“I’ve never done this before,” Susan says anxiously. “But I think my husband will divorce me if I don’t get myself together. Not really, after 40 years of marriage he’s not likely to divorce me, but he’s certainly getting tired of me. Gosh, I’m getting tired of me. I’m sorry, I realize I’m rambling and you don’t even know what I’m talking about.”
“That’s fine,” I say reassuringly to this attractive, well groomed woman who I guess to be in her sixties. “You can tell your story in whatever way feels best to you.”
“Well, we’re originally from Philadelphia. I taught school there, my husband was a successful businessman. We’d been coming down to Florida for several years during the winters – after I retired from teaching – but then two years ago my husband decided he wanted to move down here permanently. I couldn’t believe it! He was willing to leave our children, our grandchildren and our beautiful home, to come to this place! I don’t know. It’s never appealed to me that much. Too plastic. I hope I’m not offending you.”
I am flooded with more thoughts and feelings than Susan could ever know. I have heard variations of this story countless times since moving to south Florida 20 years ago. Almost invariably the man of the couple wants to move and the woman doesn’t. Almost invariably the husband loves it and has adjusted very well, while the wife continues to long for home.
Those of you who have read my book, Love and Loss, will also know that it is my story, with the added complication of my husband’s health problems pushing us towards a warmer climate. Still, it was definitely not a decision I came to easily. For four consecutive winters I flew weekly between Ann Arbor, Michigan and Key Largo, Florida, continuing to maintain my full-time practice in Ann Arbor. I obsessed and obsessed until my husband’s heart attack when I realized I didn’t want to be separated from him more than absolutely necessary. And so we moved. And I started my practice over in Boca Raton.
Susan continues. “My husband says that it’s been over a year already, that we’ve already gone back several times to visit the children and that my daughter and her family have come to visit us. He wants me to stop moping around. He wants me to start enjoying my retirement, to get out there and make friends. But all the women do here is play cards or golf and I don’t do either. But he’s right, I know I should start making a life for myself here, get involved in politics, volunteer work, something! But I’m not motivated. I feel too sad.”
As Susan speaks I feel myself going back to the time shortly after my move. It was awful. I longed for the friends, patients, and, most especially, my home on the lake that I had left behind. I felt as though I had a wall around me, protecting me from the intensity of the losses, but also disconnecting me from being fully involved in my present life. I had the advantage of my work and a network of professional colleagues, but the wall limited my ability to take in the good that existed around me.
“Tell me about your home in Philadelphia,” I say to Susan.
Tears immediately run down her cheeks. Speaking is difficult. “It was perfect. My son built it for us. He’s an architect. He built it exactly as we wanted: wood floors, cathedral ceilings, glass everywhere. There were woods all around us. It was like living in the trees, like a tree house.”
I am back in my own pain, thinking about the house that my husband built for us, visualizing sitting at the breakfast table looking through the leaves of the graceful elm tree to the lake beyond.
With more empathy than Susan can ever know, I say, “You’re talking about giving up ‘home,’ Susan, giving up a place of peace and safety. That’s a tremendous loss. It’s not something that can easily be forgotten. Or replaced.”
“Oh!” she exclaims. “You understand! And you don’t think I’m being foolish. That’s such a relief. Now I can cry. I can cry without feeling silly.”
I sit with Susan as she cries, fighting back my own tears.
Even after all my years of doing therapy, I’m still impressed by the number of people who dread sadness, using whatever excuse and/or defense to avoid it.
In the course of my eight to ten patient day, I suspect that half my patients tell me they don’t want to feel sad: It makes me feel weak; I’m afraid it will never stop; it interferes with what I have to get done; it makes my face blotchy; no one wants to be around someone who’s sad; it doesn’t accomplish anything; it feels too overwhelming; no one in my family ever cried; why would I want to be sad?
I’m not suggesting that anyone should go out of their way to feel sad, but avoiding sadness can lead to many difficulties and believing that you can’t handle sadness is even worse. It is inevitable that we will face sadness during the course of our lives, and being able to feel the sadness without running away from it is essential for us to move on with our lives.
