Becoming Myself: A Psychiatrist's Memoir by Irvin D. Yalom
My metamorphosis began when, in the late 1960s, I introduced into my therapy group Ginny Elkins (pseudonym), a Stegner Fellow in creative writing at Stanford. Her therapy was problematic because of her extreme shyness and reluctance to request or accept attention from the group. After a few months she completed her fellowship and took an evening teaching job that conflicted with the meeting time of the group.
Though Ginny wanted to continue individual therapy with me, she couldn’t afford the Stanford fee, so I suggested an unusual arrangement. I agreed to waive the fee if she would write a summary after each session describing all the feelings and thoughts she had not verbalized during our time together. I, for my part, would do exactly the same, and we would hand them in sealed envelopes to my secretary. Then, after several weeks of therapy, we would read each other’s summaries.
Why this unusual, strange proposal? For one thing, Ginny viewed me unrealistically—in psychotherapy lingo, she had soaring positive transference: she idealized me, was persistently deferential, and infantilized herself in my presence. It seemed to me that it might be useful reality-testing for her to read my raw, uncensored thoughts after each of our sessions, and, in particular, to learn of my doubts and uncertainty about how to help her. So I intended to be more self-disclosing in therapy with the hope of encouraging her to do the same.
But there was another, more personal, reason: I longed to be a writer—a real writer. I had felt stifled by the labor of writing a scholarly five-hundred-page textbook, followed by collaborating in a five-hundred-page research monograph on encounter groups. I imagined this plan with Ginny might afford me an unusual exercise, an opportunity to break my professional shackles, to find my voice by expressing anything that came to mind immediately after each hour. Moreover, Ginny was a masterful wordsmith, and I thought she might feel more comfortable communicating through the written rather than the spoken word.
Our exchange of notes every few months was highly instructive. Whenever participants study their own relationship, they are plunged more deeply into their encounter. Each time we read each other’s summaries, our therapy was enriched. Moreover, the notes provided a Rashomon-like experience: though we had lived through the same hour, we experienced the hour very differently and valued different parts of the session. My elegant and brilliant interpretations? Alas, she never even heard them! Instead she valued the small personal acts I barely noticed: my complimenting her clothing or appearance, my awkward apologies for arriving a couple of minutes late, my chuckling at her satire, my teaching her how to relax.
For years afterward, I used our summaries in my psychotherapy classes with psychiatry residents, and I was struck by the students’ intense interest in our different voices and points of view. When I showed the summaries to Marilyn, she thought they read like an epistolary novel, suggested they be published as a book, and immediately volunteered to edit them. Shortly afterward, she and our son Victor went on a skiing trip, and while Victor had skiing classes each morning, she pruned and clarified our summaries.
Ginny was enthusiastic about the publishing project: it would be her first book and we agreed that we would share the royalties equally, and Marilyn would receive 20 percent. In 1974, Basic Books published the book under the title Every Day Gets a Little Closer. In retrospect, Marilyn’s subtitle suggestion, A Twice-Told Therapy (adapted from Hawthorne), would have been far better, but Ginny loved the old Buddy Holly song “Everyday” and had always wanted that to be her wedding song. A few years later, when the Buddy Holly film came out, I listened very carefully to the lyrics and was startled to discover that Ginny had gotten the line wrong. The lyrics were actually “Every day it’s a-gettin’ closer.”
Ginny and I each wrote a foreword and afterword, and I have an indelible memory of writing mine. Though I had done much professional writing in my office in the psychiatry outpatient department, I found it too busy and noisy for writerly inspiration. Psychiatry at that time occupied the south wing of the Stanford Hospital, with offices for the chairman and faculty and many therapy rooms. Just adjacent was the wing occupied by Carl Pribram, a faculty member conducting research on monkeys, one of which would from time to time escape and romp through the clinic and waiting room, wreaking havoc. And just beyond Pribram’s lab was the file room, where patients’ records were stored. It was a dusky, windowless spot, but quiet and entirely private, and large enough for me to pace about, construct complex sentences, and read them aloud to myself. I liked that ghastly room: it brought to mind my study in the basement where, for countless hours as an adolescent, I had written poetry meant only for my own ears (though occasionally I read some to Marilyn).
I luxuriated in the hours I spent in that dusky room, searching for the right tone. It was a critical turning point—no data, no facts, no statistics, no teaching—just letting my thoughts rove. I can’t sing, but I was singing to myself. I’m certain, too, that the mountain of charts around me, thousands of patient stories, seeped into my consciousness as I began my foreword:
It always wrenches me to find old appointment books filled with the half-forgotten names of patients with whom I have had the most tender experiences. So many people, so many fine moments. What has happened to them? My many-tiered file cabinets, my mounds of tape recordings often remind me of some vast cemetery: lives pressed into clinical folders, voices trapped on electromagnetic bands mutely and eternally playing out their drama. Living with these monuments imbues me with a keen sense of transiency. Even as I find myself immersed in the present, I sense the specter of decay watching and waiting—a decay that will ultimately vanquish lived experience and yet, by its very inexorability, bestows a poignancy and beauty. The desire to relate my experience with Ginny is a very compelling one; I am intrigued by the opportunity to stave off decay, to prolong the span of our brief life together. How much better to know that it will exist in the mind of the reader rather than in the abandoned warehouse of unread clinical notes and unheard electromagnetic tapes.
