The Schopenhauer Cure

A Novel

Irvin D. Yalom

To my community of older buddies who grace me with their friendship, share life`s

inexorable diminishments and losses, and continue to sustain me with their wisdom and

dedication to the life of the mind: Robert Berger, Murray Bilmes, Martel Bryant, Dagfinn

Føllesdahl, Joseph Frank, Van Harvey, Julius Kaplan, Herbert Kotz, Morton Lieberman,

Walter Sokel, Saul Spiro, and Larry Zaroff.

1

_________________________

Every breath we draw wards off

the death that constantly

impinges on us.... Ultimately

death must triumph, for by

birth it has already become

our lot and it plays with its

prey only for a short while

before swallowing it up.

However, we continue our life

with great interest and much

solicitude as long as

possible, just as we blow out

a soap–bubble as long and as

large as possible, although

with the perfect certainty

that it will burst.

_________________________

Julius knew the life–and–death homilies as well as anyone. He agreed with the

Stoics, who said, «As soon as we are born we begin to die,” and with Epicurus, who

reasoned, «Where I am, death is not and where death is, I am not. Hence why fear

death?» As a physician and a psychiatrist, he had murmured these very consolations

into the ears of the dying.

Though he believed these somber reflections to be useful to his patients, he never

considered that they might have anything to do with him. That is, until a terrible moment

four weeks earlier which forever changed his life.

The moment occurred during his annual routine physical examination. His

internist, Herb Katz—an old friend and medical school classmate—had just completed

his examination and, as always, told Julius to dress and come to his office for a

debriefing.

Herb sat at his desk, rifling through Julius`s chart. «On the whole, you look pretty

good for an ugly sixty–five–year–old man. Prostate is getting a little swollen, but so is

mine. Blood chemistries, cholesterol, and lipid levels are well–behaved—the meds and

your diet are doing their job. Here`s the prescription for your Lipitor, which, along with

your jogging, has lowered your cholesterol enough. So you can give yourself a break: eat

an egg once in a while. I eat two for breakfast every Sunday. And here`s the prescription

for your synthyroid. I`m raising the dose a bit. Your thyroid gland is slowly closing

down—the good thyroid cells are dying and being replaced by fibrotic material. Perfectly

benign condition, as you know. Happens to us all; I`m on thyroid meds myself.

«Yes, Julius, no part of us escapes the destiny of aging. Along with your thyroid,

your knee cartilage is wearing out, your hair follicles are dying, and your upper lumbar

disks are not what they used to be. What`s more, your skin integrity is obviously

deteriorating: your epithelial cells are just plain wearing out—look at all those senile

keratoses on your cheeks, those brown flat lesions.» He held up a small mirror for Julius

to inspect himself. «Must be a dozen more on you since I last saw you. How much time

you spending in the sun? Are you wearing a broad–brimmed hat like I suggested? I want

you to see a dermatologist about them. Bob King`s good. He`s just in the next building.

Here`s his number. Know him?»

Julius nodded.

«He can burn off the unseemly ones with a drop of liquid nitrogen. I had him

remove several of mine last month. No big deal—takes five, ten, minutes. A lot of

internists are doing it themselves now. Also there`s one I want him to look at on your

back: you can`t see it; it`s just under the lateral part of your right scapula. It looks

different from the others—pigmented unevenly and the borders aren`t sharp. Probably

nothing, but let`s have him check it. Okay, buddy?»

«Probably nothing, but let`s have him check it.» Julius heard the strain and forced

casualness in Herb`s voice. But, let there be no mistake, the phrase «pigmented

differently and borders aren`t sharp,” spoken by one doc to another, was a cause for

alarm. It was code for potential melanoma, and now, in retrospect, Julius identified that

phrase, that singular moment, as the point when carefree life ended and death, his

heretofore invisible enemy, materialized in all its awful reality. Death had come to stay, it

never again left his side, and all the horrors that followed were predictable postscripts.

Bob King had been a patient of Julius`s years ago, as had a significant number of

San Francisco physicians. Julius had reigned over the psychiatric community for thirty

years. In his position as professor of psychiatry at the University of California he had

trained scores of students and, five years before, had been president of the American

Psychiatric Association.

