Love's Executioner (21 page)
Read Love's Executioner Online
Authors: Irvin D. Yalom
Tags: #Psychology, #Movements, #Psychoanalysis, #Research & Methodology, #Emotions
“I don’t see anything wrong with having some fun. Why take everything so . . . so . . . I don’t know——You’re always so serious. Besides, this is me, this is the way I am. I’m not sure I know what you’re talking about. What do you mean by my entertaining you?”
“Betty, this is important, the most important stuff we’ve gotten into so far. But you’re right. First, you’ve got to know exactly what I mean. Would it be O.K. with you if, from now on in our future sessions, I interrupt and point out when you’re entertaining me—the moment it occurs?”
Betty agreed—she could hardly refuse me; and I now had at my disposal an enormously liberating device. I was now permitted to interrupt her instantaneously (reminding her, of course, of our new agreement) whenever she giggled, adopted a silly accent, or attempted to amuse me or to make light of things in any distracting way.
Within three or four sessions, her “entertaining” behavior disappeared as she, for the first time, began to speak of her life with the seriousness it deserved. She reflected that she had to be entertaining to keep others interested in her. I commented that, in this office, the opposite was true: the more she tried to entertain me, the more distant and less interested I felt.
But Betty said she didn’t know how else to be: I was asking her to dump her entire social repertoire. Reveal herself? If she were to reveal herself, what would she show? There was nothing there inside. She was empty. (The word
empty
was to arise more and more frequently as therapy proceeded. Psychological “emptiness” is a common concept in the treatment of those with eating disorders.)
empty
was to arise more and more frequently as therapy proceeded. Psychological “emptiness” is a common concept in the treatment of those with eating disorders.)
I supported her as much as possible at this point.
Now,
I pointed out to Betty, she was taking risks.
Now
she was up to eight or nine on the revealing scale. Could she feel the difference? She got the point quickly. She said she felt frightened, like jumping out of a plane without a parachute.
Now,
I pointed out to Betty, she was taking risks.
Now
she was up to eight or nine on the revealing scale. Could she feel the difference? She got the point quickly. She said she felt frightened, like jumping out of a plane without a parachute.
I was less bored now. I looked at the clock less frequently and once in a while checked the time during Betty’s hour not, as before, to count the number of minutes I had yet to endure, but to see whether sufficient time remained to open up a new issue.
Nor was it necessary to sweep from my mind derogatory thoughts about her appearance. I no longer noticed her body and, instead, looked into her eyes. In fact, I noted with surprise the first stirrings of empathy within me. When Betty told me about going to a western bar where two rednecks sidled up behind her and mocked her by mooing like a cow, I felt outraged for her and told her so.
My new feelings toward Betty caused me to recall, and to be ashamed of, my initial response to her. I cringed when I reflected on all the other obese women whom I had related to in an intolerant fashion.
These changes all signified that we were making progress: we were successfully addressing Betty’s isolation and her hunger for closeness. I hoped to show her that another person could know her fully and still care for her.
Betty now felt definitely engaged in therapy. She thought about our discussions between sessions, had long imaginary conversations with me during the week, looked forward to our meetings, and felt angry and disappointed when business travel caused her to miss meetings.
But at the same time she became unaccountably more distressed and reported more sadness and more anxiety. I pounced at the opportunity to understand this development. Whenever the patient begins to develop symptoms in respect to the relationship with the therapist, therapy has really begun, and inquiry into these symptoms will open the path to the central issues.
Her anxiety had to do with her fear of getting too dependent or addicted to therapy. Our sessions had become the most important thing in her life. She didn’t know what would happen to her if she didn’t have her weekly “fix.” It seemed to me she was still resisting closeness by referring to a “fix” rather than to me, and I gradually confronted her on that point.
“Betty, what’s the danger in letting me matter to you?”
“I’m not sure. It feels scary, like I’ll need you too much. I’m not sure you’ll be there for me. I’m going to have to leave California in a year, remember.”
