“Marge is a creep. You know she’s a creep. How can you stand to be with her? A creep! A creep!” And then, in the most astounding theatrical performance I have ever seen, she proceeded to imitate Marge. Every gesture I had witnessed over the months, Marge’s every grimace, every action, passed in front of me in chronological order. There was Marge timidly meeting me for the first time. There she was curled up in the corner of my office. And there with large, panic-filled eyes, pleading with me not to give up on her. There she was in an autotrance, eyes closed, flickering eyelids covering frenetic REM-like activity. And there with her face in spasm, like Quasimodo’s, horribly distorted, barely able to talk. There she was cowering behind her chair as Marge was wont to do when frightened. There she was complaining melodramatically and mockingly of a dreadful stabbing pain in her womb and breast. There she was ridiculing Marge’s stutter and some of her most familiar comments. “I’m soooooooo g-g-g-g-glad you’re my psychiatrist!” On bended knee: “D-d-d-o-o-o you like me, D-D-D-Doctor Yalom? D-d-d-don’t leave m-m-m-me, I d-d-d-d-d-disappear when you’re not here.”
The performance was extraordinary: like watching the curtain call of an actress who has played several roles in an evening and amuses the audience by briefly, perhaps for just a few seconds, slipping back into each of them. (I forgot for a moment that in this theater the actress was not really the actress but only one of the roles. The real actress, the responsible consciousness, remained concealed backstage.)
It was a virtuoso performance. But also an unspeakably cruel performance by “Me” (I didn’t know what else to call her). Her eyes blazed as she continued to defile Marge who, she said, was incurable, hopeless, and pathetic. Marge, “Me” said, should write her autobiography and entitle it (here she began to chuckle) “Born to Be Pathetic.”
“Born to Be Pathetic.” I smiled despite myself. This Belle Dame sans Merci was a formidable woman. I felt disloyal to Marge for finding her rival so attractive, for being so bemused by her mimicry of Marge.
Suddenly—presto!—it was over. “Me” closed her eyes for a minute or two and, when she opened them, she had vanished and Marge was back, crying and terrified. She put her head between her knees, breathed deeply, and slowly regained her composure. For several minutes she sobbed and then finally talked about what had happened. (She had good recall of the scene that had just occurred.) She had never before split off—oh yes, there had been one time, a third personality named Ruth Anne—but the woman who came today had never appeared before.
I felt bewildered by what had happened. My one basic rule—”Treat Marge as an equal”—was no longer sufficient. Which Marge? The whimpering Marge in front of me or the sexy, insouciant Marge? It seemed to me that the important consideration was my relationship with my patient—the betweenness (one of Buber’s endless store of awkward phrases) of Marge and me. Unless I could protect and remain faithful to that relationship, any hope of therapy was lost. It was necessary to modify my basic rule, “Treat the patient as an equal,” to “Be faithful to the patient.” Above all, I must not permit myself to be seduced by that other Marge.
A patient can tolerate the therapist’s being unfaithful outside of the hour that is the patient’s own. Though it is understood that therapists embrace other relationships, that there is another patient waiting in the wings for the hour to end, there is often a tacit agreement not to address that in therapy. Therapist and patient conspire to pretend that theirs is a monogamous relationship. Both therapist and patient secretly hope that the exiting and the entering patients will not meet one another. Indeed, to prevent that from happening, some therapists construct their office with two doors, one for entering, one for exiting.
But the patient has a right to expect fidelity during the hour. My implicit contract with Marge (as with all my patients) is that when I am with her, I am wholly, wholeheartedly, and exclusively with her. Marge illuminated another dimension of that contract: that I must be with her most central self. Rather than relating to this integral self, her father, who abused her, had contributed to the development of a false, sexual self. I must not make that error.
It was not easy. To be truthful, I wanted to see “Me” again. Though I had known her for less than an hour, I had been charmed by her. The drab backdrop of the dozens of hours I had spent with Marge made this engaging phantom stand out with a dazzling clarity. Characters like that do not come along often in life.
