fascinating beginning for the article. And, most of all, he recalled Philip’s extraordinary immutability: after three years he
seemed entirely untouched and unchanged—and as sexually driven as ever.
Whatever became of Philip Slate? Not one word from him since he abruptly bailed out of therapy twenty-two years ago. Again Julius wondered whether, without knowing it, he had been helpful to Philip. Suddenly, he had to know; it seemed a matter of life and death. He reached for the phone and dialed 411.
2
* * *
Ecstasy in the act of copulation. That is it! That is the true essence and core of all things, the goal and purpose of all existence.
* * *
“Hello, is this Philip Slate?”
“Yes, Philip Slate, here.”
“Dr. Hertzfeld here. Julius Hertzfeld.”
“Julius Hertzfeld?”
“A voice from your past.”
“The deep past. The Pleistocene past. Julius Hertzfeld. I can’t believe it—it must be what?…at least twenty years. And why this call?”
“Well, Philip, I’m calling about your bill. I don’t believe you paid in full for our last session.”
“What? The last session? But I’m sure…”
“Just kidding, Philip. Sorry, some things never change—the old man is still jaunty and irrepressible. I’ll be serious. Here, in a nutshell, is why I’m calling. I’m having some health problems, and I’m contemplating retirement. In the course of making this decision I’ve developed an irresistible urge to meet with some of my ex-patients—just to do some follow-ups, to satisfy my own curiosity. I’ll explain more later if you wish. Soooo—here’s my question to you: would you be willing to meet with me? Have a talk for an hour? Review our therapy together and fill me in on what’s happened to you? It’ll be interesting and enlightening for me. Who knows?—maybe for you as well.”