“A year’s a long time. So you avoid me now because you won’t always have me?”
“I know it doesn’t make sense. But I do the same thing with California. I like New York and I don’t want to like California. I’m afraid that, if I form friends here and start to like it, I might not want to leave. The other thing is that I start to feel, ‘Why bother?’ I’m here for such a short time. Who wants temporary friendships?”
“The problem with that attitude is you end up with an unpeopled life. Maybe that’s part of the reason you feel empty inside. One way or another, every relationship must end. There’s no such thing as a lifetime guarantee. It’s like refusing to enjoy watching the sun rise because you hate to see it set.”
“It sounds crazy when you put it like that, but that’s what I do. When I meet a new person whom I like, I start right away to imagine what it will be like to say goodbye to them.”
I knew this was an important issue, and that we would return to it. Otto Rank described this life stance with a wonderful phrase: “Refusing the loan of life in order to avoid the debt of death.”
Betty now entered into a depression which was short-lived and had a curious, paradoxical twist. She was enlivened by the closeness and the openness of our interaction; but, rather than allow herself the enjoyment of that feeling, she was saddened by the realization that her life heretofore had been so devoid of intimacy.
I was reminded of another patient I had treated the year before, a forty-four-year-old excessively responsible, conscientious physician. One evening in the midst of a marital dispute, she uncharacteristically drank too much, went out of control, threw plates against the wall, and narrowly missed her husband with a lemon pie. When I saw her two days later, she seemed guilty and depressed. In an effort to console her, I tried to suggest that losing control is not always a catastrophe. But she interrupted and told me I had misunderstood: she felt no guilt but was instead overcome with regret that she had waited until she was forty-four to relinquish her control and let some real feelings out.
Despite her two hundred and fifty pounds, Betty and I had rarely discussed her eating and her weight. She had often talked about epic (and invariably unproductive) struggles she had had with her mother and with other friends who tried to help her control her eating. I was determined to avoid that role; instead, I placed my faith in the assumption that, if I could help remove the obstacles that lay in her path, Betty would, on her own, take the initiative to care for her body.
So far, by addressing her isolation, I had already cleared away major obstacles: Betty’s depression had lifted; and, having established a social life for herself, she no longer regarded food as her sole source of satisfaction. But it was not until she stumbled upon an extraordinary revelation about the dangers of losing weight that she could make the decision to begin her diet. It came about in this way.
When she had been in therapy for a few months, I decided that her progress would be accelerated if she worked in a therapy group as well as in individual therapy. For one thing, I was certain it would be wise to establish a supportive community to help sustain her in the difficult diet days yet to come. Furthermore, a therapy group would provide Betty an opportunity to explore the interpersonal issues we had opened up in our therapy—the concealment, the need to entertain, the feeling she had nothing to offer. Though Betty was very frightened and initially resisted my suggestion, she gamely agreed and entered a therapy group led by two psychiatric residents.
One of her first group meetings happened to be a highly unusual session in which Carlos, also in individual therapy with me (see “If Rape Were Legal . . . “), informed the group of his incurable cancer. Betty’s father had died of cancer when she was twelve, and since then she had been terrified of the disease. In college she had initially elected a premedical curriculum but gave it up for fear of being in contact with cancer patients.
Over the next few weeks, the contact with Carlos generated so much anxiety in Betty that I had to see her in several emergency sessions and had difficulty persuading her to continue in the group. She developed distressing physical symptoms—including headaches (her father died of brain cancer), backaches, and shortness of breath—and was tormented with the obsessive thought that she, too, had cancer. Since she was phobic about seeing doctors (because of her shame about her body, she rarely permitted a physical exam and had never had a pelvic exam), it was hard to reassure her about her health.
Witnessing Carlos’s alarming weight loss reminded Betty of how, over a twelve-month period, she had watched her father shrink from an obese man to a skeleton wrapped in great folds of spare skin. Though she acknowledged that it was an irrational thought, Betty realized that since her father’s death she had believed that weight loss would make her susceptible to cancer.
