Love's Executioner

Could anything be simpler? One innocent question and its answer. And yet, time after time, I have seen this group exercise evoke unexpectedly powerful feelings. Often, within minutes, the room rocks with emotion. Men and women—and these are by no means desperate or needy but successful, well-functioning, well-dressed people who glitter as they walk—are stirred to their depths. They call out to those who are forever lost—dead or absent parents, spouses, children, friends: "I want to see you again." "I want your love." "I want to know you're proud of me." "I want you to know I love you and how sorry I am I never told you." "I want you back—I am so lonely." "I want the childhood I never had." "I want to be healthy—to be young again. I want to be loved, to be respected. I want my life to mean something. I want to accomplish something. I want to matter, to be important, to be remembered."

So much wanting. So much longing. And so much pain, so close to the surface, only minutes deep. Destiny pain. Existence pain. Pain that is always there, whirring continuously just beneath the membrane of life. Pain that is all too easily accessible. Many things—a simple group exercise, a few minutes of deep reflection, a work of art, a sermon, a personal crisis, a loss—remind us that our deepest wants can never be fulfilled: our wants for youth, for a halt to aging, for the return of vanished ones, for eternal love, protection, significance, for immortality itself.

It is when these unattainable wants come to dominate our lives that we turn for help to family, to friends, to religion—sometimes to psychotherapists.

In this book I tell the stories of ten patients who turned to therapy, and in the course of their work struggled with existence pain. This was not the reason they came to me for help; on the contrary, all ten were suffering the common problems of everyday life: loneliness, self-contempt, impotence, migraine headaches, sexual compulsivity, obesity, hypertension, grief, a consuming love obsession, mood swings, depression. Yet somehow (a "somehow" that unfolds differently in each story), therapy uncovered deep roots of these everyday problems—roots stretching down to the bedrock of existence.

"I want! I want!" is heard throughout these tales. One patient cried, "I want my dead darling daughter back," as she neglected her two living sons. Another insisted, "I want to fuck every woman I see," as his lymphatic cancer invaded the crawl spaces of his body. And another pleaded, "I want the parents, the childhood I never had," as he agonized over three letters he could not bring himself to open. And another declared, "I want to be young forever," as she, an old woman, could not relinquish her obsessive love for a man thirty-five years younger.

I believe that the primal stuff of psychotherapy is always such existence pain—and not, as is often claimed, repressed instinctual strivings or imperfectly buried shards of a tragic personal past. In my therapy with each of these ten patients, my primary clinical assumption—an assumption on which I based my technique—is that basic anxiety emerges from a person's endeavors, conscious and unconscious, to cope with the harsh facts of life, the "givens" of existence.¹

I have found that four givens are particularly relevant to psychotherapy: the inevitability of death for each of us and for those we love; the freedom to make our lives as we will; our ultimate aloneness; and, finally, the absence of any obvious meaning or sense to life. However grim these givens may seem, they contain the seeds of wisdom and redemption. I hope to demonstrate, in these ten tales of psychotherapy, that it is possible to confront the truths of existence and harness their power in the service of personal change and growth.

Of these facts of life, death is the most obvious, most intuitively apparent. At an early age, far earlier than is often thought, we learn that death will come, and that from it there is no escape. Nonetheless, "everything," in Spinoza's words, "endeavors to persist in its own being." At one's core there is an ever-present conflict between the wish to continue to exist and the awareness of inevitable death.

To adapt to the reality of death, we are endlessly ingenious in devising ways to deny or escape it. When we are young, we deny death with the help of parental reassurances and secular and religious myths; later, we personify it by transforming it into an entity, a monster, a sandman, a demon. After all, if death is some pursuing entity, then one may yet find a way to elude it; besides, frightening as a death-bearing monster may be, it is less frightening than the truth—that one carries within the spores of one's own death. Later, children experiment with other ways to attenuate death anxiety: they detoxify death by taunting it, challenge it through daredevilry, or desensitize it by exposing themselves, in the reassuring company of peers and warm buttered popcorn, to ghost stories and horror films.

As we grow older, we learn to put death out of mind; we distract ourselves; we transform it into something positive (passing on, going home, rejoining God, peace at last); we deny it with sustaining myths; we strive for immortality through imperishable works, by projecting our seed into the future through our children, or by embracing a religious system that offers spiritual perpetuation.

Many people take issue with this description of death denial. "Nonsense!" they say. "We don't deny death. Everyone's going to die. We know that. The facts are obvious. But is there any point to dwelling on it?"

