CHAPTER FIFTEEN
THE JOHNS HOPKINS YEARS
I’m on my Lambretta, Marilyn is sitting behind, her arms encircling me. I feel the wind in my face as I watch the speedometer. Sixty-five, sixty-eight, seventy-one. I am going to reach eighty. I can do it. Eight O. I know I can do it. Nothing else matters. The handlebars vibrate slightly, then more and more, and I begin to lose control. Marilyn is crying, “Stop, stop, Irv, slow down, I’m scared. Please stop. Please please.” She screams and pounds on my back.
I wake up. My heart is racing. I sit up in bed and feel for my pulse—over a hundred. That damn dream! I know that dream too well—I’ve dreamt it many times. I know exactly what prompted the dream now. Last night in bed I was reading a passage in On the Move, a memoir by Oliver Sacks, in which he describes being a member of the “ton club,” a group of youthful motorcycle riders who had driven their motorcycles above one hundred miles per hour.
The dream is not only a dream: it is a memory of a real event that I’ve replayed countless times, both as a daydream and as a nocturnal dream. I know that dream and I hate it! The real event took place after the end of my internship, when I had a week of vacation before starting my three-year psychiatric residency at Johns Hopkins Hospital in Baltimore. Marilyn’s mother had agreed to care for our two children for a long weekend, and we took off on the Lambretta for the Eastern Shore of Maryland; it was on this trip that the event accurately depicted in the dream occurred. I didn’t think too much of it at the time—perhaps I was actually amused by Marilyn’s panic. The road was empty and I just wanted to open the throttle. Like a teenager, I was exhilarated by speed and felt absolutely invulnerable. It was only much later that I realized the extent of my thoughtlessness and stupidity. How could I possibly have involved my wife in this stunt with two young children at home? Aiming for eighty miles per hour, unprotected, bareheaded—those were the days before helmets! I hate thinking about it and even now hate writing about it. I shuddered recently as Eve, my daughter, a physician, described visiting a ward full of paralyzed young men, all with broken necks from accidents on motorcycles or surfboards. They, too, must have once felt invulnerable.
We didn’t crash. Eventually, I returned to sanity and slowed down, and for the rest of the time we rode safely through the charming little settlements on Maryland’s Eastern Shore. On the way home, when I went for a ride by myself while Marilyn napped after lunch, I hit an oil slick and took a nasty fall, scraping my knee badly. We stopped at an emergency room. The physician cleaned out the wound and gave me a tetanus antitoxin shot, and we returned to Baltimore without further mishap. Two days later, just as I was preparing to report for my first day of residency, I broke out in a rash, which soon developed into massive hives. I had had an allergic reaction to the horse serum in the tetanus shot and was immediately hospitalized at Hopkins for fear that my breathing would become compromised and a tracheotomy required. I was treated with steroids, which proved immediately effective, but I felt fine the next day and was taken off the steroids and discharged. I started my residency the next morning. In those early days of steroid use, physicians did not appreciate the need to taper steroids slowly, however, and I had an acute withdrawal syndrome with depression, along with such intractable anxiety and insomnia for the next couple of days that I had to load up with Thorazine and barbiturates to get to sleep. Fortunately, it was to be my only personal encounter with depression.
On my third day at Hopkins, we first-year residents had our initial meeting with the very formidable John Whitehorn, the chairman of psychiatry, who would become a major figure in my life. A stern, dignified man who rarely smiled, John Whitehorn had a bald pate ringed by short gray hair. He wore steel-rimmed spectacles and intimidated almost everyone. Later I was to learn that even chiefs of other departments treated him with deference and never referred to him by first name. I did my best to attend to his words, but was so exhausted by my lack of sleep and the sleeping drugs in my body that I could barely move in the morning, and during Dr. Whitehorn’s greeting to us I fell asleep in my chair. (Many decades later, Saul Spiro, a fellow resident, and I reminisced about our time together at Hopkins, and he told me he respected me enormously for having had the chutzpah to fall asleep at our first meeting with the boss!)
