A Dream

 “I’m so glad I’m talking with you today,” Rose stays, starting immediately. “I had this awful dream last night and it’s haunting me. The specifics are kind of vague at this point, but the feeling it left me with is very clear - horror. And it was like a horror movie or something out of a scary sci-fi movie, neither of which I ever watch. So it was like this force, not sure what the force was – people, aliens, I don’t know. I don’t know that I ever saw any particular thing or person, I guess that’s why I call it a force - that was going around and doing something to people so that they looked like their whole body had been burned and like instantly turned to ash and dissolved. Ugh! It makes me shudder just to think about it. And I guess I was going around trying to avoid this thing, but also to warn people, people I knew and cared about, that they were in danger. I think I had a better idea when I first woke up who some of those people were, but now I’d just be making it up. I keep shaking my head wanting that image of people dissolving into ash to go away.” She takes a breath. “So what do you think?”

“I can certainly understand how disturbing a dream it was,” I say, impressed with how Rose has managed to convey her horror so well over the telephone. “What are your thoughts?”

“I don’t know. I was watching this TV show that had a cancer patient in it last night and it struck me how he seemed to be being eaten up from the inside out.”

Silence.

“I just keep feeling the horror.”

“Where does that feeling take you?”

“The horror? I guess the horror of the pandemic, of how many people have died. Oh! I guess that could be the force, the unseen virus, killing all these millions of people.” Pause. “But I wonder why I’d have the dream now. Things do seem to be getting better, at least for us. I’m vaccinated, most of the people I love and care about are vaccinated. Why now?”

“You said you thought there were specific people you were trying to save. Even if you have to make it up, who do you think some or one of those people were?”

“My mother comes to mind. She’s been dead for over 10 years now. She had a long life, almost 100 and she was pretty good until the last few years. She was ready to go. That made it easier for me, although it was still hard losing her. Painful, but not horrifying.”

Silence.

“What are you thinking about?”

“First I was thinking about this article I read about how deaths to overdose have skyrocketed during the past year. That feels like another force taking over people, especially young people. But then I ended up

someplace entirely different. I was thinking of the horror of growing up in my house, of my parents screaming and screaming at each other, of us cowering in the corner waiting for my father to start beating up on my mother or turning on one of us. He was definitely a force to be reckoned with, although he was a specific person, a tangible force, not a sci-fi character.”

“Maybe that made him even more scary. You couldn’t just turn off the TV.”

“That would explain why I was trying to save my mother. I was always trying to save my mother and feeling awful that I couldn’t.” Pause. “But still, I don’t know why I’d be dreaming about this now. This is an old story. Why now?”

Silence.

“Any thoughts about people being turned to ash and dissolving?”

“Cremation. Lots of cremations during the pandemic.” Pause. “The Holocaust. That was certainly a force of evil. Hitler, the gas chambers. But it doesn’t seem to be about that either. It felt more contemporary, like right now.”

“All right. Right now, what’s horrifying you, scaring you, threatening you?”

“Aging. I turn 65 next month. I know that’s not old these days, but I worry about aging, about who will take care of me if I’m ill or incapacitated in some way. And I suppose death itself feels frightening, the unknown, the aloneness. Death is a pretty scary, menacing figure. You think that’s what the dream’s about?”

“It’s certainly possible. And it’s also possible that it’s about all the things you’ve talked about today.”

“I suppose.”

“What are you feeling now?”

“Definitely not as horrified. Talking about it made it less scary. I feel more removed from it, like it’s something to look at and to figure out.”

Counting the Years

Slim, youthful-looking Marjorie is trying to break her habit of reading obituaries. 

“I’ve read them for more years than I can remember. And now that I’ll be turning 65 in a couple of weeks – I hate saying that but unfortunately it’s all too true - I keep focusing on how old people are when they die, trying to figure out how much time I have left. I remember when I turned 50. I knew that more than half my life was over. Maybe that’s when I started counting the years. There are lots of people who die in their 80s or even older, but there are people who die in their 70s too. That could mean I have less than ten years to live! That scares me, really scares me. I tell myself I should just stop reading those damn obituaries, but I’m not sure I can.”

“What are you afraid would happen if you stopped?” I ask.

“Nothing. Nothing would happen.”

Silence.

“I guess it’s like then I wouldn’t know,” she says.

“Wouldn’t know?” I echo.

“Wouldn’t know who died. Or when. Or how old they were. Or what they died of.”

“And that would mean what to you, Marjorie?”

She knits her brow and sighs in exasperation. “I just wouldn’t know,” she says emphatically. “I don’t like not knowing.”

“’I don’t like not knowing.’ That’s an interesting statement. Does not knowing makes you feel powerless, out of control? After all, what we can least know is when and how we’re going to die.”