His reputation? The no–bullshit doctor`s doctor. A therapist of last resort, a canny

wizard willing to do anything he had to do to help his patient. And that was the reason

why, ten years earlier, Bob King had consulted Julius for treatment of his long–standing

addiction to Vicodan (the physician–addict`s drug of choice because it is so easily

accessible). At that time King was in serious trouble. His Vicodan needs had dramatically

increased: his marriage was in jeopardy, his practice was suffering, and he had to drug

himself to sleep every night.

Bob tried to enter therapy, but all doors were closed for him. Every therapist he

consulted insisted that he enter an impaired physician recovery program, a plan which

Bob resisted because he was loath to compromise his privacy by attending therapy groups

with other physician–addicts. The therapists wouldn`t budge. If they treated a practicing

addicted physician without using the official recovery program, they would place

themselves at risk of punitive action by the medical board or of personal litigation (if, for

example, the patient made an error of judgment in clinical work).

As a last resort before quitting his practice and taking a leave of absence to be

treated anonymously in another city, he appealed to Julius, who accepted the risk and

trusted Bob King to withdraw on his own from Vicodan. And, though therapy was

difficult, as it always is with addicts, Julius treated Bob for the next three years without

the help of a recovery program. And it was one of those secrets that every psychiatrist

had—a therapeutic success that could in no way be discussed or published.

Julius sat in his car after leaving his internist`s office. His heart pounded so hard

the car seemed to shake. Taking a deep breath to quell his mounting terror, then another

and another, he opened his cell phone and, with trembling hands, called Bob King for an

urgent appointment.

«I don`t like it,” said Bob the next morning, as he studied Julius`s back with a large

round magnifying glass. «Here, I want you to look at it; we can do it with two mirrors.»

Bob stationed him by the wall mirror and held a large hand mirror next to the mole.

Julius glanced at the dermatologist through the mirror: blond, ruddy faced, thick

spectacles resting on his long imposing nose—he remembered Bob telling him how the

other kids taunted him with cries of «cucumber nose.» He hadn`t changed much in ten

years. He looked harried, much as when he had been Julius`s patient, huffing and puffing,

arriving always a few minutes late. The Mad Hatter`s refrain, «Late, late for a very

important date,” often had come to mind when Bob rushed into his office. He had gained

weight but was as short as ever. He looked like a dermatologist. Whoever saw a tall

dermatologist? Then Julius glanced at his eyes—oh oh, they seemed apprehensive—the

pupils were large.

«Here`s the critter.» Julius looked through the mirror as Bob pointed with an

eraser–tipped stylus. «This flat nevus below your right shoulder under your scapula. See

it?»

Julius nodded.

Holding a small ruler to it, he continued, «It`s a shade less than one centimeter. I`m

sure you remember the ABCD rule of thumb from your med school dermatology—”

Julius interrupted, «I don`t remember squat from medical school dermatology.

Treat me like a dummy.»

«Okay. ABCD.A for asymmetry—look here.» He moved the stylus to parts of the

lesion. «It`s not perfectly round like all these others on your back—see this one and this

one.» He pointed to two nearby small moles.

Julius tried to break his tension by taking a deep breath.

«Bfor borders—now, look here, I know it`s hard to see.» Bob pointed again to the

subscapular lesion. «See in this upper area how sharp the border is, but all around here on

the medial side it`s indistinct, just fades into the surrounding skin.C for coloration. Here,

on this side, see how it`s light brown. If I magnify it, I see a tad of red, some black,

maybe even some gray.D for diameter; as I say, perhaps seven–eighths of a centimeter.

That`s good–sized, but we can`t be sure how old it is, I mean how fast it`s growing. Herb

Katz says it wasn`t there at last year`s physical. Lastly, under magnification, there is no

doubt that the center is ulcerated.»

Putting down the mirror, he said, «Put your shirt back on, Julius.» After his patient

finished buttoning up, King sat down on the small stool in the examining room and

began, «Now, Julius, you know the literature on this. The concerns are obvious.»

«Look, Bob,” replied Julius, «I know our previous relationship makes this hard for

you, but please don`t ask me to do your work. Don`t assume I know anything about this.