Aside from some low-grade anxiety and mild depression, I recovered from my allergic reaction in about two weeks, but I was so unnerved by the experience that I decided to seek therapy. I asked the chief resident, Stanley Greben, for advice. In that era it was commonplace, even de rigueur, for psychiatric residents to have a personal analysis, and Dr. Greben recommended that I see his own analyst, Olive Smith, an elderly senior training analyst in the Washington-Baltimore Psychoanalytic Institute, and one with royal lineage: she had been analyzed by Frieda Fromm-Reichman, who, in turn, had been analyzed by Sigmund Freud. I had a great deal of respect for my chief resident, but, before making such a huge decision, I decided to solicit Dr. Whitehorn’s opinion about my symptoms following steroid withdrawal and about starting analysis. It appeared to me that he listened with little interest, and then, when I mentioned starting analysis, he slowly shook his head and commented simply, “I believe you will find that a little phenobarbital might be more effective.” Remember that these were the pre-Valium days, although a new tranquilizing drug called Equanil (meprobamate) was shortly to be introduced.
Later I learned that other faculty members were highly amused to discover I had the audacity (or stupidity) to pose this question to Dr. Whitehorn, who was known to be extremely skeptical of psychoanalysis. He took an eclectic position, following the psychobiological approach of Adolf Meyer, the long-term previous chair of the Johns Hopkins Psychiatry Department, an empiricist who focused on the patient’s psychological, social, and biological makeup. Thereafter, I never spoke of my psychoanalytic experience to Dr. Whitehorn and he never asked.
The Hopkins Psychiatry Department had a split personality: Whitehorn’s point of view prevailed in the four-story psychiatric hospital and outpatient department, while a strong orthodox psychoanalytic faction ran the consultation service. I generally dwelled in Whitehorn territory, but I also attended analytic conferences in the consultation department, especially the case conferences led by Lewis Hill and Otto Will, both astute analysts, and also world-class storytellers. I listened enthralled to their clinical case presentations. They were wise, flexible, and thoroughly engaged with their patients. I marveled at the way they described an interaction with a patient: so caring, so concerned, and so generous. They were among my first models for the practice (and narration) of psychotherapy.
But most analysts worked very differently. Olive Smith, whom I was seeing four times a week for analysis, worked in an orthodox Freudian manner: she was a blank screen, revealing nothing of herself through words or facial expression. I rode from the hospital to her office in downtown Baltimore only ten minutes away on my Lambretta every day at 11 a.m. Often I could not help taking a quick look at my mail just before leaving, which resulted in my arriving a minute or two late—evidence of resistance to the analysis that we often, and fruitlessly, discussed.
Olive Smith’s office was in a suite with four other analysts, all of whom had been analyzed by her. At that time I considered her elderly. She was at least seventy, white-haired, somewhat bent over, and unmarried. Once or twice I saw her in the hospital going to a consultation or an analytic meeting and there she appeared younger and spryer. I lay on the couch, with her chair positioned at the end, near my head, and I had to stretch my neck and look back to see her, sometimes to check that she was still awake. I was asked to free-associate and her responses were entirely limited to interpretations, very few of them helpful. Her occasional lapses from neutrality were the most important part of the treatment. Obviously many found her helpful—including all the analysands in her suite of offices and my chief resident. I have never understood why it worked for them and not for me. In retrospect, I think she was the wrong therapist for me—I simply needed someone more interactive. Many times I have had the unkind thought that the main thing I learned in my analysis was how not to do psychotherapy.
Her fee was twenty-five dollars per session. One hundred a week. Five thousand a year. Twice my annual salary as a resident. I paid for my analysis by doing physical exams, at ten dollars each, for the Sun Life Insurance Company of Canada every Saturday, zipping around the back streets of Baltimore on my Lambretta, wearing my hospital whites.
