Ирвин Ялом - The Schopenhauer Cure
As he surfed through the charts, most of the faces immediately sprang to mind. Others
had faded, but a few paragraphs of notes evoked their faces, too. A few were the truly
forgotten, their faces and stories lost forever.
Like most therapists, Julius found it difficult to seal himself off from the
unremitting attacks on the field of therapy. Assault came from many directions: from
pharmaceutical companies and managed care, which sponsored superficial research
orchestrated to validate the effectiveness of drugs and briefer therapies; from the media,
which never tired of ridiculing therapists; from behaviorists; from motivational speakers;
from the hordes of new age healers and cults all competing for the hearts and minds of
the troubled. And, of course, there were doubts from within: the extraordinary molecular
neurobiological discoveries reported with ever–increasing frequency caused even the
most experienced therapists to wonder about the relevance of their work.
Julius was not immune to these attacks and often entertained doubts about the
effectiveness of his therapy and just as often soothed and reassured himself.Of course he
was an effective healer.Of course he offered something valuable to most, perhaps even
all, of his patients.
Yet the imp of doubt continued to made its presence known:Were you really, truly,
helpful to your patients? Maybe you`ve just learned to pick patients who were going to
improve on their own anyway.
No. Wrong! Wasn`t I the one who always took on great challenges?
Huh, you`ve got your limits! When was the last time you really stretched yourself—
took a flagrant borderline into therapy? Or a seriously impaired schizophrenic or a
bipolar patient?
Continuing to thumb through old charts, Julius was surprised to see how much
posttherapy information he had—from occasional follow–up or «tune–up» visits, from
chance encounters with the patient, or from messages delivered by new patients they had
referred to him. But, still, had he made an enduring difference to them? Maybe his results
were evanescent. Maybe many of his successful patients had relapsed and shielded that
information from him out of sheer charity.
He noted his failures, too—folks, he had always told himself, who were not ready
for his advanced brand of deliverance. Wait, he told himself, give yourself a break,
Julius. How do you know they werereally failures?permanent failures? You never saw
them again. We all know there are plenty of late bloomers out there.
His eye fell upon Philip Slate`s thick chart. You want failure? he said to
himself.There was failure. Old–time major–league failure. Philip Slate. More than twenty
years had passed, but his image of Philip Slate was crisp. His light brown hair combed
straight back, his thin graceful nose, those high cheekbones that suggested nobility, and
those crisp green eyes that reminded him of Caribbean waters. He remembered how
much he disliked everything about his sessions with Philip. Except for one thing: the
pleasure of looking at that face.
Philip Slate was so alienated from himself that he never thought to look within,
preferring to skate on the surface of life and devote all his vital energy to fornication.
Thanks to his pretty face, he had no end of volunteers. Julius shook his head as he rifled
through Philip`s chart—three years of sessions, all that relating and support and caring,
all those interpretations without a whisper of progress. Amazing! Perhaps he wasn`t the
therapist he thought he was.
Whoa, don`t jump to conclusions, he told himself. Why would Philip continue for
three years if he had gotten nothing? Why would he continue to spend all that money for
nothing? And God knows Philip hated to spend money. Maybe those sessions had
changed Philip. Maybe hewas a late bloomer—one of those patients who needed time to
digest the nourishment given by the therapist, one of those who stored up some of the
therapist`s good stuff, took it home, like a bone, to gnaw on later, in private. Julius had
known patients so competitive that they hid their improvement just because they didn`t
want to give the therapist the satisfaction (and the power) of having helped them.
Now that Philip Slate entered his mind, Julius could not get him out. He had
burrowed in and taken root. Just like the melanoma. His failure with Philip became a
symbol embodyingall his failures in therapy. There was something peculiar about the
case of Philip Slate. From where had it drawn all that power? Julius opened his chart and
read his first note written twenty–five years before.
PHILIP SLATE—Dec. 11, 1980
26 yr old single white male chemist working for DuPont—develops new pesticides—
strikingly handsome, carelessly dressed but has a regal air, formal, sits stiffly with little
movement, no expression of feelings, serious, absence of any humor, not a smile or grin,
strictly business, no social skills whatsoever. Referred by his internist, Dr. Wood.
CHIEF COMPLAINT: «I am driven against my will by sexual impulses.»
