The Cure of Folly: A Psychiatrist's Cautionary Tale

A PSYCHIATRIST'S CAUTIONAR TALE GORDOn WARfflE, fflD ECW PRESS Copyright © ECW PRESS, 2003 Published by ECW PRESS 2...

Author: Gordon Warme MD

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A PSYCHIATRIST'S CAUTIONAR TALE

GORDOn WARfflE, fflD

ECW PRESS

Copyright © ECW PRESS, 2003 Published by ECW PRESS 2120 Queen Street East, Suite 200, Toronto, Ontario, Canada M4E IE2 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any process — electronic, mechanical, photocopying, recording, or otherwise — without the prior written permission of the copyright owners and ECW PRESS. NATIONAL LIBRARY OF CANADA CATALOGUING IN PUBLICATION DATA

Warme, Gordon The cure of folly: a psychiatrist's cautionary tale / Gordon Warme. ISBN I-55O22-57I-5

I. Psychiatry—Popular works. 1. Psychiatrists. I. Title RC4fJo.W37 2003

6r6.89'i7

02002-905417-6

Cover and Text Design: Tania Craan Production & Typesetting: Mary Bowness Printing: Transcontinental

This book is set in AGaramond and Mason

The publication of The Cure of Folly has been generously supported by the Canada Council, the Ontario Arts Council, and the Government of Canada through the Book Publishing Industry Development Program. CanadS

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CANADA: Jaguar Book Group, 100 Armstrong Avenue, Georgetown, ON, LJG 554 UNITED STATES: Independent Publishers Group, 814 North Franklin Street, Chicago, Illinois 60610

PRINTED AND BOUND IN CANADA

ECW PRESS ecwpress.com

COnTERTS

1. MINDS THAT CREATE GODS i 2. THE BIRTH OF WEIRDNESS 21 3. HANDLED WITH A CHAIN

45

4. THE CRITIQUE OF PURE REASON 63 5. DUMPING SYNDROME 79 6. MY VERY OWN HYSTERIA 99 7. THE CURE BY TOUGH LOVE 131 8. SECRETS /# 9. SEVEN LETTERS FROM CATHY JONES 185 10. PERFECT! 205 ii. THERE'S NOTHING LIKE A GOOD ARGUMENT 225 12. BACH'S MUSICAL OFFERING 247 13. A TRIP TO TORONTO 269 14. THE WARRIOR 27515. IN THE SHAMAN'S CAVE 293 16. LIFE TURNS ITS OWN PAGES 303 17. TROUBLE ON THE SUBWAY $29 18. MUSES 34$ 19. FINIS OPERIS 36$ AFTERWORD 377

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Sometimes I wonder whether the world is being run by smart people who are putting us on or by imbeciles who really mean it. MARK TWAIN

Much madness is divinest sense To a discerning eye; Much sense the starkest madness. 'Tis the majority In this, as all, prevails. Assent, and you are sane; Demur,—you're straightway dangerous, And handled with a chain. EMILY DICKINSON


CHAPTERÔHE

Minos THAT CREATE GODS

Man is quite insane. He wouldn't know how to create a maggot, and be creates gods by the dozen. MONTAIGNE

When my medical school classmates and I graduated in 1957, we didn't have to take the Hippocratic oath, but I'd read it and knew I had obligations: don't give deadly medicines, even if asked; don't give a pessary to a woman to cause her to have an abortion; don't seduce patients. I also knew I was sworn to "impart a knowledge of the Art to ... disciples". I did what Hippocrates said a doctor must do and became a teacher. For 20 years, part of my teaching was to run an interviewing seminar at the Clarke Institute of Psychiatry in Toronto. In 1997, the residents (psychiatric students) and I met every Wednesday at 2 p.m. in a meeting room that had to be booked in advance and, as is usual when rooms are tightly scheduled, a colleague regularly inconvenienced me by overrunning her time. "We knocked and started to go in the way you told us, Dr. Warme,"

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THE CURE OF FOLLY

Dr. Singh, a new student, said one day. "She says she isn't finished with the room." I knocked and walked in. My colleague — I called her the Iron Lady — ignored me and. continued teaching her students. She was talking about psychic trauma, trying to brainwash her students into thinking that all psychiatric patients were victims of traumatic events, bad parents and God knows what else. The severe crease in her forehead announced that in her view, she, too, was a victim, a victim of my intrusion on her class,, I didn't bother to apologize. Her poor students weren't paying attention anyway; in fact they were squirming with embarrassment because they knew they were trespassing. "The room is booked by our group. You are scheduled to finish at two. If you don't mind, please vacate the room. Would you like me to show you the schedule?" She salvaged her pride by saying a few more sentences, then stopped, assigned reading for her next lecture, and left the room silently.

Each week, my students and I hear a case report from one of the psychiatric residents, after which I interview the patient myself. All residents at the Clarke Institute of Psychiatry are free to attend the seminar and usually 10-15 of them show up. The patients who come to the clinic aren't just cases; they are people, tremblingly alive and, along with me, displaying themselves on the stage of life. In the interview, the patients and I demonstrate to the students human life in action, a drama in the process of which I also hope to demonstrate the principles of the psychiatric interview. I do my psychiatric duty and entice the patients to reveal their secrets, secrets they don't know they have until I woo them into revealing them. The students see how patients unconsciously arrange to have lives

2

MINDS THAT CREATE GODS

of folly, madness, and suffering, and since they are experts at self-ruin, the patients teach us that they are blood brothers of that great stylist of self-immolation, Mike Tyson. As a bonus, the students witness my odd tactics for angling into a human life. Students aren't stupid. Despite their attitudes — nervous, skeptical, admiring — they understand human life even in the unexpected ways I reveal it, and although they'd never admit it, they all know they might find similar folly in themselves. The interactions between me and the patient can get overheated, at times pushing the outer limits of psychiatric propriety I sometimes worry the depth and intensity of these interviews will scare off patients, but the opposite seems to be true; most become more eager than ever to examine their lives. Our impudeur [lack of inhibition] is partly an audience effect; the patient and I, whether we intend it or not, are performers and our actions are intensified and concentrated by being observed. Since I'm trying to teach something to the students, I do my best to demonstrate hidden and unexpected psychological issues. There is no rule that says a psychiatrist has to demonstrate the unconscious — as I try to do — in a first appointment but, apart from reading great literature, how else can students learn about human life so quickly? All psychiatric students should read The Brothers Karamazov, but the amazing insights contained in that book are not enough; they need to see in person a psychiatric teacher lay such things bare. The room itself is not designed for interviews, but it's the best we've got; the oversized conference table is usually littered with Styrofoam cups and untidy piles of handouts and reading lists. On a typical day, I weave through the maze of chairs to tidy up the place, perhaps switch off one of the ceiling lights which, just to annoy me, usually flickers unpleasantly I move aside an overhead projector or some other piece of technological gear, push the papers and cups off

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THE CUM OF FOLLY

to one side — the patient will arrive momentarily, and the place has to look respectable. Most weeks, someone will have swiped my box of tissues. I move a few chairs so the patient and I will have some breathing room and can look at each other. By this point, the students know what to do and position themselves on the far side of the table, so the patient won't have to face their curious gazes unless he or she wants to.

Hanna Slendzinski was a psychologist with special training in bibliotherapy, a method of psychotherapy that uses books as a way of getting patients to think about themselves. Although she was not a psychiatric resident, I had given her permission to attend the seminar because there was nowhere else in the Institute for her to meet people with an interest in psychoanalysis and psychotherapy. Hanna came to Toronto from Poland, and I often worried about her because she had no official professional status in Canada and getting registered might involve years of extra training. I wondered how she and her husband managed financially because they had two children and he didn't have a job either. I'd heard they were moving in a few months to Detroit, where she hoped to get a position that paid real money. I was sorry she was leaving. I liked her and she had a good effect on the other students. When she spoke up in the seminar, I noticed a trait of hers that was psychologically important. Curtly, she would say, "I know," and "Why does he say that?" then alert the rest of us to something that hadn't been noticed. Simple phrases like "I can't believe it," were said so casually and with such perfect timing that I could never be sure whether she consciously saw the little paradoxes to which she drew our attention. Hanna often said she knew nothing about dynamic psychiatry because, in Poland, the psychiatry department where she had worked

4


had been solely biological and psychopharmacological in its orientation. But I was skeptical; clearly, she grasped the inner life of the patients she interviewed — she had to take her turn examining patients like everyone else — and her case reports were excellent, including fine psychological profiles which were both well written and attuned to the hidden, secret sides of her patients. Hanna wasn't a kid anymore, and it was humiliating for her to be a student again. I'm no youngster myself, so she was not just another student; she and I shared a quiet sense of comradeship. She was also very naughty — out of earshot of the younger students, she firstnamed me. "Hi, Gordon," she'd say when we passed in the corridor. I liked Hanna Slendzinski's light blonde hair and pink skin, a reminder to me that Poles and Ukrainians are full-blooded Aryans who don't match my stubborn stereotype of eastern Europeans as dark and hollow-cheeked. I had a little crush on her, even though her womanliness and her beauty were subtle. When she joined the group, Hanna usually wore a wan, pensive smile, but on this day she was animated, perhaps because she was actively being a clinician. She had spent an hour with that day's patient and was about to present her observations to the group. "The patient's name is Salman Banda," she told us. "He is a 30year-old, Canadian-born East Indian and was referred by his family doctor. The doctor is puzzled because Mr. Banda is on welfare even though he seems competent and is not unwell. Mr. Banda is blase about the referral and doesn't know what the fuss is about. He isn't troubled that he's on welfare and claims his life is okay. Before going on welfare, he worked as a school janitor. 'I don't see anything wrong with being a janitor,' he said, although I hadn't said anything about it. He quit his job because he and his girlfriend decided to move to Guelph, but when they broke up he stayed in Toronto. "He was seen last year by a psychoanalyst, Dr. Hamilton, over in the

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THE CURE OF FOLLY

Assessment Clinic who told him to come back for another assessment in six months. Mr. Banda didn't understand that recommendation either. In her note, Dr. Hamilton says the patient was uninterested in psychotherapy, but she felt that during their interview, she had been able to stir up some important issues. She suggested to Mr. Banda he should think about these things for a few months and then come back. It was something about his disappointment in his father. "The patient's mother is one of seven children. There were many artistic people in her family, some very successful. She was an oddball and was known in the family as someone interested in nothing except tidying the house. When he discussed his mother, Mr. Banda used the phrase 'tidying up' many times, as though it was an obsession of hers. In fact, it eventually became her career: she is a cleaning lady. "Mr. Banda's father is an only child and has done little with his life. He does odd jobs and drinks too much. The father comes from a lower-class family and it seems no one expected much from him. "The parents came to Canada to start a new life. They were married just before they immigrated and Mr. Banda was conceived in India immediately after the marriage — 'Conceived on the wedding night,' he said. He was born in Canada and his birth was seen as a big event that was part of the new start the family wanted to make here. "It was also a big event when he finished high school because neither of his parents had achieved that. Because he was a good student, the family thought and hoped he would become a doctor or lawyer, but Mr. Banda sort of sneered when he said that. Something about his parents' phony values. Right after high school he spent a week sleeping in a field, 'thinking things over.' His parents freaked out, which he thinks was stupid. "He's had a few girlfriends but things never last long. He loses interest in them because they are too bourgeois. 'They're just like my parents. They think I ought to go to university or college, get a career.'

6

M I N D S THAT CREATE GODS

"Mr. Banda sneers a lot. At first, I didn't see it because he has a friendly smile, but what he says always has a scornful side to it. He has an exaggerated 'laid-back' style, always leaning back and smiling when he speaks, and sort of being pompous, making pronouncements about everything. He also seems skeptical of everything I say, almost as though my words might make him puke. "He is pretty content with his life. He's going to do some thinking and reading, and when he gets his head straight, he will try to get his janitorial job back. He agreed to come here because it fits with his idea that this is a good time to rethink his life. "That's about it."

Hanna stepped out to get the patient. I smiled to myself as I anticipated the students' delighted dismay when they saw what was going to happen. One of the students, Osman Awad, noticed my grin. "Dr. Warme, why are you smiling?" Osman looked young and spoke carefully and courteously. Despite his politeness, there was a note of complaint in his voice. He didn't like my showiness. Just the same, he was intrigued by what went on in the seminar and was teasing me that day because he knew that, in my mind, I was preparing that day's "show." "Well, Osman, it's like this. We shrinks are mythoiogizers, aren't we? And I've invented a sexy myth for Mr. Banda." I let my eyes wander around the room and surveyed the other students. "Can anyone guess what it is? It's not about his genes, his pills, boring reallife events or anything like that. It's about him and how he can rethink the myths he's imposed on himself. My idea is a bit audacious and I'm chuckling in anticipation of how jittery it will make you youngsters, you nervous Nellies. So grown up — doctors and all that — but not yet ready to be illusionists. Oh, here comes our patient."

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THE CURE OF FOLLY

Students have complex reactions to teachers, especially teachers who, like me, think silence is important: silence begets mystery and fantasies. Some students are awed by me, others think I'm a jokester, and still others, secretly or overtly, want to compete with me. The young doctors also have strong reactions to one another — behind the educational formalities, there is plenty of rivalry, victimhood, love and sex. It's exaggerated in our seminar room — really an overheated laboratory — because we identify with our patients, and their stories stir us up.

Mr. Banda was an attractive, brown man with black hair, better dressed dian I had expected. He smiled and sat down, turning his chair toward the students as if all of us in the room would now have a nice chat. But the scene was set up so that he and I would have our own designated area in the room, separated from the students by the conference table and my body language, a language that insisted that something dramatic was about to happen. I was polite and said the usual: "Hi, Mr. Banda." My greeting is always unenthusiastic; it's a conventional necessity and my tone is intentionally dismissive — if not scornful — of the fact that the patient and I must waste time on trivialities when we both know matters of great importance must now be discussed. I was briefly silent, a silence during which Mr. Banda could size me up and, more important, let his imagination get going. In that fraction of a second, I mused to myself about how he was always "rethinking his life," as though he was expecting or hoping for a transformation. A question with a will of its own ran through my mind: "Is it really you?" Where in the world had that come from? The words had almost jumped out of my mouth before I could catch them. I didn't care that

8


Mr. Banda might have thought I was weird to say that; I would have rather liked it if he did. But shouldn't I have known what I was doing? Where, I wondered, did the line come from . . . ? Suddenly, I remembered. Yes, I had The Brothers Kammazov on my mind, and the line was from a story told by Ivan, one of the brothers. In the sixteenth century, the story goes, Christ appears at an auto da fe in the Grand Plaza of Seville and performs a miracle. Although everyone recognizes he is Christ, including the priests, the Grand Inquisitor also realizes that, now that the church has been fully established, Christ can no longer be what he was before. His presence on earth now can have only a subversive effect. The Grand Inquisitor has Christ thrown into a dungeon and later comes to his cell. "Is it really you?" he asks Christ. Ah, yes, I thought, this story resonates with some of my thoughts about Mr. Banda, so I'd best wait and see what happens. I remembered then that, in the story, Christ didn't answer; he was completely silent throughout the interrogation by the Inquisitor. It reminded me of a psychiatrist silently listening to a patient. In my daydream, I was the talkative patient and Mr. Banda was the silent Christ/psychiatrist; I was attributing to him the power to influence me.

"Well, Mr. Banda, what is it you need our help with?" "Nothing, really" "You are in the process of rethinking your life, I hear. Is that why you need our help?" "Nobody can help anyone else. It's a matter of will. I'm going to figure things out and then implement the appropriate solution. It's not something anyone else can do for me. There are things that can be done and I plan to do them." "You're never in need of help?"

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THE CURE OF FOLLY

"People nowadays are not intellectually rigorous enough. Improvement of oneself, psychological progress and growth, are neglected in favour of thinking that they just need to lean on someone. A little more effort and thinldng things through is all that is needed." "Surely people have always turned to others for comfort and solace? You have no need for this? You're never lonely, and never need someone to lean on?" As Hanna Slendzinski had warned us, Mr. Banda was aloof and pompous. He acted as though I had cornered him and, as we proceeded, his pronouncements became more and more like proclamations. I'd said very little, yet my line of questioning had turned him off. I sat silently and looked past him, over his shoulder at the distant wall. "I used to believe in progress and stuff like that, too," I said. "I used to give lectures — preach sermons, in other words — and write papers for psychiatric journals." I noticed that I had his attention now, perhaps because of my mocking reference to myself "preaching sermons." "All that logical junk was sort of the academic game, where we all say the same thing over and over again and applaud one another when we're done. I decided I ought to write a novel, maybe something about a weird shrink and his weird conversations with his weird patients. Actually, what I had in mind was that the important things about people are poetic and imaginative . . . poetic truth rather than boring rational truth. I guess I'll have to write about you: 'The Man Who Believes in Rational Truth and Progress.' And as I write my novel about you — about you and me? — it will have something to do with intimate human events — passion, longing, hopes and fears. "And then, when you read the book, you'll be mightily pissed off because you'll see that human affairs are juicier and sexier than logic and planning allow for." To my amazement, Mr. Banda answered in kind. Perhaps he

10


thought I'd unburdened myself to him, a turn of events that made me into the patient, appropriate given he was a man who had the answers to how a person can transform himself— by thinking things over — into a better man. "I wrote a script for a play, once." I stayed silent for a moment, wondering whether the students knew what the next question should be. Most students have a memorized list of questions, a list that lets them avoid the heat. The questions themselves are fine, it's just that the list leads them to believe that no question need be gone into exhaustively. When faced by their patients' disturbing secrets, they can gratefully proceed to the safety of the next question on their list. I paused for another fraction of a second and looked at Mr. Banda intently. "What was the play about?" Now it was his turn to be silent for a moment. He looked back at me, just as intently, He hesitated, not sure whether he now wished to take on the role of the one who "unburdens." "I was young when I wrote it, so it's kind of corny, but it's about a guy who's been in Nepal, doing the young rebel routine, thinking he's pretty cool and in touch with important Eastern stuff, smoking too much and so on. He's sort of like Joseph in the Bible because he's the youngest of several brothers. He gets involved in a project, trying to get into a community in the Himalayas, sort of a religious community. If he's like Joseph, then this would be like being sold into slavery in Egypt. The leader of the Nepalese community has died and the guy has to get in there so that they can re-establish contact with the outside world. But what he thinks will be an interesting adventure becomes a terrible journey, sort of like Ronald Coleman in Lost Horizon, because it's treacherous terrain. He is almost kidnapped by Chinese bandits. When he gets there, he sets up the shortwave radio and shows them how to use it so that they can make contact with the

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THE CURE OF FOLLY

outside world. He's also prepared to take messages back and to help them in other ways if he can. "What the people really need is a new leader, so he hangs around for a while getting to know them and figuring out a little more about what exactly they need. Although they live very close to the land, they are philosophical and artistic and so the hero of my story knows it won't be easy to find the kind of leader such a community will accept. They aren't going to be interested in a cheap guru who tells them what to do. He also knows that since this community is already set in its ways, no one will want to come here. It will be hard to fill the shoes of the leader who has died and who has been so revered. "The story ends when the people tell him that, not only do they want him as the new leader, it turns out they have been waiting for him for years. They believe he is the son of a previous leader, spirited away when he was a young child (I can't remember how I explained this, maybe it was the Chinese bandits) and that they had always thought that he'd return some day. "He becomes the leader and the people . . . live happily ever after." "Perfect," I said. I made a fist, and pumped it ever so slighdy — symbolically — for effect. "That's the story I was waiting to hear. I know this story. I've heard it before." "What do you mean, you've heard this story before?" I collected my thoughts for a moment, because I wasn't sure what story it had reminded me of. I wasn't even sure it had reminded me of any particular story. I was scanning my mind for something about a lost soul who had come back to life. Promptly, the Muses sent the story I needed.

"A young patient — let me call him Jack — once told a similar story. He was an aloof youngster who had been in really bad shape for sev-

12


era! years. Some psychiatrist thought he was autistic, or had childhood schizophrenia or something, and he was hospitalized for six months. Jack didn't speak to me for several weeks after we first started meeting. Instead, he drew cartoon strips about superheroes and brought them for me to look at. Eventually Jack started talking, although he was always detached and cautious. Come to think of it, you can be a bit aloof at times just like this kid. "One day he told me he was having a writing problem and needed me to help him out by giving him some psychiatric information. 'In my story, a man noticed his neighbours often had a light on in their attic. In fact, he'd been noticing this for 16 years but hadn't really paid attention. He was puzzled when he discovered the neighbours, a couple without children, had the whole house to themselves and had no need to use their attic. One day, fleetingly, the man caught a glimpse of a face in the attic window.' "And, Mr. Banda, as I listened to Jack, it came to me that Jack was the same age — 16 — as the boy in the attic. "Jack was stumped. His question was this: 'If there is a child in that attic, and if that child has been there for 16 years, can anything be done for him? If treated, could he become normal?' "I said the same thing to Jack as I said to you. 'Perfect,' I said to him. I made a fist, and pumped it ever so slightly — symbolically, so to speak — for effect. 'That's the story I was waiting to hear. I know this story and I've heard it before.' '"And yes,' I said in answer to Jack's question, 'I think such a boy could be helped.'" Mr. Banda stared at me silently. I stayed pensive, too. Then, I played my ace. "So, you are the Messiah?" Mr. Banda screwed up his eyes again . . . and played dumb. But I knew better. He and I had started to tell stories to one another, and

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this had changed everything, although he was still not sure he was ready to plunge into the depths with me. What was the change? The change was that he had decided to enter into my version of psychiatric theatre. That day we were performing Faust.

In Leipzig, in front of the historic Auerbach's Keller, the restaurant where, in Goethe's story, Faust and Mephistopheles met, is a statue of Mephistopheles with a group of students. He is portrayed as having begeistert the students, in other words, captured their spirits. In English we would say, "enchanted, enthralled, influenced." "Beguile" has a similar sound, but guile means trickery, and Geist means spirit. But the idea is the same: to highjack (by guile) someone's spirit (Geist). To come under enchantment is a well-known interpersonal event. In a psychiatric situation, we call it an idealizing transference (transference just means that everything has a history and that every experience is echoed in other experiences, is "transferred," so to speak). When an enchantment is enthusiastic and obvious, it can be called hysteria, common in all people, but which we take particular note of when it occurs in patients, worshipful students and adoring groupies. In patients, idealizing transferences are usually polite and respectful, but liable to evolve into submission or dependency. Such qualities, although we are always tempted to judge them, are neither good nor bad and, in other circumstances, are called loyalty, mass hysteria and hero worship. It's worth remembering that, while it's humiliating to be enchanted by a rascal, it can be wonderful to be taken in by a conjurer. It's surprisingly easy to ignite submissive and obedient reactions. Walking in Leipzig, not far from Auerbach's Keller, I was surprised by signs in store windows no different (apart from being in German) from signs in Toronto store windows:

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"Under new management." "Closing Sale." "Anniversary Special." "Fire Sale." "We've got to reduce our inventory." We all recognize these as come-ons, but market researchers also know that, despite the amused skepticism of shoppers, they improve business. It's a magical effect, a variant on being begeistert — having our spirits high-jacked. It's also the bit of human psychology that makes us benefit from placebos. A case from industrial psychology is often cited as an illustration. A company was told improved lighting would increase the productivity of its employees. New light bulbs were installed and, as sure as day follows night, productivity rose. The problem was that, shortly thereafter, it was discovered that an error had been made and weaker light bulbs had been installed instead of stronger ones. In other words, worse lighting had resulted in increased productivity. A follow-up study showed the essential factor here was change — any change. As long as there is an expectation of improvement, improvement generally occurs. As a result, psychiatric hospitals — innocently, it seems — are constantly renaming programs, announcing new projects and moving units from one floor to another, even when it's obvious these manoeuvres are just a recycling of changes that have been made many times before. It's the placebo effect. That's what had happened to Mr. Banda. When I changed my spots and became a storyteller (why a "storyteller" would have this effect, I don't know), he almost instantaneously granted me the role of the powerful, kind shaman — developed an idealizing transference — and from then on, hung on my every word. This is not unusual — many patients attribute great wisdom and power to their doctors. The unique twist in Mr. Banda's case was his initial skepticism and the

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sudden change when I became the storyteller.

"What do you mean?" Mr. Banda said in response to my "Messiah" comment. "I knew that you were the Messiah as soon as Dr. Slendzinski began to tell us your story. Widiin a sentence or two." "How did you know?" "You were the hope of the future when your parents came to Canada, you were immaculately conceived, sort of, and you've had a series of rebirths. You spent 40 days in die wilderness — okay, it was only a week — to think. To be reborn, in other words. You've come here to be reborn again, to rise from the dead on die third day, and you were the Messiah when you climbed over the Himalayas to get to Mongolia, or wherever it was." My speech was a classic example of overkill. I wanted to make sure Mr. Banda saw my point, so I gave him all my evidence in one chunk. I also wanted the students to recognize his private myth before we ran out of time. By ramming home my point and making it blindingly clear, I forfeited my most precious instrument, the air of mystery that keeps patients thinking. Had I kept ambiguous, there would have been space for more ideas to appear. "My middle name means 'Lord of Man.' How did you know this? How come you called me the Messiah? I never tell people diat's my name. I was supposed to be a doctor or a lawyer, or something very successful, like my mother's family." "You have been a janitor, I believe. Does that mean you are your mother or that you are your father?" He stared at me again. But the stare had become different from when he and I had begun 20 minutes earlier. Now he was curious.

16


"I'm not sure what you mean?" "Well, when you are a janitor, are you wasting your life like your father, or are you tidying up the house like your mother?" "I never thought of that. My mother's family always made jokes about how, as a kid, she wanted to fix up the house. She liked to 'tidy the house,' they said." "Was it 'tidying' or was it 'fixing?' Now I'm confused," I said. "No, no. She was a fixer. She was always moving furniture and persuading her parents to change things in the house." "So she wasn't a neat freak, it was more making things nice?" "That's right. And that's what she does now, decorating people's houses." "Do you mean she's not a cleaning lady?" Mr. Banda smiled. "No, no. That's just the family joke; she tidies up and she's a cleaning lady. She's an interior decorator." "Is she any good? Does she have a talent?" "Yes, I think she's very good." "So she's an artist, like a number of other people in her family. But you became a janitor, really someone who is a cleaning lady and who tidies up. You are the real McCoy." "That's true, but I'm an artist, too. I paint and I'm sometimes successful and sell stuff." "This is brand new information for me, so I guess this must be a secret, just as artistry is a secret with your mother. Both you and she must be described as cleaning ladies so no one will know that you are artists. It turns out you became the Messiah that was hoped for after all. But there is a problem. If you are one of the winners, like all the winners in your mother's family, where does that leave your father? Maybe that's why your artistry has to be a secret, so your father isn't too blatantly put in the shadows. Unless he has a secret, too, one you haven't told me about yet?"

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"No, there's no secret about father. He just drifts from job to job and sometimes drinks too much. But I'd like to get back to the idea of me as the Lord of Man for a minute. I'm not really anyone's hero. In fact I'm sort of a disciple. I've got a Pandit that I talk to." "The only Pandit that: people here in Canada know is Pandit Nehru. He was very Western and he was a lawyer. Trained as a lawyer in England. I don't really know what the word Pandit means." Except: I knew what a "pundit" was. "Pandit is a title of distinction given to certain people like Pandit Satyajit Ray and Pandit Deepak Chopra. But when my art really takes off, I will be a Pandit, too. But I'm in the process of rethinking things. Do I want to be a doctor or an artist?" "I guess it's a mystery." Mr. Banda was eager to talk further — his own secrets had caught his attention. But there was no rush; psychotherapy is rarely an emergency. I stopped the interview while I still had him thinking. There was ambiguity in the air and that would be good for him. Yes, I thought, that's what Mr. Banda needs: darkness and ambiguity. "We'll find a therapist for you. Twice a week." "Twice a week? How come?" "Can't learn to play the piano if you only practice once a week. Or tennis. This is the game of life we're talking about. It's time to stop." The students were dying to ask how I had guessed Mr. Banda was the Lord of Man. God bless students: they think I know how the magical part of my mind works. They like my flashy tricks but are also puzzled about what I am up to. They don't know yet that I intend to create misgivings in them about their own profession, especially about psychiatry's built-in authoritarianism, hierarchy, patriarchy and hero worship. The bitterest pill for them to swallow will be my denial that they and I differ fundamentally from our patients.

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Because patients suffer, I have to be careful not to be a ham in my sessions. Just the same, I needn't be utterly sober and sincere. I can be comical, magical and whimsical if I do it right. Sober psychiatrists could do with a bit more impudence.

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CHAPTERjfWO

THE BIRTH OF WEIRDHESS

On Quebec Avenue, behind a garage, my friend and I, both of us five years old, had a good look at each other's rear ends. Rear ends were, of course, hard to see, as were the front ends of girls. Bums weren't as mysterious as the front ends of girls, but we had settled what we could. That day, my friend and I realized sex is a great mystery, and I figured out that, if I wanted to become a psychiatrist, I had to learn to investigate mysteries diligently. Of course, my mother wanted such curiosity to stop, but instead I transformed it into a career, a career for which unending curiosity is mandatory. I had on a hated pair of short pants, hated because they buttoned at the side. By age five, I had already decided that manliness was an issue, and these shorts were for sissies. It was hell. As if to bring extra trouble into my life, the damn shorts wouldn't let me button them up. "Why are your shorts unbuttoned?" my mother asked. I made an excuse. "Just tell the truth and you won't get into trouble." I had heard that one before, and also the one that promised, "I can tell by your eyes if you are lying." But I told the truth just the same, and got a licking. The betrayal was bad enough, but worse was to come. When Dona, my mother's

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THE CURE OF FOLLY

sister, came over, with me right there in the room, the story of my sexiness was told. They laughed uproariously and I was humiliated. At age five, I made a resolution then and there I would never tell my mother my secrets again, and over the years, I've mostly stuck to that vow. I had been betrayed by my mother and was therefore justified in having perpetual revenge on her. It's a pretty hard fate for a mother. Most of die time, I am a responsible son, and on the surface, she has nothing to complain about. But somewhere in her being, she knows I have imposed a life sentence on her. This is one of my great personal myths, and, like all myths, it shapes and justifies my life. No one ever has to worry about me being a mommy's boy. If I have trouble with a woman, I'm always in the right. I'm especially good at always being in the right — I told the truth didn't I? You can see that my myth cannot include the idea that I am a bad guy; I do my duty. In our myths we carry the truths we like best, myths we can apply to the world when necessary. My myth includes the idea there is a bad mother on the loose in the world, and I am such a good fellow I haven't fallen into the trap of slaying the monster by turning into a monster myself. At this very moment, you can see I don't condemn my mother outright; I concede that this is a myth of mine. We all have analogous personal stories, usually with die same self-absolving intent. Narratives are the material of psychiatric work. You can see my first descent into hell takes me straight to my mother and straight to my eventual career. But hell has many levels, and the well of the past, many entry points. For some, it's past lives; for others it's in the stars. For me, it's in history.

I'm a conventional man — at least on the surface — so where do my magic thoughts come from? The ability to diink in odd ways has, I

22

THE BIRTH OF WEIRDNESS

suspect, always been in me. In medical school, I had two groups of friends. My real friends, I thought, were athletes and beer-drinkers — regular, good guys. But my other group of friends was made up of oddballs, people liable to say to a patient, "So, you are the Messiah." My best friend was Graham Copeland. He had intended to be a concert pianist but at his mother's insistence had gone to medical school instead. Graham was effeminate and nowadays it would be obvious to me he was gay. In the late 19505 homosexuality was treated differently than it is now, and gay men tended to hide their homosexuality. Although I suspected Graham was gay, in those days, the tradition was to overlook suspicions and to think of someone as homosexual only if they were known to engage in actual homosexual activities. I'd had passes made at rne by a few male friends, and for them, the word homosexual applied. Since none of us knew of actual homosexual behaviour, neither I nor any of our medical school classmates labeled Graham as gay. Despite our modern self-righteousness on such issues, we were no more judgmental about homosexuality back then than we are now. But in the '508, the common courtesy was silence, so we held our tongues. Sure, my straight pals and I made vulgar and what we thought were hilarious remarks about "fairies" and "faggots" in general — much like the modern locker-room crowd — but we said nothing about particular guys we may have privately suspected were gay. I was drawn to Graham because his mind was different and odd. He was tall and raw-boned and, in an era when hair was to be parted on one side, his was combed straight back. The signs of effeminacy were in his soft puckered mouth and his fluttery, expressive hands. Graham didn't give a damn about fancy clothes or style because he preferred the world of classy, magical minds. Memory interrupts me with a thought that I don't like: My father pursed his lips; he had a mobile puckered mouth. And I, too, purse and pucker my lips.

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THE CURE OF FOLLY

Graham's friends were musical aesthetes, but what I noticed was that their talk and their banter was ironic, mocking and playful. The world of heartiness, of good marks, and of being sexual was well known to them but, without rancor, they believed that world was the stuff of mediocrity. The standard society merited only plaintive amazement and wistfulness — a wistfulness that these things mattered so much to the rest of us. Graham and his friends Erkki, John and Gwen got together regularly to play the recorder. When invited, I was stunned to see these four, youthful adults passionately playing recorder duets, trios and quartets. There they sat, uninterested in prowling the city in search of girls (as I thought all young males were), fluttering their fingers over the stops of instruments I hadn't even known existed. On New Year's Eve, they roasted a boar's head (it was mostly gristle and fat), paraded it out the back door and back through the front, a procession accompanied by spirited Finnish songs and sayings. All were Canadian born, yet all had a distinctive way of speaking that, to my ears, was almost discrete enough to be a dialect: a mixture of effeminacy, prissiness and arrogance, with a bit of haughty, English pomposity thrown in. All were diseased in that they suffered from degenerate artistry and extreme and wicked outsiderdom. They scorned the ordinary and the coded messages they exuded caught me unawares, aroused me and tempted me. In my head and when I spoke to Graham and his friends, I sometimes practiced speaking as they did. But I never did it in the ordinary world. I still don't speak that way — except when I interview patients in front of the students, a clear giveaway that I've always been a secret blood brother of Graham, Erkki, John and Gwen. Graham was busy living life rather than living out his medical student duties. One night, before an important exam, he appeared at my door drunk and asked to borrow my notes. He'd taken no notes

24


during the year, and had no textbook. I tutored him for a few hours and, smart as a cat, he passed. But the experience didn't seem to scare him; he kept playing his ukulele out on the grass while the rest of us were attending lectures.