The truth is that we know but do not know. We know about death, intellectually we know the facts, but we—that is, the unconscious portion of the mind that protects us from overwhelming anxiety—have split off, or dissociated, the terror associated with death. This dissociative process is unconscious, invisible to us, but we can be convinced of its existence in those rare episodes when the machinery of denial fails and death anxiety breaks through in full force. That may happen only rarely, sometimes only once or twice in a lifetime. Occasionally it happens during waking life, sometimes after a personal brush with death, or when a loved one has died; but more commonly death anxiety surfaces in nightmares.

A nightmare is a failed dream, a dream that, by not "handling" anxiety, has failed in its role as the guardian of sleep. Though nightmares differ in manifest content, the underlying process of every nightmare is the same: raw death anxiety has escaped its keepers and exploded into consciousness. The story "In Search of the Dreamer" offers a unique backstage view of the escape of death anxiety and the mind's last-ditch attempt to contain it: here, amidst the pervasive, dark death imagery of Marvin's nightmare is one life-promoting, death-defying instrument—the glowing white-tipped cane with which the dreamer engages in a sexual duel with death.

The sexual act is seen also by the protagonists of other stories as a talisman to ward off diminishment, aging, and approaching death: thus, the compulsive promiscuity of a young man in the face of his killing cancer ("If Rape Were Legal . . . "); and an old man's clinging to yellowing thirty-year-old letters from his dead lover ("Do Not Go Gentle").

In my many years of work with cancer patients facing imminent death, I have noted two particularly powerful and common methods of allaying fears about death, two beliefs, or delusions, that afford a sense of safety. One is the belief in personal specialness; the other, the belief in an ultimate rescuer. While these are delusions in that they represent "fixed false beliefs," I do not employ the term delusion in a pejorative sense: these are universal beliefs which, at some level of consciousness, exist in all of us and play a role in several of these tales.

Specialness is the belief that one is invulnerable, inviolable—beyond the ordinary laws of human biology and destiny. At some point in life, each of us will face some crisis: it may be serious illness, career failure, or divorce; or as happened to Elva in "I Never Thought It Would Happen to Me," it may be an event as simple as a purse snatching, which suddenly lays bare one's ordinariness and challenges the common assumption that life will always be an eternal upward spiral.

While the belief in personal specialness provides a sense of safety from within, the other major mechanism of death denial—belief in an ultimate rescuer—permits us to feel forever watched and protected by an outside force. Though we may falter, grow ill, though we may arrive at the very edge of life, there is, we are convinced, a looming, omnipotent servant who will always bring us back.

Together these two belief systems constitute a dialectic—two diametrically opposed responses to the human situation. The human being either asserts autonomy by heroic self-assertion or seeks safety through fusing with a superior force: that is, one either emerges or merges, separates or embeds. One becomes one's own parent or remains the eternal child.

Most of us, most of the time, live comfortably by uneasily avoiding the glance of death, by chuckling and agreeing with Woody Allen when he says, "I'm not afraid of death. I just don't want to be there when it happens." But there is another way—a long tradition, applicable to psychotherapy—that teaches us that full awareness of death ripens our wisdom and enriches our life. The dying words of one of my patients (in "If Rape Were Legal . . .") demonstrate that though the fact, the physicality, of death destroys us, the idea of death may save us.

Freedom as a given seems the very antithesis of death. While we dread death, we generally consider freedom to be unequivocally positive. Has not the history of Western civilization been punctuated with yearnings for freedom, even driven by it? Yet freedom from an existential perspective is bonded to anxiety in asserting that, contrary to everyday experience, we do not enter into, and ultimately leave, a well-structured universe with an eternal grand design. Freedom means that one is responsible for one's own choices, actions, one's own life situation.

Though the word responsible may be used in a variety of ways, I prefer Sartre's definition: to be responsible is to "be the author of," each of us being thus the author of his or her own life design. We are free to be anything but unfree: we are, Sartre would say, condemned to freedom. Indeed, some philosophers claim much more: that the architecture of the human mind makes each of us even responsible for the structure of external reality, for the very form of space and time. It is here, in the idea of self-construction, where anxiety dwells: we are creatures who desire structure, and we are frightened by a concept of freedom which implies that beneath us there is nothing, sheer groundlessness.

Every therapist knows that the crucial first step in therapy is the patient's assumption of responsibility for his or her life predicament. As long as one believes that one's problems are caused by some force or agency outside oneself, there is no leverage in therapy. If, after all, the problem lies out there, then why should one change oneself? It is the outside world (friends, job, spouse) that must be changed—or exchanged. Thus, Dave (in "Do Not Go Gentle"), complaining bitterly of being locked in a marital prison by a snoopy, possessive wife-warden, could not proceed in therapy until he recognized how he himself was responsible for the construction of that prison.