Why now? «Last straw» episode a week ago which he described as though by rote.
I arrived by plane in Chicago for a professional meeting, got off the plane, and
charged to the nearest phone and went down my list of women in Chicago looking for
a sexual liaison that evening. No luck! They were all busy. Of course they were busy:
it was a Friday evening. I knew I was coming to Chicago; I could have phoned them
days, even weeks earlier. Then, after calling the last number in my book, I hung up
the phone and said to myself, «Thank God, now I can read and get a good night`s
sleep, which is what I really wanted to do all along.»
Patient says that phrase, that paradox—«which is what I really wanted to do
all along»—haunted him all week and is the specific impetus for seeking therapy.
«That`s what I want to focus on in therapy,” he says. «Ifthatis what I want—to read
and to get a good night`s sleep—Dr. Hertzfeld, tell me—why can`t I, why don`t I, do
it?»
Slowly more details of his work with Philip Slate coasted into mind. Philip had
intellectually intrigued him. At the time of their first meeting he had been working on a
paper on psychotherapy and the will, and Philip`s question—why can`t I do what I truly
want to do?—was a fascinating beginning for the article. And, most of all, he recalled
Philip`s extraordinary immutability: after three years he seemed entirely untouched and
unchanged—and as sexually driven as ever.
Whatever became of Philip Slate? Not one word from him since he abruptly bailed
out of therapy twenty–two years ago. Again Julius wondered whether, without knowing
it, he had been helpful to Philip. Suddenly, he had to know; it seemed a matter of life and
death. He reached for the phone and dialed 411.
2
_________________________
Ecstasy in the act of
copulation. That is it! That
is the true essence and core
of all things, the goal and
purpose of all existence.
_________________________
«Hello, is this Philip Slate?»
«Yes, Philip Slate, here.»
«Dr. Hertzfeld here. Julius Hertzfeld.»
«Julius Hertzfeld?»
«A voice from your past.»
«The deep past. The Pleistocene past. Julius Hertzfeld. I can`t believe it—it must
be what?...at least twenty years. And why this call?»
«Well, Philip, I`m calling about your bill. I don`t believe you paid in full for our
last session.»
«What? The last session? But I`m sure...”
«Just kidding, Philip. Sorry, some things never change—the old man is still jaunty
and irrepressible. I`ll be serious. Here, in a nutshell, is why I`m calling. I`m having some
health problems, and I`m contemplating retirement. In the course of making this decision
I`ve developed an irresistible urge to meet with some of my ex–patients—just to do some
follow–ups, to satisfy my own curiosity. I`ll explain more later if you wish. Soooo—
here`s my question to you: would you be willing to meet with me? Have a talk for an
hour? Review our therapy together and fill me in on what`s happened to you? It`ll be
interesting and enlightening for me. Who knows?—maybe for you as well.»
«Um...an hour. Sure. Why not? I assume there`s no fee?»
«Not unless you want to charge me, Philip—I`m asking for your time. How about
later this week? Say, Friday afternoon?»
«Friday? Fine. That`s satisfactory. I`ll give you an hour at one o`clock. I shan`t
request payment for my services, but this time let`s meet in my office—I`m on Union
Street—four–thirty–one Union. Near Franklin. Look for my office number on the building
directory—I`ll be listed as Dr. Slate. I am now also a therapist.»
Julius shivered as he hung up the phone. He swiveled his chair around and craned his
neck to catch a glimpse of the Golden Gate Bridge. After that call he needed to see
something beautiful. And feel something warm in his hands. He filled up his meerschaum
pipe with Balkan Sobranie, lit the match, and sucked.
Oh baby, Julius thought, that warm earthy taste of latakia, that honeyed, pungent
fragrance—like nothing else in the world. Hard to believe that he`d been away from it for
so many years. He sank into a reverie and mused about the day he stopped smoking. Had
to be right after that visit to his dentist, his next–door neighbor, old Dr. Denboer who had
died twenty years ago. Twenty years—how could it be? Julius could still see his long
Dutch face and gold–rimmed spectacles so clearly. Old Dr. Denboer beneath the soil now
for twenty years. And he, Julius, still above ground. For now.