I spent a happy year as an intern at the Vancouver General Hospital. A few months before the internship began, Graham called to say he, too, would be interning at the Vancouver General Hospital. I knew right away the arrangement had been made so he could be with me. In keeping with the semi-secret attitudes of the times, I didn't let myself clearly know the strength of Graham's attachment to me, and to the extent I did, I attributed it to his tendency to be "dependent." I didn't dare think he loved me or had a crush on me. My belief in Graham's dependency was supported by a phone call I got from his mother. "How many pairs of underwear are you taking with you to Vancouver, Gordon?" "How many pairs of underwear? . . . underwear?' I mumbled an answer but also had the standard reaction to the mothers of homosexual men: she was "overprotective," "overinvolved." No wonder Graham was . . . whatever he was. When our internship ended, on the afternoon Graham left Vancouver to return to Toronto, I found a note on the floor of my room. June 29, .rpj^ Dear Gordon I'm sorry. I didn't have a chance to pack. Could you pack up my room and ship my stuff to Toronto? Thanks. Graham

Graham had been my ticket to the most interesting people who

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THE CURE OF FOLLY

worked at the hospital. He quickly attracted a group of friends just like die recorder-playing, boar's-head-eating gang back in Toronto. There was lots of ukulele playing, singing of folk songs, and the same high-spirited self-mockery, combined with a sensitive, confident elitism. They all spoke in the literary style usually reserved for the written word. How, I wondered, did they manage this? Had they memorized The New Yorker magazine? Was Bob Hartt practicing this special language when, on die chairlift going up Grouse Mountain to ski, he sat reading Emily Dickinson? But unlike the disdain for luxury exhibited by the Toronto-boar's-head gang, the Vancouverites were suave, beautiful people with aristocratic plans and pretensions. Secretly, under my breath, I again experimented with speaking their attractive, forbidden form of speech. During that year in Vancouver, Gwen, the girl from the Graham's Toronto gang, came to visit. I realized during her visit that she loved Graham, but also knew her love was futile. I wondered why she loved him, since she and another fellow in Toronto had seemed destined for one another. I also wondered why she didn't take a shine to me. 1, after all, was solidly male, available and interested. But no, Gwen only had eyes for Graham, who obviously couldn't reciprocate. He had eyes for me. Graham even pimped for me at the student nurses' residence across the road from the hospital. He and I frequently went to the foyer of the residence, where there was a grand piano. Graham played sonatas, polkas, and gigues — anything at all, as long as it had a penetrating bony sound. As though responding to the Pied Piper, the student nurses left their rooms and. gathered around the piano. Although the nurse's residence wasn't Hamelin, it was . . . heaven. But in retrospect, because Graham was soliciting for me, it wasn't heaven for him; it was hell. Toward the end of the year, the hospital had a big, end-of-year

26


dance. I was with my nurse-sweetheart, and Graham, although he was faking, also had a date. Graham was busy "passing" but he no longer fooled me. That night, he got very drunk and, late in the evening, approached me tearfully. He embraced me drunkenly, kissed my cheek, and cried out in despair, "What am I going to do? I'm crazy, I'm schizophrenic." Consumed with jealousy and rage, he almost violated our unspoken vow of silence. In the language of the boar's-head gang, the correct thing for me to have said would have been, "Why, my dear Graham, this is rubbish. You are certainly not schizophrenic. You are merely confused about your sexual orientation." But for Graham that night, it was no laughing matter. Now, 40 years later, I know the story of Graham and me is an archetypal story; we were Sebastian and Charles of Brideshead Revisited. The realization came upon me like a bombshell when, by chance, I met Jeremy Irons, who played Charles — my role — in the television version of Brideshead. When I first watched that series, Charles was a heterosexual man who, through his homosexual friend Sebastian, discovers art and spirited life. No longer as nervous about my inner life, I now agree with the verdict of two floozies in the story who declared that Sebastian and Charles were "a couple of fairies."

Any psychiatrist worth his salt knows what I'm talking about. It's not possible to be a psychiatrist without having access to womanliness in oneself — manliness, too — not to mention an understanding of other, marginally acceptable things. Weird, magical thinking is what let me sneak into Mr. Banda's mind and ferret out his secrets, but I can't do that job unless I have a brace of unorthodox inclinations, "gay," perhaps, and maybe my dark, German side. But to really delve deeply into this, I must think strangely and turn rationality upside down:

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THE CURE OF FOLLY

We Germans wallow in music to excess — with us, music is a sickness — and every concert hall and opera house in Germany reeks of that vague, non-verbal sickness. I therefore search out the twisted obscurities of German music and, in keeping with my rational tastes, the twisted obscurities of Hegel, Marx and Heidegger, the tricky philosophers who fool us into thinking they are rational — until we try to read their books. Like them, I am rational on the surface, even in my approach to music. But if I'm not critically afflicted by the music sickness, I'm not a real German and therefore I must, methodically, rationally, and in mathematical order, learn the right symphonies and sonatas. No more pretending I'm simply a goy. I must face the delicious truth that I'm rooted in Jewishness. It's the horrible Jewish stereotype that comes to mind, the JAP of outwardness, the one who is mocked for his materialism, but that is the wrong image. The German identifies with a different Jew, the essential, dark-minded Jew who davens, thereby showing his kinship with the inward, ambiguous and skeptical German. It unsettles the standard world to know that Jews and Germans are blood brothers. German, Jew, weird-thinking, the sick sweetness ofSchonberg and Wagner: it's a filthy brew and the conformists — the ox-brains— don't like it. It is mandatory for me to be as Jewish as possible— my profession is largely populated by Jews— and I have to succeed at this before I can face up to being German. Jews and Germans relish their tendency to contemplate their innards, but we've achieved no sublime transcendence; it's just what we Germans and Jews like to do, marching to the tune of our cultural destinies — our reputed cultural destinies. We don't play the game of conformity as well as we should, which means we tend to be rulebreakers. Since World Wai' n, Germans have been furtive about this and, in order to stay invisible, break rules in the secret nooks and crannies of their own minds — we Germans who live in the diaspora behave ourselves. We also concentrate on semi-invisible things like music. Music is non-verbal so it's hard to catch us up in our depravity.

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Jews are more public-spirited rule-breakers — they let their presence be known. In 1939, when I was six, my family and I were at Lake Wilcox near Toronto. There was a sign posted on the beach: "Gentiles Only." I asked my father what it meant and he matter-of-factly said that we were Gentiles and Jews were not allowed on that beach. I had no idea what a Jew was, but I knew it was a category of person. Later that day, I spoke with a boy on the beach and told him (I was bragging) that my uncle Charlie taught swimming at the YMCA. He responded by saying he swims at the YMHA. I trotted back to my father and asked another question: "What's the YMHA?" "It's like the YMCA except it's for Jews," my father told me. I was indignant. Not because I had bad thoughts about Jews, but because there was a sign that said "Gentiles Only," which meant my Jewish friend was breaking a rule. German children are good, I thought, and always obey rules. Canadian children break rules — they are ruffians and are dirty — and this boy was a clear example. A sign was there for everyone to see and he had disobeyed. Ergo, this bad Canadian was transformed into a bad Jew. I can prove that I'm a German; somewhere in the family there is a piece of paper that, by way of baptismal certificates and church records, proved to the Nazis my family was Aryan. And then my mind turns to other truths, truths that are peculiar and delicious: My Jewish credentials are as impeccable as my German credentials. To this day, the bulk of my patients are Jewish. Jews and I attract one another; they sniff me out and I sniff them out. I have a story to explain this, but it's a made-up story with which I ward off the Nosey Parkers who aren't equipped to know the uncanny facts. When I was young, I wanted to fit in. I spoke English well, was a good, studious boy, became a doctor and chose as a wife a woman who had good Anglo-Canadian qualifications. I'd always known I would be

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THE CURE OF FOLLY

a psychiatrist, but the odd and the unusual didn't show in me at first. Now, it shows with a vengeance and I expect diat by the time this book is done, I'll have degenerated enough so that I can sign off: "Auf Wiedersehen, Jerusalem, 2003." Don't forget my homosexuality, that mind-awakening trait disclosed by my seven-year friendship with Graham Copeland. Everyone knows about the Jewish-homosexual conspiracy, but most don't know that Germans, too, are implicated. We cleverly keep our creepy, homosexual side secret. Since a friendship is not conclusive evidence that I belong to that secret society, I need to provide additional proof that I am a sissy. In the spring of 1939, I got scarlet fever. I woke up in the middle of the night delirious, with a high-pitched humming in my ears, trying to make a dream go away. In those days, scarlet fever was a worrisome infectious disease, and I was hospitalized for six weeks at the Toronto Isolation Hospital. I had never been away from my parents before. Other children in the hospital had scarlet fever, but some had polio. There was no treatment for scarlet fever, so we just waited it out. I was homesick, but never let it show because, even at age six, my everything-would-work-out-for-the-best attitude was already well developed. The hospital was strange, mostly because I'd never slept on smooth, cool sheets before — our sheets at home were flannel — nor had I eaten the strange WASP food. Lunch was sandwiches made with white bread, and the evening meal was three discrete portions — meat, potato, and vegetable. I was accustomed to mixtures and sauces. My most vivid memory is of rice pudding and tapioca pudding, foreign and strange, both of which I loved. One night, the boy in the next bed dumped a shaker of pepper on my tapioca. I was shocked at his misbehaviour, and it only confirmed that Canadian children were, as my mother said, wild and bad. I, of course, was very good but 1 liked the mischief of the other kids, and

30


would've been better off had I been more mischievous myself. I had a blister on my thumb, which the nurse punctured with a needle. I sat on the floor between her knees, gave her my blistered hand, and woke up in her arms as she carried me to my bed. It was the first time I'd ever fainted, but I don't remember being humiliated. It didn't happen again for three years, but when I was ten, I fainted again while we were lined up for our diphtheria toxoid shots at school. When I came to, I was sure that my reputation as a boy had been destroyed. Immediately after it happened, the boys in our class went to another elementary school for "manual training." We ran most of the way, and I ran hardest of all, trying to blot out everyone's sissy memories of me. That same year, in health class, the teacher spoke of veins carrying blood from the arms and legs back to the heart. "My God," I thought, "I'm sitting on my bum, there are veins there, and they're being squashed." It was time to go out for recess, and as I walked to the cloakroom the darkness was swirling in my eyes. I staggered, and fell into the wall. That time, I was able to pretend that I had tripped and knocked myself out by hitting my head. The teacher checked my head, seemed to realize what had really happened, but didn't say a word. It was Mr. Russell, a teacher who earlier that year I had challenged in class — it was 1942 — when he had made an anti-German remark. For 40 years, the threat of humiliation that came with fainting hung over my head. The need to be sure I was a man, a real man, was never far from my mind. No visitors were allowed at the Toronto Isolation Hospital, so parents gathered in the lane behind the hospital, waving and gesturing to us through a window. Some parents pried open the windows and passed in toys. A few children, knowing they would be leaving the hospital soon, handed toys out to their parents to be taken home. This was not allowed; toys in the hospital were contaminated, and had to be left behind.

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THE CURE OF EOLLY

"Probably Jews," I thought. To me, clean and German, the window prying and the smuggling were outrageous. I was prissy and pleased that my parents did not try to break the rules. Or was I as pleased as I think?

In 1961, I began my psychiatric training at the Menninger Clinic in Topeka, Kansas. Graham Copeland followed me. He had worked briefly as an anatomy demonstrator in Toronto, and while I saw little of him, he knew my plans and applied to the same residency program. By then I was worried his attachment to me was harming his independence, so I made sure Graham traveled to Kansas on his own, hoping he would find his own life. After one year in the psychiatric training program, Graham abruptly quit and went to study music at McGill University, determined to become a concert pianist. He never practiced medicine again. During that year in Topeka, he stopped hiding his sexuality and moved in with Peter, a black psychiatric aide at Topeka State Hospital. Peter had the same mannered way of speaking as the Toronto boar's head gang and the Vancouver intellectual aristocrats. Had he learned it from Graham?

Karl Menninger s books convinced me I should train in his program. He wasn't Jewish, but as a German, he was close enough. Dr. Karl (that's what we called him) was a show-business character and a genius. His passion for social causes immunized me against those who feel psychiatry should be scientific and technological. I didn't know it at the time, but Menninger's humanistic approach to psychiatry tapped into my secret world of sissy interests — a traitor to manliness, logic and progress.

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I first met him over coffee at a meet-and-greet for new psychiatric residents. He was a tall, enthusiastic man with a broad smile. "I'm Karl Menninger," he said, with a definite Kansas twang (to a Canadian, his dialect sounded exotic, like he was from the Deep South). He wore a conservative suit, with a checked flannel shirt and string tie. For a psychiatrist, the "cowboy shirt" seemed daring. He led me to a group of people with whom he had been chatting, and introduced me to each one. I soon realized that these were new residents whose names Karl Menninger had just learned. He never forgot my name either. Dr. Karl's passion for social causes would have a strong effect on all of us. For example, he said that "To call someone a schizophrenic is no different from calling someone a nigger." For many years, I struggled with that phrase — it seemed too harsh and I feared that if I used it, I would be seen as a fool. Now I know I hesitated only because I didn't yet have the courage of my convictions. Karl Menninger could say it, but I couldn't. I eventually grew up and figured out that, even though it alienates me from many colleagues, I can say firmly that calling someone a schizophrenic is no different from calling him a nigger. I know that words like schizophrenia will always be with us, but when used earnestly and concretely, they corrupt our clinical thinking. Karl Menninger's favourite campaign was against psychiatric diagnosis, which, to him, was just psychiatric name-calling. Were he alive today, he would be appalled at the new epidemic of insulting talk about patients, about suffering people who are given the nasty titles "personality disorder" and "borderline." ("Borderline what?" I might ask.) He also raged against the killing of fur-bearing animals, bad prison conditions, and the mistreatment of North American aboriginals. These passions made passion legitimate to me, and inspired me to adopt passions of my own.

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THE CURE OF FOLLY

I tried to identify with Karl Menninger, but identifying means changing your soul and such things can't be done by trying. A rocksolid identification with someone means becoming him, being him, a fundamental reorientation that, despite its profundity, is done unwittingly. Instead of admiring and loving Dr. Karl, basking for a while in my hero worship, I used to complain about his showiness, his carelessness about detail, and his tolerance for the sycophants who fluttered around him. I grabbed onto his virtues and claimed them as my own, rarely acknowledging that he had inspired me. I decided early on that I would be a psychiatric idealist: I'd never waver from my duty, never make jokes about patients, and never, ever, think of patients as having a status less worthy than mine. Karl Menninger didn't say most of these things explicitly, but he exuded those attitudes, and though I didn't see it at the time, his attitudes fell on fertile ground. Since I was a German, I was in need of a model for how to behave without prejudice. I knew how to rein in prejudice when I talked politics with my friends, but under Karl Menninger's influence, I learned how to do it as a psychiatrist. He came from Pennsylvania Dutch stock, but I knew "Dutch" was a euphemism for "German," though he never made mention of his German ancestry. I had modeled myself on plenty of other father figures before Dr. Karl. I was certainly a version of my music- and history-loving father, but he was wretchedly deficient for the world of idealism I craved. Instead of putting a stop to the stupid cruelties toward children of my mother and her sisters, he stayed passive. His love of my mother was expressed through unwavering tolerance of her ways and by indulging her. I was an angry, perfectionistic idealist, as was Dr. Karl, and my soul imbibed, feasted, and sated itself on him. His image stood on the shoulders of the other, earlier models I had tried out: my high school principal Norman McLeod, for example,

34


who I admired and who, using a clever form of split thinking, I thought I scorned. He taught me never to say, "She is a Christian while you are a Muslim," but instead to say, "whereas you are a Muslim." There was also my Uncle Charlie, the swimming teacher with the muscles and Dr. Broad, our family doctor who, knowing that, as enemy aliens we had no money, had charged us no fee during World War n. The safest fathers were fictional characters like the enigmatic Tarzan of the Apes. Like all children of my era, I grew up with Greek myths, so I knew and loved Achilles, Jason and Perseus. I was also enthralled by Joseph, the biblical dream interpreter, who I learned about in Sunday School. I'd picked up the scent of idealism before I met Dr. Karl, but, without getting credit for it at the time, he gave me a language and a cause. No psychiatric name-calling, never abandon hope for anyone — anyone— and offer help to all who ask, no matter how stupid or hopeless they appear to be. The idolatry is not over yet. Tomorrow it will be Thomas Mann or Marco Polo. But the one who I loved — even though I didn't know I loved him when I was his student — is Karl Menninger. It was all about figuring out how to turn myself into a psychiatrist — a real psychiatrist, not one who chased symptoms away as quickly as possible — and watching the role take ever deeper possession of me.

Karl Menninger knew he was a public figure. Some saw his behaviour as a product of too much ego, but I knew better. This was no cheap vanity, but the sign that he was a creature of life, a warrior, a psychiatric Muhammad AIL He was never a thin-blooded obsessive and his flamboyance woke us up and made us think. Karl Menninger was enacting his destiny. It was a social role that owned him, body and soul. Drama attracts attention and Dr. Karl caught attention wherever he went. I took him to lunch in Toronto many years later and,

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THE CURE OF FOLLY

although he didn't speak in a loud voice, others in the restaurant noticed him and whispered to one another, "Who is that?" Each Sunday, Dr. Karl taught a Bible study class at the hospital. The patients in the C. F. Menninger Hospital couldn't figure this out. Some thought he must be nuts; others suspected he was a Christian missionary. They must have been surprised when his subversive mind — not sacrilegious, subversive — stirred them up. What in the world could be going on when the most famous psychiatrist in the world teaches Bible studies, they wondered. The psychiatric community shared their ambivalence: "He's nuts," "Its show-biz," "Dr. Karl is just doing his number again."

We had the privilege of inviting Dr. Karl to consult with our hospital units, so I arranged for him to come to our little team meeting. He came, but we had to wait six months. On the big day, Dr. Karl arrived with a photographer, a dog, and a dog handler. I don't know whether this was a special day, but our reactions were mixed. Was he a fool? A hero? A god? Don't underestimate the importance of drama. After such an entrance, who could forget what happened later? I presented a case of chronic depression, a woman who lived several hundred miles away in western Kansas. When she arrived to be interviewed, there was more show business. When the woman sat down, Dr. Karl looked at her with a puzzled expression on his face. Suddenly he stood up. "Sarah," he said. "What are you doing here?" Sarah (patients are never to be addressed informally, by their first names) also stood up, they embraced, and both burst into tears. It turns out they had attended high school together 50 years earlier. And what did Dr. Karl recommend? It all seems impossibly silly to me today, but he recommended that she fly to Topeka three times a

36


week for analysis. Her husband was wealthy and this posed no financial problems. To make such a recommendation with the sparse information he had was an outrage, but don't forget Dr. Karl was a dramatist and a teacher. He was telling "Sarah" there was hope for her, and he taught us youngsters the same lesson.

Saturday mornings, Dr. Karl held a colloquium. Most of the psychiatrists and students attended, perhaps 200 in all. On picnic tables around the perimeter of the room were duplicated copies of articles and book chapters the great man had read during the preceding week, and which he thought would be of interest. Many of the articles had been sent to him by colleagues (eventually, I also sent him an article or two). The colloquium consisted of Karl Menninger's commentary on the ideas that had stirred his thinking. In the front row sat senior colleagues, who acted as intellectual consultants. Most were psychiatrists and psychologists, but often there was an English or Philosophy professor as well. If he got stuck in his thinking — he often forgot words or phrases, a tic that kept the audience on edge — he would turn to his front row and say, "Harold, what is it that Shakespeare [Erasmus, Freud] said about this? What was that quote?" The colloquium was always spiced with complaints about social problems such as crime and jail conditions. "Uh, how many of you have visited the Shawnee County jail?" he asked. "It's just up the street here. It's a good jail, mostly because of the work of one woman, a wise woman who lives here in our town. As responsible citizens, have you visited it?" The audience was silent and a few people raised their hands. "Well, if y'all haven't visited our local jail, are you any different from the Germans, who, after World War n, claimed no knowledge of concentration camps?"

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What else could one hope for in a teacher? He made us think. Having chastised us, Dr. Karl proceeded to rub it in. "I tried to get some prisoners to come over here to the colloquium today, but nobody seemed able to authorize it. But I phoned the state penitentiary and they agreed to let the Leavenworth State Prison choir come to meet with y'all." Sure enough, at that very moment, the choir entered through the rear doors. They were in chains and, within minutes, the audience was in tears. Naturally enough, melodrama was compounded by more melodrama: they sang "Nobody Knows the Trouble I've Seen." As "flair" had come to own Dr. Karl's soul, he had no choice but to poll the prisoners. We all knew the questions and what the answers would be. A black prisoner. "What was your offense, sir?" "Break and enter." "What is your sentence?" tCT" »3 rive years. A white prisoner. "What was your offense, sir?" "Break and enter." "What is your sentence?" 1 nree years. Murderers? Black: 20 years. White: 12 years. As I watched Dr. Karl's performance, I realized his theatricality wasn't a quirk. He was an icon, madly doing his duty and performing his role. The power of roles became clearer as I watched him. I saw how I enacted the complementary role of student. I, too, had a destiny as a storyteller, as an admiring student, as a propagandist for a certain vision of psychiatry, and embodied a role, sturdy and irresistible. In my own way, I was as ardent as he was, and as skilled as a disciple of Socrates or of Christ. I knew how to do it now, and indulged it as passionately as I could. It was a once-in-a-lifetime «^T-ll

??

38

THE BIRTH OF WE1RDNESS

opportunity. Karl Menninger was my one and only chance to be stamped into a psychiatrist, a role I'd always been moving toward. What else did Karl Menninger do? Well, he rode a horse, and made sure that we saw him, dressed as a Kansas cowboy, riding the grounds of the Menninger Foundation. He was 70 years old. He also read a book and wrote a review of it for publication, every day. I saw him at concerts, busily reading. Where he found the time, I don't know, but he also carried on an enormous correspondence. He once said that he wrote 40 letters a day. He also lectured to the psychiatric residents every week, something unheard of for the director of such a large institution. Usually, the lecturing duties of directors and heads of departments consist of ritual introductory remarks made at the beginning of the academic year. In September 1961, we had our first psychiatric lecture, in the auditorium of the Winter VA hospital. Sure enough, Menninger appeared at the front of the room, wearing a professional white coat. In his hand was a list of the psychiatric residents. "Instead of starting at the beginning of the alphabet, lets start at the end today. Let's see. Dr. Warme? Is Dr. Warme here? Ah, there you are. Would you please corne up to the front?" There were two chairs. "I have a patient for you. Please interview him for 15 or 20 minutes, then let him go back to the ward. His name is Mr. Donaldson." He gave me no advice, no support, no encouragement. The patient, a young man of 30, came in. I introduced myself, and we shook hands. His handshake was feeble, and he sat there silently during the whole so-called interview. I asked why he was in the hospital, what he needed help with, whether I could be of help or answer any questions. I offered him a cigarette, guessed out loud that he must be feeling uncomfortable, and reassured him about the 40 people watching. In the end, I probably needed reassurance more than he did. I was humiliated and on the verge of a

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nervous breakdown. After 15 minutes, I told Mr. Donaldson he could go back to his ward. "That was fine, Dr. Warme." Dr. Karl turned to the class, and asked for their opinions. There were a number of suggestions about how I might have proceeded and had a better result. Most of the remarks had to do with how I might have made Mr. Donaldson more comfortable. Dr. Karl was amused. "Well, Dr. Warme, let me now tell you something. Mr. Donaldson is actually not a patient. He is one of your colleagues, a fellow resident, who I asked to be the patient for today. I told him not to speak." I, for my part, was not amused. In fact, I hated him for humiliating me. Dr. Karl wanted to make die point that, when interviewing patients, we must use the social skills we already possess. We already have the interpersonal skills that make for a worthwhile interview, he insisted, and there is less to learn about interviewing than we sometimes think. To cling to an artificial "professional" style or to a predetermined series of questions is futile. What he wanted to illustrate was that, faced with an impasse, I had no recourse but to fall back on my personal methods. It was part of his personal propaganda, a message of humanism, dramatized at my expense. As I write these words, I wonder whether the interviewing seminar I have conducted for zo years was born out of that first humiliation Dr. Karl inflicted on me. Isn't it true that my own interviews are always a dramatic illustration of my social ingenuity, and never demonstrations of a silly technique? At the end of our first year of training, we were required to write a dissertation; only then could we move on to the second year of program. I was a conscientious student, and die first of the residents to complete and turn in my dissertation. Two days later, it was sent back. Dr. Karl had written on it: "I've only read one sentence. It's a dreadful

40


sentence and I refuse to read any further." I was both humiliated and frightened. Would I have to produce a new dissertation? Was I in trouble with the great man? Hopefully, I thought, he doesn't know who I am, and I won't be in jeopardy. I couldn't believe that Karl Menninger himself took the trouble to read the dissertations. There were hundreds of teachers around, and he read dissertations? In despair, I went to my supervisor. He smiled. "Dr. Karl does this every year. Change the first sentence, change the title, and wait a few weeks before resubmitting it." A few years after I left Kansas, I had an article published in a journal. Within a few days, a letter arrived, three sentences long. Dear Warme I appreciated the nice article of yours in the current issue of the American Journal of Psychiatry. I didn't understand what you said about ethology. I trust things are going well for you and your family. Sincerely Karl Menninger, MD

I was flattered the great man had written to me, since I had been only one of hundreds of students. In a few weeks I wrote back, explaining what I had meant about ethology. Within days I had an answer. This pattern continued. Karl Menninger answered my letters immediately, I answered after a few weeks. I didn't want to burden him, you see — he had to be very busy — but it turned out that he was never too busy. The correspondence petered out because of me. For Dr. Karl, it was his duty to write to me. It was his duty to be who he was, the American psychiatric culture hero. These days, such heroes don't exist. On another occasion, Dr. Karl was in Toronto and I gave him a tour of the city. As we drove by the Clarke Institute of Psychiatry

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where I work, I shyly said to him, "Dr. Karl, now /am a teacher." He harrumphed, "This isn't the time to be a teacher, Warme. Now you have to do research." I thought to myself, Bastard. Wasn't he the one who'd taught me research has little to do with our work? But then he spoke up again. "I don't mean that silly research that measures statistics and surveys populations. I mean there ought to be research done on problems like epidemic greed and vengeance, problems that cause far more trouble than the so-called diseases everyone is so busy treating."

In my office, I have a collection of miniature horses. Horses are quiet, like Tarzan of the Apes and North American aboriginals, and I have a life-long admiration for all three because they are of the strong, silent persuasion. Silent, like a psychiatrist who won't give his students a chance to ask questions and leaves them to flounder in puzzlement and mystery — to think for themselves. As a kid, it seemed to me that Indians and horses weren't into overt displays of affection or of any other emotion. They understood things quietly and were therefore deeper and more sincere. The silly, superficial Canadian kids were glitzy and false. They liked things that waste time — parties, for example. Better to identify with a horse or an Indian, because to openly identify with Germans was risky business during World War u. Germans in Canada were, of course, reserved. Besides, what else could they have been if, as my mother believed, exuberance was a phony Canadianism. Early in Dostoevsky s Crime and Punishment, Raskolnikov dreams that a carriage driver beats a horse to death with an iron bar. Freud, too, in the case study of Little Hans, tells of a horse that is beaten to the ground. Bodi of these dignified animals sank to the ground, one to his death, without giving up their quiet integrity.

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When I was a child, milkmen and bread men still drove through the neighbourhoods in horse-drawn wagons. I was attracted to the horses, mostly because they were serene; to a child in the late 19305, a horse was a quiet animal that stood by the curb waiting for its master to finish deliveries. When horses walked, they clippity-clopped 15 or 20 metres to the next house, then stopped and stood once again. They had plenty of time to brood and think. But horses were also vividly alive, as confirmed by various bodily functions that were both strange and obvious. Periodically, their contemplativeness was interrupted by neighing, coughing, and sneezing. Enormous patches of skin reacted crankily to flies and twitched them off. Their bum-holes opened up wide and, in slow motion, big steaming turds plopped out, and when they peed, it was a noisy, splashing, smelly waterfall. But even as their bodies performed so splendidly, the horses themselves were composed and thoughtful. "Nobody'd better cross them," I thought. One day, I fiddled with a horse's iron shoe. It stepped on my finger, and I lost a nail. My memory is that losing that nail taught me right from left — it was my left middle fingernail that I lost. Later, I drew horses constantly, hundreds of horses, herds of them, wild, armored, or with cowboys and medieval knights aboard. The interest in horses had started when I was even younger. At four, I put elastic bands around my head, between my teeth (a bit) and over my neck (a halter), to the chagrin of my parents, who warned that I would choke myself. I knew different and continued to play this game when they weren't around. With tables and pillows from the couch, I built enclosed spaces that, to me, were stables. In my private stable I stood silently, and without ostentation my horse body functioned as it should: I rested one hoof, horse-fashion, on its toe, purred and bubbled with my lips (the nearest I could come to reproducing a horse's sneeze). I also tried twitching my skin. I didn't play at having

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THE CURE OF FOLLY

bowel movements and peeing, but puzzled over them, too. I think of my horse collection as having been accumulated by accident, but it didn't happen accidentally. As I tell of my interest in horses, I sense that these are not idle recollections because I'm getting stirred up. And a pun: my parents said I would choke myself; the memory chokes me up. I'm the same with goodbyes. They don't bother me, I say, but there's lots of contrary evidence. My grandfather in Germany had told war stories of the neglected, injured horses at Flanders. My brother, Ernie, whose middle name is "Horst," became a jockey, I was spatially oriented to the world by the horse who injured my finger, I drew horses and now collect toy horses. The past keeps erupting into my mind when people react to my horse collection. I hear their comments and think to myself that, while they don't know it, they are with my grandfather in Flanders fields, with the dying horses. And they are on the racetrack, at Hialeah and Suffolk Downs and Woodbine with Ernie.

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CHAPTERjhKRjpE

HAIIDLED WITH A CHAIII

If you talk to God, you are praying; if God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; if God talks to you, you are a schizophrenic THOMAS SZASZ

Janet Hunter was still interviewing the day's patient, Margaret Jones, so I had time to watch the students. They were all doctors, but to me they all looked very young. I was 64 at that time, but still bemused that the students were awed and impressed by me and that some, probably because they were awed and impressed, were irritable and looking for a fight. I didn't feel like a charismatic leader, but to my amazement, that's the role that I occupied. I needed only the title of teacher, to narrow my eyes enigmatically, and that's what I turned into. In the back of my mind, I'd always had the feeling that, because I fainted, I was an unimportant sissy. But people refuse to cooperate; my opinions are listened to. That day, across the seminar room, sat Leila Singh. She was sweet

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THE CURE OF FOLLY

and pretty, like a child, but smarter than she let on. I suspected she kept a low profile so I wouldn't call on her to offer an opinion. She wore a sari and, as I walked into the room, she had casually — or should I say cunningly — wrapped her long silk scarf about her head. Leila was not Muslim, of course, but I thought to myself that, like many Indian women, she was copying the Muslim tradition, using her scarf to turn her sari into a modest chador. She knew hiding her charms would alert the world to them. I have to be careful about noticing womanly charms because, since my divorce fifteen years ago, my reputation is stained. Those who guard my morals — my paranoia suspects that it's everybody in the psychiatric community — are acutely aware that I notice womanliness more than when I was married, an observation that is surely pure imagination. A first year resident in psychiatry, Leila was still prone to rely on traditional medical thinking. She wanted me to make clear-cut diagnoses, and was always quick to suggest drug treatments. Her ambition was to be one of the orthodox, desperate to establish that psychiatry was about real, biological diseases and real treatments. She noted my eccentricities, but hadn't yet realized I was demanding that she radically change her way of thinking about patients. Beside her sat Osman Awad. Osman was my oriental prince, a very handsome devil. He was a Lebanese Christian, lean and tall with nice white skin, fine bushy mustache and a bass voice. Osman was flirtatiously trying to start a conversation with Leila but he was too obvious, too overtly friendly, too masculine. This seemed to make her nervous, so she avoided his attentions by turning toward a suitably Canadian student across the table from her, a student whose name I didn't know. Osman was an intellectual. He had read a lot of Freud, and like Leila, he was keen on discovering final answers about patients. But the final answers he was looking for were not the strictly medical answers

46

HANDLED WITH A CHAIN

Leila wanted. He wanted theories that would nail down truths like "he is a criminal because he has superego defects" or, "his primitive impulses broke through." Osman was a lot like me when I was a resident, very focused on rationalism, and I was impatient with him because I thought he ought to get over his reliance on reason — he ought to make it snappy and start thinking like me. He had seized on Freud's metapsychology: people do what they do because of an ego, an id and a superego — structures that govern their behaviour. The ego is the steering mechanism, the id is the fuel, and the superego a set of rules that guide the ego. Osman propped up his thinking by quoting Freud who, I have to admit, did like to play around with fuzzy metaphysical ideas. What Osman didn't realize was that this was a side interest of Freud's, and his real aim was to describe the striving, lively people who came to his office and notice things about them that hadn't been noticed before. This was Osman's second year in my seminar but his misreading of Freud — very common, of course — made him prone to being thrown off balance when I didn't use psychiatric jargon. He thought words like ego, self, cathexis and narcissism were terms that referred to real, solid things. His pursuit of Leila hinted that he was interested in a real, vivacious life, but when he described patients, he became wordy and intellectual. He was a typical psychiatrist, if not a typical member of the human race — we all theorize: "She does it because of her genes, her chemicals, her upbringing, the bad company she keeps, her Oedipus complex." Nobody wants to take notice of Wittgenstein and Shakespeare, luminaries who teach us to attend to the fumes and sparkle of what people actually do. To hell with metaphysical certainty, they teach us, and to hell with its opposite, skepticism — that refuge for those who glom onto a reverse dogma when they realize the truth can't be pinned down. Osman was neither bad nor stupid; he sought solace in theories

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like the rest of us. Not everyone can be like me (when I'm not a sissy) and know the final truth. It's just that everyone thinks he's got the final truth. One day, when I spoke of how a patient laughed so he wouldn't cry, Osman translated my words with just a hint of impatience: "Her laughter is a reaction formation against grief." Another time, when "envy" was mentioned, he turned it into a quasi-theoretical term: "His pathological envy causes him to repress any awareness of aggressive impulses toward those who surpass him." I hadn't yet fully whipped her into shape, but Christine Brydon, a new member of the seminar group, was catching on fast. She had an appointment to meet with me later that day because she was applying to be my full-time resident for the next academic year, beginning July I. I had heard that she was a good resident, and while we waited for Janet Hunter, she commented on Mr. Banda, the patient we'd seen the week before. "Why do psychoanalysts make patients sound so boring by reducing them to uninformative theories?" she said. "Why, for example, do they say people like Mr. Banda have an Oedipus complex? Why don't they just describe his actual fear: that he has made everyone love and admire him — including his mother — and that he'd pushed his father into the shadows?" It was an excellent question, and not one I expect to hear from students. Obviously she had smelled my way of thinking and was letting me know she and I were on the same page. I noticed I was looking forward to my interview with Christine which, perhaps, was precisely what she had intended. I never had to answer Christine's question because at that moment Janet Hunter, breathless, entered the room. "The patient came a half hour late. When I took her into my office, she said she needed some water and went to get some. Then, when she got back, she said she needed a cup of coffee. She didn't

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come back for 15 minutes, so we didn't have time for an interview. When I told her that she would be meeting with you at two o'clock, she said she couldn't stay because she had an appointment." Janet had been in the psychiatric training program for two years, but I didn't know her very well. I looked at the information sheet and saw that her patient, Margaret Jones, was 18, an age at which psychotherapy is an unattractive prospect. To an old hand like me, her flight behaviour was no surprise. The students, baffled by Janet's news, were waiting expectantly. It was time for me to be a model psychiatrist for the students, calm and inscrutable. I had done my inscrutable routine so often that it had become automatic, and there was no sign, even to myself, that I had any doubts about my actions. Let them find out for themselves, I thought, why teenagers aren't keen on the introspection game. "It's common for adolescents to be uninterested in the world of introspection," I told them. The students knew, because I was scheduled to interview Margaret Jones, the coming hour was free for me and, despite past experience, wondered if I would give them a little lecture about adolescents and psychotherapy, or whether they could raise other work problems with me. I said only that we would meet again next week, and left them sitting in the room. The students always stayed in the room after our meetings and as I left I smiled to myself as I imagined what they would be saying in my absence.