Keep in mind that right now my state of mind is terror veering toward panic. I want you

to take charge, to be entirely honest with me, and take care of me. Just as I did for you.

And, Bob, look at me! When you avoid my gaze like that, it scares the shit out of me.»

«Right. Sorry.» He looked him straight in the eyes. «You took damn good care of

me. I`ll do the same for you.» He cleared his throat, «Okay, my strong clinical impression

is that it`s a melanoma.»

Noting Julius`s wince, he added, «Even so, the diagnosis itself tells you little.

Most—remember that—mostmelanomas are easily treated, though some are bitches. We

need to know some things from the pathologist: Is it melanoma for certain? If so, how

deep is it? Has it spread? So, first step is biopsy and getting a specimen to the pathologist.

«Soon as we finish I`ll call a general surgeon to excise the lesion. I`ll be by his side

throughout. Next, an examination of a frozen section by the pathologist, and ifit`s

negative, then great: we`re finished. If it`s positive, if it is a melanoma, we`ll remove the

most suspicious node or, if necessary, do a multiple node resection. No hospitalization

required—the whole procedure will be done in the surgery center. I`m pretty sure no skin

graft will be needed, and, at most, you miss only a day of work. But you`ll feel some

discomfort at the surgical site for a few days. Nothing else to say now until we learn more

from the biopsy. As you asked, I`ll take care of you. Trust my judgment on this; I`ve been

involved with hundreds of these cases. Okay? My nurse will call you later today with all

the details about time and place and prep instruction. Okay?»

Julius nodded. They both rose.

«I`m sorry,” Bob said, «I wish I could spare you all, this but I can`t.» He held out a

folder of reading material. «I know you may not want this stuff, but I always distribute it

to patients in your situation. Depends on the person: some are comforted by information,

others would rather not know and just toss it on the way out of the office. Hope after the

surgery to tell you something brighter.»

But there was never to be anything brighter—the later news was darker yet. Three

days after the biopsy procedure, they met again. «Do you want to read this? said Bob,

holding out the final pathologist`s report. Seeing Julius shake his head, Bob scanned the

report again and began: «Okay let`s go over it. I gotta tell you: it`s not good. Bottom line

is that itis a melanoma and it has several...uh...notable characteristics: it`s deep, over

four millimeters, ulcerated, and there are five positive nodes.»

«Meaning? Come on, Bob, don`t talk around this. ‘Notable,` four millimeters,

ulcerated, five nodes? Be straight. Talk to me as if I were a layman.»

«Meaning bad news. It`s a sizable melanoma, and it has spread to the nodes. The

real danger here is more distant spread, but we won`t know that till the CT scan which

I`ve arranged for tomorrow at eight.»

Two days later they continued their discussion. Bob reported that the CT scan was

negative—no evidence of spread elsewhere in the body. That was the first good news.

«But even so, Julius, this adds up to a dangerous melanoma.»

«How dangerous?» Julius`s voice cracked. «What are we talking about? What kind

of survival rate?»

«You know we can only address that question in terms of statistics. Everyone is

different. But for an ulcerated melanoma, four millimeters deep, with five nodes, the

statistical charts show a five–year survival of less than twenty–five percent.»

Julius sat for several moments with head bowed, heart pounding, tears in his eyes,

before asking, «Keep going. You`re being straight. I need to know what to tell my

patients. What will my course be like? What`s going to happen?»

«It`s impossible to be precise because nothing more will happen to you until the

melanoma recurs somewhere in the body. When it does, especially if it metastasizes, then

the course might be quick, perhaps weeks or months. As for your patients, hard to say,

but it would not be unreasonable to hope for at least a year of good health ahead of you.»

Julius nodded slowly, head down.

«Where`s your family, Julius? Shouldn`t you have brought someone in with you?»

«I think you know about my wife`s death ten years ago. My son is on the East

Coast and my daughter in Santa Barbara. I`ve said nothing to them yet; I didn`t see any

sense in disrupting their lives unnecessarily. I generally do better licking my wounds in

private anyway, but I`m pretty sure that my daughter will come up immediately.»

