Every year at departmental graduation, the psychiatry residents put on a skit lampooning some aspect of their Stanford experience. One year I was the target, and the resident lampooning me always appeared caressing a stack of books with “Yalom” on the spine. But I took no offense: instead, I found myself rather pleased at the sight of all those books I had written.
At that time I was working on a publisher-generated book, The Yalom Reader, beautifully edited by my son Ben, that contains excerpts from my prior work and new essays. After finishing the final essay, I had a powerful, unforgettable dream about my mother that I described in the title story of my next book, Momma and the Meaning of Life.
Dusk. Perhaps I am dying. Sinister shapes surround my bed: cardiac monitors, oxygen canisters, dripping intravenous bottles, coils of plastic tubing—the entrails of death. Closing my lids, I glide into darkness.
But then, springing from my bed, I dart out of the hospital room smack into the bright, sunlit Glen Echo Amusement Park where, in decades past, I spent many summer Sundays. I hear carousel music. I breathe in the moist, caramelized fragrance of sticky popcorn and apples. And I walk straight ahead—not hesitating at the Polar Bear Frozen Custard stand or the double-dip roller coaster or the Ferris wheel—to take my place in the ticket line for the House of Horrors. My fare paid, I wait as the next cart swivels around the corner and clanks to a halt in front of me. After stepping in and pulling down the guardrail to lock myself snugly into place, I take one last look about me—and there, in the midst of a small group of onlookers, I see her.
I wave with both arms and call, loud enough for everyone to hear, “Momma! Momma!” Just then the cart lurches forward and strikes the double doors, which swing open to reveal a black gaping maw. I lean back as far as I can and, before being swallowed by the darkness, call again, “Momma! How’d I do, Momma? How’d I do?”
Could the dream’s message be—and this possibility staggers me—that I have been conducting my entire life with this lamentable woman as my primary audience? All my life I have sought to escape, to climb away from my past—the ghetto, the grocery store—yet can it be that I have escaped neither my past nor my mother?
My mother had a conflictual relationship with her mother, who spent the last years of her life in a New York nursing home. In addition to cleaning and cooking and working in the store, my mother regularly took a four-hour train ride to bring home-baked pastries to her mother, who instead of thanking her, raved about Simon, my mother’s brother. He never brought her anything but a bottle of 7-Up.
My mother told me that story so many times that I stopped listening—I was tired of her ranting. But now I feel differently. Obviously my mother felt wholly unappreciated by her only son. I often ask myself: Why didn’t I sympathize with her? Why couldn’t I have said, “How unfair! You do all that work and baking and travel to see your mother and all she does is praise Simon for his 7-Up. How grating that must have felt!” Really, how hard would it have been for me to say that? Oh, how I wish I could have been kind enough to utter those words. That simple act of appreciation would have meant so much to her. And perhaps, if I had said this, she wouldn’t still be haunting my dreams.
And, of course, the dream staggers me with the idea that as I move toward my death, that dark house of horrors, I am still looking for validation. But not from my wife, my children, my friends, colleagues, students, or patients, but from my mother! That mother whom I disliked so thoroughly and felt so ashamed of. Yes, in my dream, I turn to her. It was to her that I posed my final question, “How’d I do?” What better proof for the lasting power of early life attachments?
Such regret played a role in the therapy of a young woman I’m currently seeing. She had asked for a few consultation sessions on Skype, and in our second meeting I asked about her relationship with her parents. “My mother is a saint, and I’ve always had a warm, wonderful relationship with her. But my father… well, that’s a different story.”
“Tell me about your relationship with him.”
“The best description I can give is that it is very much like your relationship to your mother in Momma and the Meaning of Life. My father worked hard and supported the family but he was a tyrant. I’ve never heard a complimentary or pleasant word from him to anyone in the family, nor to the people who work in his company. Then, about eight years ago, his older brother and business partner committed suicide; the business went under, and my father went bankrupt. He lost everything. Now he’s angry and depressed and does nothing but look out the window all day. I’ve been supporting him financially since the bankruptcy, but not one word of thanks. Yesterday at breakfast we got into a big fight and he threw his plate on the floor and walked out.”
My patient and I have only had three meetings, but since my patient had read my story, I decided to share with her my regrets for never having empathized with my mother. “I wonder,” I said to her, “if, someday, you’ll have such regrets about your father.”
She nodded slowly, saying, “Maybe I will.”
“I’m only guessing, but I imagine that your father, who was so entirely invested in his role as provider, and who ran a big company and exercised such power in the world and in the family, might be feeling great humiliation at being supported by his daughter.”
She nods. “We’ve never talked about it.”
“Are you up to it?”
“I’m not sure. It’s something to think about.”
The following week she described an encounter with her father. “I own a large clothing store, and we were having a special event to showcase the new collection. I had extra entry tickets and thought my father might enjoy it. He came, but then, without discussing it with me, went to the staff area and jollied up to them, letting them know he was my father. When I heard about this, I lost it and said, ‘How could you have done that? I don’t appreciate your not checking with me first. I want to keep my business and personal life separate.’ He started yelling at me and I yelled back and finally he went to his room and slammed his door.”