In my office, I was surprised to notice I felt teary. I was imagining that Janet Hunter was a raw beginner, that this was the first psychiatric patient she had ever seen, and that she had lost her case. In my daydream, she was frightened and hurt by today's non-standard assessment. I was identifying with her, thinking of my own first case

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THE CURE OF FOLLY

when I was a resident — not today's Miss Jones, but Cathy Jones, a Jones girl of my very own. I'd been thinking about my sick granddaughter, Mariah, and that led me to think of my students as children, too. Despite his fine mustache, Osman Awad was little more than a keen youngster, as was Christine Brydon, who had impressed me, her teacher, with an eager question. Christine wore expensive, dark blouses that didn't reveal her secrets, but her hearty laugh suggested she was robust and erotic, so I tried to cheer myself by thinking that, since Christine showed no breasts, she was also a child. I decided that in the interview I was to have with her later that day, I would have time to check on whether it was really true that she had no bosom. Oh, yes, and pretty little Leila Singh, as well. In 1962, I had been an eager student taking on my first psychotherapy case, Cathy Jones. Cathy was also a child, referred to me by my friend, Graham Copeland, who was her hospital doctor and had told me enthusiastically that her IQ was 140. We were both greenhorn doctors, impressed by intelligence, so we figured this was a good thing. Cathy was only 16, and had been hospitalized a few weeks earlier. She had reported she had been baby-sitting for a neighbour, and when the child's father walked her home, he had assaulted her in a clump of bushes. Cathy became wildly psychotic — hallucinating and delusional — and was sent to Topeka State hospital, a traditional large asylum or mental hospital. She stayed five years. It wasn't usual for a student to take on a schizophrenic patient, especially as a first case. This didn't faze me; I was sure of the powers of psychotherapy, and just as sure my dedication would guarantee a positive outcome. High optimism is a characteristic common to most psychiatrists, especially eager beginners; I've still got a built-in certainty I can help anyone. My teacher, Karl Menninger, had an office down the street, and I was eager to prove the correctness of his words:

SO

H A N D L E D WITH A CHAIN

"Calling someone schizophrenic is no different from calling him a nigger." "Wow," I thought, "racism is finished: niggers, kikes, and schizophrenics get psychotherapy and get cured like everyone else. Cathy Jones will benefit from my heroism, and when my colleagues go astray, I'll show them the error of their ways." My teachers didn't question my optimism about Cathy, partly because it fit with some of the then-popular theories of schizophrenia. Put coarsely, the theory was that such patients had been badly patented — mothered — and were psychologically damaged. They were, according to this theory, developmentally stunted, in other words, vulnerable to being described in discourteous language: "She is infantile, primitive, immature." The theory used a lot of euphemisms, such as "inadequately internalized maternal introject" and similar balderdash, but there was no escaping the bad-parenting charge that lay behind it. I happily assumed I would successfully re-parent Cathy, with a few fancy psychotherapeutic flourishes thrown in. I did my best, but in those years, my best included a bland belief that Cathy was damaged goods, and I was in mint condition. I adopted two common prejudices: first, that schizophrenics must be made to face reality and, second, that diere should be no risky attempts made to awaken her unconscious. Whose reality, I might ask, had to be faced? Mine? Yours? The patient's? Once it had been decided whose reality was at stake, we would have to decide whether it was the internal or the external reality that was to be faced. In hindsight, I wish I'd focused on her life with relentless curiosity rather than always walking on eggshells.

Cathy was labeled a paranoid schizophrenic. When she was mute and immobile for weeks on end, the label was changed to catatonic schiz-

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THE CURE OF FOLLY

ophrenia. The day I met her, Cathy was tied to a chair, both wrists bandaged. The previous day she had attacked a nurse, and when attempts were made to restrain her, had punched both fists through a window and made sawing motions with her wrists against the jagged glass. She was convinced she was under attack and that she had no choice but to defend herself. The rows of dirty windows were usually covered with heavy, escape-proof screens, so someone must have left the screen in her room open. Cathy's door was heavy and reinforced, in case she needed to be locked in. The room was on a big, open ward, 45 metres long and 15 wide, with rows of doors along each side and a nursing station perched like an island in the middle — a fortress boxed with shatterproof glass. There, doctors and nurses huddled together, safe from contamination by the madness that surrounded us. Those who we had baptized as officially mad spent most of their days watching television. The patients made the wooden floors gleam using heavy, weighted polishers. And there was an ineradicable, filthy smell that had infested the old buildings for a hundred years: stale urine, mouse droppings and carcasses, sweat and dirt, disgusting and improper. On that ward a new, antidepressive treatment was in use, a treatment that required patients to do menial work. Despite their scrubbing, polishing and dusting, the smell remained. It was eternal. What was a i6-year-old girl doing in this hellhole?

"Hi," Cathy said warily, as I approached. This was a big day for her. She had been picked to have a psychotherapist, an exciting event in the Menninger Clinic's hospital culture, in which psychotherapists were akin to gods and in equally short supply. As I walked past the other patients on die ward, I realized I was a celebrity:

52


"Are you Cathy's new therapist?" "How come that bitch gets a therapist?" "Do you know any therapists for me?" Despite a lot of medication, Cathy was suspicious. She was also pretty, but in those days I thought it was unprofessional of me to notice. Her beauty, her sexuality and her soul didn't interest me because I was searching out disease. I knew her for 30 years and never had the courtesy (would certain moralists not realize that this is a courtesy?) of noticing her figure and the sparkle in her eyes. I only know in retrospect that she was womanly and back then, I unsexed her. She might as well have been a wooden plank, or at least a wooden plank with schizophrenia. There was a deep worry line between her eyebrows, but the eyebrows themselves were prettily arched and mobile. Her cheeks and her figure were pleasantly plump. She wore shabby hospital clothes, and didn't try to hide her bewildered and disheveled state. The day I met her, and for several weeks, she argued with voices: "Shut up. None of your business. Go to hell." Cathy didn't hide these conversations, but when asked, denied talking to anyone. I'd worked with schizophrenic people before Cathy — as a hospital doctor, not as a psychotherapist — so strange talk didn't unsettle me. Usually, I could get Cathy's attention, even when she was in the midst of an elaborate conversation with one of her voices. But some days, she mumbled to herself and completely ignored me. "It's not true. I never did. The last time I saw him was at school. He wanted me to drive him. Everybody wants to dance some more. It was a great party but my father won't let me go again. I'm going to stop. They won't let me anyway. Just tell them to shut up. Shut up! You shut up yourself." She licked her lips, and asked me to bring candy. I looked closely, and recognized the sensuality in her posture, her pouty lips, her eyes

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THE CURE OF FOLLY

— and then, as fast as possible, censored what I'd noticed. "I love Almond Joy candy bars." I knew what they were only from the radio-commercial: Oh, boy, Almond Joy. Peter-Paul Almond Joy.

I brought Cathy an Almond Joy every time we met but if she ate them at all, she didn't until after I'd left. Tuesdays and Thursdays, at 10 a.m., I sat beside her bed for an hour as she lay in a catatonic stupor. I didn't know what to do. I was supposed to be doing something important for her called psychotherapy, and, like the U.S. Mail, therapy must be delivered rain or shine, whether she slept or ranted or smeared her feces. I tried thinking and speaking out loud, because my supervisor — whose life goal seemed to be to confirm the stereotype of the drinking Irishman, whose name I don't remember and who eventually drank himself to death — didn't seem to know what I should do either. "Be with her," he said. Even then, I knew this was a banality, but avoided acknowledging the obvious: Irish Eyes understood little about psychiatry. Occasionally, I'd get a chance to bootleg some supervision from Bob (Saturnino) Ortega, a Cuban staff psychiatrist who never babbled about theories but rather asked me to provide more and more detail. "What else did she say?" he asked me, then smiled when I used psychoanalytic jargon and made me nervous with his implication that Freud's theories weren't sacrosanct. There was a whole contingent of inspiring Cubans at the Menninger Clinic and when I discussed Cathy with Tony (Antonio) Fueyo, also not my official supervisor, he asked me why she didn't move. Tony's authoritarianism drove me mad, but he was insatiably

54


curious: rather than dismissing her immobility as catatonia, he thought of Cathy as a person with a will. At a team meeting, someone mentioned our Coke machine was broken. Fueyo, our clinical chief, treated the observation as something with symbolic meaning, as though the complaint was on behalf of the whole psychiatric team: "We feel unfulfilled and say so, Dr. Fueyo, in the language of Coke machines." I thought Tony was nuts not to take the Coke machine problem at face value, but his response also taught me that psychiatrists shouldn't take things literally. Tony may have been haughty and infuriating, but he inspired me. "If you don't move, Cathy, nothing bad can happen," I said to her at our next meeting. "I guess you're scared of what you might do, so you're keeping as still as you can. In your mind, maybe there's a danger that if you move, you'll harm me, or maybe harm the whole world. I even thought for a minute you might be afraid that the world would explode if you moved." "You lie so still it reminds me of a corpse. Maybe you are a corpse today. I heard about a guy who used to daydream that he was Marilyn Monroe, dead, lying on a bier. Did someone in your family die and, if so, have you turned into that dead person?" For weeks Cathy didn't move, nor did she eat or speak. Once I came to the ward just as the hospital doctor was pushing a feeding tube into her. She was wrapped in sheets so she couldn't move, and the thick tube was forced into her nose and down her throat. I remember her terrified shrieks. "Take it off my nose!" she cried. "Stop doing bad things to my nose!" It was grim doctoring, saving lives, and I was part of it. I shuddered that she suffered, but my uneasiness was something that needed to be squelched. I had to be cool and collected; had I been a softie, my patient would have been even worse off.

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THE CURE OF FOLLY

Another day, I saw one of the hospital doctors (hospital doctors confine themselves to prescribing medication and to the administrative management of the ward) walk down the corridor carrying a tray filled with hypodermic needles and syringes. He was taking blood samples from patients for various tests, in those days, most commonly tests for syphilis. Cathy suddenly jumped from her seat, grabbed his crotch shouting, "You promised me, you promised me, a feel of your cock!" The old-fashioned glass syringes went flying. The doctor's awkward dance of avoidance was funny, and didn't leave me worried about Cathy's forwardness; I had the cocky thought that I could easily handle it. Of course I could handle it; I'd turned her into a plank, hadn't I? Like most schizophrenic patients, Cathy wasn't interested in thinking about herself. When we began, she was sure she knew what was going on — she spoke with proud confidence, and quietly dared me to contradict her. At other times she was suspicious, and when I spoke about what she'd told me, took my comments as criticisms. I'd often heard that schizophrenic patients weren't reflective — something considered to be a prerequisite for psychotherapeutic success — but I figured I had time to find out for myself. I was indefatigable because I worked in a high-powered academic setting in which there was an implicit assumption that schizophrenia could be treated with psychotherapy, but also because my intuition was that sense could be made of deviant thinking. How, I wondered, was I to undo her blaming, and get her to recognize that she attributed to others what she didn't dare to know about in herself? How could I get at the cauldron of rage inside Cathy? I wanted to enter her deepest, most hidden parts, to open her soul, and stir it up. I didn't think of Cathy as an ordinary person who had a disease. To me, her madness was not something that had been added to her, but was rather her whole-hearted and unique way of being in the world. Her mad ways reflected her hopes, fears and intentions; they had a

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purpose. Although painful, this was the life Cathy had chosen. Every intellectual, bank robber, and religious fanatic also has a wholehearted and unique way of being in the world and, like the mad, members of each group have qualities in common. The paradox is that all of us are both distinctive and resemble those widi whom we share a label. I'm different from every other psychiatrist in the world and yet resemble most psychiatrists just the same, just as Cathy resembled other schizophrenics, but was also one-of-a-kind.

We doctors had decided that our patients suffered from an affliction, something that was in them or had possessed diem, and it was our job to administer treatments that would cure, ameliorate or repair the things that afflicted them. What we called their illness was not them or their souls, we believed, it was an alien thing that had come upon them. Our treatments were twofold: we dosed the person with psychological talk (I wish this still went on in hospitals) and dosed the illness with antipsychotic and antidepressive drugs. The patients sat, bored to the point of madness, and waited for our ministrations and our decisions. These days, hospital doctors pharmacologically attack the same mythological illnesses we believed in three decades ago and, as a secondary issue, as we did, dispense morality, haircuts and entertainment. We residents tried our best to practice the philosophy of the Menninger Clinic, paying close attention to the ward culture. "Why," we asked ourselves, "are there more incidents of violence this week? Why are doctors prescribing more medications this week? Why are there more escapes?" When we could manage it, we assigned all patients to recreational activities. But this hospital was poor, and only at the private hospital — the C. F. Menninger Hospital — could patients live in a true asylum culture, where a patient can both lick his

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wounds, and wholeheartedly re-engage with the world of tests and life-adventures. On the wards were patients diagnosed as schizophrenic years earlier, and who had, at that time, been sterilized. They had been victims of the old earnest belief that the demon within really exists, the demon who must be slain lest he return in another incarnation. By the time I worked in Kansas, sterilization of schizophrenics was no longer allowed, but the attitudes that approved of it endured. To some extent they still do. Other patients had had their names changed during World War n. They were of German descent, and the new names were intended to spare them persecution during the war years. This change reduced persecution, all right; it also rendered the patients less than human, just as neuroleptic drugs protect certain patients from psychotic terror by turning them into walking zombies. To arbitrarily change a person's name and to administer dehumanizing drugs is an incivility based on the belief schizophrenics are less than human, less human than those who treat them, and less human than you and me. The belief in harmful chemicals in their brains is also part of the designation of schizophrenics as less than human. This is a strong charge, but magnetic fluids, non-existent genes, and bad chemicals, with great fanfare, have had their day. It's time that we, the questioners, had ours. Fifty years ago, the family members of schizophrenic patients who came to that hospital were told not to visit their relatives, to just tell themselves that they had died, and forget about them. We do better now, but to say that a person has a permanent biological abnormality, a "schizophrenic" abnormality, smacks of a similar denigration.

My mind had drifted far away from the students. That day, they had looked to me like children, and that day's patient had also been young, a teenager. Cathy, my tragic i6-year-old patient, had come to mind. In

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my early years of practice, I was a child psychiatrist, so it's no surprise that concern for youngsters is a big part of my psychology, and similar concerns get transposed onto my work with adults. The urgency with which I work and teach gives me away; in my mind there are children to be helped everywhere. Like the psychiatrists who find biological inferiority in their patients, I find child-like inferiority everywhere. It's no surprise that the interview I was to have with Christine Brydon later that day — she's the student who asked why psychiatrists talk so much about theories instead of just describing what patients do — would turn out to be a time for me to debate with myself about whether she was a youngster or an adult. All students at the Clarke Institute could attend my interviewing seminar, but Christine was applying to work full-time at the Psychotherapy Centre in the next academic year. Although modestly dressed — dark silk blouse and straight skirt — I realized immediately that she wasn't going to be child-like and submissive. Instead, I saw a potential Muse. A potential Muse means I'd noticed her sexuality and that was precisely what I hadn't wanted; I would have preferred her to be a child. Had she been child-like, I would have been safe — not from her — from myself. That's probably why I became a child psychiatrist in the first place. No worries about being faced by adult life and adult women. All of us, men and women alike, are liable to do a sexual inventory on the opposite sex and many of us — I certainly am — are uneasy when we notice ourselves doing it. My usual thought is, "What's the matter with me? Am I turning into an old lecher? I definitely didn't notice the sexuality of women so obviously when I was younger." But it's a lie. I'd already noticed the attractions of my female classmates in the last grades of elementary school, but I sniffed indignantly when I noticed this, and made sure I emphasized my interest in higher things like intellect. Freud was smart when he said

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that sex is everywhere, smart because he wrote about it in a way that got people to pay attention. But it was nothing new; everybody knows that sex is ubiquitous. Just as I perform not-to-be-acknowledged sexual inventories on women, they do the same to me. When I was younger, women were interested in me because I was healthy and youthful. Now, I observe that there are women, some of them decades younger than I, who are attracted to my well-honed posture of brain power and seniority. Despite wrinkles, baldness and shrunken muscles, talk of Nietzsche and opera awakens their interest. Through the ages, countless PhD supervisors, managers, priests and presidents have routinely made this observation — although nowadays we aren't supposed to notice or talk about it. I worry like everyone else that unscrupulous supervisors will sexually exploit their students. I also worry that students with equally exploitative agendas will seduce their supervisors. But I also know that, when heroes and young goddesses are put in the same room, they fall in love. To a lesser extent, this also happens when mature goddesses and coltish stallions are put in the same room. So, old lecher that I was, I noticed Christines rump, which she skillfully flicked and twitched in my direction. It reminded me of the belly dancers I'd once seen in Sharm-el-Sheik. This joking appraisal of her behaviour and mine was, and still is, my favourite defensive trick — except it wasn't just a joke. Clearly, she was putting her sexiness on display. I tried nervously to avoid noticing the rumpish part of her anatomy but, when I looked downward for safety, I noticed that she had long legs, clad in attractive gray stockings. When I sensibly raised my eyes to look her in the eye, her bosom passed across my field of vision, the bosom that I'd been joking about to myself when I'd thought earlier in the day about this interview. Oh, God, I thought, doing my best to neuter her, I don't need a hysteric like this on the service for the next year. I saw no evidence, of course, that /was the hysteric.

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"I didn't really want to be a doctor," she said, "I only went to medical school and took up psychiatry because I want to train as a psychoanalyst. Before medical school, I was an English student." "You'd thought of being an English teacher?" "Actually, no. I wanted to be a writer. After I got my degree I sat down and wrote two novels — embarrassing — and some short stories. I got one or two of the short stories published." "What were they about?" I asked. "They were mostly about the struggles of adolescents with their families and with the world. Mostly how they survived having pathetic families." I see. I noted that her face had fallen. Despite her initial confidence, it was easy to see that Christine was depressed. "Are you okay? You're looking a bit depressed." She tried to hide her tears and answered, "Just some marital problems." CCT

»

Once upon a time, every candidate applying for a psychiatric position was interviewed with great respect: he or she was invited to be a mini version of a psychiatric patient, to look inward a bit. How else could we teachers know that the applicant has the anomalous interests, mostly introspective interests, indispensable for the aspiring psychiatrist? While those interviews in many ways resembled those conducted with patients, they were modified both for the task at hand and the sensitivities of applicants. A discussion of sex, for example, wasn't obligatory, as it is with patients. But when I applied for training, I was asked detailed questions about my sexuality. I was 28 at the time, and two of the interviewers wondered why I hadn't yet married — in those days we married younger than they do now. The questions made me

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uneasy, but I was impressed that my interviewers took me so seriously. These Americans, I thought, are honest, determined and fervent. Not like cautious Canadians. By the time I interviewed Christine, the world had become politically correct, and asking her respectful and concerned questions about her depression was verboten. Taking an ordinary, humane interest in the fate and destiny of the person in my office, an interest made safe by years of psychiatric educational tradition, was no longer allowed. Dr. Brydon did not object to my question; she knew my eccentricities before she applied and had seen my style of working in the interviewing seminar. I expect she was grateful that I took her seriously. She was my choice for the position, a charge of talent waiting to be ignited, I thought. She wouldn't be easy, but better someone with spice and intelligence than a tiresome conformist who doesn't really recognize the oddness in the world.

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CHAPTER^FOVR^

THE CRITIQUE OF PURE REASOII

George Inge did unorthodox interviews and this qualified him to be one of the outsiders. The Menninger Clinic was high-powered but mainstream, so we psychiatric residents thought Inge exotic, if not outright mad. His eccentric, non-rational interviews were a challenge to reason itself. When he interviewed a patient, we could never catch exactly what was going on. He made allusions, and shared insights that awed his patient and which we knew were important but couldn't quite decipher. We were fascinated, frustrated and bewildered. Some wrote Inge off ("He's flipped") and others thought he was a genius. Now, I prefer to think of him as an inspiring madman. Inge had a knack for teaching, never bothered to expound theories, and never generalized. He just spoke enigmatically to his patients and eviscerated them — liberated their inner marvels for us to see. He and the rest of us had a common mentor: Karl Menninger. Dr. Karl didn't bother much with teaching psychiatry, but he hardly seemed to be an outsider, or, more accurately, few realized that he was. I once asked him which of the books he had written he was most proud of. The Vital Balance, he said. That book was theoretical, so perhaps Dr. Karl suffered from the same rationality madness as Osman Awad and consciously thought he ought to be both a theorist

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and a scientist. But he couldn't make himself be what he thought he was, and he didn't fool his students, either. He was life and passion and show business; it owned him heart and soul and we, his students, got the message. I, too, thought I ought to be a theorist and, like Dr. Karl, never suspected I had eccentric passions that mattered more to me than dry reason. From time to time, psychiatrists like George Inge make an appearance on the psychiatric stage. Colleagues are liable to say of them that they are in touch with the unconscious. What's meant by this is that they are quickly intuitive, refer obliquely to unexpected sides of the people they interview, and leave their victim, their amazed beneficiary, confused and grateful. The problem is that the patients are never exactly sure what it is for which they should be grateful. We're uneasy about our real belief about people like Inge — that to us they are magic. Which is not to say that talented interviewers are universally benign: one or two I've known were even disturbingly paranoid. Rather than being showy, as I am, there are many good psychiatrists who are gentle and soft-spoken. But what all good psychiatrists have in common is that they surprise, delight and unsettle the people to whom they speak. I couldn't get enough oi: teachers like George Inge but, at the time, had no idea that they were teaching important lessons. I thought they were just entertainers. Now, they are my heroes. But I don't try to be like them. That would violate their message, which has nothing to do with "trying." I now take pleasure only in whatever seeds of weirdness I notice in myself.

The best teachers were unorthodox, the opposite of me when I was young. I was ultra-orthodox at the time and acknowledged no legitimate critique of pure reason. I came from an immigrant family so I

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had to be sensible and conventional; I became a doctor. My brother Ernie, the jockey, was the eccentric. Not only that, but he became a racetrack celebrity, a Damon Runyan character. A strange reversal had occurred. I had been the important child; special, diligent and proper. But Ernie became successful, no longer Gordon Warme's brother; in fact it was the other way around. People I met said, "Oh, are you Warmie's brother? I bet on his horses all the time." "Warmie." That was Ernie's track moniker. Everyone on the track had a moniker, but my brother's was simple, a twist on his name. Others had handles like "Weak Eyes Grogan" (who wore spectacles), "Hook" (for his nose) and "Horseshoes" (for the big shoes on his big feet). I was not without a sense of humour, but I thought this kind of life was a luxury and not something to be indulged. Ernie's unusual profession embarrassed me. It had to do with class. Although I was born in Canada, being a German during World War n had exaggerated my sense of myself as an immigrant, and I was determined to wipe out that stigma. A life of adventure — riding horses — and of humour, was never to take centre stage. But humour was the centre of Ernie's world. One day, one of the jockeys, known for his glitzy self-importance, arrived in the locker room wearing a pair of new Italian shoes, which at that time were quite exotic. The shoes had long pointy toes; the jocks thought them hilarious and there was lots of teasing. Ernie suddenly took centre-stage. He had a large pair of snippers in his hand, the kind used to clip extra flesh from horse's hooves, and he lopped off the toes of the new shoes. Within two or three years, pointy Italian shoes were commonplace among the jocks. They also wore sharply tailored gangster suits (they had lots of money) and snap-brimmed fedoras. Ernie wore a big diamond and drove a white Thunderbird. Pretty low-brow, I thought enviously. Part of me knew that judgments about Ernie's class or my

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class were hogwash, but for a while I was tempted by the prejudices of the conventional world. Fortunately, I've become unorthodox, just like Ernie.

At the hospital, it was inspiring to have a reference group, especially given that, in Topeka, they shared my folly: "The Menninger Clinic is an intellectual Mecca for theorists. We are the true Freudians and the perfecters of advanced Freudian theory." Secretly, I held the sentimental belief that I cured my patients with love. Still, I continued to define myself as reasonable, industrious and theoretical. It had never occurred to me to be an overt purveyor of the love panacea because I didn't (and don't) believe such attitudes can be taught; I just assumed that I possessed an advanced form of human compassion and that no one else could practice it as well as I. It was a comfort to join the rationalists. Our joyous groupthink, our mass hysteria, was that we were rationalists with a vengeance, devoted to our lofty interest in the logos and the tbymos. By comparison, Osman Awad, my latter-day theoretical pasha, was a rank amateur at the rationalist metaphysics diat drove me when I was his age. He had a lot of work ahead of him if he wanted to catch up with me and my theories. I was a single-source theorist. I saw the world exclusively through my own inventions, and was convinced that Freud's mechanical model of the mind was the secret pathway to the soul. I was as reductionistic in that belief as are the psychiatric biologists of today. A reductionist picks his poison and from then on, he can use it to explain everything, whether it involves the functioning of a mental apparatus which needs to be tinkered with (me), a chemical abnormality which can be corrected with the right drugs (the biologists), or being a good replacement for bad parents who caused their children's illnesses (the empathy propagandists).

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The stakes race to explain human life draws a big crowd. The politically safe people's choice is a group of blithe eclectics. Does chemistry make us mad, they ask? Yes. Is it all about conflict? Yes. Astrological influence? Yes. Pollutants, parents, past lives, trauma, archetypes? Yes, yes, yes. They cheerfully endorse self-evident contradictions — tough love and empathy, free will and determinism. I didn't stay a rationalist forever; no deduction led me to spot Mr. Banda as the Messiah. I almost wish that Dostoevsky had given me a good scolding, maybe even a good hiding, many years ago. He, of course, discovered long ago that the most destructive and dangerous of religions is a faith in reason, science, revolution and the perfectibility of man. Dostoevsky figured this out with his guts; when I finally decided to grow up, I had to use my reason —- my puffed-up reason — to escape from my infatuation with intellect and theory. Some god or madness forced me in the direction of poets and artists, people who knew intuitively what I struggled to find with my intellect. Like my mentor, Dr. Karl, I thought I ought to be a theorist, but I was wrong. There were good intuitions in me, all right, but they were so walled off I had to dig them out with my mind and, later, bring them to life via the inspirational models of Thomas Mann, T. S. Eliot and Vladimir Nabokov. Has a psychiatrist ever unraveled the mind of a brilliant pedophile as Nabokov did with Humbert Humbert? To escape from rationality was to escape from all popular positions, to plant my feet firmly in mid-air and pay the price of estrangement from colleagues. Slowly but surely, I became an outsider, and while I earned brownie points widi cheerful camaraderie, it hurt to see how few of my colleagues understood my ideas, let alone agreed with me. Everyone wants a foundation on which to ground their ideas; my postmodern antl-foundationalism might have found soulmates in quantum physicists, but not among psychiatrists. Little do my colleagues know that we have no choice but to be postmodern. An

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obvious example is that we all believe in causality and in free will, a dramatic illustration of the world's lack of system. The easiest escape route for me was skepticism, the perfect foil for the belief systems everyone else seemed to prefer. But skepticism is a belief, too. As Nietzsche observed, you shouldn't make an idol out of smashing idols. What hurt most was that many students I thought I had inspired, after they stopped working with me, committed diemselves to one of the naive dogmas — a fact which was a terrible assault on my vanity. During this time, the feedback from students changed and, instead of being another pretty good teacher, their evaluations of me changed: Brilliant-4 For more senior students—9 Incomprehensible—4 No comment-8

I had an older brodier, also named Gordon, born 14 months before me, who died at about the time I was conceived. He lived his life backwards. Instead of living his life and then dying, he died first and let me live his life for him — after his death. In loyalty to him, I have also lived my life backwards. I began as a good cooperative boy, living my life in harmony with the world, declining to be a young rebel. I was not a rebellious adolescent until I was 50, and saw the truth about the Emperor's New Clothes at the wrong end of life. It has been a marvelous, gay ride; it's much more fun condemning stupidity now than it would have been 50 years ago. Since I have a lifetime cargo of information available to me, I'm good at looking like a dangerous opponent, much more dangerous than a youthful adolescent could ever be. It feels to me as though all of this has been of my choosing, but if I allow myself to see that the world is as real upside down as it is right side up, doesn't that make me just another puppet? 68


It's useless to complain about bad literature. Best just to try and write something good. The same goes for psychiatry; better that I practice my trade well and try to write something worthwhile. But I can't resist being a stinging gadfly.

What did it take to get me to think for myself? My best answer is that I sought out independent thinkers and historical figures with whom I could join forces. That's probably why, during the years I was freeing myself from traditional dogmas, I read so frantically. The best fun is to explain the development of independence by playing psychoanalyst: to carry out a thought experiment that concerns sex. But don't forget that thought experiments prove nothing —they can only make us reflect. Sex, if you think about it, is a template for independence, something private. When we are young, masturbatory sex is a solo activity, the first important activity kept private from parents. It starts even before adolescence because, when toddlers fondle themselves in the supermarket, they are told, "Don't play with yourself." The parents' ban on public sexuality coerces children into becoming sexually private, and privacy is the training ground for independence and self-reliance. In adult life, sex becomes a privacy shared by two people — a celebration of their oneness. As some wag put it, "Always remember that you are unique. Just like everyone else."

Hanna Slendzinski was more serious about psychotherapy than I realized. The American Psychiatric Association met that spring in Toronto and, although I had stopped going to boring meetings, I dropped in to the Royal York hotel to meet an old friend. There sat Hanna on a sofa in the lobby talking to Don Kinsley, a one-time

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child psychiatry colleague of mine at the Menninger Clinic. Kinsley was an over-intellectualized fool but, since fools can fool people, he was well known in the American psychiatric world. Hanna, who worked with youngsters in Poland, had tracked him down. I was early for my meeting, so I sat with them. Hanna asked Don about his work with severely disturbed adolescents and he spoke enthusiastically about setting limits, and the importance of maintaining the structure of the psychotherapeutic situation. I remember particularly that he insisted it was important to repeatedly review with the patient the rules of therapy that had been set up. Hanna was well aware that I often said the opposite, that there are no rules for the patient except that he pay his bill. What struck me then was Hanna's calm disagreement with Don. My own style would have been to wage intellectual war, to find logical reasons why my liberal attitudes were better than his and, without outright saying it, dismissing his approach as dictatorial and punitive. But Hanna put into practice with Don the manner and style she used in her psychotherapeutic practice. "I just like to listen and talk to people," she said. "If they misbehave, there's no use scolding them and laying down the law. If they come to my office, that's all that I need. If they come, I can talk to them." Don asked Hanna if she insisted her patients read the books she assigned them. Her answer was that while she was a bibliotherapist, she didn't really care whether she and her patient talked about books, the weather or any other topic. So long as she and her patient talked, she could do her job. Hanna liked talking about everything. To her, dreams, symptoms and character traits were all just pieces of the same person, and the pieces were relevant to the patient's way of being in the world. If a patient misbehaved, it was her job to find the hidden meaning of their misbehaviour. She told Don she wasn't sure why he'd

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want to prevent behaviour — since what youngsters do is about the only clue to what they are struggling with. Hanna used the word "unconscious" once or twice — mostly to hint that Don, in controlling his patients so tightly, perhaps didn't want to hear the secret issues that stirred them up. When she described her work her manner was often more persuasive than what she actually said. Her comments seemed ordinary, but Hanna had a quiet awareness of what mattered when talking to patients. She never doubted herself for a minute, even when talking to an expert in the field. At her age, I would have laboured and struggled intellectually — and probably missed the point. Kinsley left before I did. I complimented Hanna on her calmness in the face of Don's theoretical storms. She shrugged. When I complained about how, for years, I'd struggled and argued with him, she said, "Yes, I know."