As soon as I decided to take my residency at Johns Hopkins Hospital, Marilyn applied to the Johns Hopkins University PhD program in comparative literature. She was accepted and worked under the guidance of René Girard, one of the most eminent French academics of his time. She chose to write her PhD thesis on the myth of the trial in the works of Franz Kafka and Albert Camus and, with her encouragement, I began to read Kafka and Camus as well, before moving on to Jean-Paul Sartre, Maurice Merleau-Ponty, and other existential writers. For the first time, my work and Marilyn’s began to converge. I fell in love with Kafka, whose Metamorphosis stunned me as no piece of literature had ever done. And I was also jolted by Camus’s The Stranger and Sartre’s Nausea. Through narrative, these writers had plumbed depths of existence in a way that psychiatric writing never seemed to have achieved.
Our family thrived during our three years at Hopkins. Our oldest, Eve, attended nursery school right in the courtyard of the square compound where we lived with the other house staff. Reid, a lively, playful child, had no trouble adjusting to the care of a housekeeper when Marilyn was pursuing her PhD studies at the Hopkins campus fifteen minutes away. During our final year in Baltimore, Victor, our third child, was born in the Johns Hopkins Hospital, which was just one block up the hill from our home. We were fortunate to have healthy, lovable children, and I looked forward to seeing and playing with them every evening and on weekends. I never felt that my family life was an impediment to my professional life, though I am sure this was not the same for Marilyn.
I loved my three years of residency. From the very beginning, each resident had the clinical responsibility of running an inpatient ward as well as meeting with a roster of outpatients. The Hopkins surroundings and staff had a genteel, southern quality that now feels like a thing of the past. The psychiatry building, the Phipps Clinic, containing six inpatient wards and an outpatient department, had opened in 1912, when it was overseen by Adolf Meyer, who was succeeded by John Whitehorn in 1940. The four-story red brick building was sturdy and dignified; the elevator operator, a fixture for four decades, was courteous and friendly. And the nursing staff, young and old alike, sprang to their feet when any physician entered the nurses’ station—ah, those were the days!
Though hundreds of patients have passed from my memory, I remember many of my first patients at Hopkins with eerie clarity. There was Sarah B., the wife of a Texas oil tycoon, who had been in the hospital for several months with catatonic schizophrenia. She was mute and often frozen into one position for hours at a time. My work with her was wholly intuitive: supervisors were of little help, because no one knew how to treat such patients—they were considered beyond reach.
I took care to meet with her every day for not less than fifteen minutes in my small office in the long hallway just outside the ward. She had been entirely mute for months, and since she never responded by word or gesture to any question, I did all the talking. I told her about my day, the newspaper headlines, my thoughts about the group meetings on the ward, issues I was exploring in my own analysis, and the books I was reading. Sometimes her lips moved but no words were uttered; her facial expression never changed, and her large, plaintive blue eyes remained fixed upon my face. And then, one day, as I was babbling along about the weather, she suddenly stood up, walked over to me, and kissed me hard on the lips. I was flabbergasted, didn’t know what to say, but kept my composure, and, after musing aloud about possible reasons for the kiss, I escorted her back to the ward and tore over to my supervisor’s office to discuss the incident. The one part I didn’t acknowledge to my supervisor was that I had rather enjoyed the kiss—she was an attractive woman and her kiss had aroused me, but I never for a moment forgot that my role was to heal her. After that, things continued as before for weeks longer until I decided to try a course of treatment with Pacatal, a major new tranquilizer (now long discarded) that had just come on the market. To everyone’s great surprise, Sarah was a changed person within a week, talking often and generally quite coherently. In my office we engaged in long discussions about the stresses in her life preceding her illness, and at some point I commented on my feelings about meeting with her silently for so long and my many doubts that I had offered her anything in those sessions. She replied immediately, “Oh no, Dr. Yalom. You are wrong. Don’t feel that way. All through that time you were my bread and butter.”