“Just listening to you say that scared me. It’s like my heart fluttered. I always wanted to know.”

“And if you didn’t?”

“You know the first thing that popped into my head? My mother would die. I know that’s ridiculous, but that’s how I felt as a kid. My mother was sickly, although it wasn’t ever clear what was wrong with her. It was all hush, hush. Don’t upset your mother; don’t bother your mother; be good to your mother. From as early as I can remember I was scared that something would happen to her, that she’d die and it would be my fault. I think she had some kind of neurological disease. By the time I was in high school she was in a wheelchair. She died while I was away at college.”

“So your fears about dying started very early and your not knowing felt dangerous. You didn’t know what was wrong with your mother so you couldn’t protect her.” I suspect Marjorie was also angry with her mother for needing caretaking rather than providing it, but I leave that thought unsaid.  

“So you think that’s when my fears about death started?”

“I think that’s when your fears about being out of control started, including your fears about death.” Here again I say nothing about my thought that Marjorie was also fearful of being out of control of her own anger.

“I was thinking about the office next door to you,” she says. “I think it’s a doctor’s office. They’re lots of patients in walkers and wheelchairs, lots of them with aides. I don’t like it.”

I don’t like it either, I think. Recently I too have been dismayed by having the inevitability of the aging process impinge daily on my working space. I’ve also been surprised by my feelings. Both my husband – 21 years my senior - and my mother deteriorated greatly in the last years of their lives. Although it greatly pained me to watch that deterioration, it didn’t affect me in the same way. It felt as though the aging process was about them, not me. But six years have gone by. Although I don’t count the years I have left, I am increasingly aware that I am no longer young. But unlike Marjorie’s experience, my mother lived until almost 99 with a positive, rosy disposition until the end. I may not like the daily reminder, but it isn’t as frightening as it is for my patient. 

“I suspect it makes you anxious,” I say.

“Yes it does,” she replies. “But that must be true for everyone.”

“Well,” I say, “No one likes the idea of being old and infirm and helpless, but it carries extra meaning for you. It reminds you of the helplessness of both your mother and yourself. After all, you were the child. You were in need of caretaking too. You didn’t have a mother who could take care of you and that left you feeling all the more alone and scared.”

“And you think that’s why I’m afraid of dying?” Marjorie asks skeptically. 

“I think that’s one of the reasons you’re afraid of getting old and of dying. But there’s never just one reason for anything. We have to keep exploring and trying to understand.”

The Reluctant Patient, The Reluctant Therapist

Mr. Marty Stein sits across from me. With his slight, stooped frame, bald head, and sad, drooping eyes he looks all of his 89 years.  Shifting in the chair and sighing audibly he begins.

“Rose said I had to come. She said she can’t stand it anymore that I don’t talk. I’m happy with her. I don’t know what more she wants. We’ve been going out for over five years. I’m too old for this. Who ever heard of an 89 year old man seeing a … you’re a psychologist, right?”

“No one is too old for therapy,” I say nodding, “But it doesn’t sound as though you want to be here.”

“Right,” he says. “I’m not going to change now. I was married for over fifty years and my wife complained of the same thing. I didn’t change then and I’m not going to change now.”

“You sound almost proud of your reluctance to change,” I offer tentatively.

“No, just resigned. What’s the expression, ‘You can’t teach an old dog new tricks.’ But I told Rose I’d come, so here I am.”

“Can you tell me about yourself, about your background, your childhood?”

Another sigh. “My mother died when I was three. My father couldn’t take care of me – or didn’t want to – so I spent my childhood in an orphanage, two orphanages actually. The first one was in Brooklyn. It was boys and girls. Then when I was 10 they sent me to upstate New York, Syracuse, where it was just boys. It was run by rabbis, very strict. But it was okay. We got fed. And then when I got to be 18 I had to leave, so I joined the army. That was OK too. It was good actually. I grew up and learned to be responsible and even got to see some of the world. And they taught me to be a mechanic so I got to make a decent living when I got out. All in all it was a pretty good life. I have no complaints. The bad parts, I just put them away. No point in dwelling on the negative.”

As Mr. Stein relates his story, deadpan with no affect, I feel an increasing heaviness in my body and an enveloping cloud of sadness overtaking me. “You certainly had a very sad, deprived childhood,” I say gingerly.

“It wasn’t so bad. As I said, they fed me, they didn’t abuse me and in Syracuse we had lots of empty space to run around. Besides, I did all right. Took care of my wife and three kids. No complaints. I just put the bad stuff away.”

“Did you see your father over the years?” I ask, aware that I am reluctant to probe too deeply into this man’s psyche.  Over his long life, he’s built up a stalwart defense that has worked for him, protecting himself from the pain of his early life.