When I was a young, rationalist doctor, I went into analysis. My analyst, Phil Holzman, fit the bill. He was an intellectual, but when he taught seminars, he showed us how to use stories, for example from James Joyce's Dubliners, as psychological models. For me, literary teaching brought psychoanalysis and my patients to life. In my analysis, Holzman spoke allusively of Joyce's Ulysses, and of the point of the novel: the story of a father's search for a son and a son's search for a father. Holzman brought this up the right way. When I discussed Ulysses, he pointed out how I spoke of the theme of fathers and sons innocently, without knowing I was doing it. As a result of his comment, he and I enacted — of course — the roles of father and son. In my analysis, I was surprised to notice I was quoting Shakespeare, even though I'd never had a great interest in him. I knew it was Shakespeare, but didn't know from which play. Holzman cryptically

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pointed out that all the quotes were from Hamlet, again the story of a man who had lost his father. Was the invisible analyst who sat behind me, who listened and watched, my father's ghost — Hamlet Senior's ghost? "Winning" and becoming the father, the primary male, was the central issue of the analysis. Repeatedly, Holzman pointed out how I avoided winning, or at least, avoided overtly winning. This often came up as a play on the German word Gluck, which can be translated as either "joy" or "luck." It would spring up when I thought about the German translation of a famous operatic aria, Che faro senza Euridice, from Orfeo ed Euridice, written by (more wordplay) Christoph Willibald Gluck. The idea was that any joy I had in winning was only a matter of luck — I hadn't actually done it myself. The words of the German version of the aria added even more interest: "O, Ich habe Sie verlorenlAll' mem Gluck istjetzt vorbei." (Oh, I have lost her/All my joy is gone forever.) I'd identified with those lines and, like Orpheus, wanted to announce that I hadn't won and had "lost her forever." At first, I didn't accept Holzman's ideas about my fear of winning. He, I thought, was the one who was focused on banal achievement. It also wouldn't register for me that irony could be a form of winning — a triumph and, at the same time, an evasion of triumph. I wasn't smart enough at this point to realize that everyone likes to win, or that winning could take many forms — blatant, vulgar, quietly persistent, or winning disguised as losing. How better to defeat a doting father than to become a derelict? The issue with me was the deviousness of my successes: deferred, roundabout, disclaimed and joked about with clever self-mockery. Some of these nuances became clear during my analysis; to my amusement, I discover others every year, every day, and that's how it should be. The best outcome of any analysis is an understanding of the idea of analysis. Analysis can't prod us into doing this unless we're

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already willing to thump ourselves off balance and endure some bewilderment about who we are. Although Holzman was good for me, he didn't understand my interest in weirdness, or my fascination with my homosexual friend Graham and his prissy friends — especially their recognition of life as play. Life as a series of solid items, as tables, chairs, cats and dogs, is the end of life, and injecting a bit of theatricality is the beginning of life. Perhaps the artistic side of me was so undeveloped in those years no one could have recognized what I was up to. But that weird stance was the beginning of creativity, and my hidden ambition, still hidden at the time, was to be artistic in my work as a psychiatrist.

Holzman was politically adroit; it was said he was Karl Menninger's best friend. I teased him unmercifully on this point, and called him a "kiss-ass." I teased him because I guessed he was strong, proved by his intellect. I could indulge the delicious pleasure of attacking him, sure that he would survive. My real father could never have handled such attacks, but I'd always made sure I didn't know this. When my father told weak and vulgar jokes to his business associates on the phone — such jokes weren't his style — I recall that I cringed, disturbed by the servility and false comradeship. Holzman eventually moved to Chicago. Not long after his move, I was asked to introduce Roy Grinker — a professor of psychiatry, and a prominent public figure in Chicago — to a university audience in Toronto. At dinner before the meeting, Grinker and I chatted. When he heard I had trained at the Menninger Clinic, he asked me who my analyst was when I had been in Topeka. "Phil Holzman." "Really? He's in Chicago now, you know. He's my best friend." The last time he and I spoke, Holzman was at Harvard doing

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research on schizophrenia. His approach to the subject is the perfect opposite of mine. He's interested in genetics and scientific causality; I'm interested in schizophrenia as self-invention.

Karl Menninger was pushed out of his position as Chief of Staff of the Menninger Clinic in 1968. His brother William (the brothers seemed to be jointly in charge of The Menninger Foundation) had developed cancer, and had decided to secure the family succession before he died. Both Dr. Karl and Dr. Will had psychiatrist sons, and the outcome of the coup was that Will's son, Roy, ended up in the chieftain's chair. This was not a change of management at a cozy family clinic; the organization had enormous financial and physical plant resources. The Menninger Foundation was made up of a private hospital, a large state hospital, perhaps the finest in the U.S., and a large, prosperous Veterans' Hospital. It had acquired a complex of former insurance company buildings, used by the Foundation for research, education, and administration. Will Menninger feared Karl's capriciousness, and built up a dependable structure that ensured this huge psychiatric complex wouldn't get into administrative trouble. I wasn't smart enough then to know I was witnessing a familiar historical drama. Imaginative leaders are never tolerated for long, and Dr. Karl's demise anticipated what, years later, I would see in the Toronto psychiatric establishment. Serious scholarly thought and imaginative creativity, those stinging gadflies, must always be squelched. Smoothness and mediocrity must always triumph. Because he was Karl Menninger's "best friend," Holzman's career at the clinic became shaky. The turmoil and the suspiciousness were bad enough that even my career seemed precarious for a while. I was the analysand of Holzman, best friend of Karl Menninger. Holzman made

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a quick decision to move to Chicago. My analysis ended suddenly; I had about four weeks warning. It's natural I would be upset to lose my analyst. But my reaction proved too extreme, too much like the symptoms of mental illness, and lasted too long. I had a serious anxiety attack at work. While chairing the weekly staff meeting, I was overcome by the textbook symptoms — I feared I would faint, that I would be unable to speak, that I would bolt from the room. On one occasion I had the same symptoms while interviewing a patient and had to step out of the appointment. While teaching a group of medical students, the panic carne again. This time there was an added issue, about a student, a young man, good-looking, blonde, and articulate. I can't remember the exact thought, but it was clearly a case of homosexual fear. Was he after me? Did he see I was a sissy just like him? I made an excuse and went to the washroom. A few deep breaths, splashes of cold water, and a quick return to the seminar room to gut-out the horror of it. My worst fears had come true. I was weak, effeminate, and fleeing from life. My mother had been prone to fainting, and her ghost had turned up in me. I'd done everything in my power to be a man, a doctor, a father — and I had failed. The anxiety, the dread in my gut, had become permanent. It was an illness of the soul, a terrible mixture of anxiety, guilt, and depression, the "sickness-unto-death." I began running — a frantic regime — two miles several times a week in the Kansas heat. The summer temperature in Kansas regularly hits 100 degrees Fahrenheit but nothing stopped me. I was determined to kill the panic. Every day, I went home for lunch. Instead of eating, I went to the bedroom, knelt beside the bed, and sobbed desperately into the mattress. No helpful thoughts accompanied that daily ritual crisis. I thought about it, of course, trying desperately to analyze my disabling,

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terrifying madness. My poor wife knew what was happening, but also knew me well enough to offer her help in careful doses. I didn't want help, and assured her everything would be okay. My children saw nothing. I was, and still am, a good actor. After all, I had to be a real man, didn't I? The symptoms were at their peak when I was centre stage, as the teacher, the leader, or the father. My son and I were involved in Indian Guides, a father-son club. We were "Little Bear" and "Big Bear." What a burden. At the meetings, I was Big Bear, and in a panic. The group included just three or four fathers, friends of mine and their sons, but it was terrifyingly difficult. One evening, my wife and I went out to a movie — Closely Watched Trains — with our friends Ian and Sue Graham. The film includes a suicide scene in a bathtub with plenty of blood and horror. For the first time since childhood I fainted, and had to be carried out of the cinema. I was terrified, afraid I would stay sick for the rest of my life. Perhaps I wouldn't be able to support my family — like my father during the three long years he was in the internment camp. I feared I wouldn't do my duty, the duty assigned to me by God. It was easy to put two and two together and understand what was happening. Obviously, my anxiety was just a repetition of my childhood trauma, when the RCMP had taken away my father in the middle of the night, right? Twenty-seven years later, my analyst-father had also been yanked away. Both had been caught up in a political mess. Although I recognized all of this intellectually, I didn't feel it in my heart. I also didn't recall being intensely upset when I was a child, 16 years earlier. The political demise of Karl Menninger didn't consciously upset me either. I was sure everything would turn out okay for Dr. Karl and, as for Will Menninger, he was dying, and therefore, in the style of my family, I had to believe that when Dr. Will died he wouldn't die after

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all. I didn't go to his funeral, and when Karl Menninger died 20 years later, I skipped his memorial service as well.

While in analysis, I had a dream that puzzled me. "Last night I had a dream about Phyllis Leavy," I told Holzman. "Why the hell would I dream about Phyllis Leavy? I hardly know her. And that's the whole dream." There was a brief pause. A voice behind me spoke cryptically. "Phil is leaving." Holzman's stingy output of talk had been getting on my nerves that week. "What do you mean? Can't you quit playing smoke and mirrors?" I said. Suddenly I understood. I'd completely forgotten Holzman was going on vacation and realized the dream was a pun on his first name. Phyllis Leavy. Phil is leaving. Phil is loving. Phil is living. Phil is dying. To make things worse, it was a prophetic dream, one that anticipated the trouble I'd have when my analysis ended. My usual trick is not to notice endings, or even to acknowledge that endings affect me. So such events can only show themselves in a dream, carrying with them extra baggage about love and death: "Phil is living, Phil is dying." To top it off, I developed symptoms later that day. I was in the library going over some papers for that night's seminar. I'd successfully put the unpleasantness about dreams, leaving, loving and dying out of my mind, or so I thought. There in the library, my librarian friend only a few feet away, I suddenly had an aching urge to masturbate. It bewildered me, but now it's clear what the urge meant.

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If I masturbated, I was independent, self-reliant and safe — whether or not Holzman lived or died. But understanding my dream wasn't enough for me. I needed to protect myself a second time, longing for the reassurance of sexual self-sufficiency. Becoming an independent, subversive thinker involves the same psychological manoeuvre as masturbation. It demonstrates that I belong to no tribe, so there will never be anyone for me to grieve.

My separation madness in 1968 was a transparent repetition of my wartime crisis of 1939, when I was seven years old. At first, the idea seemed foreign and intellectualized, but as the months and years passed, the analogy felt more and more real. A few years later, I ran into Holzman at the Waldorf Astoria hotel. We chatted, and he told me of a recent mountain-climbing trip. Not until we'd been talking five minutes or more, did I notice that his arm was in a cast. He had broken it while mountain climbing, but during the course of our conversation, I hadn't noticed the cast. My eyes just didn't want to recognize vulnerability and injury in a father.

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CHAPTER^FIVE

Dumpinc SYHDRpfflE

People in this city are brown, white, black and yellow and, as we waited for Dr. Erez Mizrahi to arrive, I wondered to myself what that day's colour would be. My students are multicoloured, too, and so accustomed to other races and tribes that they no longer notice. The patient, Mateen Kori, was Iranian and Mizrahi, his interviewer, was an Israeli, trained at Ben Gurion University in Beersheva. He was a smart student, very sinewy and intense, but still psychologically precocious. Good psychologists, like novelists and literary critics, are disinterested — they have no personal stake in what they observe — although when I use this word, the students usually think ! mean înterested. Despite his intensity, Dr. Mizrahi also had this trait. I knew Erez was interested in Jacques Lacan, a linguistically oriented psychoanalyst, but I couldn't figure out how he might have developed such an interest. Perhaps there had been Lacanian psychoanalysts in Jerusalem. He started right in on his presentation. "Mr. Kori has been seeing doctors for many years. He has a medical condition no one can figure out and from which he never gets relief. He has come here because he has been so advised, but he's pretty skeptical that we will be of help. Actually, he's been complaining to his endocrinologist for some time that his problems are psychological, but

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now that he's here, he does nothing but complain that his problems are biological. When I mentioned this to him, he understood my words but he didn't seem to understand the contradiction. He maintains his symptoms are so obviously physical that seeing a psychiatrist doesn't make a lot of sense. Still, he is very polite and cooperative and tries to reveal as much of himself as he can. "The way it works is that when Dr. Kori eats, he begins to feel unwell almost immediately. He starts to sweat, feels faint and sometimes has to throw up. Every time he eats he is totally devastated and incapacitated. The problem has become so bad in recent years that he has been left without energy and his life has been totally wrecked. He's seen many doctors, but they haven't found anything. I asked him whether any of the doctors thought he suffered from dumping syndrome, because the symptoms sounded like dumping syndrome, but he said he'd never heard that term. "Dr. Kori's life has been ruined by his disorder. He works, but getting through the day is torture. His relationship with his wife is non-existent. But he hasn't: lost any weight; he eats despite the debilitating effect food has on him."

My goodness, I thought to myself, dumping syndrome. I haven't heard that term for decades. If I remember correctly, it's a disorder that comes on after stomach surgery, so Dr. Kori can't really have it, but Mizrahi is right to mention it because his complaint seems so similar. I remembered my teachers in medical school talking about this strange malady. The belief was that after eating, patients with dumping syndrome had an extreme outpouring of insulin that had the effect of radically lowering their blood sugar, and producing their symptoms. We used to advise such patients to eat many tiny meals a day to prevent the insulin "dumping" from happening. I also remembered

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dumping syndrome was poorly understood and some physicians didn't believe there was anything physically wrong with such patients. It was another mystery disorder, like chronic fatigue syndrome and fibromyalgia, which stirs up unexpected passion in some medical circles: "It's a real disorder, real, real, real!" Since I'm a shaman, and my mind wanders like a spirit, I'm suddenly aware that I have "dumping syndrome" myself: I feel unwell, tired, and bloated if I put sugar in my coffee or on my cereal. Magically, I can eat a tub of ice cream without trouble. A Mars bar after lunch wrecks my day, but chocolate syrup on my ice cream in the evening is fine. Unfortunately for me, I don't get that opposite placebo reaction to sugar: the sugar buzz. We magicians are liable to forget the marvels of everyday madness when it applies to us; even when we do remember, it afflicts us just the same. We become collaborators in this nail-things-down folly when we fail to remember that our patients confront us with a cornucopia of mysterious wonders: multiple personality disorder, false memory syndrome and attention deficit disorder. And then there are the calmer claims of the orthodox who insist that depression, schizophrenia, and generalized social phobic disorder are "real, real, real."

"Dr. Kori is a dentist, 45 years old, and he and his family left Iran when he was 17. His two younger brothers, a younger sister, his parents and himself came together. They didn't leave for political reasons: they had relatives here and thought life might be better. "Dr. Kori knew this was a university hospital so, right off the bat, he told me a story about his education. He had had a professor in the faculty of dentistry in Teheran, who taught things besides dentistry to the students, things like humanities and literature. Some of the students came from very poor, outlying regions of Iran and this

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professor even had to bring a knife and fork to school to show these kids how to use them. "Kori's family was Europeanized and wealthy. They were very social, and he recalls that in Iran they associated with what he thought was a fast crowd. At parties, people wore Western clothes and he also thinks they took drugs and drank alcohol, even though this was against the law. Actually, it was Dr. Kori's mother who liked moving with the fast crowd; his father went along with her but always complained. He was the serious type and had to be browbeaten into going to all the parties. "Dr. Kori also describes something odd about the family — his father and grandfather are dentists, as are his two brothers and his wife. He himself sees nothing unusual in this. It is just a family tradition, which to him — and here he protests too much — is neither a good nor a bad thing, and he can't see why I would be interested in the subject. Dr. Kori has been in practice for many years but still works for someone else. He can't explain this either, and doesn't think the topic is relevant. He doesn't seem to see anything as psychologically interesting. "He can't tell me he finds pleasure in anything he does and says his illness has ruined his marriage. Except for one thing: he enjoys playing the flute. It's his only pleasure."

The students asked a few questions, pointing out that Mizrahi hadn't given us any sexual information — not even, for example, the fact that Dr. Kori had declined to discuss sexual matters. Just the same, Erez Mizrahi had brought his patient to life, despite the briefness of his presentation. Was his lively manner responsible or was it my uncanny knack for smelling a rat and catching Wagnerian themes? Perhaps I'm good at attaching universal themes to people, a skill that

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tricks students and patients into believing I'm a wizard. The young man in the group whose name I didn't know had a morose look on his face. He was chubby and wore a suit and tie, a style of which I approve, even though his clothes were more formal than is usual in the casual atmosphere of a hospital. These suits distinguished him from the other psychiatric residents, most of whom wore informal clothes, even jeans, to work. He was an earnest fellow and I suspected he didn't appreciate it when his fellow students were joking around — too much hilarity in the room for him. "Any other comments?" I said, looking toward the morose young man. Taking my cue, he addressed a question to Erez. "Did you ask him how he felt about his mother going out all the time back in Iran?" It was a good question, because asking about feelings elaborates on what has happened; the devil, of course, is in the details. But emphasizing feelings also slows the psychological chase; I'm liable to rush in faster than many colleagues. The logical progression of possible questions, each deeper and bolder than the last, goes like this: "How did you feel about your mother going out all the time back in Iran?" "Did you worry that your mother was going out too often back in Iran?" "So your mother ran around when you were young?" "When your mother went out so much, did you think she was a slut?" When the students have perfected their impudeur, they will go beyond the factual world and ask questions in the language of archetypes. Then, they will be getting at Platonic truths, not merely the patient's thoughts. "When did you realize your mother was a slut?" Dr. No-name didn't like that I was pushy with patients, that I poked

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my snout into their secrets. He seemed disconcerted when I made jokes — even though my running gag is innocent and predictable: the students are hopelessly timid; I am tough and can't be fooled. When the other young doctors gave their verbal reports of their interviews with patients — before my interview — Dr. No-name regularly made little pronouncements about the case, always relying on the cliche of empathy: "I think she suffered an empathic failure when her brother was ill and her parents spent so much time at the hospital."

Dr. Kori, hair parted on the left, had a thick cluster of curls flowing in front of his right ear, and his upper lip featured a carefully trimmed pencil-thin mustache. He looked vaguely familiar, but I couldn't place him. He leaned back in the stiff chair and eyed me skeptically. I liked him immediately and sensed electricity in the air. I was vaguely aware my back and shoulders had straightened and my eyes had narrowed. "I hear you enjoy playing the flute." "Yes, it's one of the few things I like doing." "When did you start?" "Oh, that started when I was a kid. My mother is sort of lively, sings a lot and likes music, and got me to play. For a while I was a promising music student. But, like a lot of teenagers, I sort of lost interest in it. Now, 1 just play for myself." "What is it like when you play? Does it delight you, get you worked up?" "I guess so. I'm not sure exactly what you mean." I noticed Dr. Kori was very cautious, so I told him a little story, hoping to warm him up. "Actually, what I have in mind is something that an artist, a patient of mine, once told me. Like you, he was pretty much a loner and led a pleasureless life. He also had no friends. He was gay, but had never

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had an intimate relationship with anyone. One day, he mentioned a piece he was working on. I asked him what it was like and he described it for me, an elaborate, detailed portrayal. I couldn't imagine the thing because it was too abstract, but he described wood, painted red, underpinned by textile materials and held together with chain and rope. There were steel elements and . . . well, you get the idea. '"What amazed me was that, for the first time, this young man became animated. He was enthralled by his artistic creation — full of passion, eyes sparkling, animated gestures. I was amazed. I guess I was wondering if there is any of that in you when you play the flute? But I also want to add another story about the same young man." I was overdoing my storytelling by illustrating the idea of "joy" so extravagantly. I certainly wouldn't have done this had I been alone with the patient, where I would have had the luxury of time and Dr. Kori could have unfolded in front of his own eyes at his own pace. But because there was an audience, he and I were also entertainers, and pumped up by our dramatic performances. Had I lost control of myself, I wondered? Had our audience compelled us to be extravagant and theatrical? I also have a reputation to live up to: I'm known to do unusual interviews and the students are not to be disappointed. If they interviewed like me they are likely to fail their specialty examination, but I was not preparing them for an exam; this was their one and only chance to see mystery and awakened thinking on display. I was sure I was on the right track, that I could awaken Dr. Kori's interest. I was also determined to show my students a side of Dr. Kori that was not serious, rational or in despair, trying to get his Dionysian side up and running. I was also getting ready to tempt him further — give him more bait — convinced that a joyful, erotic side of Dr. Kori was accessible. As I was telling my next story, I realized there was something odd

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about Dr. Kori's appearance. Or did he look like he might have been gay? My gay radar only works intermittently, so I wasn't sure. "As I told you," I told Kori, "this patient was gay. One day, lying on my couch, he said there was something he wanted to do, something he had wanted to do his whole life, but had never had the nerve. Suddenly he began to make loud, high-pitched sounds, a mixture of squealing and singing and howling, sort of 'mincing' with his voice. He'd turned into a hysterical drag queen, said no words, only shrieking, pealing sounds, very high pitched and amusing. It was hilarious, but also sad because it underlined the impoverished life this young man had designed for himself. He continued for at least five minutes and, finally, fell silent. 'I've wanted to do that all my life,' he said. It was only the second time I had seen him animated, the first being when he described his art construction to me. "Dr. Kori, I've told you these stories because I'm wondering if you know what I'm talking about?" "Yes, I know what you mean." "About your flute." "Yes, I know. Yes, I get that feeling when I'm playing my flute." "So there is an artist hidden inside the dentist? But before you answer that question, let me tell you something else I've noticed. "You are a dentist, so I expected you might be a bit on the formal side, and you are. But your appearance is, to me, even more than that. There is something dignified about your appearance and about your language — sort of proper. Your mustache is carefully trimmed and your hair, well, it sort of goes off to one side — a lovelock, I think it's called. It reminds me of something I was reading about Rembrandt the other day. He had a lovelock, of which he drew many versions in preparation for a self-portrait. He was concerned that he should invent himself properly, establish correctly who he was. He was a bit of a dandy, you know, dressed himself up in fancy costumes.

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Maybe you are a new version of Rembrandt?" Dr. Kori smiled as though he wanted to speak, but I carried right on, perhaps enthralled with my own version of drag-queen-speak. "When you raise your eyebrows, you only furrow the right side of forehead, a nice complement to your right-sided lovelock. All in all, your appearance is just slightly old-fashioned, sort of like a 19405 movie. In fact you remind me of someone, but I can't quite get who it is." A voice from across the room pierced the cozy world that Dr. Kori and I had created. "It's Errol Flynn," the voice said. It was one of the young whippersnappers, Christine Brydon, breaking my iron rule that only the patient and I are allowed to speak. Christine knew perfectly well a dose of sadism spills out of my eyes if anyone dares make a peep during my interview. How can I mesmerize my patient when there is chatter coming from the audience? I looked over and unleashed a charge of invisible hatred in her direction, to which she returned an impish, invisible smile. Dr. Kori smiled. "Yes, people often tell me I resemble Errol Flynn." And sure enough, that's who he was. It was uncanny how much he resembled him, the actor whose Australian dialect had been re-honed into an English accent, the "formality" that I had noticed in Dr. Kori. "That is a very interesting description of me," he said, and smiled at me warmly. "Yes, I know what you mean about getting excited about playing the flute. I certainly get that a bit, once in a while." There it was! Right before our eyes, in one short speech, he'd switched from genuine enthusiasm to muted enthusiasm. First, he said he knew about artistic excitement, then switched (including a switch in his tone of voice) to knowing it "a bit" and "once in a while." "Did you see what you just did, Dr. Kori?" "Huh?" "How you switched from being my artist patient singing out passionately, to being a dull dentist who knows about enthusiasm 'a

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bit' and 'once in a while.'" Dr. Kori's face fell and he looked glum and depressed. He didn't like it that his madness was so clearly identified, the madness that I paraphrased ("formulated," in psychiatric jargon) to myself as follows: /, Mateen Kori, am the man who has moments of joy and eroticism that are never sustained. You, Dr. Warme, and the world— and I myself — may see my fine appearance and my pleasure in music and fine eating, but look again. Can you (and the world, and I) see that my joys are spurious and transitory? My good looks are merely aping those of someone else — ErrolFlynn — or, as you suggest, Rembrandt. But it is aping, not genuine. It is not me who is joyful. Observe my eating; it looks as though I love food but it is more misery than pleasure. I am an eating disaster. That is why my face fell: you mustn't think that my interest in what you say is anything but momentary. It is my glum face that is the final reality, not the momentary interest that I showed you. And my flute? That only shows that, in the world of joy, I'm a failure in yet another way: I didn't capitalize on a talent that I had, and I only mentioned it because you caught me off-guard. Dr. Kori's pallid statement that he was depressed was only a rough approximation of his real symptoms. His madness was a figure, an etched-in-stone sequence of joy followed by despair. He happily succeeded in pushing his rock to the top of the mountain, only to have it roll to the bottom again. He was Sisyphus.

But at least Dr. Kori had become enthralled with me, and his current glumness was not the full-blown wretchedness he got when he ate. "You are an interesting man, Dr. Warme, and you are quite right about my artistic side. Most of the time, I am a very serious person. I work hard at dentistry and am a perfectionist. My wife is a careless person while I tend to be very sensible and this often causes trouble

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between us. I don't like it that you follow so many hunches. And I don't understand the point you are making by telling me about that other patient. You'll say that I'm just doubting everything or being obsessively uncertain. That's true of me all right, I do worry a lot. It pays to be careful about things and I wouldn't want to go off halfcocked. I understand what you said about good things changing into disappointment, but you don't really seem to have much evidence for this, do you?" Dr. Kori had dried up. In my psychiatric way I was judging him for this, as though I knew a way of life better than his: "He ought to be more enthusiastic, ought to be peppier and more radiant." At that moment, I seemed to believe being rational and sensible was somehow less worthy. I suppose what was happening was a countertransference, that is to say, I was acting out with Dr. Kori one of his typical scenarios, a scenario in which he possessed all the seriousness and other people in his world got to play out frivolity and enthusiasm. What else could I have expected? Surely, Dr. Kori had to appear in everything he did, whether I liked it or not? What obligation, I might have asked myself, did he have to become lively? My guess was that Dr. Kori's doubting guaranteed that he would never burst into artistry, drag-queen-ness, or whatever it was he feared. If other impulses should assert themselves, doubting would nicely cancel them out. Difference and uniqueness — that is to say, assured self-confidence — was anathema to Dr. Kori and he had done his best to avoid them by becoming a cookie-cutter copy of the family tradition. If he became a dentist, he wouldn't have to take on new or exciting ways of thinking. He joined forces with the men in his family, all industrious, conscientious, and boring. His mother and sister (and Dr. Kori hinted that this may have been true of his wife, too) were exactly the opposite — artistic, musical, gay (in the old sense), and lived their lives singing and laughing.

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Meanwhile, all boldness and confidence was masked by Dr. Kori's malignant tendency to doubt and undo everything he thought. Indeed, he second-guessed and doubted what others said as well. He told his doctor he needed psychological help; he told us he needed biological help. Psychologically, it was the perfect guarantee that he would never be definite, self-confident or potent. Dr. Kori's self-canceling life was painful and made him a cousin not only to Sisyphus, but to Hamlet.

"Dr. Kori, I wonder if your artistry means that you resemble the women in your family, your mother and your wife?" His face fell. He looked for a moment as though he might have a nervous breakdown. I had touched a sore spot. "Not at all," he insisted. "How did you come up with that?" Underneath Dr. Kori's fa9ade lurked a strong identification with his mother's gaiety, a dangerous possibility relegated to unconscious status by unrelenting, sober industriousness. Like many of us, he feared being disloyal to his father and my speculation was that, had he not followed the tradition of men becoming dentists, he would have felt he was letting the family down. But perhaps that's too mild: he would have been a traitor to his father's traditions. "Your mother and sister are Dionysian and you and your male relatives are Apollonian," I told him. Dr. Kori's ears perked up. Fancy language and references to mythology made him feel safer. "Yes, my mother and sisters are full of life and energy, and the men in my family are too sensible and thoughtful," he agreed. "I remember a sensuous Brazilian woman who nearly drove me wild. She helped me to understand life, passion and energy. But I developed extreme ejaculatio praecox with her and when I really tried hard to restrain my

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orgasms, I became utterly impotent." Well, of course Dr. Kori would have ejaculated prematurely. The sensuous Brazilian woman was a reincarnation of his sexy mother who ran around to parties. Or, further along in the progression of possible questions, his mother who was a slut. But I didn't say this to Dr. Kori, probably because 1 didn't want to give Dr. No-name the satisfaction of knowing that he'd been on the right track. ! was a bit pissed off with him for being such a do-gooder, full of empathy and earnestness, but he had been the one who asked Dr. Mizrahi how the patient felt about his mother going out all the time, so I knew he had a dirty mind like me. "When you were a young man," I asked, "were you more energetic? What were you like? Certainly, it seems that when you risked choosing a sensuous Brazilian woman, you were tempted to be energetic and more, to be adventuresome and erotic." "Oh, yes. I had much more energy. I had a nice life like other people." "Did you have girlfriends?" "Yes, I had quite a few girlfriends." "Can you tell me more about that?" "Well, I'd often really like a girl, but when she started to like me, I'd want to get away. With my wife, I knew the same thing would happen. But I wanted to get married, so I married her on logical grounds, not because I longed for her. She was a sensible woman with a good career — she's also a dentist, you know — so we got married. But I can't say we've been happy, mostly because I have been unwell. I wish I could get the proper treatment for this eating problem before the rest of my life gets wasted." "So girls liked you?" "Yes, they did." He paused, thinking. "They liked me a lot. I was very sexually active with a lot of different women. I just seemed to fall

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into sexual relationships with women." "Well," I said, "I guess being Errol Flynn made that inevitable?" "Yes, I know. They seemed to like my looks." Did Dr. Kori know, I wondered, that Errol Flynn swung both ways? He often answered with the phrase, "I know," and I believed he meant it. Dr. Kori was aware of much more than he let on at first. But his illness and its attendant wretchedness were untouchable. In the world of his illness, which had become the centrepiece of who he was, no knowledge of what he knew was permitted. He clung desperately to his wretchedness, needed it, diereby assuring that he could not be the scoundrel Errol Flynn. "You were the eldest son in your family. Were you special because of that?" "Not really." "Your mother and your sister weren't like the women you met later in your life, then. They weren't vulnerable to your charms?" "Why would a first son be special?" I was definitely turning into an incorrigible storyteller, perhaps because Dr. Kori had begun his interview with Dr. Mizrahi by telling the story about the Iranian teacher who showed students how to eat with a knife and fork. And Dr. Kori had already shown me he would melt when I entertained him widi a telling story, a story that turned me into another admired dental professor. I decided on a story that might lead him to see more of his hidden, exciting side, the part of his personality that dangerously linked him with his mother. "I knew a guy from the Levant [ 'Levant"? Why the fancy term?} once," I said. " When he was born — or when he was about a year old — his mother sat him on a stool naked, with his legs spread. She then took a full frontal-view photograph and proudly sent prints to everyone in the family in Lebanon, U.S., London — everyone. The reason why your mother did that was because you were her first-born

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son . . . oops, excuse me . .. my friend's mother, I mean, did that was because he was her first-born son." Dr. Kori laughed. He and I were satisfied with the interview. We sat and looked at one another briefly. "It's time to stop. You probably realize by now that this is so much a part of your character that you'll have to take a really serious crack at it. I think you probably need to get into analysis three or four times a week, you know. We will find someone who has the time available and call you in a few weeks." "Thanks a lot."

On this day, the group deserved a little pep talk, not just because Christine had broken my rule, but also because I'd made an unexpected recommendation. "He's an interesting man, but difficult," I told them. "You know I rarely recommend analysis, but this guy's troubles are so deeply ingrained I doubt anything else will touch him. He's also the type who might go for analysis three or four times a week. Usually, I reserve analysis for people in the mental-health business, because it makes us so much better at our work." In response to my recommendation, Leila Singh batted her eyelashes and did her "I'm just a naive beginner" number. "Aren't psychosomatic disorders depressive equivalents? Should the patient also be put on an antidepressant?" I was convinced Leila knew what I thought about such drugs. The Iron Lady had once left a reading list on the seminar table and I had directed my group to an article that made it clear that, because the placebo effect is so powerful, we couldn't know whether antidepressants did anything at all. I'd found it amusing at the time that such an enthusiastic drug peddler had left behind an article on placebos. Leila Singh

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was a keener, and almost certainly would have read the article immediately. Had she to ally herself with the Iron Lady and make my life miserable? Or was she flirting? I just smiled enigmatically. My usual self-satisfaction — or smugness — was not humming like a Ferrari, as it usually does. Although she was feigning seriousness, Christine Brydon was secretly giggling because she'd put one over on me, despite violating my students-stay-silent rule. Leila wasn't finished with me, either. She had another question: "Shouldn't it be explained to him that these psychosomatic disorders are depressive equivalents so that he begins to understand himself better?" What a waste of time that would have been. Dr. Kori wouldn't have been convinced for a second. People with psychosomatic complaints are always intractable in their conviction that they have a physical disorder. Explaining that it was otherwise would not only be a waste of time, it would have alienated him. Explanation may provide a comfortable, cordial pastime for some people, but it's also a sure sign of thin-bloodedness, measuring out one's life in coffee spoons. "Don't forget to live," Goethe said, echoing a popular expression I've been hearing lately: "Get on with it!" As a psychiatric method, explaining is futile and Leila had seen enough of me to know that I don't explain, even to excuse myself — perhaps especially when I suspect that I'm trying to excuse myself. While I was meditating, Leila waited for an answer. By Jove, I thought, the little rascal has even rolled her eyes at me. "Hmm," I said. The women had beaten up on me that day, but I'm a pro and they never realized they'd gotten under my skin. Erez had news he'd delayed telling us while I interviewed Dr. Kori. It seems that when he'd gone to bring him in for his interview, Dr. Kori had not been in the waiting room as expected. Erez found him

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in the cafeteria, about to tuck into a generous plate of food. A few days later, Dr. Kori left a message on my voice mail, not the voice mail of his primary physician, Dr. Mizrahi. He said he had decided not to enter psychotherapy because he needed to get his eating problem straightened out first. If he decided to proceed later, he would phone again. He'd made an appointment with another endocrinologist who he'd heard was good. I was surprised at this sudden change of heart; in the interview he seemed so anxious to talk to someone. But he was repeating his usual pattern: an initial flurry of interest, followed by withdrawal and disappointment. A few weeks later, Dr. Kori phoned Dr. Mizrahi — not me, this time — and asked for another appointment.