I didn’t know her name and she didn’t have much freedom, but we each knew how to find the other. In the next hour she tried several times to come to me again. I could see Marge flicker her eyelids and then close them. Only another minute or two, and we would have been together again. I felt foolish and eager. Balmy bygone memories flooded my mind. I recalled waiting at a palm-edged Caribbean airport for a plane to land for my lover to join me.
This woman, this “Me,” she understood me. She knew that I was weary, weary of Marge’s whimpering and stuttering, that I was weary of her panics, her curling up in corners and hiding under desks, and weary of her thready childlike voice. She knew I wanted a real woman. She knew that I only pretended to treat Marge as an equal. She knew we were not equals. How could we be when Marge acted so crazy and I patronized her by tolerating her craziness?
“Me’s” theatrical performance, in which she regurgitated all those snippets of Marge’s behavior, convinced me that both she and I (and only she and I) understood what I had gone through with Marge. She was the brilliant, beautiful director who had created this film. Though I could write a clinical article about Marge or tell colleagues about the course of therapy, I could never really convey the essence of my experience with her. It was ineffable. But “Me” knew. If she could play all those roles, she must be the concealed, guiding intelligence behind them all. We shared something that was beyond language.
But fidelity! Fidelity! I had promised myself to Marge. If I consorted with “Me,” it would be catastrophic for Marge: she’d become a bit player, a replaceable character. And that, of course, is precisely what “Me” wanted. “Me” was a Lorelei, beautiful and intriguing, but also lethal—the incarnation of all Marge’s rage and self-hatred.
So I stayed faithful and, when I sensed “Me” approaching—for example, when Marge closed her eyes and began to enter a trance—I was quick to jar her awake by shouting, “Marge, come back!”
After this happened a few times, I realized that the final test still lay ahead: “Me” was inexorably gathering strength and desperately trying to return to me. The moment demanded a decision, and I chose to stand by Marge. I would sacrifice her rival to her, pluck her feathers, pull her asunder, and, bit by bit, feed her to Marge. The feeding technique was to repeat one standard question, “Marge, what would ‘she’ say if she were here?”
Some of Marge’s answers were unexpected, some familiar. One day when I saw her timidly scanning the objects in my office, I said, “Go ahead, speak, Marge. Speak for ‘her.’”
Marge took a deep breath and revved up her voice. “If you’re going to pretend to be a Jewish intellectual, why not furnish your office like one?”
Marge said this as though it were an original thought, and it was apparent that she had not remembered everything “Me” had said. I couldn’t help smiling: I was pleased that I and “Me” shared some secrets.
“All suggestions are welcome, Marge.”
And, to my surprise, she offered several good ones. “Put a partition, perhaps a hanging fuchsia plant, perhaps a standing screen, to separate your cluttered desk from the rest of the office. Get a quiet dark brown frame for that beach picture—if you must have it—and above all, get rid of that ratty tapa-cloth wall hanging. It’s so busy that it gives me a headache. I’ve been using it to hypnotize myself.”
“I like your suggestions, Marge, except that you’re being tough on my wall hanging. It’s an old friend. I got it thirty years ago in Samoa.”
“Old friends may feel more comfortable at home than the office.”
&
nbsp; I stared at her. She was so quick. Was I really talking to Marge?
Since I hoped to establish a confederacy or fusion of the two Marges, I was careful to stay on the positive side of each. If I antagonized “Me” in any way, she would simply take her revenge on Marge. So I took pains, for example, to tell Marge (I assumed “Me” heard everything) how much I enjoyed “Me’s” insouciance, vitality, brashness.
But I had to steer a tight course. If I were too honest, Marge would see how much I preferred the other Marge. Probably “Me” had already taunted Marge with it, but I saw no evidence. I was certain that “Me,” the other Marge, was in love with me. Perhaps she loved me enough to change her behavior! Surely she must know that I would be repelled by wanton destructiveness.
