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.”

Stuck

I’d seen Billy before, during his senior year of high school. His plan was to go to school in central Florida, about three hours from his home, a plan he carried through despite considerable anxiety. He wasn’t sure what he wanted to major in or what career he wanted to pursue, pretty typical feelings for many adolescents. Still, his anxiety seemed excessive, related to a fear of separation and much ambivalence about growing up. 

Billy is now seeing me again after moving back home having graduated from college with a degree in English. Not surprisingly he has been unable to find a job.

“I haven’t really looked all that hard,” Billy says sheepishly, his sandy blonde hair hanging over his eyes. “I mean, I know it’s rough out there – the unemployment, especially for kids my age. I don’t have anything special to offer. I’m not sure I could stand the constant rejection.”

“How’s it feel being home?” I ask.

He shrugs. “OK, I guess. It’s like always.”

Billy is the second of six children, all spaced closely together. His parents have a marketing business they run from home. The house is usually pretty chaotic. Not much time put aside specifically for the family or for quality one-on-one time with each other.

“Are all your siblings home?” I ask, trying to gauge the degree of chaos.

“All except Christine. She’s working in Boston. And Melody will be going back to college, but other than that they’re.”

“What led you want to come back to see me?”

“I’m feeling kind of down. I’m like stuck, not doing anything. Mostly I stay in my room and busy myself on the computer. Just passing time.”

“You’re not seeing your friends?”

“Most of them aren’t here anymore. Or they’re working. I haven’t really called around much.”

“You do sound pretty depressed.”

“Yeah, I know. I was thinking I should go back and see the psychiatrist. I hate going back on that stuff, but I feel lousy.”

“Well, calling me and planning to call the psychiatrist is certainly taking action.”

“I guess. But that’s not going solve my problems for the rest of my life.”

“What do you think your problems are, Billy?”

“I don’t know. I don’t know what I want to do.”

“Is that the problem, or is the problem that you’re not sure – or at least a part of you isn’t sure - that you want to do anything.”

“What do you mean?”

“Well, I wonder if part of you feels comfortable living at home, having your parents take care of you.”

“That’s kind of true, but it also doesn’t make sense to me. It’s crazy at home. It’s like a zoo. And it’s like no one even knows I’m there!”

“I think you just said something very important, Billy. Maybe it’s that you want to stay home until someone does know you’re there. Maybe what you’re feeling is that you never got to be seen, to be appreciated and that until you get that – until you get what you never got – you’re going to stay home and wait.”

“But I’d wait forever!”

“That’s true, Billy, you would. You’d never get what you wanted and you certainly couldn’t get what you wanted in your past. There’s no way to turn back the clock.”

“Wow! This is heavy. Do you think that’s it? Do you think that’s why I’m stuck.”

“I think that’s one reason. We humans are pretty complex beings and it’s not like one reason explains everything. And not even knowing that one reason – assuming it’s correct – is going to automatically make you able to do things differently.”

“What will?”

“I think that involves really feeling what it was like for you as a little boy, surrounded by all these siblings, your parents harassed and busy with their own lives, never feeling cherished as a unique you. That means feeling your sadness and your anger, neither of which is exactly easy for you.”

“So you really think it’s about the past?”

“I think it’s about your past and your present and I think they both really impact your future.”

“It sounds hard. But I guess I’m not doing anything else. I might as well work on me.”

“That’s a very courageous response, Billy. I hope you can allow yourself to feel proud of yourself, because I certainly do.”

Billy turns red. Mumbling, “See you next time,” he makes a beeline for the door. 

Escape!

A colleague told me that a patient of his had stopped treatment the previous day without any warning and that he felt hurt and angry. I both understood and commiserated. I also began thinking about some of the patients I’ve had over the years who quit without notice and how well I remember at least some of them, even those I saw over thirty years ago. 

There was a man I saw for several years who came in one day and said he wasn’t getting anywhere and was leaving. When he left, I started crying. Was I crying because I would miss him, because I had failed him, because I was narcissistically injured by my failure? Probably all of the above.  As I look back on that treatment today I know that he was a man who was terribly afraid of his own feelings of neediness and vulnerability and that he dealt with his fear by keeping everyone at bay.  He wasn’t going to get anywhere near me; he wasn’t going to let me in. I still remember that he told me that all he dreamed about was alternating screens of black and white. As a young clinician, although I understood the barrenness of his internal landscape, I had no idea that he was terrified of getting close. 

Another patient – perhaps even earlier in my career – was a woman who so feared closeness that she had sex only three times in her twenty year marriage. She wanted children so she thought she would try three times and take whatever she got. She had two children! When she announced one day that she was leaving, I tried to persuade her to come in through the end of the month so that we could both deal with our feelings about her leaving. Although she had no idea what feelings I was talking about, she agreed. During those final sessions she felt less anxious and uptight. Even then I knew that having a clear way out, an exit strategy, made it possible for her to be more relaxed and related. I didn’t then understand why. Today I get it. People who are afraid of their own dependency can never get too close for fear that they might be too greedy and want too much.

Probably my oddest termination occurred with a patient I saw only a few times. I was a more experienced clinician by then. I knew that this woman had difficulties with closeness and intimacy, but we were early in the treatment and I wasn’t making any grand interpretations. We had our session and she left. Under the chair I noticed a letter which I assumed she’d forgotten. When I retrieved it I saw that it was addressed to me. In it was a check and a letter that said today was our last session! I was stunned. We had spent an entire session and she gave not the slightest hint, at least not to my awareness, that she didn’t plan to continue. Seasoned clinician or not, she definitely got by me. I’d like to know why she left. I’d like to know why she chose to leave a letter as opposed to talking with me about her decision. But I’ll never know. Among the many things that remain unknowable to me forever.

So what’s the lesson here? Neither love nor caring nor empathy are, in and of themselves, enough.  And the therapist, despite all her knowledge and years of experience might still not understand what is going on with a patient.