I used to invite other teachers to do my seminar from time to time so the students could be exposed to a variety of interviewing styles. The last visiting professor was Jack Edelstein, who, like Dr. No-name, went on and on about "empathy" — some tripe about non-empathic parents causing the patient to have a fragmented self, "failures in intersubjectivity," and some pretty naive talk about the supposed cure. To his mind, a psychiatrist should be empathically responsive — as though an insensitive, natural-born boor could be empathic on command. I guess the idea was that psychiatrists can, and should be, better, more empathic parents than the patient's real parents had been. In his demonstration interview, Jack repeatedly asked our patient how he felt about this or that event, apparently unaware that my seminar allows only highbrow theatre, and is not a suitable venue for the feelies. My student without a name spoke the same weak language, earnestly and with a hint of rebuke in his voice. In recent years, a cohort of nervous teachers like Jack Edelstein have been trying to teach students to avoid some of Freud's unsettling

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ideas. Freud saw, and wrote down, that evil, usually unconscious, is in all of us. He also wrote about how we ignore this, especially in ourselves. I want to say the avoidance of this unattractive fact is new, but it's not; Freud's ideas have always been found repellant. This shows up in clinical work when evil, cowardice and falseness in our patients is denied. We trick ourselves by using words for their actions that emphasize innate goodness and the need for fulfillment. The constant temptation is to let them off the hook by blaming someone or something else. It's parents, we say, or the bad chemicals in which their brains are bathed. In die past, we blamed demonic possession, the gods, or fate. When we get nervous about the unattractive things we see in our patients, we're ready to blame anyone about whom we hear a complaint and stop listening for die hidden messages. None of us wants to keep Goethe's words in mind: "We are most offended by our faults when we discover them in others." I'm amazed at this — although I shouldn't be. I keep hoping good literature will immunize psychiatrists against error, but it won't. Turning people into "things" is another tactic for escaping the passions of real life. We all avoid Buckminster Fuller's recognition that "I seem to be a verb." "It's my need (impulse, drive, instinct)," we are always tempted to say, "that made me do it." The truth is that it's me, and not my need. The use of nouns for what we do can be crudely silly. Dr. No-name, for example, propped up his damaged patient theories by hanging onto a metaphysics of mental "things" such as cohesive or fragmented selves, true or false selves, and other such twaddle, a tangled grammar in which the mind became a minefield of silly, newly invented nouns. When used well, nouns can be lyrical and poetic. I was recently browsing through a biography of Emily Dickinson written by my

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friend John Cody and came upon a passage in which her poetic mind is treated as a noun: "Emily's mind was like an opal, rent by fissures and fractures, brittle, never coalescing into a unity, reflecting first this, then that fracture-surface." It's a fine simile and captures the magic of every creative mind.

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CHAPTEFLSIX

ttly VERY Own HYSTERIA

I was sitting across from Dr. No-name one day — he's the resident to whom Leila had turned a couple of weeks earlier when Osman tried to chat her up — and an unbidden thought popped into my mind: "I hate him." This struck me as peculiar, because I'm fond of my students, even Dr. No-name who, in his proper suit and tie, looked cuddly and vulnerable. I guess that's why I kept forgetting his name — his mushy fervor for empathy, his conviction that he was kinder, more understanding and responsive than the rest of us, had gotten on my nerves more than I realized That what I felt was "hate" gave me away. I've got mushiness in my system, too, and it takes a special effort, something extreme, to fight off what I fear and loathe in myself. A fragment of my mother had also been awakened; she was someone who confidently hated anyone whose actions didn't suit her taste. My distaste for Dr. No-name's style was becoming a tangible revulsion, a dead giveaway that it was a reaction with deep roots in my psychology. I'm good at covering up my arbitrariness but deep down, I'm still a despot. It's not that I am unkind to patients, or that I never share some of Dr. No-name's arrogance, his belief in himself as the universe's big breast. I had thought the same thing of myself when I was his age. But in those days, such

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fantasies were safer — the "cure by love" hadn't yet become a cult. We don't call it love, nowadays; the grand fantasy of being the best, most nourishing breast on the planet has become institutionalized and has a doctrine, a rationale and a lexicon of ceremonial terms: empathy, "fragmented selves" that need empathic nutriment, "cohesive selves" that miraculously flourish in the wake of empathic responsiveness. It's a pretty insulting thesis that we humans have no will of our own, and are merely straightforward creations of the world's treatment of us. Were this true, the shit that rains down on every life might convince us we are all victims. These unfortunate, fragmented patients (although said to be broken, they look like people to me, no different from you or me), these psychiatrists tell us, all had bad parents who failed to dose them adequately with empathy. If the world is divided into nurses and patients, it becomes easy to see patients as weak and vulnerable. But my kind of psychiatrist is different. We don't see patients as vulnerable; we treat weakness as a psychological posture with a purpose. When we stand back and observe our patients, it isn't that we don't care, it's because we've learned to tolerate the terrible tension between moral concern and objective observation. Although we may appear hard-boiled, we are also supple, not so single-minded. When I suffered from Dr. No-name's affliction, I was more secretive about it; I didn't publicly crusade on behalf of empathy. In a way, I was worse because, all by myself, without being indoctrinated by a cult and without a theoretical rationale, I had decided I knew the secret of how to love my patients. I was the one and only person who cared with unqualified determination. The belief in the cure by kindness is a universal affliction, and so I curbed my impatience with Dr. No-name. How could I be impatient with him when I had held the same beliefs myself? No matter how much I mocked my belief that I cured people with love, no matter how much I scorned what hints of

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it snuck into the open, I was as convinced as anyone else that my dedication could effect miracles. In the days when I worked with Cathy Jones, I wasn't bashful about believing in the cure by love. I was like Ralph Greenson, the man who thought he could cure Marilyn Monroe by love. In the last months of her life, Marilyn's work habits were getting worse. She repeatedly phoned in sick and the film she was working on, Somethings Got to Give, fell hopelessly behind schedule. Eventually, she was fired and the film was never completed. In 1962, Ralph Greenson was arguably the best-known psychoanalyst in the US. He had written the standard textbook on technique used in American Psychoanalytic Institutes and had a high profile in psychoanalytic and psychiatric politics. He was also Marilyn Monroe's psychoanalyst. During the filming of Something's Got to Give, Ralph Greenson succumbed to the belief he could cure Marilyn with love. He intervened with the film's producers, asking for patience and reassuring them he would ultimately be able to make Marilyn comply with any reasonable request. In the end, he couldn't. In his final and most bizarre move, he had the star move into his home so that, in his words, "she could learn what it was like to live in a normal family." Greenson's arrogance is remarkable in itself but how in the world could he justify talking about her to other people? Marilyn was his patient and medical ethics dictates, especially for a psychiatrist, he shouldn't even have acknowledged she was a patient. An unprofessional madness had taken hold of Greenson. Somewhere along way, he'd forgotten the technical guidelines that help us evade error — and he wrote the textbook. He acted like the student who told me that, when a patient brought beer to his appointment, they shared a six-pack. Amazingly, the student s supervisor agreed with this approach, seeing it as the administration of worthy love, a sort of pub-love therapeutics.

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Occasionally, such nonsense is even advocated in the psychiatric literature, as on this occasion, unabashedly: Dr. Earl Bond, in a lecture to the Fellows of the Menninger School of Psychiatry, March 1957, described a patient afflicted with severe mental illness of lengthy duration in the course of which she expressed overtly many sexual wishes. One day her physician, in an experimental mood, picked her up and held her in his arms, thrusting the nipple of a nursing bottle between her lips. She drank the milk avidly, expressing great satisfaction. "This," she said, "is what I have always wanted, this non-sexual love." This episode marked the beginning of a rapid return to recovery.

There are also accounts of cures produced by spankings, sexual intimacy or symbolically smearing feces. I wouldn't be surprised if, one day, I hear that mutual poop-smearing, this time with real poop, has been found to cure something, a brand new ritual that perhaps could be toasted with a swig of golden urine. I'm pretty smart at avoiding hokum these days, but as you will see, my work with Cathy Jones became a monkey-see, monkey-do imitation of the Ralph Greenson strategy.

All competent psychiatrists know the pitfalls of excessive belief in their own powers. Without realizing it, most take steps to immunize themselves against collapses into love — the belief they love better and more thoroughly than anyone else. They are aware their patients idealize them, thinking of them as ultimately wise and powerful. A few fools fall into the trap of believing what they hear, a trap that's easy to fall into, if only because most patients tend to feel better no matter what their psychiatrists do. But wiser psychiatrists see to it that they don't believe everything they hear.

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On the surface, it looks as though psychiatrists never grow up, because so many of them pursue more and more training. After qualifying as psychiatrists, many doctors train as psychoanalysts or as specialists in psychotherapy, while still others receive ongoing supervision of their work from senior colleagues. Study groups are popular and in these groups, psychiatrists present their work to one another. Most psychiatrists don't think about why they do these things, but it's clear to me it's because they have a secret wisdom; they see things like Ralph Greenson's conduct with Marilyn Monroe as a warning, and that the fantasy of being the primal father or the earth mother is liable to corrupt us all.

By now, I've got my cure-by-love fantasies well disguised; they usually show themselves in my work habits: an excess of dedication, industriousness, conscientiousness and reflectiveness. I'm always determined to be the most studious kid on the block. It takes a shrewd observer to see this as anything other than good doctoring. I'm a fabulous liberal, too, so liberal I never have to give advice. If it's asked for, I tell my patient that, by asking for advice, he is assuming I know how he should live his life better than he does. I believe I'm right on that point, but my response has become so automatic it spills the beans: it's life or death for me that I remain an unconditional liberal. I have many colleagues who also avoid answering questions, but lapses are common and I'm probably the champion at sitting silently (like a horse), just listening and analyzing. I'd hate to get a clear look at the arbitrariness that hides behind this style of mine. Why else would my liberalism be so extreme? It was a patient of mine, Susan Wever, who first startled me by drawing attention to this character trait of mine. One day, as she chattered away, I was pondering a tone in her voice that had caught my attention on other occasions. She wasn't exactly whining, although

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there was something akin to whining in the way she was speaking. I knew it wasn't whining, because that's a specialty of mine — making everything the patient does into "a specialty" is part of the ideal psychiatrist I've invented for myself. I have a trick I use when my resolve weakens and a patient gets on my nerves: I turn the obnoxious trait into a pet project. Nothing can threaten my professional balance. If the real world won't live up to my ideal standards, then fuck it, I just set up in my mind an ideal psychiatrist who can flog me into doing my job properly. My ideal phantom psychiatrist isn't a do-gooder. He puts his faith in serious thinking and has consulted with the Muses and the gods. That doesn't guarantee that he can always make me do good work, but it does keep me on my toes. If whining gets on my nerves, I theorize about it. "Why the hell would someone whine when they know it turns people off?" One day, the answer came to me. They do it precisely because it turns people off. Upon reflection, this counterintuitive conclusion is obvious. Everyone knows whining is unattractive, and those who don't want to put people off don't do it. Whiners, I realized, were no different from drinkers, gamblers, and braggarts; they know they will reap a bitter harvest, but persist nonetheless. All are disciples of the goddess Ruin, Zeus's first daughter. Self-ruin is the root of madness and is what makes our profession necessary. It's easier to see in children: they whine and whine and whine, until the parent blows up. Some explosive yelling, or a clap on the bum and, presto, the whining stops. The child whines to turn people off, earns the clap on the bum it (unconsciously) wants, and the guilt problem, whatever it was, is solved. It's one of those things that, as a psychiatrist, I should have figured out much sooner. But as I listened to Mrs. Wever, I realized again it was not whining I heard. The best clue was it didn't annoy me. Ah, here was the word

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I needed, come to me from God-knows-where. It was protest. It wasn't "complaining," nor was it unattractive. The word protest, legitimate protest, fit the bill. Once I had a good word, I could talk to her about it. "Mrs. Wever, I've been puzzling about a certain tone in your voice. For a while, I thought it might be whining, but you're not really a whiner. Just now, I realized what it is. You are making a protest. Can you tell me about that, about what you are protesting against?" Mrs. Wever was quietly thoughtful for a while, but there was a hint of impatience in her eyes. It was as though she was thinking, "Why the hell didn't you notice before?" "This is hard to tell you, but you're right," she said. "Once you said 'protest,' I realized there is something on my mind that I haven't been telling you. Part of it is that you are so fucking conscientious. It drives me crazy. You never chat, you're always on time, you think so hard about everything I say — it's maddening. If, once in a while, you would let up, relax, it would be easier. I can't even complain that you're uptight or fussy — you're actually quite relaxed and friendly. But it's the damn, endless, conscientiousness." What does she expect? I thought to myself. I'm a German. Mrs. Wever paused. I remembered that, a couple of months earlier, I had pointed out in her something similar to what she had just identified in me. She was fussy and tidy, and had been worrying about touching my wall, and getting nail polish on it. She never wept, because she feared getting my pillow dirty, and brought me bigger tissues — king size. Now, Mrs. Wever was complaining about something I had devoted my life to perfecting: being the good father who never lets anyone down. How could she disapprove? Like a psychiatrist, she was describing a pattern, and got me to think about myself. "When your father died," she continued, "I read the notice in the

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obituary column. It's bizarre — you saw me that very afternoon, the day he died — but I never saw any reaction in you at all. It's that infuriating conscientiousness of yours. I also heard that you separated from your wife a couple of months after your father died, but I didn't see any sign that you were going through a crisis. It drives me crazy, especially when I haven't got anything to complain about. That's the protest you hear in my voice." Mrs. Wever's comments made me rethink who I was. At first I wondered what the devil she could be complaining about; wouldn't anyone want a conscientious psychiatrist? But slowly it sank in that I was hoarding all the virtue, and leaving her as the only sinner in the room. Like the empathy floggers I'd scorned, I was a virtue-flogger, busy making my patients feel guilty. Knowing what I now knew about a trait I thought I already understood, made my head spin. That elusive thing called change, the something sought so eagerly by psychiatrists, arrives in unexpected ways. I knew I couldn't just will myself to become negligent or lazy once in a while, but something began to ferment. New forms of love became a possibility.

I had started worrying about Hanna Slendzinski again. I'd become very fond of her and once in a while we even gently flirted with one another, but something had gone awry. I sometimes saw Hanna in the nursing station of the emergency department as I walked to my office. Then, when I arrived in the corridor outside my office, she would "coincidently" happen to be there. Obviously, having seen me walk past Emerg, she'd deliberately taken the inside route to my corridor so that we would meet. It happened so often I could no longer write it off as an accident. I had suspected she had a little crush on me, but Hanna was a restrained and dignified woman, so chasing me down meant there was love trouble in the air — romantic rather than merely

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flirtatious or curative love. I told myself I would have to talk to her about this when I got a chance. It was nearing Christmas, and the psychiatric partners were holding their seasonal party. I knew Hanna would be there, so to quell my anxiety I took a swig of vodka from the bottle I'd planted in my bottom desk drawer two or three years back. The bottle was intact, though once the cleaning staff make their periodic discovery of my emergency bottle, the level of booze has a habit of rapidly diminishing — along with telltale lipstick marks. As expected, Hanna was there and, after snatching a glass of wine to give my hands something to do, I cornered her. "Ah, Hanna," I told her. "You are my good friend. But you and I have to be careful, you know. We are bumping into one another too often." I can't remember what she said, but whatever it was, I suddenly lost my resolve to settle our little turmoil. Most of all I was suddenly very aware of Hanna's face, and saw things in it I'd never before noticed. I'd always thought she wore no makeup, but I now noticed she was wearing lipstick, subtly but beautifully applied. She had used the little trick whereby her lips were outlined in a darker colour than die rest, both so faint I had to look carefully to see it. I was also aware that I was suffering. Hanna was emitting sparks of womanliness, and they were going straight into my heart. I didn't know what had gone wrong with my body, but it had hurts and thrills running through it. Hanna and I were still talking, but I couldn't keep track. I knew the real conversation was in our heads. She had on just a smidgeon of eyeliner, just enough for her eyes to turn into goddess eyes. "Oh, my," I said. "Let's take our wine and go downstairs." I realized that sex, even where there is no sex, is a private thing. Downstairs we went, wineglasses in hand. In my office, I regained

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my poise. There was no point in beating around the bush. "Don't jump Hanna. I'm going to touch your lips." With my right forefinger, I gently stroked my finger along the length of her lips. She looked off dreamily into the distance. "What did it feel like?" she said. "I'm not sure," I answered. "When I was a child, I used to crawl into my parents' bed on Saturday and Sunday morning. They wanted to sleep in, but I used to touch my parents' lips just like that. I don't know why I suddenly remembered that and had to touch your lips, Hanna, but I do know that it isn't our turn in this life. In another life it will be our turn. Right?" "Don't be upset, Gordon," she said. Oh, God, 1 thought. I knew that, like all things in life, our moment would be brief but, just the same, I murmured under my breath, "Let us put our heads and feet together, mouth on mouth, heart on heart." That's all I remember. Someone had seen us go into my office with our wineglasses, so there were a few rumours — harmless gossip, I guess.

My infatuation with Hanna showed me that, for me, love has to be in the romantic mode; it's my very own hysteria. And, to my good fortune, my hysteria matched hers. In 1960,1 practiced for six months as a family doctor in Toronto and witnessed another kind of hysteria, as classical and well known as mine. I was working in Geoff Cranston's practice in Scarborough, a suburb of Toronto, and was surprised to discover he was not a good doctor. He listened avidly to pharmaceutical company representatives who pestered us and enthusiastically peddled their wares to patients until a new salesman arrived with a different product. When I told

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Cranston tkat in Germany the doctors used herring salad as a laxative, he was impressed and eager to try that on his patients as well. Even when I argued I'd been poking fun at the German doctors over what was only a superstition, he still wanted to know how herring salads were prepared. When cornered, Geoff abandoned all direct treatments and relied instead on prayer. I was looking forward to running the practice on my own when Geoff went on vacation. I already thought I had the inside track on how medicine should be practiced but, to my surprise, few patients came while Geoff was away: most just waited for his return. My feelings were hurt and I was puzzled. If I was a better doctor than him, why would the patients wait for his return? It was an early lesson in magic. I was too young to be cast in the role of sage — my medical skills were easily trumped by Geoff's age. Geoff belonged to an evangelical Baptist church and every morning, before our office began, he gathered the staff to pray. Marion Robertson, a social worker who'd developed malaria while working as a missionary in Africa, was one of our patients. She did her best to make herself plain — wore no makeup, sombre clothes — but in a movie, she'd have ripped off her glasses, let down her hair and been transformed into a ravishing beauty. She had worked in our office for a while and at our morning prayer meeting I'd expertly scanned her fine figure — not with love or lust, but perplexed by the conjugation of beauty and primness. We had two offices, one fully equipped, the other suitable only for routine matters. One morning, I was in the smaller office, and needed a piece of equipment from the larger office, but Geoff was in there with a patient. Office visits were usually brief, so I waited. I didn't like to interrupt, but I, too, had a patient so, eventually, I knocked apologetically and walked in. Marion Robertson stood naked in the centre of the room. Geoff

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Cranston was on his knees behind her, studying her back, and palpating it. How long does it take to examine a back? I wondered. What the hell is he doing? I noticed Geoff had beads of sweat standing on his forehead. "Gordon," he said, "I'm glad you've come in. Marion is having back pain. I've examined her up and down, and just can't figure out what's going on." Naive and young I may have been, but I had no trouble figuring out what was going on. I could sense Marion's sexual arousal while Geoff, in an equally intense state, convinced himself he was doing his medical job. Neither he nor Marion had any idea they were performers in an obvious hysterical episode. The sexual crisis ended when I arrived, and routine measures and investigations were recommended. At midnight a few weeks later, in Fran's restaurant at Yonge and College streets, I checked my phone messages. There was a call from Geoff. "Gordon, I'm not well. I know it's late, but would you mind coming to the house? I need some help." Geoff hadn't said what was wrong, still I dropped off my girlfriend, and headed for Scarborough. The house was dark when I arrived. I knocked, but there was no answer. I opened the front door, and peered into the dark house. "Geoff?" I could see a light on upstairs, but no one answered. I'd been in the house before, so I cautiously entered and went upstairs. The light came from the master bedroom, where I heard Geoff calling. "Gordon, I'm in here." In the middle of the bedroom stood Geoff, naked. There was no sign of his wife. His figure, I'm afraid, did not rival Marion Robertson's. "It's bad, Gordon," he told me. "My back is in bad shape."

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Such hysterical adventures are more common than we like to think, and while Geoff's plight makes for an amusing scene, I have to be careful not to be frivolous or mocking.

What in the name of God is this love thing, more mysterious than time and death? Despite the blathering pundits, it's not our hormones. I'll earn enemies if I call it a cultural ritual, because cultural rituals feel optional — even when they're not. In our depths we all believe that a destiny like Romeo's or Juliet's is one of the great achievements in life. But why does love tear us to pieces, and why have countless poems and stories been written about love? And why do we all worry about people who've never experienced love? I guess it's necessary for each culture to devise a reproduction story that works — our species would disappear without one — and being male and female plays a central role in that story. So when I met Hanna at the Christmas party, the essence of the tumult was that suddenly two archetypes switched themselves on — she turned into the primal woman and I turned into the primal man. Our 3O-minute love affair had all the poignancy of a performance of Tristan und Isolde, Wagner's mad, intoxicating opera. That 3O-minute affair may have been shorter than we deserved, but duration has little to do with it. Maybe fevered talk was less than we deserved, too. The cure by love that I spend so much time damning is in the story of Hanna and me, too. We don't always acknowledge it, but part of love is the idea of healing, helping, awakening. I thought Hanna was in a bad marriage and that I'd be the cure for that unhappiness. I expect that she aimed to cure me with love — that she'd heal a lonely bachelor.

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My sickness over Hanna is mixed up with my feelings about my German grandmother. Both liked the way I was and it bewildered me, because I expected them both to tell me I ought to be a good boy, a good, German boy. I admired Hanna's quiet intelligence, which, because my grandmother was similarly brainy, made it easy for me to blur the two. In my grandmother's case, she didn't bother being quiet about it. My trip to Germany in 1958 was to be an adventure and a sentimental visit with the grandparents I'd never met. It was also the fulfillment of my father's duty to visit his parents, a duty which, for money reasons, he was never able to do himself. I had a scholarship, and had arranged to work as a Gastarzt (visiting physician) at the Ludolf Krehl Klinik in Heidelberg. Many historically important psychiatrists had worked in Heidelberg, including Emil Kraepelin, Kurt Schneider, Karl Jaspers, and Wilhelm (Willy) Mayer-Gross. MayerGross moved on to London, and for many years was the predominant influence in British psychiatry. His textbook of psychiatry was still in use in Toronto when I was a medical student. I also had in mind plenty of skiing, and relearning the language that, many years before, had been my mother tongue. I had booked passage on the S. S. Maasdam of the HollandAmerica line, sailing out of New York. A few weeks before I left Toronto for New York, I got a phone call from Graham Copeland. "I'm going to Europe too, Gordon. I hope you don't mind but I've arranged to go on the same ship as you." I knew this could be trouble, but my liberalism disorder was already at work, so I made no complaint. There were many young people on the ship and 1 teamed up with Maria, a German girl who had been an au pair in Los Angeles for the past year. Graham made sure his homosexuality stayed a secret by pairing off with a woman — she's still my friend — named Lois Hummel.

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In Rotterdam, we all went our separate ways — except for Graham, who stuck with me. I was on my way to Winterberg to visit the parents of a friend, where I intended to brush up on my German before meeting my grandparents. I also had in mind a quick trip to Hamburg to visit Maria. Graham had the problem solved "I'll see you in Heidelberg," he announced. I suspected the worst: Graham would go to my grandparent's home and wait for me there. I had my first good look at Germans in the Koln (Cologne) railway station. I was 2,5, and when I saw the crowds I heaved a sigh of relief. Without realizing it, I'd expected signs of wickedness in German people. The people I saw were ordinary. Clearly, I had imagined a race of monsters populating Germany, a fear of which I was never conscious until that moment in the station. It's not even that the people were particularly well behaved. Two men, for example, argued noisily at a stand-up food counter. "Don't you dare say 'du'to me, you jerk," was the gist of what was being said. Although the arguing was boorish and loud, they didn't look like monsters; just jerks. Although I hadn't done it at the age of five, over the years I'd learned to discriminate between trivial conflicts like a public squabble, and real evil, which needs earnest attention. Earlier, I had assumed my mothers shenanigans were evil when, in fact, they were just an ordinary form of silliness. The Koln railway station awakened my interest in monsters, an interest shared by all psychiatrists. The thing to keep in mind is that monsters both exist and don't exist, and are highly mobile. I, for example, rarely find myself a monster, but am skilled at projecting evil into other people.

I arrived in Heidelberg in November. As expected, by the time I got

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to my grandparents Graham was already ensconced, but in the grand gala that surrounded my arrival, he was ignored. My grandmother knew when my train would arrive, and stood on her doorstep. Over the door was a big banner: "Herzlich Willkommen!" [Welcome from the heart]. I was taken aback. My family had no rituals; we never celebrated, in my mind because we were sensible Germans, unlike the windy, false Canadians. I had never allowed myself to complain about our lack of birthdays, or even to act with joy or enthusiasm. But there was that gaudy sign, contradicting all my protective thoughts about my parents. Germans, it seemed, celebrated after all. "Mein Kind, mein Kind," [My child, my child] shouted my grandmother, as she embraced and kissed me. I had no living memory of my parents kissing me. Inside, sitting in his chair by the window, was my grandfather, acting dignified and sensible like a military officer, but with tears in his eyes. There I was, in Heidelberg, the first tangible sign of my father, their only child, in thirty years. Wine was siphoned out of a barrel. Within minutes, neighbours arrived, and joined in on the cake, wine, coffee, curiosity and wonder. I was full of wonder, too. My family were being sociable, they belonged to a neighbourhood, to a group. Here was my very own Oma and Opa. Oma was snaggle-toothed and stout, the spitting image of the witch from "Hansel and Gretel." Opa was a small, trim martinet — a martinet lest his sentimental side should show. He was erect and proper, and had a smartly waxed mustache and a small goatee. Oma wouldn't let a hint of dialect come out of her mouth, and spoke only High German, but my grandfather spoke with a Berlin dialect. Many years later, when my children were born, my father became O'pa, and now, I am Opa. Meeting my grandparents tore me to pieces, as did meeting other relatives in Europe. I was in a trance, and despite the firestorm of emotion, I moved methodically from situation to situation, as if I'd burst myself open. For 26 years I had believed separations and reunions

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meant nothing to me. In Germany, I searched out everyone, seared my soul, and shed nary a tear. At first I lived at the clinic where I worked, but my bed was on the top floor, in the lab where, every night, a researcher spent hours playing with test tubes. I quickly gave up and moved into my grandparents' house. It wasn't much better. In the winter of 1958-59,1 nearly froze for lack of heat. I didn't like it, but the place and time made it feel normal. Once a week, I stripped to the waist, and washed myself with soap and cold water. Then I dressed my upper body, undressed the bottom half, and did the same down below. I could have had a bath, but that would have involved borrowing a galvanized steel tub from a neighbour. The tub was reputed to have once been used by Adolph Hitler, so I might have snuggled my arse into the same spot his arse had once been snuggled. The only warm place in the house was the kitchen, with its wood-burning stove. Since all the doors in the house were closed and locked with heavy keys, little heat escaped from the kitchen to ease the chill in the rest of the house. I was callous about Graham, who I avoided by keeping busy on my own. He acted as though he didn't notice. Oma instantly understood Graham: "Bin warmer Eruder" [A warm brother]. A few months later, I went to Switzerland to ski with Lois Hummel (by then Graham had given up the pretense he was involved with her) and Marc Hamel, a friend from Montreal. When I got back to Heidelberg, Graham was gone — Oma had lacked him out. I spied packages of food in the cupboards, packages I had helped to wrap when I was a teenager, in the years immediately following World War n. Food had been in short supply, and we shipped coffee, tea, SPAM, sugar, and whatever else could be sent by mail. Years later, my grandmother was still hoarding some of this food, "just in case." We ate according to the German tradition. In the morning, I was given a wooden board and a sharp knife, while the table was spread

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with bread, various cold meats and cheeses. The evening meal was exactly the same. But at exactly noon, we ate the main meal of the day, my grandmother having been up at six to start the soup. When the clock struck 12, my grandfather stood up from his chair by the window, and took his seat at the table. His plate of soup arrived just as he sat down. If it didn't, he'd want to know what was going on. Opa dropped his dialect, and spoke precisely in High German. "Can a man not expect the ordinary civilities of everyday life? Damn it all, this is an outrage." As he spoke, he twirled his waxed mustache. Oma, though far more robust than he, was frightened, and hustled to get the food on the table. After lunch, my grandfather returned to his window, to watch a daily spectacle: Emil was due to come by. Emil was a derelict, perhaps a madman, and very obsessional. He would walk, hesitate, retreat, and then try again. He tapped and checked the sidewalk [the Trottoir] with his cane, obviously in distress, unable to decide whether it was safe to step here or to step there. Meanwhile, my grandfather gave a running commentary that cracked us up. "Da geht er noch mal. Ach, nein, jetzt zuriick. Vorwarts, march'!" ["There he goes. Oops, no, now back again. Forward, march!"] In recent years I've discovered another Emil, also a derelict, who haunts the street outside the Clarke Institute. He is a drinker, and arrives outside my office window each morning, summer or winter, wearing a parka with his bottle in the inside pocket. He also begs for handouts on the street. Like the Emil in Germany, he is a fretful worrier, taking out his bottle, returning it to his pocket, checking his surroundings, and then trying again. "Da geht er, noch mal." My grandfather had been a career soldier, and when he spoke of World War i, his most worrisome memory was of the horses and their terrible suffering. Again and again, he returned to the mud of Flanders, to the wounds and helpless distress of the animals. But his

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concern about horses stirred my interests: my model horses, my brother Ernie (Horst), the jockey and racehorse trainer. When my grandfather was decommissioned in 1918, in accord with German custom he was given a civil service job at the Universitat Heidelberg as an assistant to various professors. He had mischief in him, and spent a lot of time with the students. I have many photos of him with my father and his classmates, drinking and partying. There are also pictures of dueling sessions and of the gatherings of the legendary dueling fraternities. When I was a boy, I liked to look at pictures of the bloody aftermath, the opponents formally posing for their portraits, covered with blood. German dueling is not fencing, and is done with sabres. The idea is to cut your opponent on the head or cheek, to give him one of the sought-after dueling scars. As a child, I was amazed at the bleeding combatants, bloodied despite that fact they were allowed a variety of protective gear. Some wore protective collars so that the heavy swords wouldn't cut a carotid artery or vein. Others had on steel-rimmed goggles. I guess it all depended on where they wanted to have their scar. Lest Oma overwhelm him, my grandfather kept tight control over money. Oma had to beg for every cent and complained bitterly to rne; not just because of the money, but because she was determined I should recognize my grandfather's faults, and prefer her. I realized my father had been similarly stingy with my mother and feared I would repeat the pattern when I married. One day in our basement when I was 16, I had said to my father (out of earshot of my mother), "Why don't you ever give Mutti some money? She has to beg for every cent and in the end you have to give her housekeeping money anyway." My father's face turned red with rage. For him — for me too — this was an archetypal moment. I was standing with my mother against my father — like so many Greek heroes, Telegonus, Oedipus,

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even Zeus. For a moment I thought he would hit me, and if he had, I might have hit back. We were both filled with fury. The moment passed, but my stomach was knotted for days, and I couldn't look at my father or speak to him. I hadn't stood up for my mother on her account; I had always found her cruel and selfish. I didn't duplicate my father's stinginess, but I reprised my fathers money habits in other ways. My father had been a tightwad, but gave my mother gifts. Her clothes came from the expensive shops in Toronto, she had jewellery, and my father worked long hours to ensure she lived in a home she could be proud of. More precisely, my father wanted to be sure her dearest dream would come true: that she would be a "lady." My mother was from a peasant village in Austria, and he, the student prince from Heidelberg, rescued her. I am the same romantic as my father. All of us have our conditions for being in love, mine have often been contingent on being able to enact my version of prince charming rescuing the maiden in distress. Hanna knew this about me and, while he disguises it as a technical intervention, empathic responsiveness, so does Dr. No-name.

My grandmother was a wonderful but difficult woman. She was an intellectual, and we spent hours drinking coffee (German coffee was far better than anything I'd ever tasted), drinking beer (also very good) and smoking Marlboro cigarettes (I had easy access to the American military stores). I was accustomed to the Waspish formality of Canada, and it was awkward for me when she hugged and kissed me, especially as her hygiene was always a bit precarious. But as my father's reincarnation, it was my duty to let her embrace me. She, it turned out, cured me with love. It was strange to watch her. I sat at the kitchen table while she happily insisted on serving me. Oma awakened in me a mother hunger that

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I never knew existed, and which I've understood better as the years went by. I watched my grandmother's hands as she ground the coffee and poured water through the filter (at that time, filtered coffee was uncommon in North America). They were old hands, but they moved elegantly and lovingly as she prepared the wonderful, God-given coffee. My grandmother's hands were also full of love when she served food — wine or beer as well. When she served herself, her hands were ordinary; when she served me, they were alive, erotic and glowing. It didn't matter that her hands were dirty or her nails broken because they pulsed with love and tenderness. She looked like an old battleaxe, she was an old battleaxe, but her lips moved sensuously when she ate and when she spoke to me, her reborn child and hero. She touched the tip of her tongue to her lips as Aphrodite would have done, pouted and curled them with her own, private genius. She didn't flick her hair to die side like Hanna, or twitch her bottom at me like Christine, nor did she hide cunningly behind a chador/scarf like Leila, still my grandmothers eroticism shone through. As part of her self-assigned mother function, Oma taught me proper German manners. "After eating," she said, "you must not say, 'Ich bin voll'[l am full]. The proper thing to say is, 'Ich bin zufrieden [I am content]." Her coaching was different from what I had grown up with. Rather than criticizing bad practices, she was passionately aiming to enrich my character. She also had humourous advice: Nach dem Essen, soil mann rauchen, Oder eine Frau gebrauchen. After eating, one should smoke Or make use of a woman.