I was her bread and butter. I have never forgotten that utterance and that moment. It returns to my mind often when I’m with a patient, clueless about what is going on, unable to make helpful or coherent remarks. It is then that I think of dear Sarah B. and remind myself that a therapist’s presence, inquiries, attention may be nourishing in ways we cannot imagine.
I began attending weekly seminars with Jerome Frank, MD, PhD, the other Hopkins full professor, who, like Dr. Whitehorn, was an empiricist and persuaded only by logic and evidence. He taught me two important things: the basics of research methodology, and the fundamentals of group therapy. At that time, group therapy was in its infancy, and Dr. Frank had written one of the few good books on the topic. Every week, the residents—our eight heads crammed together—observed his outpatient therapy group through one of the first two-way observational mirrors to be used in this context, a hole in the wall that was only about one square foot large. After the group meeting, we met with Dr. Frank for a discussion of the session. I found group observation to be such a valuable didactic format that, years later, I would use it in my own group therapy teaching.
I continued to observe the group every week long after the other residents had finished the course. By the end of the year, Dr. Frank had asked me to lead the group when he was away. From the very beginning I loved leading groups: it seemed obvious that the therapy group offered a rich opportunity for members to give and receive feedback about their social selves. It seemed to me a unique, rich setting for growth, allowing members to explore and express parts of their interpersonal selves and to have their behavior reflected back to them by their peers. Where else could individuals offer and obtain such honest and constructive feedback from a set of trusted equals? The outpatient therapy group had only a few basic rules: in addition to total confidentiality, the members were committed to show up for the next meeting, to keep communicating openly, and not to meet with each other outside the group. I recall envying the patients and wishing I could have participated as a member in such a group.
Unlike Dr. Whitehorn, Dr. Frank was warm and approachable—by the end of my first year, he suggested I call him “Jerry.” He was a great teacher and a fine man, modeling integrity, clinical competence, and the necessity for research inquiry. We stayed in touch long after I left Hopkins, and we met whenever he visited California. On one memorable occasion, our families spent a week together in Jamaica. In old age, he developed severe memory problems, and I visited him in a residential center whenever I was on the East Coast. The last time I saw him, he told me that he spent his days looking at interesting things outside his window, and that each morning he awoke with a clean slate. He rubbed his hand over his forehead and said, “Whoosh—all the memories of the preceding day are wiped out. Entirely gone.” Then he smiled, looked up at me, and gave his student one final gift: “You know, Irv,” he said, reassuringly, “it’s not so bad. It’s not so bad.” What a sweet, lovely man. I smile whenever I think of him. Decades later, I felt greatly honored by being invited to give the first Jerome Frank Psychotherapy Lecture at Johns Hopkins.
Jerry Frank’s group therapy method fit neatly into the interpersonal approach then au courant in American psychodynamic theory. The interpersonal (or “Neo-Freudian”) approach was a modification of the older, orthodox Freudian position; it stressed the importance of interpersonal relations in the individual’s development throughout the life cycle, whereas the older approach placed most of its emphasis on the very early years of life. This approach was American in origin and heavily based on the work of psychiatrist Harry Stack Sullivan, as well as on European theorists who had immigrated to the United States, especially Karen Horney and Erich Fromm. I read a great deal of the interpersonal theoretical literature and found it eminently sensible. Karen Horney’s Neurosis and Human Growth was by far the most heavily underlined book of my residency days. Though Sullivan had a great deal to teach, he was, unfortunately, such an abysmal writer that his ideas never had the impact they deserved. In general, though, his work helped me understand that most of our patients fall into despair because of their inability to establish and maintain nurturing interpersonal relationships. And, to my mind, it followed that group therapy provided the ideal arena in which to explore and to change maladaptive modes of relating to others. I was fascinated by the group process and, throughout my residency, led many groups in both inpatient and outpatient settings.