“I keep telling you I don’t feel sad,” Daniel says to me angrily. “I don’t know why you’re so determined for me to be sad. Who the shit wants to walk around feeling depressed all the time?”
“Feeling depressed, Daniel, isn’t the same as feeling sad. Depression is like a blanket of numbness, a non-feeling, a deadness. Sadness is much sharper, more acute.”
“Great so now you want me to suffer! Just what I needed from my therapist!”
“And I think the reason you find yourself snapping at everyone, including me - which is definitely better than your boss or your ex-wife – is because you can’t allow yourself to feel your sadness. I’m not saying you don’t have things to be angry about because you obviously do. Your wife cheated on you…”
“Ex-wife.”
“Sorry, your ex-wife …” Suddenly I stop myself. “What’s going on here?” I wonder out loud.
“You were telling me all the reasons I have to be angry including my ex-wife taking my kids, my money and my house!” Daniels says sarcastically.
“Yes, I was,” I say more softly with a puzzled frown. “But I realized I’d adopted the same tone as you. I was arguing with you, arguing with a snide tone. I don’t want to do that,” I say still confused.
Silence.
“Daniel, what’s going on here? I’m not your enemy. I’m on your side, remember?”
Silence.
A thought passes through my mind. I’m concerned I’m going to lose Daniel, afraid that he’ll leave treatment. And how would I feel if he left? I’d be sad, I’d miss him, I’d regret us not getting to work through his anger that seems like such a blatant defense against his sadness that lurks underneath. His sadness. My sadness. His snide tone. My snide tone. Sadness turned to anger.
“I think I just figured out why I adopted that tone, Daniel. And I think it’s the same reason you get angry. You don’t want to feel the sadness of all your losses. You don’t want to feel sad about not seeing your kids get ready for school in the morning, about not seeing the sun set through the trees in your backyard, not getting to walk Spotty around your neighborhood, not …”
“Stop!” Daniel practically screams as me, but he’s eyes fill with tears before he covers them with his hands.
“I’m sorry,” I say. “I didn’t mean to overwhelm you. You have had a lot of losses. But sadness can be borne, Daniel. You and I together can help you to learn to bear sadness, so that you don’t have to run from it, so that you don’t have to be so afraid of it.”
Daniel looks up at me with pleading eyes, “I miss them all so much. I don’t know why she did it, why she took everything away from me.”
Daniel is allowing himself to feel his pain. He hurts, but from this place of genuine feeling he will, in time, be able to move forward.
“I’ve started reading your book,” Leah says at the start of her session. “I like the way you’ve done it, going back and forth from your patients to yourself.”
“Thank you.”
“I want to ask you something. In hindsight, do you think it was worthwhile for you to worry about your husband dying from the beginning of your relationship?”
For those of you who are new to my blog, my book, Love and Loss in Life and in Treatment, traces my relationship with my husband, George, through our meeting, the development of our intense, loving relationship, through his illness and eventual death and its effect on my work with patients. Since my husband was 21 years my senior I always assumed that he would die before me and I always worried about it.
I answer Leah’s question. “I knew not only in hindsight but also in foresight that my worrying about his death didn’t help either me or him. But I couldn’t not worry. It’s not that I worried about his dying every minute of every day. It didn’t take over my life; it didn’t ruin my time with my husband.”
“Oh,” she responds. “That’s different.”
Leah is referring to the fact that she is constantly anticipating catastrophe. And her worries do in fact take over her life. She becomes convinced that her daughter will get run over by a car and checks in on her repeatedly during the day. She becomes frightened that her husband will lose all their money and asks him for an accounting of their finances several times a week. She is afraid of developing breast cancer, often doing a self-breast exam several times a day. At some level she knows that these fears are irrational, but she can’t stop herself.
“I’d never be able to handle it!” she bemoans.
“What is it that you mean by being unable to handle it?” I ask, a question I have asked many times before.