«That blister on your palate,” Dr. Denboer shook his head slightly, «looks
worrisome. «We`ll need a biopsy.» And though that biopsy had been negative, it caught
Julius`s attention because that very week he had gone to Al`s funeral, his old cigarette–smoking tennis buddy, who died of lung cancer. And it didn`t help then that he was in the
midst of readingFreud, Living and Dying, by Max Schur, Freud`s doctor—a graphic
account of how Freud`s cigar–spawned cancer gradually devoured his palate, his jaw,
and, finally, his life. Schur promised Freud to help him die when the time came, and
when Freud finally told him that the pain was so great that it no longer made sense to
continue, Schur proved a man of his word and injected a fatal dose of morphine. Nowthat
was a doctor. Where do you find a Dr. Schur nowadays?
Over twenty years of no tobacco, and also no eggs or cheese or animal fats.
Healthy and happily abstinent. Until that God–dammed physical exam. Now everything
was permitted: smoking, ice cream, spare ribs, eggs, cheese...everything. What
difference did any of that matter any longer? What difference did anything make?—in
another year Julius Hertzfeld would be leeched into the soil, his molecules scattered,
awaiting their next assignment. And sooner or later, in another few million years, the
whole solar system would lie in ruins.
Feeling the curtain of despair descending, Julius quickly distracted himself by
turning his attention back to his phone call with Philip Slate. Philip a therapist? How was
that possible? He remembered Philip as cold, uncaring, oblivious of others, and, judging
from that phone call, he was still much the same. Julius drew on his pipe and shook his
head in silent wonder as he opened Philip`s chart and continued reading his dictated note
of their first session.
PRESENT ILLNESS—Sexually driven since thirteen—compulsive masturbation
throughout adolescence continuing till present day—sometimes four, five times daily—
obsessed with sex continually, masturbates to give himself peace. Huge hunk of life spent
on obsessing about sex—he says «the time I`ve wasted chasing women—I could have
gotten Ph.D.s in philosophy, Mandarin Chinese, and astrophysics.»
RELATIONSHIPS: A loner. Lives with his dog in a small flat. No male friends. Zero. Nor
any contacts with acquaintances from past—from high school, college, grad school.
Extraordinarily isolated. Never had a long–term relationship with a woman—consciously
avoids ongoing relationships—prefers one–night stands—occasionally sees a woman as
long as a month—usually woman breaks it off—either she wants more from him, or she
gets angry at being used or gets upset about his seeing other women. Desires novelty—
wants the sexual chase—but never satiated—sometimes when he travels he picks up a
woman, has sex, gets rid of her, and an hour later leaves his hotel room on the prowl
again. Keeps a record of partners, a score sheet, and in past twelve months has had sex
with ninety different women. Tells all this with flat affect—no shame, no boasting. Feels
anxious if he is alone for an evening. Usually sex acts like Valium. Once he has sex, he
feels peaceful for the rest of the evening and can read comfortably. No homosexual
activities or fantasies.
HIS PERFECT EVENING? Out early, picks up woman in bar, gets laid (preferably
before dinner), dumps woman as quickly as possible, preferably without having to buy
her dinner but usually ends up having to feed her. Important to have as much evening
time as possible for reading before going to bed. No TV, no movies, no social life, no
sports. Only recreation is reading and classical music. Voracious reader of classics,
history, and philosophy—no fiction, nothing current. Wanted to talk about Zeno and
Aristarchus, his current interests.
PAST HISTORY: Grew up in Connecticut, only child, upper middle class. Father
investment banker who committed suicide when Philip was thirteen. He knows nothing
about circumstances or reasons behind father`s suicide, some vague ideas that it was
aggravated by mother`s continual criticism. Blanket childhood amnesia—remembers
little of his first several years and nothing about his father`s funeral. Mother remarried
when he was 24. A loner in school, fanatically immersed in studies, never had close
friends, and since starting Yale at 17, has cut himself off from family. Phone contact with
mother once or twice a year. Has never met stepfather.
WORK: Successful chemist—develops new hormonal–based pesticides for DuPont.
Strictly an eight–to–five job, no passion about field, recently growing bored with his work.
Keeps current with the research in field but never during his off hours. High income plus
valuable stock options. A hoarder: enjoys tabulating his assets and managing his
investments and spends every lunch hour alone, studying stock market research.
IMPRESSION: Schizoid, sexually compulsive—very distant—refused to look at me—not
once did he meet my gaze—no sense of anything personal between us—clueless about