Writing that foreword was a vital moment of transition. I searched for a more lyrical voice and at the same time turned my attention to the phenomenon of transiency, my entry point into an existential worldview.
About the same time that I was seeing Ginny in therapy, I had another literary encounter. One of Marilyn’s colleagues presented us with a rare behind-the-scenes glance at Ernest Hemingway, who had committed suicide in 1961. In a university library her colleague had seen a cache of unpublished letters Hemingway had written to his friend Buck Lanham, the commanding general of one of the Normandy invasion armies. Though he was not permitted to copy them, Marilyn’s colleague furtively dictated the letters into a small recorder, transcribed them, and lent us his copy for a few days, permitting us to paraphrase but not quote from them.
The letters shed considerable light on Hemingway’s psyche. I collected some more information by traveling to Washington, DC, to visit Buck Lanham, at that time an executive at Xerox, who was kind enough to speak to me of his friendship with Hemingway. After rereading many of Hemingway’s works, Marilyn and I hired babysitters and took off for a long, secluded weekend at the Villa Montalvo Arts Center in Saratoga, California, to collaborate on an article.
Our article, “Hemingway: A Psychiatric View,” was published in 1971 in the Journal of the American Psychiatric Association and was instantaneously picked up by hundreds of newspapers around the world. Nothing that either of us has written, before or since, has ever attracted such attention.
In the article we examined the sense of inadequacy underlying Hemingway’s blustering exterior. Though he had toughened and relentlessly driven himself in difficult masculine endeavors, such as boxing, deep-sea fishing, and big-game hunting, he was vulnerable and childlike in his letters to General Lanham. He venerated the real thing—the strong and courageous military leader—and spoke of himself as a “chickenshit writer.” Though I appreciate him greatly as a writer, I did not admire his public persona—it
We laid out our intentions early in the article:
While we appreciate the existential considerations generated by Hemingway’s encounters with danger and death, we do not find the same measure of universality and timelessness as with a Tolstoy, or a Conrad, or a Camus. Why, we ask ourselves, is this so? Why is the Hemingway worldview so restricted? We suspect that the limitations of Hemingway’s visions are related to his personal psychological restrictions. . . . Just as there is no doubt he was an extremely gifted writer, there is also no doubt he was an extremely troubled man, relentlessly driven all his life, who in a paranoid depressive psychosis killed himself at the age of 62.
Though Marilyn and I always collaborate closely—each of us reading drafts of each other’s writing—this is the only piece we’ve ever written together. We still remember this experience with pleasure and feel that perhaps, even at our advanced age, we will find another joint project.
CHAPTER TWENTY-TWO
OXFORD AND THE ENCHANTED COINS OF MR. SFICA
My many years at Stanford often blur together in my memory, but my sabbaticals stand out clearly etched in my mind. During the early 1970s I continued to teach medical students and residents and enlisted many of them as collaborators in psychotherapy research. I published journal articles on group therapy for alcoholics and group therapy for bereaved spouses. At some point my publisher asked me to undertake a second edition of my group therapy textbook. Knowing this project would require my full attention, I applied for a six-month sabbatical, and, in 1974, Marilyn and I and our five-year-old son, Ben, left for Oxford, where I would have an office in the psychiatry department of the Warneford Hospital. Our daughter, Eve, had begun college at Wesleyan, and my other two sons remained behind to finish the school year in Palo Alto under the care of old friends, who would stay with them in our home.
We had rented a house in the center of Oxford, but shortly before we arrived, a British airliner crashed, killing all passengers, including the father of the rental family. So, at the last minute, we scrambled to find another Oxford residence. When we found that none were available, we rented a charming old thatched-roof cottage in the small one-pub village of Black Bourton, about thirty minutes away from Oxford.
Black Bourton was small, very British, and very secluded: perfect conditions for writing! Revising a textbook is demanding and dull work, but necessary if the book is to remain relevant. I analyzed some research I had just completed, seeking to understand more about what really helped patients during therapy. I had given a large sample of successful group therapy patients a questionnaire of fifty-five statements (related to catharsis, understanding, support, guidance, universality, group cohesiveness, etc.), and just on a whim at the last minute, I threw in a cluster of five unorthodox statements I labeled as “existential factors”—statements such as “recognizing that no matter how close I get to others, I must still face life alone,” or “recognizing there is no escape from some of life’s pain and from death.” I had asked patients to sort these into piles (a “Q sort”) from least to most helpful, and was amazed to find that this whole throw-in category of existential factors ranked far higher than I had expected. Clearly, existential factors were playing a greater role in effective group therapy than we had realized, and I set about making this explicit in a new chapter.