Since patients tend to resist assuming responsibility, therapists must develop techniques to make patients aware of how they themselves create their own problems. A powerful technique, which I use in many of these cases, is the here-and-now focus. Since patients tend to re-create in the therapy setting the same interpersonal problems that bedevil them in their lives outside, I focus on what is going on at the moment between a patient and me rather than on the events of his or her past or current life. By examining the details of the therapy relationship (or, in a therapy group, the relationships among the group members), I can point out on the spot how a patient influences the responses of other people. Thus, though Dave could resist assuming responsibility for his marital problems, he could not resist the immediate data he himself was generating in group therapy: that is, his secretive, teasing, and elusive behavior was activating the other group members to respond to him much as his wife did at home.

In similar fashion, Betty's ("Fat Lady") therapy was ineffective as long as she could attribute her loneliness to the flaky, rootless California culture. It was only when I demonstrated how, in our hours together, her impersonal, shy, distancing manner re-created the same impersonal environment in therapy, that she could begin to explore her responsibility for creating her own isolation.

While the assumption of responsibility brings the patient into the vestibule of change, it is not synonymous with change. And it is change that is always the true quarry, however much a therapist may court insight, responsibility assumption, and self-actualization.

Freedom not only requires us to bear responsibility for our life choices but also posits that change requires an act of will. Though will is a concept therapists seldom use explicitly, we nonetheless devote much effort to influencing a patient's will. We endlessly clarify and interpret, assuming (and it is a secular leap of faith, lacking convincing empirical support) that understanding will invariably beget change. When years of interpretation have failed to generate change, we may begin to make direct appeals to the will: "Effort, too, is needed. You have to try, you know. There's a time for thinking and analyzing but there's also a time for action." And when direct exhortation fails, the therapist is reduced, as these stories bear witness, to employing any known means by which one person can influence another. Thus, I may advise, argue, badger, cajole, goad, implore, or simply endure, hoping that the patient's neurotic worldview will crumble away from sheer fatigue.

It is through willing, the mainspring of action, that our freedom is enacted. I see willing as having two stages: a person initiates through wishing and then enacts through deciding.

Some people are wish-blocked, knowing neither what they feel nor what they want. Without opinions, without impulses, without inclinations, they become parasites on the desires of others. Such people tend to be tiresome. Betty was boring precisely because she stifled her wishes, and others grew weary of supplying wish and imagination for her.

Other patients cannot decide. Though they know exactly what they want and what they must do, they cannot act and, instead, pace tormentedly before the door of decision. Saul, in "Three Unopened Letters," knew that any reasonable man would open the letters; yet the fear they invoked paralyzed his will. Thelma ("Love's Executioner") knew that her love obsession was stripping her life of reality. She knew that she was, as she put it, living her life eight years ago, and that, to regain it, she would have to give up her infatuation. But that she could not, or would not, do and fiercely resisted all my attempts to energize her will.

Decisions are difficult for many reasons, some reaching down into the very socket of being. John Gardner, in his novel Grendel, tells of a wise man who sums up his meditation on life's mysteries in two simple but terrible postulates: "Things fade: alternatives exclude." Of the first postulate, death, I have already spoken. The second, "alternatives exclude," is an important key to understanding why decision is difficult. Decision invariably involves renunciation: for every yes there must be a no, each decision eliminating or killing other options (the root of the word decide means "slay," as in homicide or suicide). Thus, Thelma clung to the infinitesimal chance that she might once again revive her relationship with her lover, renunciation of that possibility signifying diminishment and death.

One experiences interpersonal isolation, or loneliness, if one lacks the social skills or personality style that permit intimate social interactions. Intrapersonal isolation occurs when parts of the self are split off, as when one splits off emotion from the memory of an event. The most extreme, and dramatic, form of splitting, the multiple personality, is relatively rare (though growing more widely recognized); when it does occur, the therapist may be faced, as was I in the treatment of Marge ("Therapeutic Monogamy"), with the bewildering dilemma of which personality to cherish.

While there is no solution to existential isolation, therapists must discourage false solutions. One's efforts to escape isolation can sabotage one's relationships with other people. Many a friendship or marriage has failed because, instead of relating to, and caring for, one another, one person uses another as a shield against isolation.

A common, and vigorous, attempt to solve existential isolation, which occurs in several of these stories, is fusion—the softening of one's boundaries, the melting into another. The power of fusion has been demonstrated in subliminal perception experiments in which the message "Mommy and I are one," flashed on a screen so quickly that the subjects cannot consciously see it, results in their reporting that they feel better, stronger, more optimistic—and even in their responding better than other people to treatment (with behavioral modification) for such problems as smoking, obesity, or disturbed adolescent behavior.

One of the great paradoxes of life is that self-awareness breeds anxiety. Fusion eradicates anxiety in a radical fashion—by eliminating self-awareness. The person who has fallen in love, and entered a blissful state of merger, is not self-reflective because the questioning lonely I (and the attendant anxiety of isolation) dissolve into the we. Thus one sheds anxiety but loses oneself.