She had strong feelings about hair loss as well. When she first joined the group, Carlos (who had lost his hair as a result of chemotherapy) was wearing a toupee, but the day he informed the group about his cancer, he came bald to the meeting. Betty was horrified, and visions of her father’s baldness—he had been shaven for his brain surgery—returned to her. She remembered also how frightened she had been when, on previous strenuous diets, she herself had suffered considerable hair loss.
These disturbing feelings had vastly compounded Betty’s weight problems. Not only did food represent her sole form of gratification, not only was it a method of assuaging her feeling of emptiness, not only did thinness evoke the pain of her father’s death, but she felt, unconsciously, that losing weight would result in
her
death.
her
death.
Gradually Betty’s acute anxiety subsided. She had never before talked openly about these issues: perhaps the sheer catharsis helped; perhaps it was useful for her to recognize the magical nature of her thinking; perhaps some of her horrifying thoughts were simply desensitized by talking about them in the daylight in a calm, rational manner.
During this time, Carlos was particularly helpful. Betty’s parents had, until the very end, denied the seriousness of her father’s illness. Such massive denial always plays havoc with the survivors, and Betty had neither been prepared for his death nor had the opportunity to say goodbye. But Carlos modeled a very different approach to his fate: he was courageous, rational, and open with his feelings about his illness and his approaching death. Furthermore, he was especially kind to Betty—perhaps it was that he knew she was my patient, perhaps that she came along when he was in a generous (“everybody has got a heart”) state of mind, perhaps simply that he always had a fondness for fat women (which, I am embarassed to say, I had always considered further proof of his perversity).
Betty must have felt that the obstructions to losing weight had been sufficiently removed because she gave unmistakable evidence that a major campaign was about to be launched. I was astonished by the scope and complexity of the preparatory arrangements.
First, she enrolled in an eating-disorder program at the clinic where I worked and completed their demanding protocol, which included a complex physical workup and a battery of psychological tests. She then cleared her apartment of food—every can, every package, every bottle. She made plans for alternative social activities: she pointed out to me that eliminating lunches and dinners puts a crimp into one’s social calendar. To my surprise, she joined a square-dancing group (this lady’s got guts, I thought) and a weekly bowling league—her father had often taken her bowling when she was a child, she explained. She bought a used stationary bicycle and set it up in front of her TV set. She then said her goodbyes to old friends—her last Granny Goose Hawaiian-style potato chip, her last Mrs. Fields chocolate chip cookie, and, toughest of all, her last honey-glazed doughnut.
There was considerable internal preparation as well, which Betty found difficult to describe other than to say she was “gathering inner resolve” and waiting for the right moment to commence the diet. I grew impatient and amused myself with a vision of an enormous Japanese sumo wrestler pacing, posturing, and grunting himself into readiness.
Suddenly she was off! She went on a liquid Optifast diet, ate no solid food, bicycled forty minutes every morning, walked three miles every afternoon, and bowled and square-danced once a week. Her fatty casing began to disintegrate. She began to shed bulk. Large folds of overhanging flesh broke off and were washed away. Soon the pounds flowed off in rivulets—two, three, four, sometimes five pounds a week.
Betty started each hour with a progress report: ten pounds lost, then twenty, twenty-five, thirty. She was down to two hundred forty pounds, then two hundred thirty, and two hundred twenty. It seemed astonishingly fast and easy. I was delighted for her and commended her strongly each week on her efforts. But in those first weeks I was also aware of a cruel voice within me, a voice saying, “Good God, if she’s losing it that fast, think of how much food she must have been putting away!”
The weeks passed, the campaign continued. After three months, she weighed in at two hundred ten. Then two hundred, a fifty-pound loss! Then one hundred ninety. The opposition stiffened. Sometimes she came into my office in tears after a week without food and no compensating weight loss. Every pound put up a fight, but Betty stayed on the diet.
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