“And then?”
“I started to leave, but then I started thinking of what a miserable evening this was going to be for my mother… and, yes, for my father, as well, and I thought about what you had said about your mother. So I took a breath and knocked on his door and talked to him. ‘Look, Dad, I’m sorry. But here’s my point. I invited you to see one of my events, but I didn’t want you to go and cozy up with my employees—what I wanted was to share the event with you. How often do we ever do that?’”
“What a wonderful thing to say. And then?”
“For once he was silent. Almost dumbfounded. And he came over to me and hugged me and he cried. I’ve never, ever, seen him cry before. And I cried, too. We cried together.”
Yes, this is a true story—almost word-for-word.
Momma and the Meaning of Life contains the most effective teaching tale I have ever written, “Seven Advanced Lessons in the Therapy of Grief,” that was meant to serve as a primer for therapists using an existential approach.
Irene, an esteemed surgeon, called upon me for assistance. Her husband was dying of cancer at a young age, and Irene’s grief was understandably acute. Several years before, I had spent two years leading a group for people who had recently lost a spouse, and as a result of this project, I considered myself expert in working with bereaved patients and agreed to work with Irene. Extraordinarily intelligent, but frosty and severe with herself and others, Irene became my patient for two years. Our work together showed me how much I still had to learn about loss: hence the title of the story, “Seven Advanced Lessons in the Therapy of Grief.”
My first lesson occurred in our very first session, when she described the dream she had had the night before.
I’m still a surgeon, but I’m also a grad student in English. My preparation for a course involves two different texts, an ancient and a modern text, each with the same name. I am unprepared for the seminar because I haven’t read either text. I especially haven’t read the old, first text, which would have prepared me for the second.
I asked her if she remembered anything about the name of the texts. “Oh, yes, I remember it clearly. Each book, the old and the new, was titled The Death of Innocence.” For a therapist with my interests and background, this was a great gift. Imagine, two texts—an ancient and a new one—and the ancient text (i.e., one’s earliest years) was needed to understand the new.
It wasn’t only that Irene’s dream promised an intellectual treasure hunt of the highest order; it was also a first dream. As I explain in “Seven Advanced Lessons,” ever since 1911, when Freud first discussed it, a mystique has surrounded the initial dream that a patient reports in therapy. Freud believed that the first dream is unsophisticated and highly revealing because beginning patients still have their guard down. Later in therapy, once they have worked through different dreams with the therapist, the dream-weaver residing in the unconscious grows cautious, taking care thereafter to manufacture more complex and obfuscating dreams.
Following Freud, I often imagined the dream-weaver as a plump, jovial homunculus, living the good life in a forest of dendrites and axons. He sleeps by day, but at night, lying on a cushion of buzzing synapses, he drinks honeyed nectar and lazily spins out dream sequences for his host. On the night before the first therapy visit, the patient falls asleep full of conflicting thoughts about the upcoming therapy, and the homunculus within goes about his nighttime job weaving those fears and hopes into a dream. Then, after the therapy session, the homunculus learns that the therapist has deftly interpreted his dream, and from that time forward he takes care to bury the meaning ever deeper in nocturnal disguise. Of course, this is all just a foolish fairy tale—if only I didn’t believe it!
I remember with eerie clarity my own dream, on the night before the first session of my personal analysis over fifty years ago, which I also describe in “Seven Advanced Lessons.”
I am lying on a doctor’s examining table. The sheet is too small to cover me properly. I can see a nurse inserting a needle into my leg—my shin. Suddenly there’s an explosive hissing, gurgling sound—WHOOOOOSH.
The center of the dream—the loud whoosh—was immediately clear to me. As a child I had been plagued with chronic sinusitis, and every winter my mother took me to Dr. Davis, an otolaryngologist, for a sinus draining and flushing. I hated his yellow teeth and his fishy eye, which peered at me through the center of the circular mirror attached to the headband otolaryngologists used to wear. As he inserted a cannula into my sinus foramen, I felt a sharp pain and then heard a loud whooooosh—the same whooooosh I heard in the dream—as the injected saline flushed out my sinus. Looking at the quivering, disgusting mess of pus in the chrome drainage pan, I thought some of my brain had been washed out. In my first dream in analysis, that real-life horror had blended with my fear that shameful and disgusting thoughts would come out of me on the analytic couch.
Irene and I worked hard on her first dream. “So you hadn’t read either text,” I began, “especially not the old one.”
“Yes, yes, I expected you to ask about that. I hadn’t read either text, but I especially hadn’t read the ancient one.”
“Any hunches about the meaning of the two texts in your life?”
“Hardly a hunch,” Irene replied. “I know exactly what they mean.”
I waited for her to go on but she simply sat in silence, looking out the window. I had not yet gotten used to Irene’s irritating trait of not volunteering a conclusion unless I explicitly requested it.