While my grandmother and I smoked and drank, we argued — mostly about politics. I had never had close contact with an intel-

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lectual before, and had to be in top form to keep up with her arguments. We definitely settled on a preference for North American men, who were cheerful and helped to do the dishes, versus German men who were intellectual and serious. Despite his anal obstinacy, we decided that Martin Luther was preferable to the papists. My German was weak:, so Oma insisted on using Latin based German words. "Since I use Latin-based words, you must understand what I am saying; English also has many Latin based words." What she really meant was that English was nothing more than a clumsy, working version of the language of Ovid and Caesar, so on command, I should be able to understand her. It was all bullshit, of course, though she expected me to believe it. My grandmother was one of those wonderful outrageous characters who are lovable in their demandingness, and reminded me of my demanding teachers, Sammy Sergeant and J. C. Boileau Grant. One day, while we argued and smoked, there was a knock on the door. She answered, and I heard some banter. "Ach, du, noch mal, Affen-G'sicht?" [Oh, you again, ape-face?] In came the visitor; it was the Lutheran clergyman. My grandmother had formally left the church 20 years earlier, but the clergyman still loved her, and when he came in, I was displaced. Now, they smoked, drank and argued — and adored one another. My grandmother still loved men, even with only one fang left in her mouth. She rented rooms, mostly to visiting professors at the university. These professors had the same reaction as the pastor and me: they loved her. One of them, an American from Oregon, even paid to have central heating installed in the house in the 19305, although my grandparents couldn't afford to use it while I was there. In 1945, it had created a problem: since the house had central heating, it was to be commandeered by the American military. When two officers came to the house to inform my grandparents, my grand-

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mother reacted with quick shrewdness. Communicating in sign language, she adopted a look of horror, led the officers to an outside window, and indicated that they should look inside. She ran indoors, threw open the blind, and pointed to the bed. She uncovered her old mother, exposing the huge, liquid-filled pemphigus blisters that covered her body. The officers needed no further persuasion. They left, probably believing my great-grandmother had leprosy or the plague. My mother told me Oma had had an affair with one of the professors in the late 19205 while my father was still in Germany, and that he had caught them in bed. It was important to my mother to pass on this information; to her, all women were Ludern [whores] — except her. But I suspect the story was true, and think that's what precipitated my father's flight to Canada. I doubt it was her only affair, although the photographs show she was never pretty, and never adorned or beautified herself. She had erotic Aphrodite powers independent of flashing smiles and body display. We argued about one more thing: her belief— her stated belief— that the Holocaust never happened. Western propaganda. She also believed genetic engineering was important, as had been demonstrated by Emil Kraepelin, the central figure during Germany's one-time dominance of world psychiatry. Jews, Africans and Asians, of course, were minderwertigen Rassen [less valuable races]. She seemed to think I didn't know she read Heine, and listened to Mendelssohn. In the middle of our shouting matches, while she went downstairs to get more beer, my old, quiet grandfather spoke up. "She knows. The Nazis took her friends." But he said nothing in her presence because he was afraid of the power of her mind. I didn't hear much other Holocaust denial while I was in Germany, but one incident stands out. One night I went to a movie, and before the feature, they screened a documentary about the liberation of the camps, showing heaps of starved, dead bodies. I'd seen such films before,

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and watched with a mixture of fascination and horror. Suddenly, there were shouts. "Bullshit. Propaganda! Turn this garbage off." "Shut up, you Nazi!" "Who are you calling a Nazi?" "You, asshole, so lick me on the ass." And it was not just an isolated argument. A cluster of people at the front of the cinema had begun to quarrel in loud voices. Then, to my astonishment, it got worse — punches were thrown, bodies were flung to the ground, the cursing increased. That's all I remember. I was horrified that some Germans still denied what had happened, and proud that others had stood up to them. Germans typically have their own Stammhaus [literally, a "stemhouse"] , a favourite cafe to which they go regularly. Every Tuesday, we went to my grandmother's, "Das Eisernes Kreuz" [The Iron Cross], always sitting at the same table, and joined by a group of my grandmother's friends, the "free thinkers." The evening was spent drinking wine and beer and enthusiastically denouncing religion. On Saturday nights, we went to my grandfather's Stammhaus, "Zum Seppel," a university watering hole, famous because it was a hangout in Sigmund Romberg's operetta, The Student Prince. The place was filled with students, smoke, and noise, but my old grandfather was noticed right away and a cigar and his personal stein of beer always arrived immediately. I made my last visit to my grandmother in 1975, after my grandfather's death. She was 92 by then, and wouldn't live much longer, so I had taken my children to meet her. Oma made a little speech to each of them, confident that she was the grand matriarch who had important last words to deliver to them. They didn't understand German, of course, but her style and her message were obvious. "Continue your education. Your parents are educated people and

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you must emulate them. Germany is your country as well as Canada, and you should learn the language. Lebe Wohl [live well]." My children stared in silent amazement that this ugly, ancient, but queenly woman was really their great-grandmother. Ten days later, she was gone. She had waited to meet my children, and having fulfilled her last matriarchal duty, died. I had spent my life struggling to explain the problem of Germany, and I still do: it was a historical inevitability; one of countless holocausts that will afflict mankind forever; a Jewish victim stance called it down on their own heads. My struggle for an explanation was no different from the struggles for understanding I faced when I listened to my patients. Freud's solution, reduced to a banal formula, was that all can be reduced to history and myth. His primary example was that, in our personal lives, all of us face the heat and the passion of sexual sin and sexual triumph within our own families — the story of Oedipus, obligatory and inevitable. As the years passed I, too, saw the inevitability of myth and history in my patient s lives, but there was always a problem: how to acknowledge myth and history without inviting my patients to evade the heat, the hurt and guilt over what they actually do. When my patient hates me or loves me passionately, it's always easier to shift to history. "You're just repeating with me what happened with your mother, your father, or whoever." The value of myths, I realized, was that they can — and must — be told over and over again. Like the movies, they are tolerable, though brute facts can't always be swallowed. Telling Germany's Holocaust story as plain fact, over and over, is liable to wear thin, lose force, and invite rejection of the story. I have a myth for the Holocaust. It is the story of Daedalus's labyrinth, originally as beautiful as any German beer garden. Pasiphae, King Minos's wife, fell in love with a beautiful bull and, from that union, was born a racially different child, Astetius. All was well until

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Asterius reached puberty, when filthy sexuality tipped the balance against his inter-species, his racially mixed origins. The labyrinth became a concentration camp in which he was segregated and where he was given a new name, the Minotaur. 1 felt sorry for the Germans. Times were tough and people were poor. I read in the newspapers of the German economic miracle, and in a fundamental sense, the country was doing well. But in comparison to Canadians, the people in the streets wore shabby clothes, the automobiles in the streets were small — some only had three wheels. On the other hand, there was good food in the stores, the police drove BMWS, and the taxicabs were Mercedes-Benz. One didn't see much of the police. If they made themselves too obvious in the streets, people made sarcastic remarks: "Bloody nerve, standing out in public like that." Police discretely stayed on side streets near the main thoroughfares, but rarely appeared on the main street itself. The public was sick of uniforms. There was even an article in the Frankfurter'Allgemein, complaining of too much public police presence. I eventually ran out of money, and for a few months worked for the American army in Kafertahlwald, with the status of a German civilian physician. We were hard on the soldiers. If we thought one was on sick leave improperly, we gave him two ounces of castor oil. Once they paid that penalty, we could check off on their record that their sick call had been "in the line of duty." My most difficult job came while working in the military prison on Christmas day, 1958. All soldiers in solitary confinement had to be seen by a doctor every day and, while I was on duty, I had to visit those sad youngsters. Bewildered and shocked by the furious blow fate had dealt them, they were depressed, and I became depressed as well. They were boys, many of whom had never been away from home before. I'm always telling myself I'm immune to the sting of loss and loneliness, but the world keeps bloodying my nose.

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I was roughly the same age as the American soldiers, but was Canadian, and a civilian. I didn't wear a necktie and a jacket — obligatory for off-duty Americans — and MPS repeatedly assumed I was non-compliant American military. My English was indistinguishable from American English, so they didn't believe me when I told them I wasn't American. I must confess it was fun spooking the MPS. I, too, was youthful and a bit rebellious. My industrious work habits were well established, and I didn't bother with lunch, coffee breaks, or any of that nonsense. One day, one of our volunteers, the wife of a senior American officer, made a medical appointment to see me. When she arrived in my office, she produced a basket which contained lunch for me — and for her. "You work too much," she said. She was attractive: plump, charmingly light-hearted, and 15 years older than I. Her breasts were noticeable, even in a volunteer's uniform. I liked her because she was feisty and energetic, but she was married, had children, and her husband was a high-ranking officer. I managed to convince myself that, despite her flirting, she was simply a kind-hearted volunteer. We ate our lunch, flirted and laughed, and after half an hour, I maneuvered her out of my office. That night after work, as I headed for the intercity Strassenbahn [streetcar], my lunchpartner intercepted me in her big American car. As we pulled away, she passed me a bottle of whiskey. She drove me to Heidelberg, but I saw she was too drunk to drive back, so I took the wheel and drove her home to Kafertahlwald, parked the car in front of her house, and fled. I ended up at a tram station waiting for the streetcar I had intended to take two hours earlier. Also waiting was an American doctor, a captain, who worked in our clinic. He knew both my lady friend and her husband. Kafertahlwald seemed to have turned into an open plain. To the right were the neat, clapboard houses of Patrick Henry Village, to the

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left were open fields. We could see the streetcar approaching tar away on the left. Suddenly, we saw my lady friend's car, weaving across the lawns of the houses. She had spotted me, and her goal was to get to where I was waiting for my streetcar. It all happened in slow motion. I was transfixed: would she get to me first, or would the streetcar? The moral is that, in our dangerous world, an industrious, virtuous doctor is liable to be persecuted by a seductive, frivolous adulteress. When I think how judgmental and hysterical — yes, hysterical — any of us are liable to become, I summarize my story differently: a stuffy doctor is invited by an adventurous, cheerful woman to join in an escapade known to mankind since the dawn of history.

November nth in Germany isn't like Canada's Remembrance Day or America's Veteran's Day. At n minutes after the nth hour, of the nth day, of the nth month, Patching begins. Patching is Mardi Gras, or Karnival. That night, my friends and I gathered to listen to the new songs for that year's pre-Lenten celebrations. Not much happened during December and January, but as Lent approached, the celebrations began. The various Kneipen [inns, drinking spots] hired entertainers, piano players, and singers, and more elaborate entertainment appeared everywhere. We began going out regularly to drink and eat, and one night in a neighbourhood Kneipe, a young woman approached our table and asked me to dance. Not only that, but she addressed me as "du. "At that time, the intimate form of address was never used casually, but during Fasching, everything was reversed. 1 learned how to use the intimate form "J 1 m the maitre d . I paused, too, and thought this over. "I guess you mean that you're turning into the actual father, but you feel safer if you say so 'once removed,' by saying you are only a maitre d', a sort of artificial father."

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There was yet another pause. "Thanks for being sensitive," Mr. Allen said with a twinkle. He was playing the humour game properly for a change, so I knew I'd better respond in kind. "I think it's time for a. hug." We both roared with laughter.

Jim Forster — the former Dr. No-name — had the same problem with me as Mr. Allen had with his wife. Just as Mr. Allen couldn't believe his wife and I were troubled by his passivity and complaining, three years earlier in my seminar, Jim couldn't believe I'd been troubled by his habit of seeing our patients as victims. It baffled him. He'd been intrigued by my interviews, and so he couldn't figure out why he and I thought so differently about things. He was also disconcerted that I didn't explain much, and always left him wondering what the devil I had in mind. But Dr. Forster was a smart resident and very determined — so determined, in fact, that he asked to have me as his psychotherapy supervisor. I was surprised at his request. In the seminar, he was clearly uncomfortable with my interviewing tactics, and was always pestering me to talk about theories. In his comments to the group, Dr. Forster tried hard to get me to acknowledge instincts, ego weaknesses and developmental fixations or, failing that, reverted to the theoretical stance he liked best: the speculation that patients have suffered parental or "empathic" failures, as he liked to put it. In this respect, Dr. Forster's ideas were very modern. Everybody is talking about empathy these days, tangled with die assumption that patients are victims or survivors. But he was also old-fashioned because, unlike the other residents, he always wore a suit and tie. Dr. Forster was determined that he and I should understand one

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another, and that the nasty truth about life should never arrive for us — the fact that, between any two people, irreconcilable realities eventually come into play. Martin Buber and Jiirgen Habermas had the same naive hope as Jim, arguing that if two people go about it the right way, a harmonious interpersonal deliverance will emerge. It's a wonderfully optimistic warm-bath reverie but, with all deference to Jim, Buber and Habermas, the water soon gets cold. I suspect Jim imagined I would somehow see the error of my ways and come around to believing in a final, correct theory, especially the one that insists a hurtful and neglectful world is what causes people to suffer. In this, he and I were alike. Despite myself, I'd secretly had the same thought: that one day I could convert Jim to my ways. A few weeks earlier, my mother had lodged her own protest when the world wouldn't conform to her preferences. Ernie and I had been visiting her in the nursing home and she began by criticizing Ernie's trousers. "They're awful," she said. "They don't fit. Why do you wear them?" It seemed she hasn't yet learned that, after the age of 30, all men's trousers are baggy because they no longer have buttocks — unless they're squash players or speed skaters. But my mother's main target that day was me. "You have two pairs of socks on! Why do you wear two pairs?" I didn't respond, perhaps assuming that, as with one of my students, my silence would inspire her to think. "Why are you wearing two pairs of socks?" she repeated. "You are crazy. Do you hear me? You are crazy." She turned toward Ernie. "T T ' ries crazy." All my life I have been filled with loathing for my mother when she pulls such stunts. I still loathe it, but am now more like a wise old horse. This "loathing" is nothing more than me doing the same thing, wanting her to come around to my vision of how a mother should

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behave. In these moods, my mother is like Dr. Forster, insistent that my world should match hers. In other words, like the rest of us, my mother madly wants the world to come round to her way of thinking. She is in a panic lest we, her children, should be distinct and unique. I fear that this madness —Jim, my mother, and I are only this moment's examples of it — condemns us to never-ending wars, divorces and estrangements.

The woman whose psychotherapy Dr. Forster chose to follow with me was Mrs. Paris, assessed when he was in my group, and who, at the very end of the interview, had revealed she'd been sexually abused by her father. Janet Hunter had done the first interview and I remember watching Janet's English boniness melt away when she'd coyly let me see she was a woman. Mrs. Paris was Jim's first psychotherapy case, and I suspect he asked Janet Hunter to refer her to him. Mrs. Paris was an incest victim, and victims turned Jim's crank. When our supervision began, he'd been seeing her for three years. "The therapy has gone very well and Mrs. Paris hasn't been depressed for ages," Jim told me. "The story of the incest was a lot worse than she told us; it went on for a lot longer than she first said. She's been badly traumatized because she and her father were sexually involved until she was in her 205. She didn't tell anyone about it and what she said about her sister also being abused wasn't true. Even after she was married, Mrs. Paris s father would come to her apartment to help out with something and she would be angrily aware of the sexual power she had over him. Sometimes she would lead her father on as a sort of revenge. She could see that he felt bad about it. She even worries sometimes that her daughter might be her father's child and not her husband's. Though she is much better, she wants to keep coming, and I suspect there is still some secret that she hasn't told me about. If

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you remember, Dr. Warme, she had several secrets back when we first interviewed her. "But she doesn't really speak ill of her father. In fact it's quite the opposite — she talks a lot about what a good person he is, how successful he is, and how helpful he has been to her and her husband. Oh, yes, the 'older man' she mentioned during the assessment, the one she had the affair with in high school — that was actually her father she was talking about." I remembered the story very well. Mrs. Paris had been confused and inconsistent as she told the story of her "psychosexual development." And I remembered how she tried with her flashing eyes to get me to be her therapist. Surely she had also tried to seduce Jim, although he may not have been aware of it. He was alert only to feelings of a certain sort: sadness, loneliness and the other signs of hurt. The rest he avoided, trying to make both of us believe he doesn't know about that other category of feelings: lust, hatred, envy, vengeance. Whether Jim wanted to notice Mrs. Paris's seductiveness or not, I expected he'd let me see it when it came up. Then, when I'd pointed it out, he'd be able to say I was the one with the dirty mind. Poor Dr. Forster was increasingly aware that conflict never ends. His work with Mrs. Paris had robbed him of an exclusive villian -— the abusive father — who he could blame for her depression because Mrs. Paris had now implicated herself. I prayed it was sinking in that his preferred cure was treacherous: the cure by racism and judgment of others. Hating parents, Israelis or Palestinians has fine but spurious therapeutic effects. "She really does speak a lot about what a good person her father is," Jirn said, puzzled. "It comes up all the time. Considering her history, it seems strange." "Have you made any comment about this?" "Not really."

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"Any ideas about why she might do this?" Jim shook his head. "No rush, Jim. Keep thinking about it." "I'm getting kind of frustrated with her about this. I try to empathize." "What do you say?" "Well, I kind of underline it, that she really speaks well of her father and how it's important to her to let me know about it. I say things like, 'He is a very smart and effective man and you admire him for this.'" "You know me pretty well by now, Jim. Can you imagine what I'd •oj sayr "You'd come up with some odd angle, I guess." "You might think so from the interviewing seminar, but this isn't a diagnostic interview — this is treatment. You have the leisure to go into everything in detail rather than momentarily identifying a few dramatic themes. What I would say to her would be very similar to what you say, but it would also be different." Jim liked to nitpick with me in the seminar, but now that I was his supervisor, he seemed to be intimidated. It was hard to get him talking because he was still stuck with his "decisive moment" with me, the moment at which he realized we are in different worlds. He hated it that philosophical differences were so hard to bridge. "What I'd do is caricature her praise of her father," I said. "I'd help her to see that the praise is overdone — too emphatic, too one-sided. I'd hint, and eventually say direcdy, that all the talk about how wonderful her father is suggests she's trying to convince you — and herself, too — that he is good. 'Methinks the lady doth protest too much,' I'd say. Were nothing bugging her, she'd only have had to say it once. I'd keep mentioning the frequency and the broken-record nature of what she's saying. This is what: you are doing, except you are doing it by

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feeding back to her exactly what she says. You don't add that she must have a self-deceiving purpose in mind. The way you do it is a standard approach, but I'm impatient and I'd push her into thinking about her motives for going on and on the way she does." Jim's face twisted, he squinched his eyes and pursed his lips. He could not disagree or argue with me, but he clearly didn't like what I said. My tactic, to him, was aggressive and pushy — which is in some ways true but could just as easily have been thought of as determined. Jim preferred interventions that emphasized sadness, regret and love — words that were encompassed by his favourite code-word: empathy. Jim was dying to have me see patients as so full of suffering that he and I could do the external devil trick. Mrs. Paris was a poor soul and had been harmed by that nasty devil, her father, who Jim and I could denounce together. Instead of making Jim happy and becoming his ally, I'd put Mrs. Paris in the drivers seat, nailed down the idea that she was actively engaged in praising her father, and was up to something. To Jim, Mrs. Paris had to be a victim. Mrs. Paris is as disappointing to Jim as I was to my mother. She was proud I was a doctor, but she would have liked me better had I been more helpless. My constant self-reliance robbed her of what she wanted — a child she could take care of. Nearly all of us (maybe with the exception of manipulative opportunists) like taking care of others, but Jim likes his charges to stay dependent — I insist to him they're going to become self-reliant. Incompatible worlds.

Hanna Slendzinski had moved back to Toronto earlier in the year and was again attending my interviewing seminar. We had our personal reunion in the corridor outside the meeting room, the same corridor where she had once wickedly called me by my first name. This time we

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kissed politely, but instead of cheek touching cheek, our lips contrived to have a half-hearted meeting. That kiss, our first and last, meant that for the next few weeks at least, we didn't tiptoe around what was going on between us. We often had lunch or dinner together and, on one of those evenings, she even told me she "needed a hug." Had Hanna said that I should hold or embrace her, kiss her or make love to her, I would have reacted, as I'd often done, with waves of love and longing. She and I might have become lovers there and then or, had I been in my prudish mode, I might have responded with a coward's version of moral wisdom. Still, for that terrible moment, the request for a "hug" sounded ominously needy and absurd to me, absurd enough that I was overwhelmed with sadness. The day had arrived, I thought, when Hanna and I would discover we lived in different universes. "I need a hug" had called up my knee-jerk repugnance for modern fads. The pressure of my personal madness blocked out wisdom and, like every human act, my sudden alienation from Hanna had a secret, mad purpose, to give a message to the world and to myself: "I'm a crotchety crank and not a young panther as the world and I may have been deceived into believing." I couldn't have immunized myself against this by living in a compartment or by avoiding people like Hanna. The nasty truth is that everybody is different from me. I might as well have decided that, since cobras, elephants and roses were different from me, I should have blocked my ears and eyes to them as well. I wasn't just troubled by cultural differences and fads; anyone outside of my skin would have eventually alienated me. No matter how much I wanted affinity between us, I couldn't get curious about Hanna's dissimilarity from me, and compulsively judged her for a fault that was not a fault. This suggests racism and prejudice will endure and all bliss will be temporary. Hanna had worked for a short time in Kosovo. She still had flashbacks and bad dreams, she told me, and wished the organization she'd

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worked for had done a better job of debriefing her. My craziness about the word "hug" reappeared, this time not momentarily. For me, Hanna's story about Kosovo was a claim that she was a victim. Hanna was suffering, and someone else was to blame. Our romance, I realized, was being sabotaged by my usual nuttiness, my absurd, malignant nuttiness. I told her my reaction, with a pretend twinkle in my eye, but Hanna quickly understood the driven pessimism that lurked behind my weak humour. There would be no mutual tolerance of difference for me. I made jokes and poked fun at myself, but Hanna recoiled when I told her what I, in contrast to her, would have done about flashbacks and bad dreams. "I would have waged war," I told her. "Debriefing would have been a chance for me to raise hell about what I had seen and, had I still not gotten over it, I would have designed new ways of raising hell within the organization, probably by writing a stinging brief." It would be easy to claim that I reacted so weirdly simply because I couldn't tolerate the external obstacles to our romance: she was my student; she had a husband. But the truth lives inside me, not in exterior events. Like half the human race, Hanna invited her devils to transform themselves; they had been wicked and must repent, soothe and comfort her. Meanwhile I, in alliance with the rest of the human race, was equally unforgiving, and would contemplate only a delicious battle against devils. Her way of dealing with devils repelled me, and my ways — I know for sure — would equally repel her.

There was another poor soul harmed by a nasty devil. Graham Copeland's devil was me, oblivious to the perils of the heart he'd risked by loving me many years ago. Despite my experimental attempt at treating him with bibliotherapy, I'd had no word about him. But later

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that year, Roman Borsch phoned to tell me that Graham had died. Roman had been in Topeka at a reunion of Menninger alumni when he'd heard the news. No one Roman had talked to knew where Graham was, or even that he'd lived in Berlin. Nor did anyone know what caused his death. By the time I called, Graham's phone in Berlin had been disconnected. It was my turn to search out words of sadness, regret and love. Unlike my reaction to earlier experiences of death and loss, when I heard about Graham's death, I had very ordinary reactions; I wished I'd spoken to him about certain things, not about the tremendous change in him between 1962 and 1997, nor about his feud with Heinz. Instead, I wanted to talk about how, in the face of his youthful love for me, which lasted many years, I had feigned being coyly oblivious. I wanted to make it up to Graham. I also wanted to tell him something that I probably would never have said out loud — that I'd loved him, too, and of course, to lighten things by saying it was the fault of the gods that our ways of loving didn't match. For me, things like that must be lightened up. I say it's just part of Zeus's golden net when humour eases the pain of the world, but it's more than that; it's also fear and flight. I grieved Graham in repeated flashes of hurt and loneliness — and by developing a chronic conviction that, because I never had the chance to talk to Graham, I'd feel frustrated the rest of rny life. Strangely, I also pitied myself, as though I'd spent 35 years intending to clear things up with Graham, and now I'd left it too long. Life turns its own pages. Death, too, turns its own pages. Six months after I heard about Graham's death, my brother and sister-in-law, both in their mid-5os, died within three weeks of one another. I felt little grief, but then wept when I told people and when I was with my family. As Ernie and I drove to my brother-in-law's funeral, both of us were crying, even though I was worrying about Ernie. There was a smell of urine in the

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car, and I wondered whether he'd peed his pants. But there was no stain on his trousers, nor could I smell booze on his breath, booze being the usual cause of his incontinence. We sat with the family in the front pew of the church. When the service was finished, Ernie and I walked up the aisle first, for Ernie a slow, cane-assisted task because his neurological handicap was much greater than that of most stroke victims. The clergyman stood at the back of the church, composed and reverential. When Ernie spotted him, his face lit up. "How ya doin'?" he said in a loud voice, doubly loud because the church was silent. He pointed at himself and said, "Ernie Warme, Ernie Warme . . . racetrack, racetrack." I looked down and saw that Ernie's trousers now had a large wet patch. Later, I spoke to the priest and said sheepishly, "I guess at every funeral worth its salt, someone gets drunk, someone picks a fight, or someone faints."

The weeks passed and Jim Forster tried my way with Mrs. Paris, although his heart wasn't really in it. He was also approaching her his way, emphasizing only what she said and not pushing the idea she had a motive for her behaviour. But he was also getting impatient, or more accurately, jealous. I read between the lines and realized what he might be thinking: "Mrs. Paris, how can you speak so well of that bad man who abused you, when you never speak well of me, a man who is only kind and sympathetic to your plight?" Just slightly, Jim had lost his temper with Mrs. Paris a couple of times. Once he used the word "ridiculous" for her praise of her father; another time he said directly that a bad man like her father deserved her anger, not her praise. To hear this was a great relief to me, because

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it meant that I wasn't beating up on Jim as much as I feared. Had I been really roughing him up, he would never have confessed to his little outbursts of temper. As it turned out, Mrs. Paris was acutely attuned to Jim's hurt. She knew about men, and read his reaction to her right away. In her typical fashion, she waited until an appointment was finished before, yet again, springing her surprise. "Dr. Forster, I have something important to tell you," she'd said. "That whole business of incest never happened. My father isn't really a bad man and that's why I've been telling you about his virtues. When I first told you about the incest, I really believed it had happened — I'd believed it for years. But in the last year or so, I realized that it never happened. I don't know why I ever thought it happened because, really, I always knew it wasn't true. But it seemed true when I told it to you." Reality cavorts and writhes, and makes us mad. I'm an old-timer, but I was still bowled over when, yet again, I was faced with the madness of the world. But for Jim it was worse: this turn of events was incomprehensible — he thought Mrs. Paris's new story had to be a lie. Poor soul. He wanted the final truth — louder music, stronger wine. Jim thought he had found a patient who was a true and exemplary victim, a doctor-patient set-up that satisfied his every instinct. Were Mrs. Paris lying about the incest not having happened, Jirn was faced with a new problem — a liar. It's hard to see a liar as a victim, and one way or another, Jim was faced with a world (the only world there is) that is always a story. Once he has the gut-knowledge that we trade in narratives, he'll have turned into a psychiatrist. "Well, Jim, it's not too late to change your mind about being a shrink," I teased him. "This is a crazy business we're in; anyone with an ounce of sense would get out while the getting is good." Jim gave me a weak, baffled smile. He looked pale.

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Six months later, there was a further turn of events. Mrs. Paris affirmed one day that her husband had sexually abused their teenage daughter just before she came to the Clarke for her initial assessment. She had suspected this and recently had discussed with her daughter what had happened on a particular evening. There'd been a party for her daughter's young friends, and her husband had gotten involved. After necking with one of the girls, he had seduced his own daughter. Deciding such stories were true, or denouncing Mrs. Paris as a liar, was easier than not knowing. One of the problems Jim and I had was that we'd never had a good argument. We should have considered this learning tactic, because Jim had assessed Dr. Long, and seen us battle one another when I did my interview. Through the grapevine Jim will also have known that, despite our war, Dr. Long had become my patient — a war followed by understanding. It's true that, in the crunch, Jim wanted everything to be nice. But I, too, had avoided arguing; perhaps I feared that if I challenged him too strongly, he would never become my disciple. It had occurred to neither of us that a good quarrel might have brought us together.

Frank Kellner, who was also in analysis with me, lived in a completely different world. He was angry that he'd lost the religious beliefs he had before he began taking antipsychotic medication. He'd scoured the literature on schizophrenia and insisted that a high percentage of those who recovered from madness maintained they were happier when they had their delusions. With Mr. Kellner I did better than with Cathy Jones. When I began seeing him, he had spent five years in his parents' home writing

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up his thoughts about his place in the world. In the process he had decided he had become a woman. Indeed, he had invented an alternate universe. Subsequently, Mr. Kellner became violent at home and in his neighbourhood, and was twice hospitalized. After a few months of testing me suspiciously, Mr. Kellner stated he had a gift for me; he knew of a new universe created by God which I could now share in. In that world there were different physical and natural laws, and it was populated by alternate species unknown in our world, some of whom could speak, albeit in a new language. These creatures had very different values from ours and were divided into genders we know nothing about. God, he told me, had created him as a part of that universe and he, Mr. Kellner, was the creator of yet another universe, just as different as the special one God had put him in. In the universe Mr. Kellner had created was someone who, in turn, would create yet another alternate universe. His gift to me was that, should he die, he had bequeathed to me the universe that he himself had created. If, as I did at first, I'd hinted that he might be tempted to participate in our current universe, Mr. Kellner would get annoyed. "I'm neglecting my universe enough already by coming to see you," he replied. "I'm responsible for my universe and for the living creatures who populate it. You forget, Dr. Warme, that ideas are real and have an existence independent of those who think them, and independent of their existence in books and libraries." I had a choice with Mr. Kellner. I could align myself against his personal universe or, alternatively, if I could figure it out, I could talk to him in his alternate world. Whether or not he joined me in my world (if he could figure zYout), would be up to him. By then, I was smart enough to do the latter. This neither cured him nor changed him. I say I "did better" because, instead of pushing him to adjust, I helped him think about his life. Bit by bit, he talked about why he

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lived in a different universe, and why he created his universe as he did. A few months after he stopped coming to my office, Mr. Kellner began smashing dishes, then struck his mother and was hospitalized. There are two glib explanations for this turn of events. First, he stopped seeing me because he was beginning to break down, or alternately, he broke down because he stopped seeing me.

Madness was in the air, and this time it decided to light on Leila Singh. I wonder if, in 30 years, she'll be at peace with this story. One afternoon, she gave me a phone call: "Hi, Dr. Warme. This is Leila Singh speaking." "Well, hello Dr. Singh. You're here at the Clarke again, I think. Isn't your office down near Emerg?" "Yes, I've been here since July," she said. Dr. Long, still in analysis with me, had occasionally given me an update. He focused on Leila because, like me, he'd noticed her manic enjoyment of Western ways — a reminder of Dr. Long's negative reactions to his own mothers sensuality. Leila had adopted Western dress, he told me, and at a recent party (her husband wasn't there) Leila had danced gaily, then enthusiastically smoked up. Later, he'd heard she passed out. Dr. Long was gently amused by Leila's antics. Did this mean I was curing him?

"Uh, Dr. Warme," Leila continued. "I'd like to make an appointment to meet with you. It's a personal matter and I'd like to see you in your private office if that's possible." We set a time for the following week. When she arrived, Leila was as charming as ever, but she was pale and her smile forced. I paid attention, but more than 1 liked, I still had an agenda — I was looking for opportunities to convert her to my way

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of thinking about psychiatry. Leila played her tongue over a bit of loose skin in the corner of her upper lip, a habit I'd noted when she was in my group a year or so before; I'm now sure my grandmother touched her tongue to her lip in the same delicate, sensual way. As I'd heard, she wore Western clothes, slacks and a sweater. Like all beautiful women, Leila knew instinctively how to select and wear clothes; her slacks fit perfectly and I, not adjusted to modern fashion, noted uneasily that her mons veneris was plainly outlined.

She has a mons veneris that's interesting, but I've reached an age when I'm short of anatomical virtues. My grandchildren are well aware of me and my body and at "Camp O'Cotteg," my summer cabin, little Stefani licked my bald head after I'd been chopping wood, a gustatory appraisal of my pate that earned me the title of "Salty Head" for the rest of the summer. Before I grew a beard, Jessica noticed my cleft chin (does a cleft chin resemble the pudendum?) and announced my new name was to be "Bum Chin." My grandchildren haven't noticed that the seat of my trousers is now always baggy. Once fi]led with ample buttocks, my trousers now give away my physical decline. It came to my attention when I consulted a weight guesser at a fair (I look thin and can often fool them). To my horror, the barker pulled on the seat of my trousers, and discovered the seat was empty. "Your rear end seems to have gone missing," he said. I'd obviously misplaced my gluteal parts somewhere on the fairground. My arthritic left knee had its cartilaginous meniscus removed 30 years ago and, after so many years, the cartilage on the articular surfaces of my thigh and leg bones has completely worn away. My knee is now bone on bone, and the loss of my buttocks means that, when I ride my bicycle, my skinny rump and the saddle are also bone on bone.

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Such absurd private musings were a sure sign that I was worrying about why Dr. Singh was here, that I'd anticipated she would tell me a disquieting story. "So why are you here, Dr. Singh?" I asked her. "I've gotten myself in trouble," she said. "I didn't know what to do and I was talking to Jim Forster about it. He said I ought to talk to you. What's happened is that I've been involved with a patient at the hospital where I worked last year, a man who is paraplegic. He is older than me and has many cultural interests. He knows about art and literature and a lot of things I've never had anything to do with. My husband isn't interested in such things, so it was all very new to me, even though my brother writes poetry. Because he was handicapped, my brother was encouraged to develop his writing, but right from the start, I was supposed to be a doctor." I waited for her to say more. "It's awful. My friend has a minivan and we used to go out in it, but after a while I started to feel really bad. I have three children, you know." I had seen Leila's son on the unit one day, but was unaware she had three children. And for a lover she had picked a paraplegic man, paralyzed from the waist down, which automatically meant their affair was sexually complicated. I'd heard of physiotherapists getting involved with their paralyzed patients, but I was surprised the childlike Dr. Singh would have done this. I would have expected her to pick a strong man, but perhaps this man's obvious intellectual strengths had filled the bill for her. Her choice of a handicapped man as her lover showed that, in addition to getting herself rescued, she also wanted to save someone. "I've told my husband about this and he's ready to forgive me. I'm

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not seeing this fellow right now, but I don't know what to do. I'm in love with him." Ten minutes had gone by, and I already knew enough to refer her to a psychotherapist. Nevertheless, I did my duty and began to collect historical information from Dr. Singh. She stopped me. "No, no, Dr. Warme. I'm not here to get help — I want to arrange for my husband to get some help. Can you see him? Or, if not, can you recommend someone for him to see?" Up to now, I hadn't noticed that being a helper was so important to Dr. Singh, even when she insisted in the seminar that patients should be diagnosed and quickly treated. She'd assessed Mr. Evans for me, and thought she'd cured him in one hour by persuading him to confront his parents with some imagined evil they'd done him. Leila had been upset the day she assessed Blaire Allen — his masculine physique had made her nervous, I thought. Later I realized it was his childishness that bothered her, and now she was rescuing someone — her husband. But surely she was worried about herself, too? A few seconds before, she'd said of her affair: "I don't know what to do. I'm in love with him." When Leila told me she wanted help for her husband, I guess I was supposed to get on board with some moralistic and preachy psychological slogans: "Psychological help is a very personal thing . . . " "Your husband really ought to decide for himself that this is what he wants . . . " "If you arrange for this treatment on his behalf it will mean that . . . " Even though such stuff is alive and well in me, and while I'm usually annoyed when people try to use psychiatry to get their spouses to think their way, the truth is it doesn't matter a damn how a patient comes to be in a psychiatric conversation, so long as it helps tliem.