As I was starting to address this idea I received a call from the United States informing me that I had just been awarded the prestigious Strecker Award in psychiatry. I was very pleased, of course, but not for long. Two days later, an official letter arrived providing details: I was required to give an address to a large audience in Pennsylvania a year hence. No problem with that. But next I learned I had to submit a monograph on a topic of my choice within four months to be published by the University of Pennsylvania in a limited edition. Writing that monograph was the last thing in the world I wanted to do: once I start a writing project I get very single-minded and put everything else on hold. I considered declining the prize, but several colleagues dissuaded me, and eventually I arrived at a compromise: I would write my monograph on existential factors in group therapy, and it would serve double duty—both as the Strecker monograph and as a chapter in my textbook revision. As I look back on that moment, I believe this was the beginning of the work that would culminate in my textbook Existential Psychotherapy.
Black Bourton lies in the Cotswolds, a bucolic region in southern England renowned for its vivid green fields ablaze with blossoms in spring and summer. The local preschool where we placed Ben was excellent, and overall the living was superb, but for one thing—the weather. We had been spoiled by sunny California and, in mid-June, Marilyn bought a heavy sheepskin coat. By late July we were so damp and so sun-starved that one rainy morning we found ourselves at a travel agency in Oxford requesting a flight to the nearest sunny and inexpensive spot. The agent smiled knowingly—she had dealt with whining California tourists before—and booked us a trip to Greece. “You and Greece,” she assured us, “will become the best of friends.”
We enrolled Ben in a congenial summer camp in Winchester, and our son Victor, who had joined us in June at the end of his school term, went on a youth bicycle tour in Ireland. Then Marilyn and I boarded a plane for Athens. From there, the following day, we would begin a five-day bus tour of the promised eternally sunny Peloponnesus.
We landed in Athens feeling lighthearted and ready to explore, but our luggage had failed to arrive. We had only a carry-on containing mostly books, and we found a small general store still open in the late evening near our hotel in Athens, where we purchased travel essentials: a razor, shaving cream, toothbrushes, toothpaste, underwear, and a black-and-red-striped sundress for Marilyn. For the next five days we wore the same clothes, and when Marilyn wished to swim, she wore her one T-shirt and my underpants. Our dismay over our lost luggage soon evaporated and we grew accustomed to traveling light. In fact, as the days passed, we found ourselves grinning as we watched our fellow tourists grunting as they loaded their big suitcases on the bus, while we hopped on free as birds. Disencumbered, we felt ourselves more deeply connected to the places we visited: Mount Olympus, where the first Olympic Games had taken place over 2,500 years ago; the ancient theater of Epidaurus; and the mountain site of the Delphic oracles, which Marilyn loved most of all, comparing it to Vézelay, France, for its beauty and spiritual loftiness. At the end of the tour we returned to the airport, and there, to our utter astonishment, saw our two bags circling on the empty carousel. With some ambivalence, we collected them and embarked for our next stop, Crete.
At the Crete airport we rented a small car and spent the next week leisurely circling the island. Only shards of memory persist after forty years, but both Marilyn and I remember that first night on Crete sitting in a taverna, looking at the light of the moon reflected in the flowing water of the canal passing only a few feet from our table, marveling at appetizers we’d never seen before: platters of baba ghanoush, tzatziki, taramasalata, dolmades, spanakopita, tiropita, keftedes. I loved these so much I never ordered a main course in Crete.
“I want nothing. I fear nothing. I am free.” Nikos Kazantzakis’s words brought a shiver to my skin as I read them the following day on his tombstone just outside the ancient Venetian walls surrounding the city of Heraklion, the capital of Crete. Having been excommunicated by the Greek Orthodox Church for writing the very book I had just read on the flight to Greece, The Last Temptation of Christ, Kazantzakis was forbidden a burial within the city. I kneeled by his tomb to pay homage to this great spirit and spent much of the remainder of our trip reading his Odyssey: A Modern Sequel.
At the immense palace of Knossos, we were entranced by the frescoes of powerful bare-breasted women carrying offerings for sacrifices presided over by
We drove up into the mountains and made our way to an austere Cretan monastery. Although we were invited for lunch, we were permitted to visit only a very small part of the monastery, lest we disturb the meditation of the monks. Besides, no females were allowed to enter the main monastery—not even female animals, including hens!
While in Heraklion we set out looking for ancient Greek coins as a high school graduation present for our oldest son, Reid. In the very first shop we were told it was illegal to sell ancient coins to tourists, but every coin merchant ignored that dictum and readily—if furtively—showed us a private cache. Of all the coin shops, we were most impressed by Sfica’s, directly across from the National Museum, with a large golden painting of a bumblebee on the front window. After a lengthy discussion with the genial and knowing Mr. Sfica, we bought a Greek silver coin for Reid and two others that Marilyn and I would wear as pendants. He assured us we could return them at any time if we were dissatisfied. The following day we visited a small basement shop owned by a wizened Jewish antique dealer. There we bought some inexpensive silver Roman coins and, in the course of our transaction, showed him the coins we had just purchased from Sfica. He examined them briefly and pronounced, with great authority, “Fakes—good fakes. But fakes all the same.”