«Julius, I`m so sorry to have to tell you all this. Let me end with a little good news.

There`s a lot of energetic research going on now—perhaps a dozen very active labs in

this country and abroad. For unknown reasons the incidence of melanoma has risen,

almost doubled in the last ten years, and it`s a hot research area. It`s possible that

breakthroughs are close at hand.»

For the next week Julius lived in a daze. Evelyn, his daughter, a classics professor,

canceled her classes and drove up immediately to spend several days with him. He spoke

at length to her, his son, his sister and brother, and to intimate friends. He often woke in

terror at 3A.M. , crying out, and gasping for air. He canceled his hours with his individual

patients and with his therapy group for two weeks and spent hours pondering what and

how to tell them.

The mirror told him he didn`t look like a man who had reached the end of his life.

His three–mile daily jog had kept his body young and wiry, without an ounce of fat.

Around his eyes and mouth, a few wrinkles. Not many—his father had died with none at

all. He had green eyes; Julius had always been proud of that. Strong and sincere eyes.

Eyes that could be trusted, eyes that could hold anyone`s gaze. Young eyes, the eyes of

the sixteen–year–old Julius. The dying man and the sixteen–year–old gazed at each other

across the decades.

He looked at his lips. Full, friendly lips. Lips that, even now in his time of despair,

were on the edge of a warm grin. He had a full head of unruly black curly hair, graying

only in his sideburns. When he was a teenager in the Bronx, the old white–haired, red–faced, anti–Semitic barber, whose tiny shop was down his street between Meyer`s candy

store and Morris`s butcher shop, cursed his tough hair as he tugged at it with a steel comb

and cut it with thinning shears. And now Meyer, Morris, and the barber were all dead,

and little sixteen–year–old Julius was on death`s call sheet.

One afternoon he tried to attain some sense of mastery by reading the melanoma

literature in the medical school library, but that proved futile. Worse than futile—it made

things more horrendous. As Julius apprehended the truly ghastly nature of his disease, he

began to think of melanoma as a voracious creature sinking ebony tendrils deep into his

flesh. How startling it was to realize that suddenly he was no longer the supreme life

form. Instead he was a host; he was nourishment, food for a fitter organism whose

gobbling cells divided at a dizzying pace, an organism that blitzkrieged and annexed

adjacent protoplasm and was now undoubtedly outfitting clusters of cells for cruises into

the bloodstream and colonization of distant organs, perhaps the sweet friable feeding

grounds of his liver or the spongy grassy meadows of his lungs.

Julius put aside the reading. Over a week had gone by, and it was time to move

past distraction. The hour had come to face what was really happening. Sit down, Julius,

he told himself. Sit down and meditate upon dying. He closed his eyes.

So death, he thought, has finally made its appearance on stage. But what a banal

entrance—the curtains jerked open by a roly–poly dermatologist with a cucumber nose,

magnifying glass in hand, and costumed in white hospital coat with his name stitched in

dark blue letters upon his upper breast pocket.

And the closing scene? Destined, most likely, to be equally banal. His costume

would be his wrinkled pinstriped New York Yankees night–shirt with DiMaggio`s

number 5 on the back. The stage set? The same queen–sized bed in which he had slept for

thirty years, crumpled clothes on the chair beside the bed and, upon his bedside table, a

stack of unread novels unaware that their time would now never come. A whim–pering,

disappointing finale. Surely, Julius thought, the glorious adventure of his life deserved

something more...more...more what?

A scene he had witnessed a few months ago on a Hawaiian vacation came to mind.

While hiking he had quite by chance come upon a large Buddhist retreat center and saw a

young woman walking though a circular labyrinth, constructed of small lava stones.

Reaching the center of the labyrinth she stopped and remained motionless in a lengthy

standing meditation. Julius`s knee–jerk reaction to such religious ritual was not charitable,

generally falling somewhere in the territory between ridicule and revulsion.