Now that’s a facet of psychotherapy we don’t learn about in training: have a romance with your patient’s worst enemy, and then, when you are sure the enemy loves you, use that love to neutralize her attacks upon your patient.
Over the next several months of therapy, I continued faithful to Marge. Sometimes she would try to tell me about Ruth Anne, the third personality, or slip into a trance and regress to an earlier age, but I refused to be seduced by any of these enticements. More than anything else, I resolved to be “present” with her, and I immediately called her back whenever she started to leave my presence by slipping away into another age or another role.
When I first began to work as a therapist, I naively believed that the past was fixed and knowable; that if I were perspicacious enough, I could discover that first false turn, that fateful trail that has led to a life gone wrong; and that I could act on this discovery to set things right again. In those days I would have deepened Marge’s hypnotic state, regressed her in age, asked her to explore early traumas—for example, her father’s sexual abuse—and urged her to experience and discharge all the attendant feelings, the fear, the arousal, the rage, the betrayal.
But over the years I’ve learned that the therapist’s venture is not to engage the patient in a joint archeological dig. If any patients have ever been helped in that fashion, it wasn’t because of the search and the finding of that false trail (a life never goes wrong because of a false trail; it goes wrong because the main trail is false). No, a therapist helps a patient not by sifting through the past but by being lovingly present with that person; by being trustworthy, interested; and by believing that their joint activity will ultimately be redemptive and healing. The drama of age regression and incest recapitulation (or, for that matter, any therapeutic cathartic or intellectual project) is healing only because it provides therapist and patient with some interesting shared activity while the real therapeutic force—the relationship—is ripening on the tree.
So I devoted myself to being present and faithful. We continued to ingest the other Marge. I mused aloud, “What would she have said in that situation? How would she have dressed or walked? Try it. Pretend you’re her for a minute or two, Marge.”
As the months passed, Marge grew plump at the other Marge’s expense. Her face grew rounder, her bodice fuller. She looked better, dressed better; she sat up straight; she wore patterned stockings; she commented upon my scuffed shoes.
At times I thought of our work as cannibalistic. It was as though we had assigned the other Marge to a psychological organ bank. Now and then, when the receptor site was well prepared, we withdrew some part of “Me” for transplantation. Marge began to treat me as an equal, she asked me questions, she flirted a bit. “When we finish, how will you get along without me? I’m sure you’ll miss my little late-night calls.”
For the first time, she began asking me personal questions. “How did you decide to get into this field? Have you ever regretted it? Do you ever get bored? With me? What do you do with your problems?” Marge had appropriated the bold parts of the other Marge as I urged her to do, and it was important that I be receptive and respectful to each of her questions. I answered each one as fully and honestly as possible. Moved by my answers, Marge grew ever bolder but gentler in her talks with me.
And that other Marge? I wonder what’s left of her now? A pair of empty spike heels? An enticing, bold glance that Marge has not yet dared to appropriate? A ghostly, Cheshire cat smile? Where is the actress who played Marge with such brilliance? I’m sure she’s gone: that performance required great vital energy, and by now Marge and I have sucked all that juice out of her. Even though we continued our work together for many months after the hour “Me” appeared, and though Marge and I eventually stopped talking about her, I have never forgotten her: she flits in and out of my mind at unexpected times.
Before we began therapy, I had informed Marge that we could meet for a maximum of eighteen months because of my sabbatical plans. Now the time was up, our work at an end. Marge had changed: the panics occurred only rarely; the phone calls were a thing of the past; she had begun to build a social life and had made two close friends. She had always been a talented photographer and now, for the first time in years, had picked up her camera and was once again enjoying this form of creative expression.