This is precisely why therapists do not like to treat a patient who has fallen in love. Therapy and a state of love-merger are incompatible because therapeutic work requires a questioning self-awareness and an anxiety that will ultimately serve as guide to internal conflicts.

Furthermore, it is difficult for me, as for most therapists, to form a relationship with a patient who has fallen in love. In the story "Love's Executioner," Thelma would not, for example, relate to me: her energy was completely consumed in her love obsession. Beware the powerful exclusive attachment to another; it is not, as people sometimes think, evidence of the purity of the love. Such encapsulated, exclusive love—feeding on itself, neither giving to nor caring about others—is destined to cave in on itself. Love is not just a passion spark between two people; there is infinite difference between falling in love and standing in love. Rather, love is a way of being, a "giving to," not a "falling for"; a mode of relating at large, not an act limited to a single person.

Though we try hard to go through life two by two or in groups, there are times, especially when death approaches, that the truth—that we are born alone and must die alone—breaks through with chilling clarity. I have heard many dying patients remark that the most awful thing about dying is that it must be done alone. Yet, even at the point of death, the willingness of another to be fully present may penetrate the isolation. As a patient said in "Do Not Go Gentle," "Even though you're alone in your boat, it's always comforting to see the lights of the other boats bobbing nearby."

This question plagues contemporary men and women, and many seek therapy because they feel their lives to be senseless and aimless. We are meaning-seeking creatures. Biologically, our nervous systems are organized in such a way that the brain automatically clusters incoming stimuli into configurations. Meaning also provides a sense of mastery: feeling helpless and confused in the face of random, unpatterned events, we seek to order them and, in so doing, gain a sense of control over them. Even more important, meaning gives birth to values and, hence, to a code of behavior: thus the answer to why questions (Why do I live?) supplies an answer to how questions (How do I live?).

There are, in these ten tales of psychotherapy, few explicit discussions of meaning in life. The search for meaning, much like the search for pleasure, must be conducted obliquely. Meaning ensues from meaningful activity: the more we deliberately pursue it, the less likely are we to find it; the rational questions one can pose about meaning will always outlast the answers. In therapy, as in life, meaningfulness is a by-product of engagement and commitment, and that is where therapists must direct their efforts—not that engagement provides the rational answer to questions of meaning, but it causes these questions not to matter.

This existential dilemma—a being who searches for meaning and certainty in a universe that has neither—has tremendous relevance for the profession of psychotherapist. In their everyday work, therapists, if they are to relate to their patients in an authentic fashion, experience considerable uncertainty. Not only does a patient's confrontation with unanswerable questions expose a therapist to these same questions, but also the therapist must recognize, as I had to in "Two Smiles," that the experience of the other is, in the end, unyieldingly private and unknowable.

Indeed, the capacity to tolerate uncertainty is a prerequisite for the profession. Though the public may believe that therapists guide patients systematically and sure-handedly through predictable stages of therapy to a foreknown goal, such is rarely the case: instead, as these stories bear witness, therapists frequently wobble, improvise, and grope for direction. The powerful temptation to achieve certainty through embracing an ideological school and a tight therapeutic system is treacherous: such belief may block the uncertain and spontaneous encounter necessary for effective therapy.

This encounter, the very heart of psychotherapy, is a caring, deeply human meeting between two people, one (generally, but not always, the patient) more troubled than the other. Therapists have a dual role: they must both observe and participate in the lives of their patients. As observer, one must be sufficiently objective to provide necessary rudimentary guidance to the patient. As participant, one enters into the life of the patient and is affected and sometimes changed by the encounter.

In choosing to enter fully into each patient's life, I, the therapist, not only am exposed to the same existential issues as are my patients but must be prepared to examine them with the same rules of inquiry. I must assume that knowing is better than not knowing, venturing than not venturing; and that magic and illusion, however rich, however alluring, ultimately weaken the human spirit. I take with deep seriousness Thomas Hardy's staunch words: "If a way to the Better there be, it exacts a full look at the Worst."

The dual role of observer and participant demands much of a therapist and, for me in these ten cases, posed harrowing questions. Should I, for example, expect a patient, who asked me to be the keeper of his love letters, to deal with the very problems that I, in my own life, have avoided? Was it possible to help him go further than I have gone? Should I ask harsh existential questions of a dying man, a widow, a bereaved mother, and an anxious retiree with transcendent dreams—questions for which I have no answers? Should I reveal my weakness and my limitations to a patient whose other, alternative personality I found so seductive? Could I possibly form an honest and a caring relationship with a fat lady whose physical appearance repelled me?