But, now, as he thought about that meditating young woman, he experienced softer

feelings—a flood of compassion for her and for all his fellow humans who are victims of

that freakish twist of evolution that grants self–awareness but not the requisite

psychological equipment to deal with the pain of transient existence. And so throughout

the years, the centuries, the millennia, we have relentlessly constructed makeshift denials

of finiteness. Would we, would any of us, ever be done with our search for a higher

power with whom we can merge and exist forever, for God–given instruction manuals,

for some sign of a larger established design, for ritual and ceremony?

And yet, considering his name on death`s roster, Julius wondered whether a little

ceremony might not be such a bad thing. He jerked away from his own thought as if

scorched—so thoroughly dissonant was it with his lifelong antagonism to ritual. He had

always despised the tools by which religions strip their followers of reason and freedom:

the ceremonial robes, incense, holy books, mesmerizing Gregorian chants, prayer wheels,

prayer rugs, shawls and skullcaps, bishop`s miters and crosiers, holy wafers and wines,

last rites, heads bobbing and bodies swaying to ancient chants—all of which he

considered the paraphernalia of the most powerful and longest–running con game in

history, a game which empowered the leaders and satisfied the congregation`s lust for

submission.

But now, with death standing next to him, Julius noted that his vehemence had lost

its bite. Maybe it was simplyimposed ritual he disliked. Perhaps a good word could be

found for a little personal creative ceremony. He was touched by the newspaper

descriptions of the firemen at ground zero in New York, stopping, standing, and

removing hats to honor the dead as each pallet of newly discovered remains was brought

to the surface. Nothing wrong with honoring the dead...no, not the dead, but honoring the

life of the one who died. Or was it something more than honoring, more than sanctifying?

Wasn`t the gesture, the ritual of the firemen, also signifying connectivity? The

recognition of their relationship, their unity with each victim?

Julius had a personal taste of connectivity a few days after his fateful meeting with

his dermatologist when he attended his support group of fellow psychotherapists. His

fellow doctors were stunned when Julius revealed the news of his melanoma. After

encouraging him to talk himself out, each group member expressed his shock and sorrow.

Julius couldn`t find any more words, nor could anyone else. A couple of times someone

started to talk but did not, and then it was as if the group agreed nonverbally that words

were not necessary. For the final twenty minutes all sat in silence. Such prolonged

silences in groups are almost invariably awkward, but this one felt different, almost

comforting. Julius was embarrassed to admit, even to himself, that the silence felt

«sacred.» Later it occurred to him that the members not only were expressing grief but

were also removing their hats, standing at attention, joining and honoring his life.

And perhaps this was a way of honoring their own lives, Julius thought. What else

do we have? What else other than this miraculous blessed interval of being and self–awareness? If anything is to be honored and blessed, it should simply be this—the

priceless gift of sheer existence. To live in despair because life is finite or because life

has no higher purpose or embedded design is crass ingratitude. To dream up an

omniscient creator and devote our life to endless genuflection seems pointless. And

wasteful, too: why squander all that love on a phantasm when there seems too little love

to go around on Earth as it is? Better to embrace Spinoza`s and Einstein`s solution:

simply bow one`s head, tip one`s hat to the elegant laws and mystery of nature, and go

about the business of living.

These were not new thoughts for Julius—he had always known of finiteness and

the evanescence of consciousness. But there is knowing andknowing. And death`s

presence on the stage brought him closer to really knowing. It was not that he had grown

wiser: it was only that the removal of distractions—ambition, sexual passion, money,

prestige, applause, popularity—offered a purer vision. Wasn`t such detachment the

Buddha`s truth? Perhaps so, but he preferred the path of the Greeks: everything in

moderation. Too much of life`s show is missed if we never take off our coats and join in

the fun. Why rush to the exit door before closing time?

After a few days, when Julius felt calmer with fewer sweeps of panic, his thoughts turned

to the future. «One good year» Bob King had said, «no guarantees, but it would not be

unreasonable to hope for at least a year of good health.» But how to spend that year? One

thing he resolved was not to make that one good year a bad year by grieving that it was

not more than a year.