As my first year progressed, I began feeling overwhelmed by all the data, all the various clinical conditions I encountered, the idiosyncratic approaches of my supervisors, and I longed for some comprehensive explanatory system. Psychoanalytic theory seemed the most likely option, and most psychiatric training programs at that time in the United States were analytically oriented. Though today’s chairmen of psychiatry are generally neuroscientists, in the 1950s most of them were psychoanalytically trained. Johns Hopkins, aside from the consultation service, was a leading exception.
So I met dutifully with Olive Smith, four times weekly, read Freud’s writings, and attended the analytically oriented conferences in the consultation wing of the department, but as time went by I grew increasingly skeptical of the psychoanalytic approach. My personal analyst’s comments seemed irrelevant and off the mark, and I grew to feel that, though she wanted to be helpful, she was too constrained by the edict of neutrality to reveal to me any of her real self. Moreover, I was coming to believe that the emphasis on early life, and primal sexual and aggressive drives, was severely limiting.
The biopsychological approach at that time had little to offer aside from such somatic therapies as insulin coma therapy and electroconvulsive therapy (ECT). Though I personally administered these many times and sometimes saw extraordinary recoveries, these treatments were disparate approaches discovered by accident. For example, clinicians have for centuries observed that convulsions caused by various conditions, such as fever or malaria, had a salutary effect on psychoses or depression. So they searched for methods of inducing hypoglycemic coma and seizures both by chemical (Metrazol) and electrical (ECT) means.
Toward the end of my first year, a newly published book titled Existence by the psychologist Rollo May came to my attention. It consisted of two long, excellent essays by May and a number of translated chapters by European therapists and philosophers, such as Ludwig Binswanger, Erwin Straus, and Eugène Minkowski. This book changed my life. Though many of the chapters were written in deep-sounding language that seemed designed to obfuscate rather than to illuminate, May’s essays were exceptionally lucid. He laid out the basic tenets of existential thought and introduced me to the relevant insights of Søren Kierkegaard, Friedrich Nietzsche, and other existential thinkers. As I look at my 1958 copy of Rollo May’s Existence, I see notations of approval or disagreement on almost every page. The book suggested to me that there was a third way, an alternative to psychoanalytic thought and the biological model—a way that drew from the wisdom of philosophers and writers from the past 2,500 years. As I browsed through my old copy while writing this memoir, I noted, with great surprise, that Rollo, around forty years later, had signed it and written, “For Irv, a colleague from whom I learn Existential psychotherapy.” This brought tears to my eyes.
I attended a series of lectures on the history of psychiatry, stretching from Philippe Pinel (the eighteenth-century physician who introduced a humane treatment of the insane) to Freud. The lectures were interesting, but, to my mind, flawed in the assumption that our field began with Pinel in the eighteenth century. As I listened, I kept thinking of all the thinkers who had written on human behavior and human anguish long before—philosophers, for example, such as Epicurus, Marcus Aurelius, Montaigne, and John Locke. These thoughts, and Rollo May’s book, persuaded me that it was time to begin an education in philosophy, so during my second year of residency I enrolled in a year-long course in the history of Western philosophy at the Johns Hopkins University Homewood campus, where Marilyn studied. Our textbook was Bertrand Russell’s popular History of Western Philosophy, and, after so many years of physiological, medical, surgical, and obstetrical textbooks, these pages were ambrosia to me.
Ever since that survey course, I’ve been an autodidact in philosophy, reading widely on my own and auditing courses both at Hopkins and, later, Stanford. I had no idea, at the time, how I would apply this wisdom to my field of psychotherapy, but, at some deep level, I knew I had found my life’s work.