“I don’t know. I just couldn’t handle it. I’d come apart. My anxiety would overwhelm me. I wouldn’t be able to get out of bed.”
“Is it that you’re afraid you wouldn’t survive?”
“No, I’d survive. I know I’d survive. But there are worse things than not surviving, there’s living in constant torment.”
I find myself thinking about my cat, Pippin, who became sick when she was fifteen. At that point George had been dead for 2 ½ years, my mother for 3 months. For the 16 months before George’s death I lived in a state of constant anxiety as we rode the roller coaster ride of hope followed by the threat of loss, followed again by hope and the threat of loss. And finally the horror of the loss itself. Then came the ups and downs of my mother’s decline with repeated seizures and increasing debilitation. But when Pippin became ill I felt exactly what Leah was expressing. My anxiety felt out of control. I felt I couldn’t handle it. I couldn’t take care of another sick being and I certainly couldn’t bear losing another living creature I loved. I felt “copeless.”
“Leah,” I say, “I just had a thought. We all have scary, overwhelming experiences as infants and small children, things that feel over-stimulating to us, things we can’t make sense of – your being bitten by the family dog, your mother leaving you to go off to work. These experiences make us feel helpless, powerless, scared. They make us feel copeless. And they stay with us, even if we’re not always aware of them. And if something comes up in the present that feels overwhelming, those feelings can come back to us. We forget about our adult selves and we’re back to being copeless little beings.”
“That makes sense. But why do I keep thinking of all these horrible ‘what ifs?’”
“That’s a good question. Perhaps because you think if you rehearse all the possible catastrophes you’d be able to handle them if they happened.”
“So are you saying it’s a good idea to keep thinking of all of them?”
“No, not at all. I think we need to look at some of those old, scary situations and “grow you up,” so you no longer feel like a helpless child, but rather a capable, competent adult who can deal with life’s difficulties.”
“But what if I got breast cancer? I know I couldn’t deal with it.”
Once again I’m reminded that neither my words nor my insights translate into a “quick fix” for a patient. Leah and I have a long way to go.
Marcy comes rushing into my office 15 minutes late, throws herself in my chair, and sighs with exasperation.
“I don’t get it,” proclaims my attractive, 29 year old patient, carefully attired in a grey business suit, looking like the lawyer that she is. “No matter what I tell myself I’m always late. I’m late here, to work, to meet friends! Well, you know! We’ve been through this a million times. The only thing I’m not late for is court, thank goodness. That’s all I’d need. Get my ass in contempt!”
Marcy and I have indeed discussed her problem with lateness many times. And it’s not just lateness, but all kinds of procrastination. She wrote college papers the night before they were due, never felt prepared for exams, let mail pile up in her apartment, and now often feels ill-prepared for court.
We have discussed her difficulty with separating, with pulling herself away from one activity or one person to go to another. We have explored procrastination as an expression of her anger, as in, you can’t make me be on time or write this paper or pay this bill. We have set up tasks for her to fulfill – next time you come to see me you will be able to tell me that for one day this past week you were on time for every appointment. She is never able to fulfill these agreements.
I like Marcy. She is warm, engaging, and smart. I’ve gotten used to her lateness and don’t have much feeling about it. I’m sorry that her sessions are abbreviated, but I’ve accommodated to the shorter time. Marcy leaves promptly at the designated time, never objects, never tries to extend the hour.
Marcy was the second of three daughters, her parents both busy lawyers who expected their children to be good, do well in school, and pretty much raise themselves. Marcy always had difficulty getting to school or turning in assignments on time. Her parents would talk to her, lecture her, encourage her, but basically leave her to deal with the consequences of her problem. Obviously, now an attorney, Marcy was able to do more than well enough to get by.
“My Dad was asking me again last night if I didn’t think I should try to get into a big firm, make a lot more money. But I love being a legal aid lawyer! I love being able to help people who really need my help. Besides, I’d never to be to meet all the deadlines of a big firm. My Dad doesn’t bug me about it, just brings it up from time to time.”