One night, unable to sleep and craving some comfort, he restlessly browsed in his

library. He could find nothing written in his own field that seemed even remotely relevant

to his life situation, nothing pertaining to how should one live, or find meaning in one`s

remaining days. But then his eye fell upon a dog–eared copy of Nietzsche`sThus Spake

Zarathustra. Julius knew this book well: decades ago he had thoroughly studied it while

writing an article on the significant but unacknowledged influence of Nietzsche on

Freud.Zarathustra was a brave book which more than any other, Julius thought, teaches

how to revere and celebrate life. Yes, this might be the ticket. Too anxious to read

systematically, he flipped the pages randomly and sampled some of the lines he had

highlighted.

«To change ‘it was` into ‘thus I willed it`—that alone shall I call redemption.»

Julius understood Nietzsche`s words to mean that he had to choose his life—he had

to live it rather than be lived by it. In other words he should love his destiny. And above

all there was Zarathustra`s oft–repeated question whether we would be willing to repeat

the precise life we have lived again and again throughout eternity. A curious thought

experiment—yet, the more he thought about it, the more guidance it provided:

Nietzsche`s message to us was to live life in such a way that we would be willing to

repeat the same life eternally.

He continued flipping the pages and stopped at two passages highlighted heavily in

neon pink: «Consummate your life.» «Die at the right time.»

These hit home. Live your life to the fullest; and then, and only then, die. Don`t

leave any unlived life behind. Julius often likened Nietzsche`s words to a Rorschach

exam; they offered so many opposing viewpoints that the readers` state of mind

determined what they took from them. Now he read with a vastly different state of mind.

The presence of death prompted a different and more enlightened reading: in page after

page, he saw evidence of a pantheistic connectedness not previously appreciated.

However much Zarathustra extolled, even glorified solitude, however much he required

isolation in order to give birth to great thoughts, he was nonetheless committed to loving

and lifting others, to helping others perfect and transcend themselves, to sharing his

ripeness.Sharing his ripeness —that hit home.

ReturningZarathustra to its resting place, Julius sat in the dark staring at the lights

of cars crossing the Golden Gate Bridge and thinking about Nietzsche`s words. After a

few minutes Julius «came to»: he knew exactly what to do and how to spend his final

year.He would live just the way he had lived the previous year—and the year before that

and before that. He loved being a therapist; he loved connecting to others and helping to

bring something to life in them. Maybe his work was sublimation for his lost connection

to his wife; maybe he needed the applause, the affirmation and gratitude of those he

helped. Even so, even if dark motives played their role, he was grateful for his work. God

bless it!

Strolling over to his wall of file cabinets, Julius opened a drawer filled with charts and

audiotaped sessions of patients seen long ago. He stared at the names—each chart a

monument to a poignant human drama that had once played itself out in this very room.

As he surfed through the charts, most of the faces immediately sprang to mind. Others

had faded, but a few paragraphs of notes evoked their faces, too. A few were the truly

forgotten, their faces and stories lost forever.

Like most therapists, Julius found it difficult to seal himself off from the

unremitting attacks on the field of therapy. Assault came from many directions: from

pharmaceutical companies and managed care, which sponsored superficial research

orchestrated to validate the effectiveness of drugs and briefer therapies; from the media,

which never tired of ridiculing therapists; from behaviorists; from motivational speakers;

from the hordes of new age healers and cults all competing for the hearts and minds of

the troubled. And, of course, there were doubts from within: the extraordinary molecular

neurobiological discoveries reported with ever–increasing frequency caused even the

most experienced therapists to wonder about the relevance of their work.

Julius was not immune to these attacks and often entertained doubts about the

effectiveness of his therapy and just as often soothed and reassured himself.Of course he

was an effective healer.Of course he offered something valuable to most, perhaps even

all, of his patients.

Yet the imp of doubt continued to made its presence known:Were you really, truly,

helpful to your patients? Maybe you`ve just learned to pick patients who were going to

improve on their own anyway.

No. Wrong! Wasn`t I the one who always took on great challenges?

Huh, you`ve got your limits! When was the last time you really stretched yourself—

took a flagrant borderline into therapy? Or a seriously impaired schizophrenic or a

bipolar patient?

Continuing to thumb through old charts, Julius was surprised to see how much

posttherapy information he had—from occasional follow–up or «tune–up» visits, from

chance encounters with the patient, or from messages delivered by new patients they had

referred to him. But, still, had he made an enduring difference to them? Maybe his results

were evanescent. Maybe many of his successful patients had relapsed and shielded that

information from him out of sheer charity.