Later in my residency I had a three-month clerkship at the nearby Patuxent Institute, a prison housing mentally ill offenders. I saw patients in individual therapy and led a daily therapy group of sexual offenders—one of the most difficult groups I’ve ever led. The members spent far more energy trying to persuade me they were well adjusted than they did working on their problems. Since they had an indeterminate sentence—that is, they were incarcerated until psychiatrists declared them recovered—their reluctance to reveal a great deal was entirely understandable. I found my experience at Patuxent fascinating, and by the end of the year decided I had sufficient material to write two articles: one on group therapy for sexual deviants, and another on voyeurism.
The voyeurism article was one of the first psychiatric publications on that topic. I made the point that voyeurs did not simply want to view naked women: if voyeurs were to experience great pleasure, it was necessary that the viewing be forbidden and surreptitious. None of the voyeurs I had studied had sought out strip joints or prostitutes or pornography. Second, though voyeurism had always been considered an annoying, quirky, and harmless offense, I found that not to be true. Many inmates I worked with had started with voyeurism and then progressed to more serious offenses, such as breaking and entering and sexual assault.
As I was writing the article, my medical-school case presentation of Muriel came to mind, and just as I had evoked the audience’s interest by beginning that presentation with a story, I began my voyeurism article with the tale of the original Peeping Tom. My wife, while working on her doctorate, helped me retrieve early accounts of the legend of Lady Godiva, the eleventh-century noblewoman who had volunteered to ride naked through the street to save her townspeople from the excessive taxation imposed by her husband. All the townspeople, save Tom, showed their gratitude by refusing to look at her nakedness. But poor Tom could not resist a peek at naked royalty and, for his transgression, was struck blind on the spot. The article was immediately accepted for publication in the Archives of General Psychiatry.
Shortly afterward, my article on the techniques of leading therapy groups for sexual offenders was published in the Journal of Nervous and Mental Disease. Unrelated to my Patuxent work, I also published an article on the diagnosis of senile dementia. Because it was unusual for residents to author publications, the Hopkins faculty responded very positively. Their plaudits were gratifying but also a bit puzzling to me because writing came so easily.
John Whitehorn always dressed in a white shirt, necktie, and brown suit. We residents speculated he had two or three identical suits, since we never saw him wear anything else. The entire resident class was expected to attend his annual cocktail party at the beginning of every academic year, and we all dreaded it: we had to stand for hours dressed in our suits and ties and were served a small glass of sherry and no other food or drink.
During our third year, the five other third-year residents and I spent the entire day every Friday with Dr. Whitehorn. We sat in the large corner conference room adjacent to his office as he interviewed each of his hospitalized patients. Dr. Whitehorn and the patient sat in upholstered chairs, while we eight residents sat a few feet away in wooden chairs. Some interviews lasted only ten or fifteen minutes, others lasted an hour, and sometimes two or three hours.
His publication “Guide to Interviewing and Clinical Personality Study” was used in most psychiatric training programs in the United States at the time and offered the neophyte a systematic approach to the clinical interview, but his own interviewing style was anything but systematic. He rarely inquired about symptoms or areas of distress, but instead followed a plan of “Let the patient teach you.” Now, over half a century later, a few examples still remain in mind: one patient was writing his PhD thesis on the Spanish Armada, another was an expert on Joan of Arc, and another was a wealthy coffee planter from Brazil. In each of these instances, Dr. Whitehorn interviewed the patient at great length, at least ninety minutes, focusing on the patient’s interests. We learned a great deal about the historical background of the Spanish Armada, the conspiracy against Joan of Arc, the accuracy of Persian archers, the curriculum of professional welding schools, and everything we wanted to know (and more) about the relationship between the quality of the coffee bean and the altitude at which it was grown. At times I was bored and tuned out, however, only to discover, ten or fifteen minutes later, that a hostile, guarded, paranoid patient was now speaking more frankly and personally about his or her inner life. “You and the patient both win,” John Whitehorn said. “The patient’s self-esteem is raised by your interest and your willingness to be taught by him, and you are edified and will eventually learn all you need to know about his illness.”