“He’d come and visit sometimes. But he could never be counted on. He wasn’t reliable. I don’t even know how many wives he had. And he stole money from me. While I was in the army I sent him money to hold for me and he gambled it away.”

“That must have made you very angry.”

“I guess. At the time. But I just started working again and built up my little nest egg. As I said, no point dwelling on the negative.”

“And your mother? Do you remember her?”

“Nah. I was only two or three when she died. I didn’t know anything more than the orphanage. When that’s all you know, it’s okay. As I said, my life turned out pretty good.”

What next, I ask myself. If this man was 30 or even 20 years younger, I’d be far more eager to explore his defenses, to try and get to the pain that must reside underneath. Is my reluctance to attempt to plumb his depths ageism? Perhaps. But he has the same reluctance. Except he’s here.

“Mr. Stein, you say that Rose insisted that you come. What would happen if you didn’t? Why did you agree? Is there anything you’d like to get out of coming here?”

“She’s a good person. I don’t think she’d stop seeing me, but maybe she would. I don’t think so, though. But I’d like to make her happy. Maybe you could help me work on things to talk to her about.”

“How about what you were telling me about today? Your background. Your experiences.”

“You think she’d be interested in that old stuff?”

“Yes, I suspect she would. So maybe that’s one thing we could do. You could tell me things about yourself, as kind of practice for telling Rose.”

“I guess.”

We are both still reluctant participants, perhaps fearful of exposing too much pain on the one hand, or dealing with the deadness of meaningless conversation on the other.

Born to Suffer

While seeing a patient today I thought, not for the first time, about my aunt. They’re both elderly, originally from New York, long widowed, and burdened by the loss of their only child. Despite being anxious, perfectionistic worriers they have, over the course of their long lives, shown great strength and a capacity to endure. 

Unfortunately, however, each sees herself as a person who has suffered greater hardship than any other human being; each sees herself as continually singled out by the powers that be to endure unimaginable pain.  Although both have suffered great pains and losses, their view of themselves as the one who suffers the most, makes it impossible for them to enjoy their day-to-day lives, makes it impossible for them to take joy from life’s simple pleasures.

In today’s session, for example, my patient Rose and I had the following interaction.

“They changed the place of my card game tonight. I don’t know why they had to do that. They’re always doing things that make my life more difficult,” she says anxiously. “We’ve always played at Barbara’s house. Now we’re playing at this new girl’s house. They said it’s easy to get to, but it’s dark and I’m afraid I won’t find it. I drove by to see where it was, but that’s in the daylight. What if I can’t find it at night?”

With my patient, I am understanding and empathetic.  She is, after all, not a young woman. She feels alone, vulnerable, unsure of herself.

“I understand that it’s scary to drive someplace new at night. Perhaps you could go with someone,” I add trying to be helpful.

“Phyllis did offer to drive. But she sometimes drinks too much. I wouldn’t want to be in a car with her if she was drinking. We could get in an accident.”

Fighting a bit of exasperation, I point out to Rose how she is spoiling her own pleasure. “You look forward to this game all week. You say what good players they are and how you always end up having a good conversation. I wonder if by worrying so much about finding the place or if Phyllis might get in an accident, you’re spoiling the whole evening for yourself.”

“I’m not spoiling it. They spoiled it by changing the place we’re playing. And now I have to suffer for it.”  

It is at this point I think about my aunt. At 93 my aunt who has emphysema and heart disease underwent abdominal surgery, choosing surgery over hospice when given only those two options, displaying the grit and determination she is so often capable of. She came through it beautifully. After a few days some fluid settled in her lungs making it more difficult for her to breathe. The problem was resolved relatively quickly. 

While she had the breathing problems, however, every time I saw her or spoke with her she bemoaned her fate. “Why does everything always happen to me?” Or, “Somebody up there doesn’t like me.” Or, “What did I do to deserve all this trouble?”

I finally lost all patience. “You’re 93! You just survived abdominal surgery! You should be celebrating, shouting for joy! This is just a blip along the road. You’ll be fine.”  

So the question is, why am I so much more accepting of my patient’s complaints and worries than my aunt’s? Yes, I can become a bit exasperated by my patient, but in general I am far more tolerant and understanding. I could say the answer is simple: when I’m wearing my therapist hat I’m expected to be more tolerant so I am. And there is probably some truth in that. But I think the answer is more complex.

This aunt is my father’s sister, the father I always hoped to change and make different. He had the same doomsday approach to life, the same conviction that he was marked to suffer, that life was all about suffering. So probably, although I don’t consciously think of my father when I’m with my aunt, his ghost stays with me as I continue trying to fix that which has always been and always will be unfixable.