“Right now,” Marcy continues, “I’m trying to get this kid off. He’s kind of slow, was with a bunch of kids when they snatched a woman’s purse. I don’t think he had a clue what was going on. But I have a real hard-ass judge. I don’t know what will happen. But I’m trying my best.” Marcy pauses, knitting her brow. “I just realized that I have no problem with deadlines on this case, no problem getting to appointments, no problem filing the motions. I don’t even have to try. I just do it.”
“Do you think that’s because you like the kid, feel sorry for him, want to help him?” I ask.
“Well, I do, but I feel that way about lots of cases and that usually doesn’t help.”
A series of thoughts flash through my mind: She’s not late to court because she’s afraid of being in contempt, she has a hard-ass judge for this case, her father doesn’t bug her, I don’t have strong feelings about her lateness.
“I wonder, Marcy, if the reason you do things on time for this case is that you have a hard-ass judge.”
She looks at me quizzically.
“I wonder if you’ve always wanted someone to care enough about you to be a hard-ass, to say this behavior isn’t okay, to care that you’re not getting someplace on time, to care that you’re getting a B rather than an A because your paper’s late. It’s even true for me. Why don’t I take a tougher stand about your lateness? Why don’t I insist that you get here on time? Why don’t I feel more about your cheating yourself of a third of your session?”
“Why don’t you?” Marcy asks quietly, dropping her head.
“I think part of it is who I am as a person – I’m not authoritarian, I’m not judgmental. But I also think it’s because you’ve never passionately been cared about and you’ve never passionately cared about yourself and that although you desperately want a “hard-ass judge,” you don’t expect much from the people in your life. And that’s the dynamic we unconsciously reenact here.”
“Wow! That’s heavy! It makes sense, but I’m not sure what to do with it.”
“I’m not sure either, Marcy, but I think it’s important for us to know about and to watch in terms of the interaction between us and between you and others as well. And maybe we’ll need to revisit your childhood and look at what more you wanted from your parents.”
Theirs was a storybook romance. Living in separate cities, their relationship began on the telephone: long conversations about her first two disastrous marriages, uncertain that she’d ever want a new man in her life; his pain about caring for two wives and having them both die. He quoted poetry to her. She told him about her life as a psychoanalyst. A nurse and administrator by profession, he had read all of Freud. He studied philosophy and spoke German. By the time he flew down for them to meet for the first time, they were already in love. He wanted more. She was frightened. He persevered. In time she realized how supportive he was of her professional life, of her connection to her women friends. He wanted to add to her life, not take her over.
This love story is neither about me nor any of my patients. It is about my very good friend Emily and her new man, Paul. When Emily first met Paul she told me he looked like George, my deceased husband with whom I too had a storybook relationship. When I met Paul for the first time, I didn’t think he looked that much like George – except for the same strikingly blue eyes – but I thought he was a lot like George, eager to proclaim his admiration, love and devotion for Emily to anyone who would listen.
So, after much trepidation on her part, a year ago Paul moved into Emily’s house. Emily basked in Paul’s love, her radiance and happiness obvious to all. And Paul couldn’t stop talking about his good fortune. It was a joy to be with them, a joy to see them glow in each other’s presence. After more trepidation and uncertainty, Emily agreed to marry Paul. Their wedding date was set for the last Saturday in June.
In April we spent four days together at a psychoanalytic meeting in Boston with another friend and colleague, Donna, continuing to celebrate their most wonderful connection. Not too long after returning home, Paul was hospitalized. Pneumonia. Not a big deal I thought, I know lots of people who’ve been hospitalized with pneumonia, many much older than Paul. There was some concern about his arrhythmia, but nothing to be alarmed about. Time passed. Emily told me Paul had been admitted to ICU. I was shocked. What happened? His pneumonia was unstable. What did that mean? They didn’t know what was causing it. His breathing wasn’t improving despite four different intravenous antibiotics. I started to feel sick.