After the morning interviews, we had a two-hour lunch served in his large, comfortable office on good bone china in leisurely southern style: a large salad, sandwiches, codfish cakes, and, my favorite dish until this very day, Chesapeake Bay crab cakes. The conversation stretched from salad and sandwiches to dessert and coffee and ranged over many topics. Unless we steered him in a particular direction, Whitehorn was prone to discuss his new ideas on the periodic table. He would walk to the blackboard and pull down the periodic table chart that was always hanging in his office. Though he had taken psychiatric training at Harvard and had been chairman of psychiatry at Washington University in St. Louis before coming to Hopkins, he had originally been a biochemist, and had done substantial research on the chemistry of the brain. I remember posing questions about the origins of paranoid thinking, to which he responded at great length. Once, when I was passing through a phase of highly deterministic thinking about human behavior, I suggested to him that total knowledge of all the stimuli imposing upon the individual would allow us to predict with precision his or her reaction, both in thought and action. I compared it to hitting a pool ball—if we knew the force, angle, and spin, we’d know the reaction of the ball being struck. My position prompted him to take the opposite view, a humanistic perspective that was foreign and uncomfortable for him. After a lively discussion, Dr. Whitehorn said to the others, “It is not out of the question that Dr. Yalom is having a bit of fun at my expense.” As I think back on it, he was probably right: I do recall feeling a bit amused that I had maneuvered him into the very humanistic point of view I usually espoused.
My only disappointment with him came when I lent him a copy of Kafka’s The Trial, which I had loved in part for its metaphorical presentation of neuroticism and free-floating guilt. Dr. Whitehorn returned the book a couple of days later, shaking his head. He told me he just didn’t get it and that he’d rather talk to real people. By that time, I had been in psychiatry for three years, and I had yet to encounter any clinician who was interested in the insights of philosophers or novelists.
After lunch we returned to observing Dr. Whitehorn’s interviews. By four or five o’clock I began getting antsy, eager to get out and play tennis with my regular partner, one of the medical students. The house staff tennis court was only two hundred feet away in an alcove between the departments of psychiatry and pediatrics, and on many Friday evenings I kept my hopes alive until the last rays of sunshine had vanished, then sighed and turned my full attention back to the interview.
My final contact during my training with John Whitehorn came in my last month of residency. He summoned me to his office one afternoon, and when I had closed the door behind me and sat before him, I noticed his face seemed less severe. Was I mistaken, or did I discern friendliness, even a trace of a smile? After a typical Whitehornian pause, he leaned toward me and asked, “What do you plan to do with your future?” When I said that my next step was my upcoming mandatory two years of service in the army, he grimaced and said, “How fortunate you are that we are at peace. My son was killed in World War II in the Battle of the Bulge—a God-damned meat grinder.” I stammered that I was sorry, but he closed his eyes and shook his head to indicate that he didn’t wish to speak further of his son. He asked about my plans after the army. I told him I was uncertain about the future and had responsibilities to my wife and three children. Perhaps, I told him, I might enter practice in Washington or Baltimore.
He shook his head and pointed to my published papers lying in a neat pile on his desk and said, “Publications like these say something else. They represent the steps of the academic ladder one must ascend. My gut tells me that if you continue thinking and writing in this manner, there might be a bright future for you in a university teaching department—one, for example, such as Johns Hopkins.” His final words rang in my ears for many years: “It would be flying in the face of fortune for you not to pursue an academic career.” He ended the session by giving me a framed photograph of himself with the inscription, “To Dr. Irvin Yalom, with affection and admiration.” It hangs today in my office. As I write, I see it now, resting uncomfortably alongside a picture of Jolting Joe DiMaggio. “With affection and admiration”—as I think of those words now I am astonished: I never recognized those sentiments in him at the time. Only now, as I write this, do I register that he, and Jerome Frank, as well, had indeed served as mentors to me—great mentors! I know it’s time to discard my notion that I am entirely self-created.
