In my post (Feb 4, 2009) about physicians who are or become writers I neglected to mention Irvin D. Yalom. Yalom is Professor Emeritus of Psychiatry at Stanford University who has written two highly regarded textbooks, Existential Psychotherapy and The Theory and Practice of Group Psychotherapy, as well as several short stories and novels related to his therapeutic practice.
On his website he notes that it was “mainly in fiction where I found a refuge, an alternative, more satisfying world, a source of inspiration and wisdom. Sometime early in life I developed the notion—one which I have never relinquished—that writing a novel is the very finest thing a person can do.” And while he decided to a pursue training in medicine he knew from the beginning that he would eventually go into psychiatry.
In his novel The Schopenhauer Cure Yalom describes the experience of a psychotherapist who, when confronted with his own mortality following a routine physical exam, begins to wonder about his former patients and whether or not he made any difference in their lives. He is especially interested in one patient who he treated unsuccessfully for sex addiction many years ago. Julius tracks down this individual, Philip, who much to his surprise has become a philosophical counselor dedicated to educating his clients about the power of Schopenhauer’s philosophy in overcoming their problems.
Throughout the novel, Yalom describes Julius’s ruminations as he approaches the end. He sees a woman walking toward him: She’s probably no older than me. In fact, she’s my future—the wart, the walker, the wheelchair. As she came closer, he heard her mumbling. And he comes to the realization that …to grow old gracefully I had to accept the limiting of possibilities. No longer would any “nubile, breasty girls with the Snow White faces … turn his way with a copy smile and say, “Hey, haven’t seen you here for a while. How’s it going?”
And yet, at the same time he is aware that: Though he had loved Miriam from the moment he laid eyes on her in the tenth grade, he simultaneously resented her as an obstacle blocking him from the multitude of women he felt entitled to enjoy. He had never completely acknowledged that his mate-search was over or that his freedom to follow his lust was in the slightest way curtailed.
What is one to make of this apparent contradiction? Whenever I think about this sort of dilemma, I recall a remark Jane Smiley made in an essay about marriage:
Let’s say there is only one thing we know about men: that they feel a tension between monogamy and promiscuity. Let’s further say that the balance of that tension is different in different men, and that possibly the balance is inherited, and it changes as the men age, sometimes from monogamy toward promiscuity and sometimes from promiscuity toward monogamy.
Much of the Schopenhauer Cure describes the meetings of Julius’ therapy group composed of former clients, including Philip who is relentless in his explanations of Schopenhauer’s philosophy. In this way Yalom contrasts his own approach to therapy with Schopenhauer’s pessimistic views about the conditions that give rise to change.
It’s not ideas, nor vision, nor tools that truly matter in therapy. If you debrief patients at the end of therapy about the process, what do they remember? Never the ideas—its always the relationship.
We should treat with indulgence every human folly, failing and vice, bearing in mind that what we have before us are simply our own failings, follies, and vices. For they are just the failings of mankind to which we also belong and accordingly we have all the same failings buried within ourselves. We should not be indignant with others for these vices simply because they not appear in us at the moment.
In spite of its academic flavor, I greatly enjoyed reading The Schopenhauer Cure. It is that rare mix of philosophical and personal reflection combined in an ongoing dialogue between individuals who have led lives of considerable interest.