More time passed. Then Emily called to tell me Paul was on a ventilator, that they’d put him in a medically induced coma and had found blood in his lungs. The cardiologist told Emily he might die. The pulmonologist said to wait and see. I called all our friends. We cried together. It was so impossible to comprehend. We mourned for Emily, for Paul.
And so began the vigil, the up and down of his condition, the roller coaster ride of being buoyed by apparently good news, only to be followed by the sickening drop of more negative information. I knew about this roller coaster ride. I’d lived it with George for sixteen months. Images flashed before me – his agonizing pain from metastatic prostate cancer, his heart attack after his first chemotherapy treatment, the cardiologist suggesting I call his children, his determination to survive, his subdural hematoma resulting from a fall, his becoming jaundiced, his final giving up – “It’s enough already.” But as awful as it had been, as awful as it still was, I had George for twenty-nine years. Emily had Paul for only two! It was incomprehensible. It couldn’t be!
But like their storybook romance, this story has a happy ending. The bleeding in Paul’s lungs was being caused by his blood thinning medication. They took him off, but the drug remained in his body for almost a week. And so the vigil continued, but the hope increased. Finally Emily called and left a message – Paul was off the ventilator, his lungs were improving, he could speak. I burst into tears, tears of relief, of pure joy. I called. Emily put Paul on the phone. He couldn’t speak well, but he could speak! I cried again.
And so, on June 29, 2013 Emily and Paul will be married on Hollywood Beach. And we will all rejoice in their extra-special relationship and good fortune and we will all remember how fragile life is.
Why did I ever agree to see Paula? I didn’t have good feelings about her from the very beginning. She barely smiled as I greeted her in the waiting room, seemed to eye me warily, and held herself rigidly erect. My first impression was that she might be schizoid, someone who distances and keeps herself apart from others to protect herself from feeling her own vulnerability. She’s thirty-five, tall, a bit overweight, with short black hair cropped close to her face. She described herself as a computer nerd.
Today is only our fourth session, but it is not proceeding well. She sits across from me with a smirk on her face, her arms folded in front of her, staring fixedly at me.
“Paula,” I begin, too uncomfortable to let the silence continue, “It seems as though we’re back in the place we’ve been the last two sessions. I feel as though you’re daring me to say something brilliant and until I do you’re not saying anything.”
“That’s pretty good,” she says, her smirk increasing.
I want to slap her. “Do you want me to be angry with you?” I ask.
She shrugs.
I am not pleased. We sit in silence. Five minutes goes by. She uncrosses and crosses her arms, her legs. She says nothing. I flash on Kathryn the schizoid patient I wrote about in my book, one of my more unsuccessful treatments. But Kathryn was horribly anxious. She would never have been able to sit through this silence. She would have just gotten up and left. OK, does that mean I’m feeling Paula’s anxiety for her, that I need to help Paula take back her own feelings? I decide to give it a shot.
“I wonder, Paula, how you feel in this silence, whether it makes you at all anxious or whether I’m the only one in the room who’s feeling the anxiety?”
She raises an eyebrow at me. “You were doing better the first time around.”
I am ready to kill her. And then I remember another patient I wrote about and my reaction to him when he demanded that I be brilliant. He wanted me to be brilliant just as his father demanded that he be brilliant and just as my father demanded the same from me. And that demand always resulted in both my patient and I being frozen with anxiety. So my earlier patient was doing to me the same thing that had been done to him. He was acting out his childhood experience except now he was in the role of his father and I was the frightened child.
I think about Paula and am a bit baffled. In our first session she described her father as a middle-level manager who didn’t seem particularly bright or demanding. What did she say about her mother? Not much actually. I guess I had the impression she was a housewife, but now I wonder.
“Paula, I find myself wondering about your mother. What did she do?”
Paula’s smirk fades immediately. She glares at me. “You get a gold star,” she says sarcastically. “My mother was a Pulitzer Prize winning journalist who wrote novels on the side. She edited all my papers all through school. They were never good enough. I actually wanted to write. I became a computer technician instead.”
Sadness fills the room.