As I ended my three years of residency, Dr. Whitehorn was ending his long career at Johns Hopkins, and I, along with the other residents and the entire faculty of the medical school, attended his retirement party. I remember well how he began his farewell address. After a lively introduction by Professor Leon Eisenberg, my supervisor in child psychiatry, who would soon assume the chair of the Harvard Department of Psychiatry, Dr. Whitehorn stood up, walked to the microphone, and began, in his measured, formal voice: “It has been said that a man’s character may be judged by the character of his friends. If that is so…,” he paused and very slowly and deliberately scanned the large audience from left to right, “then I must be a very fine fellow indeed.”
I had only two contacts with John Whitehorn after that. Several years later while I was teaching at Stanford, a close member of his family contacted me saying that John Whitehorn had referred him to me for psychotherapy, and I was pleased to be able to offer him help in a few months of therapy. And then, in 1974, fifteen years after my last face-to-face contact with him, I received a phone call from John Whitehorn’s daughter, whom I had never met. She told me that her father had had a massive stroke, was near death, and had very specifically asked for me to visit him. I was entirely dumbfounded. Why me? What could I offer him? But of course I did not hesitate, and the following morning I flew across the country to Washington, where, as always, I stayed with my sister, Jean, and her husband, Morton. I borrowed their car, picked up my mother, who always enjoyed a car ride, and drove to a convalescent hospital just outside of Baltimore. I arranged comfortable seating for my mother in the lobby and took the elevator to Dr. Whitehorn’s room.
He appeared much smaller than I recalled. He was paralyzed on one side of his body and had expressive aphasia, which greatly impaired his ability to speak. How shocking it was to see the most gloriously articulate person I had ever known now drooling saliva and grubbing for words. After a few false starts, he finally managed to utter, “I’m… I’m… I’m scared, so damned scared.” And I was scared, too, scared by the sight of a great statue felled and lying in ruins.
Dr. Whitehorn had trained two generations of psychiatrists, a great many of whom were now chairmen at leading universities. I asked myself, “Why me? What could I possibly do for him?”
I ended up not doing much. I behaved like any nervous visitor, searching desperately for words of comfort. I reminded him of my days with him at Hopkins and told him how much I had treasured our Fridays together, how much he had taught me about interviewing patients, how I had taken his advice and had become a university professor, how I tried to emulate him in my work by treating patients with dignity and interest, how, following his advice, I let patients teach me. He made sounds but could not formulate words, and finally, after thirty minutes, he fell into a deep sleep. I left shaken and still puzzled about why he had called for me. Later I learned from his daughter that he died two days after my visit.
The question “Why me?” ran through my mind for years. Why call for an agitated, self-doubting son of a poor immigrant grocer? Perhaps I was a stand-in for the son he had lost in World War II. Dr. Whitehorn died such a lonely death. If only I could have given him more. Many times I wished for a second chance. I should have said more about how I treasured my time with him, and told him how often I thought of him when I interviewed patients. I should have tried to express the terror he must have been feeling. Or I should have touched him, or held his hand, or kissed his cheek, but I desisted—I had known him too long as a formal, distant man, and besides, he was so helpless that he might have experienced my tender gestures as an assault.
Some twenty years later, in a casual lunch conversation, David Hamburg, the chairman of psychiatry who brought me to Stanford after I left the army, told me he was doing some housecleaning and found a letter of support for my appointment from John Whitehorn. He showed me the letter and I was stunned by its final sentence: “I believe that Dr. Yalom will become a leader of American Psychiatry.” Now, as I reconsider my relationship with John Whitehorn, I think I understand why I was summoned to his deathbed. He must have viewed me as someone who would carry on his work. I’ve just now turned to look at his picture hanging over my desk and try to catch his gaze. I hope he was comforted by the thought that, partly through me, he would continue to ripple into the future.