He noted his failures, too—folks, he had always told himself, who were not ready

for his advanced brand of deliverance. Wait, he told himself, give yourself a break,

Julius. How do you know they werereally failures?permanent failures? You never saw

them again. We all know there are plenty of late bloomers out there.

His eye fell upon Philip Slate`s thick chart. You want failure? he said to

himself.There was failure. Old–time major–league failure. Philip Slate. More than twenty

years had passed, but his image of Philip Slate was crisp. His light brown hair combed

straight back, his thin graceful nose, those high cheekbones that suggested nobility, and

those crisp green eyes that reminded him of Caribbean waters. He remembered how

much he disliked everything about his sessions with Philip. Except for one thing: the

pleasure of looking at that face.

Philip Slate was so alienated from himself that he never thought to look within,

preferring to skate on the surface of life and devote all his vital energy to fornication.

Thanks to his pretty face, he had no end of volunteers. Julius shook his head as he rifled

through Philip`s chart—three years of sessions, all that relating and support and caring,

all those interpretations without a whisper of progress. Amazing! Perhaps he wasn`t the

therapist he thought he was.

Whoa, don`t jump to conclusions, he told himself. Why would Philip continue for

three years if he had gotten nothing? Why would he continue to spend all that money for

nothing? And God knows Philip hated to spend money. Maybe those sessions had

changed Philip. Maybe hewas a late bloomer—one of those patients who needed time to

digest the nourishment given by the therapist, one of those who stored up some of the

therapist`s good stuff, took it home, like a bone, to gnaw on later, in private. Julius had

known patients so competitive that they hid their improvement just because they didn`t

want to give the therapist the satisfaction (and the power) of having helped them.

Now that Philip Slate entered his mind, Julius could not get him out. He had

burrowed in and taken root. Just like the melanoma. His failure with Philip became a

symbol embodyingall his failures in therapy. There was something peculiar about the

case of Philip Slate. From where had it drawn all that power? Julius opened his chart and

read his first note written twenty–five years before.

PHILIP SLATE—Dec. 11, 1980

26 yr old single white male chemist working for DuPont—develops new pesticides—

strikingly handsome, carelessly dressed but has a regal air, formal, sits stiffly with little

movement, no expression of feelings, serious, absence of any humor, not a smile or grin,

strictly business, no social skills whatsoever. Referred by his internist, Dr. Wood.

CHIEF COMPLAINT: «I am driven against my will by sexual impulses.»

Why now? «Last straw» episode a week ago which he described as though by rote.

I arrived by plane in Chicago for a professional meeting, got off the plane, and

charged to the nearest phone and went down my list of women in Chicago looking for

a sexual liaison that evening. No luck! They were all busy. Of course they were busy:

it was a Friday evening. I knew I was coming to Chicago; I could have phoned them

days, even weeks earlier. Then, after calling the last number in my book, I hung up

the phone and said to myself, «Thank God, now I can read and get a good night`s

sleep, which is what I really wanted to do all along.»

Patient says that phrase, that paradox—«which is what I really wanted to do

all along»—haunted him all week and is the specific impetus for seeking therapy.

«That`s what I want to focus on in therapy,” he says. «Ifthatis what I want—to read

and to get a good night`s sleep—Dr. Hertzfeld, tell me—why can`t I, why don`t I, do

it?»

Slowly more details of his work with Philip Slate coasted into mind. Philip had

intellectually intrigued him. At the time of their first meeting he had been working on a

paper on psychotherapy and the will, and Philip`s question—why can`t I do what I truly

want to do?—was a fascinating beginning for the article. And, most of all, he recalled

Philip`s extraordinary immutability: after three years he seemed entirely untouched and

unchanged—and as sexually driven as ever.

Whatever became of Philip Slate? Not one word from him since he abruptly bailed

out of therapy twenty–two years ago. Again Julius wondered whether, without knowing

it, he had been helpful to Philip. Suddenly, he had to know; it seemed a matter of life and

death. He reached for the phone and dialed 411.