Annoyed, I let the silence last a minute or two. Finally I obliged: “And the meaning of the two texts, Irene, is—”
“My brother’s death, when I was twenty, was the ancient text. My husband’s death to come is the modern text.”
“So the dream is telling us that you may not be able to deal with your husband’s death until you deal first with your brother’s.”
“You got it. Precisely.”
The content that we dealt with was illuminating, but the process (that is, the nature of the relationship between us) was confrontational and highly charged, and ultimately the work on our relationship was to be the true source of healing. In one session, our discussion of a dream about a wall of bodies separating the two of us led to an anguished outburst:
“What I mean is, how can you understand me? Your life’s unreal—warm, cozy, innocent. Like this office.” She pointed to my packed bookshelves behind her and to the scarlet Japanese maple blazing just outside the window. “The only thing missing are some chintz cushions, a fireplace, and a crackling wood fire. Your family surrounds you—all in the same town. An unbroken family circle. What can you really know of loss? Do you think you’d handle it any better? Suppose your wife or one of your children was to die right now? How would you do? Even that smug striped shirt of yours—I hate it. Every time you wear it, I wince. I hate what it says.”
“What does it say?”
“It says, ‘I’ve got all my problems solved. Tell me about yours.’”
Many times Irene’s comments hit home. A story is told about the Swiss sculptor Alberto Giacometti, whose leg was broken in a traffic accident. While lying in the street, waiting for the ambulance, he was heard to say, “Finally, finally, something has happened to me.” I know exactly what he meant. Irene had my number, all right. Teaching at Stanford for over thirty years, I’d lived in the same house, watched my children walk to the same schools, and never had to face dark tragedy: no hard, untimely deaths—my father and mother died old, he at sixty-nine, she in her nineties. My sister, seven years older, was still alive at that time. I had not yet lost close friends, and my four children were all healthy.
For a therapist who has embraced an existential frame of reference, such a shielded life is a liability. Many times I have yearned to venture out of the ivory tower into the travails of the real world. For years I imagined spending a sabbatical as a blue-collar worker, perhaps as an ambulance driver in Detroit or a short-order cook on the Bowery or a sandwich maker in a deli. But I never did. The siren call of writing retreats to Bali or a visit to a colleague’s Venetian apartment or a fellowship to Bellagio on Lake Como was irresistible. In many ways, I have been insulated from hardship. I’ve never even had the growth experience of a marital separation, never faced adult aloneness. My relationship with Marilyn has not always been placid—thank God for the Sturm und Drang, since we have both learned from it.
I told Irene she was right, and I admitted that I’ve sometimes envied those who live more on the edge. At times, I told her, I worry that I may encourage my patients to take a heroic plunge for me.
“But,” I told her, “you’re not right when you say I have no experience of tragedy. I can’t help thinking about death. When I am with you, I often imagine how it would be if my wife were fatally ill, and each time I am filled with indescribable sadness. I am aware, fully aware, that I’m on the march and that I’ve moved into another life stage. All the signs of aging—my torn knee cartilage, my fading vision, my backaches, my senile plaques, my graying beard and hair, dreams of my own death—tell me I’m moving toward the end of my life.”
She listened but said nothing.
“And another thing,” I added, “I’ve chosen to work with dying patients, hoping they would draw me closer to the tragic core of my own life. And indeed they did; I went back into therapy for three years as a result.”
After such a retort, Irene nodded. I knew that nod—that characteristic nod cluster of hers, one sharp chin jerk followed by two or three soft nods—her somatic Morse code to tell me I had made a satisfactory response. I had grasped the first lesson—that to treat grief, the therapist cannot stay distant, but must encounter mortality at close range. And many more lessons followed around which I chose to structure the story. In this tale, the patient was the real teacher, and I was only the intermediary passing on her lessons.
The piece I most enjoyed writing was without a doubt “The Hungarian Cat Curse.” In this story, Ernest Lash (on leave from Lying on the Couch) attempts to treat Merges, a vicious, German-speaking cat in his ninth and final life. Merges was a well-traveled character who, in an earlier life, had consorted with Xanthippe, a cat living in Heidegger’s home, and was now mercilessly haunting Artemis, Ernest’s lover.
On one level the story is a farce, but on another level I think it may be my deepest discourse on death and the amelioration of death terror. I wrote much of the story during a visit with Bob Berger, a close friend since medical school who died during the writing of this memoir. I set the story in Budapest, and Bob, who had grown up in Hungary, gave me Hungarian names for the characters, streets, bridges, and rivers.
I fondly remember a public reading of Momma and the Meaning of Life at Book Depot in Mill Valley, where my son Ben, a theater director, and I read the Ernest-Merges conversation aloud. I’m not keen on memorial services, but if my family decides to have one after my death, I’d like that dialogue to be read—it would lighten up the event. So please, Ben, play the cat and choose one of your brothers, or one of your favorite actors, to play Ernest.