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"I'm working on forensics," she said, as though signaling it was now time for social chit-chat. "I'm becoming very interested in genetic factors in people with antisocial personalities." Dr. Singh had heard me make jokes about those vague genetic factors we invoke when we don't know what else to say, so she wasn't passing on innocent information. Unlike Jim Forster, who truly wanted to find common ground, Dr. Singh seemed out to goad me. But why, then, would she have sought me out? I guessed then that my suspicions about her — when she'd been in my seminar, I'd thought they were just fantasies — were correct — she wanted someone to rein her in, make her behave like a proper Sikh lady. Dr. Singh feared her sexual powers and hoped that I, or some other man, would be powerful enough to resist her charms. She might still have been hoping I'd rein her in, scold and advise her. By getting involved with a patient, she'd crossed a line and had committed the Great Psychiatric Crime. There was no doubt about what I was supposed to do: report her instantly to our professional College. The College would have tried to apply another version of instant solutions and fast cures, this time using disciplinary action. The College's diagnosis would have been that Leila had improperly wielded power over a patient. They would have been correct — except that in this case, it's also possible an ass-backwards diagnosis would have made the committee's deliberations more interesting. For the sake of therapeutic leverage, wouldn't it have been wiser for a committee to interpret this heartbreaking situation the other way around: that she feared her power rather than merely having wielded it, and perhaps had wanted assurance she could not seduce every man who came her way? If I'd reported Dr. Singh — and I was committing a professional offense if I didn't — I would have wrecked any possibility of helping her myself, because I would have betrayed her secrets. I might even have wrecked any hope of her getting help from someone else: how

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could she have trusted any future psychiatrist?

"That's fine, Dr. Singh," I told Leila. "Get your husband to give me a phone call. I'm not sure I can see him myself, but if I can't, I'll find someone for him. This is a tough situation you are in, all right. A bad mess. A big change in the smooth flow of life. Is there more about it you want to tell me?" "Oh, no, Dr. Warme," she said. "I just came because I didn't think I should talk to you about my husband over the phone. I'm grateful you will talk to him. Thanks a lot." And with that, she left. Her husband phoned a few days later, but he couldn't manage any of the times I offered him. He said his schedule would settle down in a week or so, and he would call again then. He didn't.

Leila's situation threw me into a frenzy of second-guessing: had I done the right thing? I'd seen that Leila was having trouble years ago, but liked it when she flirted with me and tried to make me jealous by straightening Jim Forster's necktie. If I'd seen it before she became a "sex-abuse case" — that's what the College calls such situations — should I have spoken to her at the time? If my greatest expertise is in human psychology, shouldn't I take note of what I see going on in my students, just as I might have taken note of it with Cathy Jones, Graham Copeland and later, with Christine Brydon? The irony is that, had I spoken to Leila a couple of years ago, or had I handled our interview differently, I would still have secondguessed what had happened. Had I done the opposite and stuck my nose into her affairs, would I have worried I was treating her as a child, thereby preventing her from observing herself or from designing her own response to what she observed? 328

CHAPTER^SEVEnfEEII

TROUBLE on THE SUBWAY

Labourers and the uneducated can make use of the Greek myths I tell them, and as intuitively as anyone else, listen to my intellectual interpretations. I, fancy-pants psychiatrist that I am, am just as versatile at negotiating the working-class world. It was a chilly November morning, and I was in Hudson Plumbing Supplies to buy a special washer for my wounded kitchen-sink faucet. Beside my elbow was a girlie calendar, something drought to be tacky in my world. But on that day, I was in a state of enlightenment. I realized this girl-caricature was beautiful — but I'd never say it out loud. Her plump breasts were dazzling, as was her silky skin. Her posture and her eyes celebrated life and womanliness and I'd be a deadbeat if I didn't admit this. Many men were already at work behind the counter, even though it was only 7:30 a.m. One was wearing a soiled team jacket, the others a potpourri of Indian sweaters and lumberjack shirts. Everyone seemed in a good mood. Four men worked the battery of telephones and, as another guy passed, one of them kicked him in the pants. "Oops," he said. "My foot just flew up all by itself." The kicker was black, but the receiver of the kick marched straight on, a good sign that racism is vanquished in this establishment. Too much jocularity in response to a kick from an African-Canadian might

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give away an overdone acceptance that all this was meant in fun. "Here it is," my server told me as he handed me my washer. He was wearing a baseball hat indoors and had knitted gloves without fingers, drawing attention to his nicotine-stained fingers. "Are you paying cash?" "Yes, unless it's more than a hundred bucks." He smiled and wrote out a bill. "Five hundred bucks," he said. "The deal's off," I replied. The miserable washer cost five dollars and I handed him three two-dollar coins. He handed me back a loonie and said, "There's your change, buddy." As I walked out into the cold, I was suffused with love of the world.

Dr. Long: savage fighter, scornful cynic, mother-hater. If such a man could give birth to a poet, the poet who lives within him, I guessed there was hope for me. In the past, I've done a good job of self-deception, forever thinking of myself as the ultimate democrat. Haven't I proved psychoanalysis can be offered to schizophrenics and niggers? I may not write poems, but I can quote Shakespeare and Nietzsche to my patients, can't I? Unfortunately, my pious liberalism and self-admiration take a beating when a great truth is revealed: I'm as evil as the next guy. As I accumulate experience, and become better acquainted with people like Socrates and Vladimir Nabokov, I become a better psychiatrist. Unfortunately, experience and the great minds of history also make me better at self-deception. Were I to tell a patient her behaviour was "ridiculous" as Jim Forster once did to Mrs. Paris, I'd know immediately something had gone awry. The truth is I'm so bloody slick at this game, nowadays my sadism with patients is subtle, clever and invisible. My colleagues see my belligerence when I get into academic

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fisticuffs at scientific meetings, but even there, I'm oblivious. To me, it's what academics are supposed to do. Dr. Long doesn't fight so much these days because he knows how the psychiatric game is played. When he visits Hudson's Plumbing Supplies, he knows how that game is played, too. Dr. Long isn't the same stubborn psychiatric student I first interviewed three-and-a-half years ago, yet in some ways, he's exactly the same. Then, he had paradoxical food interests: he liked sausage as long as it was Jewish or in a deli, and not Hungarian or German. He is still a paradox: he's a hardrock warrior on the athletic field, and quietly writes poetry. One day in therapy, he brought a typewritten sheet of paper that he handed to me. A young girl is standing beside me on the subway. She is a redhead with white transparent skin, and the tip of her poor little nose is red, her eyes puffy. She has a cold. She wears baggy bell-bottom trousers, which are exactly the right length for fashion, but six inches too long for safe walking, so her shoes are invisible. A delicate, delicious breast is snuggled against my left shoulder blade. She is a glorious nymphet, and I, being both glorious and evil, am fabulously hysterical: a pervert. Like everyone else on the packed subway car, the girl and I are silent and impassive. Despite the meeting of breast and scapula, and despite the stirrings of lust, everyone is silent, silent as a tomb. The world has turned strange for me. How can I be impassive when a nymphet sniffs and dabs at her nose, two inches from my ear? How can hundreds of us be silent, most looking off into some non-existent place, as though unaware of everyone else, packed together like collaborators in a mad orgy of group sex?

"While standing there on the subway," Dr. Long told me, "I thought of a story you once told about how you were lost in a reverie while you were looking at a painting of two young girls. I remembered how your mind wandered and suddenly, the other day, I realized that

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kind of reverie happens to me all the time, and I was doing it on the subway train at that very moment." Dr. Long was thinking of The Calmady Children, Laura Anne and Emily, painted by Sir Thomas Lawrence, a picture in an art book I'd wistfully looked at one evening when I was worrying about my sick granddaughter. Somebody must have told him the story because I'm sure he was working at St. Mike's at that time, so wasn't eligible to be in my seminar. The next year, some months after he had begun his analysis with me, he did start to attend. Once in a while, everyone wreaks magic on the world — transforming subways, cocktail parties or committee meetings into high drama, farce or caricature. Graham Greene once said writers must have a "splinter of ice" in their hearts so that they can stand back from horror and watch it dispassionately. Psychiatrists like Dave Long and me are in the same boat, duty-bound to mine life's moments for our professional use, for the awakening and refreshment of our mental instruments. Watching, listening and attending as scrupulously as a private eye are our stock-in-trade. Dr. Long is not just aping me. Nor would it be correct to say he is identifying or turning into another version of me. He's always had this proclivity in him, but his fighting style used to make it invisible. I identified with Dr. Long as well and noted associations that had come to mind as I read his typewritten page. I had flashbacks to other trains: the thrilling efficiency of modern German trains, the train to Cologne which, when I was a young man, led me into the heart of Germany, a Germany I had expected to be the heart of darkness. Other trains with packed boxcars that once traversed Germany; the train that brought my father home from an internment camp. And when my father was interned, I too had come home from camp on a train, except my camp was a summer camp, a pleasure island, courtesy of the Toronto Star Fresh Air Fund.

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Dr. Long intruded on my reverie. He seemed to have lost his magic thinking and had reverted — as I used to do — to the earnest and rational. He was saying something he may have picked up from me, because once in a while I still slip into beating up on my listeners. He was delivering a sermon, too young to know sermons are boring even when they are interesting. "My daydream on the subway was an escape from life," he said, "and yet that's the only way of knowing about life. It was coolness, dreaming, and eternity-contemplation [this sounded like me]. How many people on the subway saw there was something odd about this scenario, and how many would have been baffled if asked about it? All of us were obeying a strict, constraining code of behaviour — I want to call it a ritual [ritual? For sure he'd picked up that word from me] — that made the world safe and manageable. I'd better not have violated die subway code, and responded sexually to the small, nymphatic eggbreast nestled against my ribs. The world knows we have to be realistic, which means . . . we're not supposed to be realistic." It was a good sermon, and I could have carried on with it without missing a heartbeat. But I liked Dr. Long's Lolita story better. If you don't behave yourself on the train, Dr. Long, there will be chaos; you'll be a sex fiend. It will be your turn to be the victim of a media feeding-frenzy. When you are in a silent passion over your nymphet, you're in the same frame of mind as teenagers are when they are in a froth over Mick Jagger, or Bill Clinton was when in a passion over Monica — and even as the moralists are when they're in a passion against the rest of us. The moralists are as blind as the rest of us when in the throes of one of our culture's rituals of indulgence or judgment. Ritual togetherness is everywhere. We're all singing in unison.

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Zeus, and his modern incarnation, Tony Soprano, love mortal women (like Europa). They are Dr. Long on the subway, living out a wonderful ritual of love. As they are chiefs, they have privileged access to women, especially virgins and nymphets. It's an archetypal story, a tribal enthusiasm, a law, and we alpha males practice it whether we are Mayans, Parisians or ancient Greeks. My enemies, those who gaily live life on the surface, are appalled when I say this and don't allow that they, too, are obeying a law as compelling as the law of love and sex: the law of propriety, decency and good sense. I'm forever caught in a tradition that is wonderful and delicious if a nymphet bewitches me — the way the sniffly-nosed redhead had bewitched Dr. Long on the subway train. It's just as wonderful and delicious if I judge, and find wicked, dirty-minded men like Dr. Long who lust after young girls. It's excitingly sexy; no matter which side I'm on, one version or another of Prince Charming and the fair young maiden: teacher and student, boss and secretary, doctor and nurse, and yes, even doctor and patient. On the other side are prudence, wise self-reflection and the Inquisition. Then there is the great sin between father and daughter, which must not even be named.

Dr. Kokott, a young doctor I'd been supervising for a few months, once reported me because I'd sat with my leg draped over the arm of my chair during her supervisory appointment. She had instantly read my secrets — my hysteria — and immediately invoked a stereotype more commonly used by men. Men of this unfortunate ilk are unsettled by joyous versions of womanhood — nervous Nellies, disconcerted by the sparkle of someone like Flaubert's Emma Bovary, who they'd label "hysterical" without realizing that so-called hysteria is merely documentation of womanhood prospering. A tight skirt (low-cut blouse, fragment of visible flesh) automatically means she's

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asking for it. "Asking for it," means fucking her, but also means beating or raping her. This kind of attitude amazes me. Why in the world are womanhood and manhood offensive, vulgar and terrifying? If Dr. Kokott had encountered Dr. Long's hysterical fugue on the subway train — they'd been student colleagues just a year before — would she have thought he was "asking for it?" Dr. Kokott had recognized the unspoken sexual content of our meetings, but opted to treat it explicitly rather than tacitly, as is usual. But her literalness embodied a judgment against our sexuality. I put my leg over the arm of the chair, she told the committee, to show off my sexuality. She was right, thank God, because it meant my sexuality was normal and intact. I may not reek of sweat and sperm like Dr. Long, but Dr. Kokott's keen nose had scented telltale traces of masculinity. Without knowing it, she'd acknowledged my sexuality — it's just that she did it according to a currently popular perversion of the truth. She'd rejected two other possibilities: the error of sexual involvement, and the option of quiet semi-awareness. Despite her apparent sexlessness, my young psychiatric resident was a fine but demure variant on womanliness, her sexuality easy to recognize, even as she goose-stepped to the tune of some modern fascists. When I told a friend this story, he said I was coming close to calling her a Fern-Nazi. Of course I was. Dr. Kokott's explicit aim was to do me professional harm for no reason other than my being a man. During our supervision hours, she didn't choose the chair in which most of my students sit. Instead, she chose a chair in which she didn't face me, at right angles to mine. If I use her way of thinking, I'm supposed to say she sat this way so I'd have a full-profile view of her tits. I never flirted with Dr. Kokott, which suggests I sensed something was amiss, even though I wasn't aware of what I sensed. I note that the world has finally woken up and made buggery legal but, in contrast, a new morality says I'm not allowed to flirt with my

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secretary. We flirt anyway, and enjoy imagining the reaction of those joyless deadbeats, just as I imagine homosexuals in years past enjoyed the reaction of anti-gay deadbeats to their styles of flirting — and fucking. I wonder what Dr. Kokott thinks of bum-fucking? But I'm not so tolerant of fathers. It would have mattered had the fathers — the committees that are at risk of taking strange complaints seriously — had failed, and had suggested impropriety on my part.

My colleagues don't like it: when I call everything a ritual, including styles of psychiatric illness, the behaviour of day-to-day life, and goosestepped complaints to education committees — but they are. I don't really want to be a ritualist, and like most people, prefer to think of myself as rational and sensible. I'm like my fact-collecting father, I say; I see it as good fortune that I've escaped my mother's excited mindlessness. When I was 10, I learned in school that light takes eight minutes to travel from the sun to the earth. When I told my mother this, she just scoffed. To her, this was nonsense: light is light and we see the sun directly. Her unscientific response allowed me to distance myself from her. I was scientific and sensible, not emotionally overwrought like her. But now I know we see the sun plainly, that the facts of science are true but boring, and my mother's vision had been poetic — even though she didn't know it and had therefore missed the fun. In those days, I didn't like Auden's definition: "Poetry is what makes nothing happen."

Since I'm happiest when I can judge what others do, I'm at risk of thinking it a silly ritual when other people do things. When I complain about a gossipy witch hunt concerning an errant colleague, I do so with the full conviction that I am having a rational response to a dangerous

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rumour-mill. And if I do the opposite and rage against my colleague's moral laxity, I'm not really doing the opposite at all; I've just changed my target. For today, I'm convinced of the need to speak out, and the rational necessity of moral outrage. I always think I'm the rational one, but my energy, the joyous enthusiasm and dexterous wit I employ when complaining about someone else, gives me away. In such instances, I'm a ritual celebrant, allied with a group I joyously support, feasting together on the carcasses of those we're sadistically denouncing. My individualism won't endure because it, too, is exposed as another currently popular ritual self-definition. Although it's clear to me that our era prizes individualism, I also know individualism is as ephemeral a truth as any other, that I am enslaved by forces greater than me, and that such forces can carry me along with hurricane energy. So when I'm thinking I'm immune to mass opinion, I sit quietly and smugly enjoy the idea that I belong to an elite that sees through the pettiness of the rabble. But despite my self-satisfaction, I can only know who I am by saying, "I am like so and so, or this group or that. They, like me, are rational and superior." When I announce I'm like no one else in the world, I end up being recognizable, despite myself. People are liable to say (and probably do), "Tsk, tsk, he's just an oddball, a cynic, a skeptic," all terms that peg me as a member of a recognizable sub-group. Even the dramatists who lose their identities in dissociative fugues, have identities after all: they're members of a well-known group of fugists, complete with typical behaviours and characteristics. Chronic fatigue syndrome, fibromyalgia sufferers and those merely allergic to the whole world have all figured out how to identify with their preferred reference group. But small or aberrant groups like these must be noisy, because there is hot debate about whether these disorders exist at all. They've got to prop themselves up with drama to nail down the reality of their existence.

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The ancient Greeks make these questions easier for me. More honestly than most of us, they knew they were the dupes of the ritual interests of someone else, in their case, the gods. In keeping with modern preferences, I deny gods, and maintain it's me, the autonomous individual, who decides what I will do. Years of worry have made me recognize my eager participation in the agendas of my gods, the gods of group membership or social roles. I have a larger stake in our secular society than I sometimes like to admit. I acknowledge my rituals tentatively and at arm's length. I say that I don't believe in Valentine's Day or religious rituals, but I participate in them because my life is poorer if I don't. I'm a true believer in science, which I insist is rational, and deny that it's a form of ritual thinking. But it's that belief in the rationality of science that is the ritual. It's wonderful when science produces tangible results, just as it's wonderful that inspiring propaganda, or picking the right flowers on Valentine's Day produces tangible results. The rituals I believe in most ardently are precisely the ones I like to think of as rational. It's rational whether I'm a conservative, a social interventionist, a businessman or a union member. It seems that even though I know the world is ritualistic and truth is made, not found, I'm forever using the words ritual and magic for what others do. I'm hung up on Enlightenment rationalism — despite an appreciation of Schonberg, Freud, and quantum mechanics. The ancient Greeks were just as convinced of their rationality. They ate the flesh of the burned sacrifice, and the gods breathed the smoke into their nostrils. The gods needed no nourishment; they were immortal, and the ancient Greeks could therefore come to the rational conclusion that the gods needed only the non-nourishing pleasures of smoke, nectar and ambrosia.

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I risk being thought ridiculous if I say love is a ritual, and that acts of love have little to do with hormones. Love poems aren't speaking on behalf of testosterone, and like a mantra, they've got to be recited over and over again. The same goes for lovemaking. Because it's a ritual, it has to be urgently repeated, well beyond any reasonable physiological need or capacity. Like the cooing words of love, my lovemaking must be imaginative and adventuresome. Even elementary forms of love — the first date, the first holding of hands, the first kiss — are miracles of mutuality. Romeo knows his coffee invitation will be accepted, and holding hands and kissing happen romantically, with both he and Juliet attuned to the magical moment. Characters like Kramer on the television program Seinfeld, are the opposite — they are socially inept. When Kramer meets an angel on a subway train, he lives out a ritual of failure just as standardized as romantic perfection — not because he has two left feet, but because he has his own skills, a carefully calculated blueprint for failure. It is guaranteed ungainliness — he offers the kiss at exactly the wrong time, and his apparent attempt to hold hands is a grope and a disaster. When I interview a feminist of the silly breed, any signal that I know she is a woman and I, a man, is forbidden. In her preferred ritual, we are two pieces of lumber. In contrast, I am required by my preferred rituals to think of her as a life-denying fool. If I ask, she will tell me wit and wooing are sexual put-downs, fluttering eyelashes and attractive clothes are just crass seduction. If it has to do with the mind and body, innocent fun is not understood. When an angry feminist and I meet — I'm just as angry — things will be awkward, and she'll later discuss it (with ritual enthusiasm) with her like-minded friends, who will explain the events of the interview by saying, "You know that male shrinks are only interested in indulging their hormones and putting down women." As eagerly scornful as she, I will enthusiastically tell the story of the interview to

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my colleagues who, in response to my prompts, will give me the ritual reply I'm after: "You know that these women are ball-breakers."

Dr. Long had applied for psychoanalytic training but wasn't offered a place in the first year class. He'd been advised to apply again the following year. He'd been stubborn when I first interviewed him and I suspect he did some debating with the three senior analysts who'd done his screening interviews. I have privileged access to Dr. Long's inner world and know he'd be a good psychoanalyst, but application procedures, like hiring procedures, are impossibly weak and the interviewers couldn't pick up that, despite not having a diploma, Dr. Long was a psychoanalyst already. It's a state of mind, not a piece of paper; psychiatrists and psychoanalysts are born, not made. Another applicant, also in analysis with me, had sailed through the three industrial-grade interviews with ease. This young woman, to whom I also had privileged psychological access, was without psychological intuitions. She pushed drugs at patients and embarrassed her students by yelling at patients in the clinic. In her personal life, the woman was a shoplifter — no one knows except she and I — and had once harassed a tax auditor who disallowed certain deductions she had claimed. She'd found his home phone number and called in the middle of the night. For 20 years, my working assumption, and the working assumption of education committees, is that much can be learned in a well-conducted interview. I assume this to be true, but I also know that interviews don't always recognize natural-born analysts, nor do they recognize the bad-tempered bully. When first interviewed by me, no one would have believed Dr. Long could be a sensitive, artistically gifted psychologist. In the interviews conducted by the training committee, they would not have seen what I saw regularly. As Dr. Long

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denounced the corruption of the world, I insisted that he note that while these were facts, more importantly, they were an obsession and a fanaticism. Being Dave Long, what else could he do but argue? "It isn't, it wasn't, I'm not. . ." That much, Dr. Long's interviewers would have seen. But what they would not have seen were his next words, words he and I worked three years to unearth. "I saw my Dad's boss humiliate him," he said. "I told you I would tell you the story some day, but that's all I can say today. I want clear targets to battle against, but I know the problems of life are just life, and that really pisses me off. The enemy I have to fight can't be fought against, because it's unknown and unpredictable. It might strike me down and it may lift me up. I hate it that it's not a clean fight against a clear-cut enemy." Dr. Long had been cured, but I'm damned if I know of any disease of which I had cured him. It may be truer to say he cured me, because the man he'd become had taught me a lesson I ought to emblazon on my forehead: Don't try to adjust to the shit that life rains down on us, because adjusting means becoming one of the gray people. Do that, and we go to our graves horrified by the cowardly life we have lived. Dr. Long taught me to keep fighting, to see clearly that, while the ills of the world are here to stay, we must stand up to those ills just the same. That advice is as true for rascals as it is for honest citizens, because even rascals get more shit than they deserve. Isn't that what Achilles did, and the lesson all warriors teach? Never hide and never go along with the pathetic idea that for every problem, even trivial ones, we must enact a law, establish a grievance committee, give a pill, invent a new diet, and believe there is a solution. If we're real warriors, we'll shrug off slogans masquerading as guidelines for how to live. Our reward will be to suffer forever and die with honour. If we're Mttfwarriors, we'll also suffer forever, but die with dishonour. It's a lesson

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that must be learned again and again and, although I've learned it from Dr. Long, I've learned it plenty of times before, most eloquently from Victor Hugo: "If suffer we must, let's suffer on the heights." Psychiatry is not, and never has been, about chemicals, bad parents and trauma. It's about difficult realities like honour and loyalty, and about greed and vengeance. We witch doctors uphold the former and battle the latter.

Never once had Dr. Long commented on my collection of horse figurines. But as our work wound down he told me that, when he finished, he would give me a horse for my collection. On the last day, at the end of the appointment, he handed me a folder. "I told you I would give you a horse." When the door closed behind him, I opened the folder: THIS IS A HORSE This is a horse whose breath disintegrates beneath him in spring water he drinks, ice forming in the rivulets of spilled water and breath. This is a horse whose rider is not just the dumb cold afternoon. This is a shadow of a horse embarrassing the distilled light of this altitude, one thousand feet above the summer. Shadows are the broken bones of night that penetrate this day. This is the space between rider and horse,

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between the sky and ice that touch them on all sides, the space somehow reduced in their descent. The etiquette of evening allows shadows to reach ahead, man and horse to ride shadows. Let's call a spade a spade. This is not a horse. It is only my breath disintegrating beneath me; the empty in the hollow of the horse's back. It is the space between men.

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CHAPTERÊIGHtEEn

IIIVSES

The sky was darkening, my mind was atwitter and my ears and eyes were waking up. Robert Samson lay on my couch talking to me and, strangely, it was my story he was telling, about a series of women, his muses, marching through his life. When he'd been a child, his mother was a fanatical homemaker and sometimes kept Mr. Samson home from school to help her. She'd remove her clothes and, naked, frantically vacuum, dust and polish everything in the house. Mr. Samson hated those days because he'd been sexually aroused. Mr. Samson's wife was upset because they never made love anymore, but her husband had a secret. Two or three times a day, a black limousine picked him up, and a silent chauffeur drove him to an old house in the country. There, a butler took him to the mistress of the house, a young woman with large breasts and a very beautiful face. Around her neck she wore an iron cross. Mr. Samson was obliged to treat the woman with great respect, and when she insulted him, it was he who had to apologize. What happened was always the same. He submitted, kissed her boots and feet, then shrieked with horror as she approached him with the iron cross, intending to gouge out his eyes. At that moment, another woman entered the room.

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This ritual masturbation fantasy, repeated several times a day, was always constant: utterly predictable and boring — if you take repetition to be boring. My muses have also been repetitious, but they never seem boring to me either. The new woman who always entered the room was younger than the first, more beautiful, and her breasts were larger. She, too, wore the iron cross, with which she now gouged out the eyes of the first woman. Mr. Samson groveled before her, crawled to her feet, and offered his face as she moved toward his eyes with the cross. Mr. Samson had a second orgasm just as the door opened to reveal a third woman, younger, even more beautiful, with even larger breasts. This is why Mr. Samson and his wife no longer have a sex life. He was having four or five masturbatory orgasms a day.

Muses assume many shapes. We all know them: masturbatory dominatrix, tidy mother — naked or clothed — the beloved, powerhouse grandmother, schizophrenic Cathy Jones, or twitchy-bottomed student. My mad mother, too, had been a neat freak. Many a Saturday I spent the morning cleaning the house under her supervision, working fast and finishing the vacuuming, mopping, and polishing in record time, before asking to go out to play with my friends. "You couldn't have done a good job so quickly," she'd say. "Do the mopping again." How could I turn into a man if I did housework? My mother wasn't naked when she did the housework; that happened at night when she and my aunt Dona wore negligees, satiny and transparent. If my amplified thinking alerts me when there's a muse in the neighbourhood, then Leila Singh must have been one. Earlier that year, the hospital began to buzz with the news she herself had told me about, that Leila had had an affair with a patient. In little fragments

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— I don't get to ask my patients for the details of the gossip they pass on — I heard that, not only was the affair public knowledge, but it had been Leila herself who'd broken the news. After a few weeks, the talk died down but, three months later, the story resurfaced with a new twist. Leila's brother, I heard, was paraplegic and — buzz, buzz — it was he, not a patient, with whom Leila had had the affair. Leila's fear of her power over men turned out to be an underestimation of the actual state of affairs: she'd gotten the whole hospital yearning for the juicy details of her private life. Oh, my. I hoped she'd be all right. My patient Cathy Jones was schizophrenic, but she was a safer muse than Mr. Samson's mother, my mother, or Leila Singh. I'll settle for a more modest muse and Cathy is just the ticket; she is never naked, her clothes are baggy and her skin dry and scaly. Just the same, she stirs me up in her own way and has made me rethink the notion of madness. My patronizing attitude toward her — wasn't she, like all crazy people, inferior to me, irrational, out of touch with reality, deluded? — showed me I was as intolerant of difference as everyone else, and convinced people like Cathy had to be transformed into normal people like me as fast as possible. When I was faced with Cathy, I completely forgot the craziness of socialist versus capitalist, Israeli versus Palestinian, Hindu versus Muslim. We can find a rationale for all those, but not for Cathy's madness — even when hers is only tragic and never harmful to others. The weirdness of committed schizophrenics doesn't cause the kind of damage done by committed Christians, Muslims, Jews, Hindus, socialists and capitalists. Muses stir me up.

As planned, Christine Brydon began working full-time at the Psychotherapy Centre in July of 1997. After her one-year stint, she would graduate from the psychiatric training program. When she began, I

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noted she was neither naked nor schizophrenic, nor — despite bearing the name of Christ — did she wear an iron cross. In her office, Christine set up a tiny statue of a ballet dancer, a conch shell, three small pots, and some books, literary rather than medical. Her previous experience as an English student and writer still defined how she presented herself. Looks as though I've got myself a gem for the next year, I thought to myself. Sure enough, as soon as she began work, Christine was brazen enough to believe she could have opinions about patients, opinions that, as all good citizens know, can only be held by senior staff. In other words, Christine was observant and perceptive, and she knew it. It wasn't long before I realized that, while she'd been quiet in my interviewing seminar, she wasn't just another shy student, overimpressed by my observations. Christine had plenty of opinions of her own. She'd been shy in the group but, alone with a man, she was bold as brass. Christine wrote up cases, and because she was a writer, formulated them with more wit and descriptive skill than any student I'd supervised previously. To stay ahead of her, I had to muster all my accumulated experience. I even cheated, keeping her off-balance with obfuscating psychiatric jargon. As she was my resident, it was my job to help her to learn something. She, it turned out, was equally determined she would teach me something. She had decided, I guess, that she was one of my muses; but everything got mixed up. I had previously thought there were two categories of women: women of life (hysterics) who were sexy, exciting, and full of display, and women of mind (obsessionals) who had plenty of rational intelligence. Somehow, a new configuration was revealing itself: the eros of mind and the intelligence of sensuality. Christine showed me the mind of the father and the ecstasy of the mother could be transposed and, it seemed, weren't legitimate divisions after all. Christine hated putting psychiatric labels on patients, and stub-

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bornly objected when I told her what she already knew perfectly well: that it was a medical and a hospital requirement that every patient have an official diagnosis. Christine was busy being a psychoanalyst before she actually was one or, more accurately, before she was one of those psychoanalysts who object to diagnosis. She'd told me three years before that she'd gone to medical school and specialized in psychiatry with the sole goal of becoming an analyst. Her argument with me was that psychiatric diagnosis was silly beyond belief, an idea that she would have figured out herself if she hadn't already heard me poking fun at my colleagues in the interviewing seminar. I remember something like this coming out of my mouth: "'Eureka,' they cry, 'phobias are caused by a phobic disorder! Anxiety is due to an anxiety disorder! Schizophrenic symptoms are due to a schizophrenic disorder! Depression is due to a depressive disorder!' Is it possible that psychiatrists who think this way might argue cheerfulness is due to a cheerfulness disorder? Any intellectual desperados who don't understand rny complaint should consider joining the infantry." The reality is actually worse than what I told the students. These arse-bandits — those who are currently hi-jacking, raping and pillaging our noble profession — are missing the thousand and one messages in the symptoms they hear about, statements of complaint in which patients encode the most precious parts of themselves. They are also missing out on the fun of psychiatry, which, I guess, is hard cheese for them. Drinking coffee, having three beers, and biting fingernails aren't diseases, but the bandits have made sure they've found a way of inserting them into the diagnostic manual. Despite the hoopla, there is no evidence nose-picking or nitpicking are bone fide diseases — and they invent new ones every day — any more than depression or schizophrenia. The idol is scientism, a stance that suggests poetry, love and wickedness are caused things. Modern psychiatric madmen believe patients

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are polluted by abnormal chemicals. When I call them on this ungrounded belief, they have two responses: "We're on die verge of discovering . . . [something]." "It's obvious they have a disease." Sure it's obvious. My German brother, Adolf Hitler, once said that he knew things that were obvious about Jews. I've been told that it's now forbidden to use the reductio ad hitlerum as an argument, but I'm a German so I figure I'm allowed. Am I supposed to pretend he didn't exist or that there's nothing to learn from him? The materialists, all too often by way of the press, are always telling us they've discovered the cause of dreams. It's always some brain centre diat's implicated. Such "discoveries" are no better than some more popular materialistic notions for example, that dreams are caused by an undigested bit of Camembert or by a blob of Skippy peanut butter. Our odd habits of thought are liable to make us forget it's a. person who dreams, and not some material stuff. The brain centre called the nucleus of Edinger-Westfahl and the fragment of Camembert cannot dream, nor can peanut butter, but a person certainly can. A psychiatrist true to his shamanic ancestry will always ground his thinking in dynamic persons, not static materials. My colleagues forget madness is just a variant on the weird behaviour of the rest of us, but when I say this, I'm being as outrageous as Christine. Unconventional behaviour invites us to concoct a label; the offender is a deviant, madman, criminal, revolutionary. The gods illustrate the ubiquity of unconventional behaviour. As far as I can see, any god worth his salt has a repertoire of weirdness at his disposal, as does every literary and mythological figure. It's what makes human conduct riveting. Christine was just as cranky as me. Both of us needed calming by someone like Thomas Mann: .. . [They] must be won over, so much is fact; and they are to be won,

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that must be a fact too, since they are not bad, but only a little stiffnecked and defiant. . . and prone to shuffle their feet.