I felt pleased with our work but was not deluded into thinking that she had finished therapy, nor was I surprised, as our final session approached, to see a recrudescence of her old symptoms. She retreated to bed for entire weekends; she had long crying jags; suicide suddenly seemed appealing again. Just after our last visit, I received a sad letter from her containing these lines:I always imagined that you might write something about me. I wanted to leave an imprint on your life. I don’t want to be “just another patient.” I wanted to be “special.” I want to be something, anything. I feel like nothing, no one. If I left an imprint on your life, maybe I would be someone, someone you wouldn’t forget. I’d exist then.
Marge, please understand that though I’ve written a story about you, I do not do it to enable you to exist. You exist without my thinking or writing about you, just as I keep existing when you aren’t thinking of me.
Yet this is an existence story—but one written for the other Marge, the one who no longer exists. I was willing to be her executioner, to sacrifice her for you. But I have not forgotten her: she avenged herself by burning her image into my memory.
10
In Search of the Dreamer
“Sex is at the root of everything. Isn’t that what you fellows always say? Well, in my case you may be right. Take a look at this. It’ll show you some interesting connections between my migraines and my sex life.”
Drawing a thick scroll from his briefcase, Marvin asked me to hold one end, and carefully unrolled a three-foot chart upon which was meticulously recorded his every migraine headache and every sexual experience of the past four months. One glance revealed the complexity of the diagram. Every migraine, its intensity, duration, and treatment, was coded in blue. Every sexual rush, colored red, was reduced to a five-point scale according to Marvin’s performance: premature ejaculations were separately coded, as was impotence—with a distinction made between inability to sustain an erection and inability to have one.
It was too much to absorb in a glance. “That’s an elaborate piece of work,” I said. “It must have taken you days.”
“I liked doing it. I’m good at it. People forget that we accountants have graphic skills that are never used in tax work. Here, look at the month of July: four migraines and each one preceded by either impotence or a grade-one or -two sexual performance.”
I watched Marvin’s finger point to the blips of migraine and impotence. He was right: the correlation was impressive, but I was growing edgy. My timing had been thrown off. We had only just begun our first session, and there was much more I wanted to know before I would feel ready to examine Marvin’s chart. But he pressed it before me so forcefully that I had no option other than to watch his stubby finger trace out the love leavings of last July.
Marvin at sixty-four had suddenly, six months ago, for the first time in his life, developed disabling migraine headaches. He had consulted a neurologist, who had
been unsuccessful in controlling Marvin’s headaches and then referred him to me.
I had seen Marvin for the first time only a few minutes earlier when I went out to my waiting room to fetch him. He was sitting there patiently—a short, chubby, bald man with a glistening pate and owl eyes which never blinked as they peered through oversized, gleaming chrome spectacles.
I was soon to learn that Marvin was particularly interested in spectacles. After shaking hands with me, his first words, while accompanying me down the hall to my office, were to compliment me on my frames and to ask me their make. I believe I fell from grace when I confessed ignorance of the manufacturer’s name; things grew even more awkward when I removed my glasses to read the brand name on the stem and found that, without my glasses, I could not read it. It did not take me long to realize that, since my other glasses were now resting at home, there was no way that I could give Marvin the trivial information he desired, so I held out my spectacles for him to read the label. Alas, he, too, was farsighted, and more of our first minutes together were consumed by his switching to his reading glasses.
And now, a few minutes later, before I could proceed to interview him in my customary way, I found myself surrounded by Marvin’s meticulous red-and-blue-penciled chart. No, we were not off to a good start. To compound the problem, I had just had a poignant but exhausting session with an elderly, distraught widow whose purse had recently been stolen. Part of my attention was still with her, and I had to spur myself to give Marvin the attention he deserved.
Having received only a brief consultation note from the neurologist, I knew practically nothing about Marvin and began the hour, after we completed the opening eyeglass ritual, by asking “What ails?” That was when he volunteered that “you fellows” think “sex is at the root of everything.”
Love's Executioner and Other Tales of Psychotherapy Page 27