“I’m really sorry, Paula. I can feel how painful that was for you, never feeling good enough, never being able to freely express what you wanted to say.”
“Don’t get carried away. Just because you figured it out doesn’t mean you get a free ride.”
Although I can feel myself bristle, I remain determined to stay with the sadness. “So it’s easier for you to be a harsh taskmaster like your mother, than to feel the pain you felt as a not-good-enough little girl.”
I think I see Paula’s eyes fill with tears. But she draws herself back into her rigid self and closes down.
This will be a very long treatment. All I can do is hope that my newfound understanding will help sustain me through the difficult times ahead.
Andrea again calls me from home.
“I’m sorry,” she says, her voice hardly above a whisper. “I know I said I’d try to come today but I can’t. I can hardly get myself out of bed. I can’t leave the house. I keep calling in sick to work. I hope I don’t get fired. I just can’t function. I’m so scared,” she adds crying.
Those of you who follow my blog will have met Andrea a few weeks ago, the woman who had been sexually abused by her father and felt herself more endangered after the Boston Marathon bombings. And now there’s the case in Cleveland, the shocking imprisonment for over ten years of three young women who were finally able to escape.
“It’s all right, Andrea,” I say gently. “I understand. You know I always say that you can only do what you can do. We’ll do whatever we need to do to help you through this.”
“I don’t think I will get through this. I’m back there. I’m back in that horrible house. I keep seeing those disgusting green walls. And the closet. I’m locked in that closet. I feel like huddling in a corner, folded over on myself, just like I was as a child, hoping that he’d leave me alone, but not wanting to be left in that closet for hours or days at a time. So did I wish he’d come back? That’s disgusting. I’m disgusting.”
“I bet you don’t think those three women are disgusting, Andrea.”
“No, of course not, they’re heroes. I don’t know how they endured for all those years. And that child! That child has never seen the outside world. That seems impossible to take in!”
“Notice how caring and compassionate you are towards those women and the child,” I say. “I wish you were able to have even a tiny bit of that compassion for yourself.”
“It’s not the same.”
“In what way isn’t it the same, Andrea?”
“They were imprisoned. They had no choice. I could have told. Why didn’t I tell?’ she asks plaintively, crying. “Why didn’t I run away?”
Although Andrea and I have covered this ground many times, her self-loathing and need to blame herself remains very difficult to change. To emotionally accept that she was an abused, helpless, dependent child without any options, is to accept her total vulnerability. And as awful as the guilt and self-hatred is, it is preferable to feeling completely powerless.
“You were a child, Andrea. And he was your father. There was no place for you to go. These women are adults now and they all went back to the embrace of their families. I’m not minimizing the horror of their story in any way. But I don’t want you to minimize the horror of yours either. You were as helpless and powerless as they were.”
“But that doesn’t make me feel better!” Andrea wails.
“I understand that Andrea. I understand that hating yourself, thinking you could have done something, anything, in many ways feels better than experiencing your total helpless. But, and this is an important but, you’re no longer that helpless child. You’re a competent, capable adult. It doesn’t mean bad things can’t happen, but today you have many more options than you had as a child.”
“But why didn’t I tell?”
“Because you were afraid, because you were ashamed, because you didn’t know what would happen if you told.” Suddenly I have a thought. “I wonder Andrea, if in addition to these women’s story making you more frightened, whether it also made you even madder at yourself for not figuring out a way to tell. Here you see how supportive and welcoming and thrilled complete strangers are of these women and I wonder if that made you almost envious, like you’re still in hiding and no one ever got to applaud you.”
Andrea mumbles something on the other end of the phone.
“I’m sorry, Andrea, I didn’t hear you.”
“I said you’re right. I found myself almost wishing I were those women. And then I got furious at myself for that thought. Disgusting! How could I want to be them? What’s wrong with me? I must be sick, sick, sick.”
“I think it makes complete sense, Andrea. So maybe you should try to stop beating up on you. And maybe, just maybe that might help you to feel less scared, like the person you’re really scared of these days is you.”