Christine and I had made a bargain concerning diagnosis. If she put an official diagnosis in the body of the case history, I let her invent an imaginative designation and put it at the beginning of her report as a caption, perhaps something like: "Achilles, leader of armies, conqueror of cities, greatest of runners." She agreed, mostly because she thought the suggestion hilariously funny. Thereafter, her official hospital records started with captions like: "The Liar Who Says He Loves Women." "By the Skin of His Teeth." "The Rogue and Peasant Slave with the Mind of a Princess." This wasn't done for fun — Christine's titles were serious attempts to capture the essence of her patients' character styles. The "Rogue and Peasant Slave with the Mind of a Princess," for instance, was a depressed woman who presented herself as the world's biggest dud. She said she fully expected someday she would be a derelict, except she had spent her childhood as the sexiest, smartest, and best-behaved child in her family, and her young adult life as the most successful and desired woman wherever she went. Would the label, "depressive reaction," have better captured her essence? I remembered how Christine wiggled her bum the first time I interviewed her for her position, so I had a caption for her, too: "The Mind Who Wags Her Tail"

Christine enjoyed working with men, and whenever she was with them was enthusiastic, optimistic and insightful. Although smart, with wickedly shrewd insights into people, she couldn't always apply her intelligence to women. She found in them unattractive qualities;

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to her, most women were mindless flirts and bimbos. But doctors must treat everyone who comes their way, so against her will, and in accord with medical tradition, Christine was required to demonstrate competence widi men and women, young and old, and to work with them whether they smelled like perfume or reeked of the gutter. Christine hated being supervised; she didn't want to learn from me. She felt she could do her learning from books, although that doesn't explain why she'd chosen to work on my service. What Christine really wanted was to help me, and the supervisory situation made that hard for her. She admitted she'd had a history of stimulating men to do better work, to develop new ideas and, through her prompting, become stars, but didn't seem to think this noteworthy. It was just a fact about her and her abilities; in her mind, it was legitimate and natural to promote my development. In my case, it wasn't so easy for her to pull off. In addition to my official educational duties, I had a matching teaching demon, an iron, inner law that demanded I teach. But protocol, custom or my determination weren't going to stop Christine Brydon. Christine insisted that my position didn't leave room for the uniqueness of every situation, and was therefore just another example of the dumbing down of psychiatry. She scoffed when I said the question was whether or not she felt she was a student. She changed the subject to the problems of academia. "Has this profession no understanding of its history of scholarliness, its philosophical grounding?" she complained. "No one can do this work without at least some bits and pieces of a classical education. I sometimes get the feeling that, instead of trying to understand how the Greeks struggled with the problem of mind, people in this field struggle to ape Oprah Winfrey's understanding of mind." Christine was a pain in the neck, always on the attack. At first, I thought she was tilting at windmills, but it turned out hers was a well-

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reasoned system of skepticism — and I'm a sucker for skepticism. Christine's antics mirrored what I was always tempted to say, except I still wanted to be popular, so I (sometimes) held my tongue. The trouble with hold-your-tongue wisdom is that it's shallow. On automatic pilot, I'm inclined to question every truth; but I also know all-embracing disbelief is impossible. The problem arises when doubting becomes a system. Skepticism is really just one more possible mindset — a philosophical stance, if you like — that helps us play, make jokes and see the ironies of life, for starters, not to mention change our minds. But skepticism is just as seductive as the solid beliefs of Osman Awad, Leila Singh and Jim Forster — who Christine called "the drivel-king," the "pudding-realist" and "the lover boy," respectively.

Without me knowing it, Christine had persuaded my secretary to give her access to the computer, and extracted from it a book of mine that was in preparation. Chapter by chapter, she made copies until she had the whole thing. Then she told me. I was annoyed, but what could I do? Report her to the education committee? Pilfering my book out of the secretary's computer was enough to get her in big trouble, but Christine insisted her behaviour was legitimate and honourable. I called it a violation of my privacy, not to mention a corruption of my secretary. Christine didn't care what I said, and dared me to do something about it. Then there was Christine's contention that if she didn't want to work with women, why should she? In my supervisory meetings with her, she refused to tell me about her patients. She had other things she vitally wanted to talk about: me, my book, intellectual matters, the politics of the Institute, the stupidity of the world at large. Every day, Christine put a piece of my book in my mailbox, along with a sharp and exhaustive critique. Her big complaint was that I'd said I hadn't

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wanted to write a boring, standard textbook, but that I nevertheless kept making assertions and rational arguments and summoning lists of supportive facts and quotations. It wasn't the content to which she objected, it was the form and style: "Intensify!" "Make your point with stories." "These sermons bore me." tiC ' I" Stop it! Christine used her literary skill to challenge me and to critique what I'd written. Still, Christine was a student and a psychiatric greenhorn, and her behaviour, to say the least, was outrageous. And then there was me: how dare I comment on her arse, if only in my head or on the page? On the other hand, how dare she extract my book from the computer; she might as well have pulled out my dick. To top it off, I conspired with her in her rebelliousness. Since it would obviously feed into her defiance, suggesting to Christine that she should put captions on her case histories was pretty damn silly — even though it might have been harmless with a different resident. Didn't the medical records department complain, and wasn't there eventually a memo from the Clinical Director?

For me, the worst part was that Christine had stolen the role I cherished for myself. She scorned bureaucrats and I had to defend the system. How could I undo this, I wondered, without squelching Christine's imagination and without turning myself into one of those pale criminals — an official who tells people to "conform to the rules because it is a requirement." One day, as Christine complained yet again about some administrative requirement, I said, "Christine, you are a bloody thief. Here I am, a quiet rebel, trying to get away with being a nonconformist and

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hoping to pass on my gospel to a few students, and you come along and steal my thunder. If I told you we shrinks have to be careful not to fall into the trap of making our patients conform, turning them into 'nice' people, you one up me and give me a lecture about normalizing you, making you 'nice' by demanding you write regular assessment notes, or insisting that you tell me about your patients. I've arranged my life so that I can think of myself as a maverick, and here you come along and insist that you are the maverick while I am just another administrator. "But you know I'm not just joking around about this, Christine. Our conversations take only one form: you're the free spirit and I'm the rule-giver who tries to squelch you. How the hell did we get into this game? It's as though there are only two kinds of people, free spirits and enforcers. The worst is that I always end up being the enforcer. How did we get into this?" Christine was untouched by my jocularity. Her flashing eyes weren't the eyes of eroticism; she was infuriated by what I'd said. "You just want me to be a yes-man," she objected. "You can't fool me with your joking around. You remind me of that guy at the UN, Kofi Annan, always talking in his sweet, soft voice when you can see that he is boiling with rage underneath. You're furious at me and you just want me to knuckle under. I came to work on this service because I'd heard that you weren't like that, but I see you're like all political correctness freaks, pretending to be so moral and good-natured, but full of poison underneath, with your 'zero tolerance' and your campaigns to humiliate everyone who does something different — or something trivially stupid." Yes, I had noticed Kofi Annan's voice. Is mellifluent the right word? Dulcet tones? Yes, I knew about the false democracy of the modern world, leaders who avoid hard decisions, screen their decisions from view with a flood of surveys, all-staff meetings, retreats and question-

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naires, a modern version of bread and circuses that we permit because we fear the day when we ourselves will have to be the leaders. Christine was right. I was a coward like everyone else and didn't want her to hate me. I hadn't used the empathy ploy on her — its sugariness was too obvious for me — but my jokes were a version of the same ploy: I'm just a good natured guy, I know the world is stupid but you and I understand one another and we go along with it out of prudence, okay? To myself I was unwittingly saying, "Don't take a hard decision, don't insist on good work and don't become the leader/father too obviously." I watched and I learned. Christine would not be pigeonholed as a liberal, a socialist, or a reactionary. Like all people, she was composed of fragments of many things. There is no such thing as a rational world, plan or system; there are only bits of rationality, some good and some stupid. She left me reeling. "You damn politically correct conformists are systematic racists, even though you deny it," she railed. "You're intolerant of non-conformity and don't understand about 'good' bigotry, the bigotry against politicians and administrators, good because diese people need to be criticized to keep them on their toes — as long as it doesn't turn into a witch hunt. But that's what happens. Take Bill Clinton, for example. Philip Roth said that when Clinton was in trouble they should have put a sign on the White House that read, 'A human being lives here.' Why isn't there action against welfare bums, or psychiatric drug propagandists, to keep them on their toes? You, for example, don't flatly say the guys who push drugs are wrecking psychiatry, even though you slyly insinuate it all the time." Well, /thought I'd been braying like an ass about the drug idiocy, but . . . "The worst racism of all," Christine continued, "is the war that's been waged for 30 years against European men. All men are under

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attack, especially the scholars and the warriors. I hadn't really used the word 'warrior' until I heard you use it, Gordon, but it's a very good word. How the hell can the world survive without warriors? What joyful and admiring image of men can we have unless it's as people who protect the weak and the women?" "Gordon?" Since when was I "Gordon" to this young whippersnapper? Christine knew what the Spartans discovered 2500 years ago — that victors who seek the approval of other states, and who placate the conquered, are not thanked.

I had to focus more on Christine's uniqueness — her madness — than on the madness of her patients. She told me nothing about them anyway. But my way of talking to Christine also smacked of impropriety; psychiatric educators frown on anything that suggests a supervisor is acting like a therapist. It's not that Christine complained about me — on the contrary, she probably thought I was a wimp, beating around the bush instead of tackling her head-on. My answer to the concern about supervision turning into psychotherapy is to tell my colleagues they shouldn't be so earnest. Neither psychotherapy nor supervision are holy procedures; they're just good, serious talk about what's going on. I'm not saying talk isn't powerful, it's very powerful indeed, but the real issue is whether the power of talk is used for good or evil. The anxiety of my disapproving colleagues reminds me of the psychiatrists who fear straight talk with patients will cause regression and decompensation. They're the ones who'd disapprove of me working analytically with Mr. Allen because he ranks so high on the scale of unconventionality he has earned the label "schizophrenia." What nonsense. Psychotherapy is only talk, albeit serious and non-traditional talk. But it certainly doesn't damage patients. Nor is

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the study of a student's madness an impropriety. Supervisors and psychotherapists can be ignorant and ridiculous, of course, but that's true of the whole world. What was to be done? Should I have banished any discussion of the things foremost in Christine's mind, the things that most clearly expressed the workings of her soul, the only tool with which she could do her psychiatric work? And besides, despite her unorthodoxy, Christine did good work, and was a font of psychiatric knowledge. Unexpected behaviour is no problem when I'm with a patient because, unless he damages property or disrupts people in adjacent offices, to my mind he can do no wrong. Whatever he does — talk, read a magazine, stand on his head, skip appointments — is 100 per cent him, which is what he and I are trying to notice. As long as a patient pays for the time he's purchased from me, it's not my job to steer, guide, or persuade him to "try." What matters is whether I am smart enough to understand why this is the person he has designed himself to be today, and to understand how his actions fit into his wider life and his past. My job is to connect everything to everything else, to help him wise up about himself. Whatever he does is his most pressing expression of his immediate being. If I interfere with that, it would show I fear knowing certain things about him or, like an old-fashioned fascist, believe I know better than him what he ought to talk about. But what about Christine Brydon? Wasn't she just being who she was? Shouldn't I have demanded that she smarten up, get on the ball, and fill me in on her patients for whom, after all, I'd been responsible? When she said preposterous things, shouldn't I have taught her and showed her she was being preposterous, led her toward the true educational path? Or, if my most highly developed skill was helping people learn more about who they are, wasn't that the best thing I should have offered Christine? When she spoke of me and my foibles, might this have helped us to learn something worthwhile about her

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fear and her own foibles, her fear that I, her hero, might have been flawed? And her fear I might not be able to handle her? Christine lived as though haunted by a question: are women too powerful and potent, even for men who on the surface look heroic? In other words, I eventually realized Christine believed something after all, that she had a leak in her skeptical project of doubting everything. Maybe, if she was outrageous enough, I'd rear up, flex my muscles, and put her in her place. Actually, Christine's madness was perfectly designed to create such a scenario because, if I I'd gotten too nervous I might have reported her to the education committee, and they'd have stepped in and dealt with her. Wouldn't I then have been the powerhouse man who crushed her improper behaviour? To Christine, women were most safely thought of as boring, pathetic, and weak, so boring she wouldn't bother to work with them. It was a safety device; if she never got to know a woman well, she'd never have to find out that women are perfectly competent. Should Christine ever have unearthed that terrible truth about women's strength, wouldn't she become frightened that men were at risk? No, best to believe that all women (except her, and she'd see to it that men were given a leg up) are boring ciphers, while men are heroes. So I said things like: "What is this madness for male heroes who must be stimulated and awakened?" "Wouldn't it be awful if I were a really bad writer?" "I'll bet you were a nervous wreck when you read the first pages of my book." "You were determined to have a really good teacher this year." "Since you rarely end up alone in your office with a woman patient, there must be something about women you don't want to know." "I know women bore you, but since you and I are shamans, we also know about strange things like paradoxical truth, that every great

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truth has its opposite, and that boredom is the perfect cover-up for fascination. Actually, that's one of my rules for myself: if I ever start feeling bored with a patient, I wonder what it is I might be nervously fascinated by. Patients do it, too. "When they say, 'God, you must find me boring!' I always figure they must be worrying that I'm getting very interested in them. So I'm wondering if something like that is going on in you, that there are fascinating secrets in women you don't want to know about. Men are the opposite; they're always of high interest to you, even me and my book. I sometimes get the feeling that your male patients are all a mixture of Muhammad Ali, Achilles and Frederick the Great." Christine's reaction was to stay silent. She preferred controversy, but once in a while she could let herself be pensive. I didn't bring up her mother, her father, her husband or her brother, or dreams and sex — as I might have had she been my patient. My interpretive comments were psychotherapeutic, albeit cautiously so. But had Christine herself mentioned a parent, personal madness, or scandal, I wouldn't have backed off. For her part, Christine frenetically analyzed me, the hospital organization, and the culture at large. At first glance, it seemed like she also avoided all analysis of herself. Like Dave Long, Christine had a noisy exterior that belied her tender innards.

Recently, Christine told me, she'd talked to Osman Awad, now a staff psychiatrist at the Clarke, and he'd told her of his interest in cognitive behaviour therapy (CBT) and interpersonal therapy (IPT) — modern fads that will fade. The new terms are, of course, gobbledygook; could there be a psychological approach to patients that was not interpersonal, cognitive or behavioural? I don't much like the word psychotherapy, either, because therapy is imbedded in it, a word that

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conjures thoughts of illness and disease. For me, psychoanalysis is the best word, but I also like soul-talk, thymos-ta\!&. or /0gw-talk. Maybe my throwaway line is best: psychotherapy is talk between worried citizen and wizard. I frequently saw a harried Osman in the corridor rushing to the elevator, briefcase in hand. He had started wearing a necktie and jacket, as I did until recently, indicating he'd become one of us, the allimportant staff doctors. When he took up his new interests, Osman didn't understand he'd sold his soul and taken up a fad. Once upon a time, Osman's heart was in the right place, albeit a logical, theoretical place. I assumed the anatomical location of his heart was still in order, but at the time he hadn't calmed down enough to talk to people without a slogan, plan, or goal in mind. The new methods he was peddling were manual-based, in other words, perfect for research because they're predetermined by the manual, and therefore measurable. In my mind, I offered him free advice: Two-thirds of your patients will show improvement, Osman; I can tell you this without access to the data you are accumulating. And by the way, did you follow a manual when you wooed your wife? And would you make notes while making love to your mistress?

I pressed on with Christine's supervision, always a bit edgy because it so little resembled the supervision I usually do. Sometimes, she responded to my remarks scornfully, but once in a while she regarded me with a mixture of uneasiness, relief and thoughtfulness. Once or twice, she even confessed to being confused. I never responded to Christine's critiques of my book, but they affected me. Week after week, Christine dropped off her comments in my mailbox. Sometimes her ideas provoked in me those two predictors of change — restless sleep and unsettling dreams. Despite myself,

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I'd allowed Christine to become a muse. She insisted I face up to my fear of being literary and flamboyant, and scorned my addiction to facts and information. Her mad provocations made me pay attention, and helped me to let go of old hopes that there could ever be an accurate and logical science of mind. As Christine brought about this change in me, she couldn't know she was inviting me to let my father die away and to awaken my mother in me. For her part, she was keeping me, the father — that is to say, her father, all fathers — alive in her. My father had led me to good sense, arithmetic order, and facts. My mother was spit and venom, and perfumed, imaginative sighs. I had clung to the fraudulence of the psychiatric enterprise for a long time, but over the years it had begun to crumble. Christine pushed me into seeing just how sermonizing and intellectually vacuous I'd become. A Victorian Order nurse who'd fed me waffles in 1945, and my grandparents celebrating my arrival in Germany in 1958 also did their share. Christine fed and celebrated me, and helped me clear out what was left of the bigotry I'd honed into a psychiatric style.

Once I'd regained my composure, Christine began to look different. Like my Oma and Cathy Jones, Christine turned into a spectacle of sumptuous femininity. Her eyes and teeth shone more brightly, her nails lengthened and her bottom seemed svelte and sturdily alive. As always, it was most obvious in her fingers and lips. Christine was furious I wouldn't acknowledge her as my muse, and hinted she would take her revenge by having an affair with one of my patients, or a previous supervisor. Christine didn't change me on her own; I was already well along that road. But she helped me to tell stories as personally and specifically as I could. The uniqueness of events had become more central to me, and generalizations about the nature of man started to stick more

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than ever in my craw. My muses had corrupted me, and brought me to life. Most important of all, I finally figured out that, if the worlds of sex and intelligence can be transposed, so could the worlds of madness and sanity.

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CHAPTERJlillEfEEn

Finis QpERis

On an autumn evening, a Friday, a telephone message from Cathy awaited me when I got home. In a matter-of-fact voice, she said, "Hi Warmie, could you call me when you get in? I have good news and bad news." There had been no hints in Cathy's letters or in her occasional phone calls that gave away what she meant, nor had there been any troubling news that I knew. I phoned back at 9:00, and again at 10:30. No answer. I called on Saturday morning; no answer. At noon on Saturday, Cathy's aunt phoned and told me she had died. The doctor said she'd had an attack of asthma during the night and had stopped breathing. I phoned the doctor, explained who I was, and hinted that I knew more than I'd mentioned, but he courteously explained that she had stopped breathing. Finis opens. Oh my God, I thought. What a pain. I was supposed to go to the ballet on Tuesday and now I'll have to go to a funeral. As I thought this, I noticed the tears in my eyes and had flashes of Cathy's face, dead, and tear-stained like mine. But I am a doctor; I know how to turn into ice. After my initial bizarre reaction, I grieved, but only in a muted way. Cathy's life had come to an end, which meant her suffering was over. Hadn't her telephone message said, "I've

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got good news and bad news"? The good news was the end of the goddamn misery, suffering, and loneliness. But it was also good that death wasn't Cathy's whole story. There was also honour, worth and struggle. The doctor in me resolved to be sensible. I didn't excitedly phone Cathy's family, spilling the beans that her death had been a suicide, nor did I pressure the family doctor to investigate further. In my mind, I also gave Cathy a gift. "Finis opens,''I'd said aloud, a glamorous Latin epitaph for her, a final, dramatic flourish, and my little tribute to her. No, I didn't grieve in the usual sense, but for a week or two I shook my head a lot — sort of amazed, stunned, and relieved. It's only now, as I write these words, that I can weep. What an astonishing ordeal, labour and trial she and I had been through. Dare I think of it as something else; dare I think of it as an adventure? Cathy would have liked chat idea, but would the world approve? Cathy's death condemned me to another life sentence, condemned me to be ordinary and human, the same penalty imposed on me by Graham's death. I'll always be haunted by the idea that there are things I ought to have said to Cathy, although I'll be damned if I know what they are. After her death I round two quotations in Cathy's file I'd put away years ago — two more epitaphs — copied by me onto a scrap of paper. The first was from Thomas Mann, the second, Miguel Cervantes. . . . they and the whole audience espoused the view that rejection is a destiny like any other, with a dignity of its own. Every condition is a condition of honour . . . We cannot all be friars, and many are the ways by which God leads his own to eternal life.

Finally, there was this poem by W. B. Yeats. It could only have been written on behalf of Cathy.

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Had I the heavens' embroidered cloths, Enwrought with golden and silver light, The blue and the dim and the dark cloths Of night and light and the half-light, I would spread the cloths under your feet: But I, being poor, have only my dreams; I have spread my dreams under your feet; Tread softly because you tread on my dreams.

I'd learned from Cathy, and she inspired this book. I'd set out to mother her and she gave birth to me, I miss her, and swear she is my final muse.

We can't as an act of will decide on our myths. The culture and the unconscious have minds of their own; they pick our myths for us. I used to think we were entitled to live by any myths we wished, but I'm not so broad-minded anymore. Now, I stick with stories that have withstood the test of time. The Greek myths are my favourites, and that's why Cathy is my final muse, because after all, she was my first. And, yet, secretly and potently, my mother may turn out to have been the first, though all the same the last. Thank God there are only nine Muses because I couldn't handle one more. In a crazy way, I've mixed Cathy up with Carol, a foster child who lived with my family after my father was released from the internment camp. A series of children had lived with us in 1942 and 1943 (most of the internees stayed until the war ended in 1945, but through the intervention of friends, my father was released late in 1942). But in 1943, Carol, a newborn, came to live with us. She was Jewish and her mother was unmarried. To me, it's still astonishing that Jews, in the middle of World War n, would have boarded their child with a German family. Although her mother visited weekly with her married

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boyfriend, Carol was treated as our very own child. No one said so, but in my mind, she was being raised as a nice German girl. We loved her and when, at age two, she left, we were devastated. We'd assumed she would stay forever. On the day I got the news that Cathy was dead, I remembered Carol, who I thought I'd forgotten. She'd been my baby sister, and I last saw her 58 years ago. I was acutely aware that Carol's parents were Jewish. To me, they even looked Jewish, though I had no image in my mind of what a Jew should look like. We lived in a WASP neighbourhood and the only Jew I'd ever met was the boy who, despite the sign that said, "Gentiles Only," was on the beach at Lake Wilcox. To my amazement, Carol's father occasionally brought me gifts. He had noticed I liked building model planes and he brought models larger and better than I could afford. He also noticed I used old, safety-razor blades to shape the balsa wood, and had the inevitable nicks and cuts on my fingers. So he bought me an X-Acto knife I treasured for many years.

The patients who I assess in the interviewing seminar meet with me and, after 30 minutes, disappear into history. Like Cadiy and Carol, they come and then they are gone, like my students — but none are forgotten. I blunder into old students in the corridors of the hospital from time to time, and am embarrassed when I don't remember their names. Worse, I was recently shocked when I did not recognize my exwife at a wedding. Absolutely gone, I guess — except as a piece of history. Captain Ahab, intent on finding Moby Dick, puts it all into perspective for me when he hoists his tot of rum and, with the crew of the Pequod, drinks a toast: "Like life, gulped and gone." As I've said earlier, I regularly see Osman Awad striding toward the elevator carrying his briefcase. He is well thought of in the department

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of psychiatry, and students enjoy his teaching. When we bump into one another, his eyes light up enthusiastically and he greets me warmly. But I've got the goods on him — he still thinks I'm a villain. A student once snitched on him, reporting to me that Osman had told him to avoid me as a supervisor. Dave Long also shows up in my corridor now and then, as does Christine Brydon. Dave's inner poetry remains concealed from the casual observer, but on my wall, alongside portraits of Mann, Shakespeare and Wittgenstein, I've hung his poem. Klimpt's luscious portrait of Danae is there, too, as is my old grandmother — and Zeus's golden net. Christine has gotten plump but she still wiggles. A few days after the World Trade Center bombings, she cornered me, and as though we'd never stopped our meetings, carried on with her diatribe: "We'll see what happens now, whether the Yanks decide to act like warriors or whether they'll have to smother their actions with consultations, alliances, explanations — bloody excuse-making, I call it — instead of doing the right thing." I've heard that Leila Singh and Jim Forster are now in private practice, and recently I saw them going into the auditorium together. They were part of an enthusiastic crowd of people attending a conference on some psychiatric public relations triumph, something important like "sleep hygiene," masterful advice bequeathed to us by years of research: don't drink coffee for a few hours before bed, have a quiet room, develop regular sleep habits, etc. This advice, when offered by a psychiatrist, earns him more than $100 an hour. As he walked into the auditorium, I noted that, like Lewis Caroll's white rabbit, Jim was still rushing. Leila smiled her sweet smile and wore Western clothes. Was it my imagination, or did she look bruised and tender? If she was now less sure of herself, had Leila become wiser? I've heard no further gossip about her, but I expect she's still licking her wounds. Am I different because I've had my own analysis, or is it life events

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that have shaped me? Could it really be true that it's all in my genes, or is it just luck? Perhaps it was the nine Muses, my Muses, who unsetded and woke me to life. They're mine — the many people I've loved, inspiring and passionate, both consumed by the bright sexuality of mind and body, and, since love is folly, broken by loneliness and despair. A few weeks ago, I had lunch with my difficult mother, now 92 years old. She looked across the table with a twinkle in her eye and remarked: "It's hard living without a woman." She paused, and twinkled a bit more. Was it Zeus's golden web glittering in her eye, the net that redeems me from my years of exasperation with her? "But with a woman it gets crowded

A noose has choked off my old way of life. I've long abandoned professional politics, stopped reading psychiatric journals, and have written no new articles for journals. The referees who screen such articles, more than anything else, have become censors and protectors of the faith. Anything that deviates from the faith is screened out — and as I've said, I'm no longer a believer. The noose around the neck of my past tightens further, the heat increases, and the threatening clouds signal the incoming storm. In 1998,1 asked my mother about the events of 1939: "What exactly happened when the RCMP came that night? How many of them were there? Was it really four in the morning? Did they search the house, and use crowbars on something?" My memories were pretty much right. And then, 25 years after the traumatic ending of my analysis, I asked the long-delayed question: "When they took Pappa away, was I very upset?" "No, you weren't," said my mother. "You were a very good boy. But

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/was very upset. I used to go into the bedroom and cry, I had panic attacks, and couldn't sleep for almost a year." "When you went into the bedroom, did you cry into the mattress?" "I did. You remember that?" I knew it because I had lived it out in myself when I lost my own analyst-father in 1968. Phil Holzman and I had thought it was me lying on his couch for four years. Little did we know it was my mother, the mother I never wanted to be. I was thunderstruck that I had so dramatically identified with my mother — especially since I had assured myself that I would never be like her. The identification was profound and detailed, the absorption of an injury that was in someone else, and relocated in me. My mixedup reactions to my analyst, Phil Holzman, and to my teachers, Herb Schlesinger and Bob Wallerstein, were samples of the same psychological trick. At first I thought they were German. Then they, the Jews of the world, were no longer injured; they were German like me, and therefore okay. It's the guilt of the survivor, whether it's the young generation of Jews who were spared the Holocaust, or the young generation of Germans who are now spared the blame. While this story revealed a vital and eternal truth about me, it was also a defensive falsehood — I was thrilled to be thunderstruck by rny mother's information. It meant that I could indulge my preferred madness: it wasn't me who had a bad separation reaction to loss, after all. I could cling to my belief I was immune to the loss of fathers, since it was her, not me who'd been upset. To lock in my immunity idea, and to illustrate the power of identification, I frequently told my students this amazing story of a perplexity of deaths.

When I was a child, my fainting and panic attacks had proved to me I was a sissy and a girl, my greatest fear come true. And yet I also

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feared being a boy. I was more rough-and-tumble than most, but a fear of boyishness made me hide it from adults — with them, I was very well behaved. I still maintain that goodbyes and losses don't bother me. As a result, I'm extra vigilant about my patients' reactions to my absences, because I'm liable to underestimate how much it might affect them. I can't fear losses; I'd be a sissy — like my mother who reacted so strongly to my father's internment. But I hate being alone and, old bachelor that I've become, the absence of a woman in my life makes me feel like a social misfit. If I invite a woman to dinner, I'm liable to suffer little hints of anxiety, fearing that the whole anticipation of the evening is a stupid illusion, the universal illusion of togetherness: "You're no one till somebody loves you . . ."

Greek mythology saves all of us from die grim realities of madness. It also teaches us how we might defang, reframe, and refresh the grim realities we all seem to face. The greatest of teachers was Zeus himself, that silly, impulsive philanderer. How did the old fool pull off such a trick? By way of two heroic deeds: the creation of the world of the Olympians and the conception of Helen of Troy. I've told you the first of these stories, how Zeus swallowed the universe, then vomited it out again, transformed, to our eternal benefit. That act created the world of the Olympians, the world diat sparkles, remembers and speaks. Zeus's second heroic deed was to force Nemesis — "necessity" — to give birth to beauty. Zeus was attracted to mortal women and had no interest in tampering with the Fates. The Fates were all women, all right, but they were also ancient, disturbing, and hostile. Zeus preferred to dabble with those ancient Spice Girls, die beribboned maidens who played in the fields with the beautiful white bulls. But one day, Zeus changed. He became enamored of the Fate we

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know as Nemesis. He'd grown up by this point, and was ready to love an adult woman, rather than always falling in love with giddy young girls. At first, Nemesis tried to elude Zeus by fleeing, and changing herself into many slippery shapes. When the mad flapping came to an end, with Zeus as swan, and Nemesis as goose, the two were joined. He had forced her to yield. The way of the world has been fundamentally altered by this event. Nemesis — necessity — was forced to yield. Ordinarily, we're all inclined to yield to necessity, but these days, strangely, it's the other way around, and grim reality, just slightly, seems a little less grim. The Olympians have been obliged to open a window to hope, although we should not allow ourselves to think of great hopes, high hopes. Like the hope that emerges from Pandora's box, this hope is delicate and tiny. From her "box," Pandora's femininity, emerges the same yielding good Nemesis has surrendered to us. Important stories are always repeated; that's why myths are ever present in opera, cartoons, art — even in the names of automobiles. Zeus therefore continues in his disguise as a swan, and repeats his seduction with Leda. From Nemesis' womb, a white egg appears, and is transported by Hermes into Leda's womb. From that egg emerges a perfectly formed, tiny Helen, the most beautiful woman who ever lived. Zeus has forced necessity to yield up beauty. This is the second of the great stories in which Zeus teaches psychiatrists how to do their work. The tragic schizophrenic man or woman, are they fated to be forever mad? Is schizophrenia a dreadful chemical destiny, a fate brought upon its victims by Nemesis? Or can we, like Zeus, struggle against the inevitable, wrench from it a small victory, a fragment of beauty in the midst of suffering? Are we grownup enough to love the mature and adult woman, Nemesis, and seduce her into yielding up her beauty? In truth, psychiatrists have no choice. Mature or not, we also must

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fulfill our destinies, which is to change destiny. Like the ancient Greeks, we must make a shift, give up power as our raison d'etre, and shift our interest toward beauty. We will never be able to bathe the whole world in light, as Zeus did, but much will be gained if we can splash droplets of light on the world, and into the lives of the mad. Stern reality never ends, of course, but before Zeus brought forth his era of the Olympians, grim reality was just plain grim. Now something is different; grimness has taken on a new, barely perceptible glitter. When armed with this new perspective, the ironies of life become visible to us, as does the silliness, the humour, and the realization that everything that's been thought can be thought over more than once. We can smile at our own foibles and at the stupidity of the world, and, once in a while, avoid the unwarranted and grim conclusion that madness is an incurable disease. It's not that; it's a way of life for some people with whom psychiatrists sometimes talk. This is the model of the world I choose. If I'm smart, I'll see mental illness for what it is, just life twisting and turning before my eyes. With the benefit of Zeus's inspiration, I can grit my teeth and emulate him, knowing Nemesis, the Fates and Cronus will always resist my caresses at first. I'll respond to their resistance by increasing my ardour, and by perfecting my skills of seduction. Like Zeus, I'll find scraps of beauty in every evil or madness that afflicts my patients. Zeus overcame his fear of the Fates, as incarnated in Nemesis. Her maturity was no longer an obstacle, or an eternal biological impediment. Zeus lost interest in the pretty Spice Girls who played with the bulls, and if I ever become a grown-up, I'll do the same. I'll lose my fear of destiny, and once and for all, stop believing my patients are somehow chemically and biologically unfit.

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My mother, my first and last Muse, gets confused these days, but she's still herself. At lunch, she recently asked me my name. "I'm Gordon." "Oh, yes, Gordon. How old are you?" t( o« • » Sixty-nine. "Sixty-nine? . . . " She giggled mischievously into her hand. "It's time to get married!" It's quiet and neither of us speak, but I smile ruefully at her confused alertness. "The girls that work in the home are so well trained. They are very good housekeepers. You ought to marry someone like that." I smiled and shook my head, but suddenly she corrected herself. "Maybe you shouldn't marry a good housekeeper. Maybe you should marry a sexy housekeeper." My mother's native instinct, her life-long passion, has been to be unrelentingly critical and mean. So I have to give credit to Zeus for giving a befuddled old woman that hilarious, glittering line.

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AFTERWORD

The names of the patients and students have been changed in this book, as have the names of some of my friends. Graham Copeland had a distinguished musical career, but did not discover the secret of Bach's Musical Offering. That discovery was actually made by the musicologist Ursula Kirkendale, who I have heard of but never met. I have used her story to disguise Graham's identity. My colleague Robert Maunder wrote the poem, "This is a Horse," not Dr. Dave Long. Another colleague, Jack Lieber, wrote the untitled poem about the shaman sitting in his cave. You will have noticed a skew in the way I have presented the cases: I have recorded a lot of my talk, and little of what the patients said. In the consulting room it's the opposite; the psychiatrist is quiet, and his moments of talking are only very occasionally long-winded. What patients say to their doctors is easy to report. But how the psychiatrist responds and enters into the dialogue is harder. With-out knowing about the psychiatrist's own life, his private musings and how he speaks to his patients, how can the psychiatric story come to life? I hope I've allowed for that. Robin Roger and Jack David read and criticized several versions of

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this book. More than I like to admit, their advice led to improvements, especially because they insisted I should reveal things about which I'm usually circumspect. My editor, Kevin Connolly, frequently unsettled me by understanding my intent too well; when I read his critiques, I wondered if I'd violated my Hippocratic oath by revealing medical secrets improperly. Despite my stubborness, he got me to improve my petrified medical language and prodded me into making this a much better book.

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