But I had to steer a tight course. If I were too honest, Marge would see how much I preferred the other Marge. Probably “Me” had already taunted Marge with it, but I saw no evidence. I was certain that “Me,” the other Marge, was in love with me. Perhaps she loved me enough to change her behavior! Surely she must know that I would be repelled by wanton destructiveness.
Now that’s a facet of psychotherapy we don’t learn about in training: have a romance with your patient’s worst enemy, and then, when you are sure the enemy loves you, use that love to neutralize her attacks upon your patient.
Over the next several months of therapy, I continued faithful to Marge. Sometimes she would try to tell me about Ruth Anne, the third personality, or slip into a trance and regress to an earlier age, but I refused to be seduced by any of these enticements. More than anything else, I resolved to be “present” with her, and I immediately called her back whenever she started to leave my presence by slipping away into another age or another role.
When I first began to work as a therapist, I naively believed that the past was fixed and knowable; that if I were perspicacious enough, I could discover that first false turn, that fateful trail that has led to a life gone wrong; and that I could act on this discovery to set things right again. In those days I would have deepened Marge’s hypnotic state, regressed her in age, asked her to explore early traumas—for example, her father’s sexual abuse—and urged her to experience and discharge all the attendant feelings, the fear, the arousal, the rage, the betrayal.
But over the years I’ve learned that the therapist’s venture is not to engage the patient in a joint archeological dig. If any patients have ever been helped in that fashion, it wasn’t because of the search and the finding of that false trail (a life never goes wrong because of a false trail; it goes wrong because the main trail is false). No, a therapist helps a patient not by sifting through the past but by being lovingly present with that person; by being trustworthy, interested; and by believing that their joint activity will ultimately be redemptive and healing. The drama of age regression and incest recapitulation (or, for that matter, any therapeutic cathartic or intellectual project) is healing only because it provides therapist and patient with some interesting shared activity while the real therapeutic force—the relationship—is ripening on the tree.
So I devoted myself to being present and faithful. We continued to ingest the other Marge. I mused aloud, “What would she have said in that situation? How would she have dressed or walked? Try it. Pretend you’re her for a minute or two, Marge.”
As the months passed, Marge grew plump at the other Marge’s expense. Her face grew rounder, her bodice fuller. She looked better, dressed better; she sat up straight; she wore patterned stockings; she commented upon my scuffed shoes.
At times I thought of our work as cannibalistic. It was as though we had assigned the other Marge to a psychological organ bank. Now and then, when the receptor site was well prepared, we withdrew some part of “Me” for transplantation. Marge began to treat me as an equal, she asked me questions, she flirted a bit. “When we finish, how will you get along without me? I’m sure you’ll miss my little late-night calls.”
For the first time, she began asking me personal questions. “How did you decide to get into this field? Have you ever regretted it? Do you ever get bored? With me? What do you do with
your
problems?” Marge had appropriated the bold parts of the other Marge as I urged her to do, and it was important that I be receptive and respectful to each of her questions. I answered each one as fully and honestly as possible. Moved by my answers, Marge grew ever bolder but gentler in her talks with me.
And that other Marge? I wonder what’s left of her now? A pair of empty spike heels? An enticing, bold glance that Marge has not yet dared to appropriate? A ghostly, Cheshire cat smile? Where is the actress who played Marge with such brilliance? I’m sure
she’s
gone: that performance required great vital energy, and by now Marge and I have sucked all that juice out of her. Even though we continued our work together for many months after the hour “Me” appeared, and though Marge and I eventually stopped talking about her, I have never forgotten her: she flits in and out of my mind at unexpected times.
Before we began therapy, I had informed Marge that we could meet for a maximum of eighteen months because of my sabbatical plans. Now the time was up, our work at an end. Marge had changed: the panics occurred only rarely; the phone calls were a thing of the past; she had begun to build a social life and had made two close friends. She had always been a talented photographer and now, for the first time in years, had picked up her camera and was once again enjoying this form of creative expression.
I felt pleased with our work but was not deluded into thinking that she had finished therapy, nor was I surprised, as our final session approached, to see a recrudescence of her old symptoms. She retreated to bed for entire weekends; she had long crying jags; suicide suddenly seemed appealing again. Just after our last visit, I received a sad letter from her containing these lines:
I always imagined that you might write something about me. I wanted to leave an imprint on your life. I don’t want to be “just another patient.” I wanted to be “special.” I want to be something, anything. I feel like nothing, no one. If I left an imprint on your life, maybe I would be someone, someone you wouldn’t forget. I’d exist then.
Marge, please understand that though I’ve written a story about you, I do not do it to enable you to exist. You exist without my thinking or writing about you, just as I keep existing when you aren’t thinking of me.
Yet this
is
an existence story—but one written for the other Marge, the one who no longer exists. I was willing to be her executioner, to sacrifice her for you. But I have not forgotten her: she avenged herself by burning her image into my memory.
10
In Search of the Dreamer
“
Sex is at the root of everything. Isn’t that what you fellows always say? Well,
in my case you may be right. Take a look at this. It’ll show you some interesting connections between my migraines and my sex life.”
Drawing a thick scroll from his briefcase, Marvin asked me to hold one end, and carefully unrolled a three-foot chart upon which was meticulously recorded his every migraine headache and every sexual experience of the past four months. One glance revealed the complexity of the diagram. Every migraine, its intensity, duration, and treatment, was coded in blue. Every sexual rush, colored red, was reduced to a five-point scale according to Marvin’s performance: premature ejaculations were separately coded, as was impotence—with a distinction made between inability to sustain an erection and inability to have one.
It was too much to absorb in a glance. “That’s an elaborate piece of work,” I said. “It must have taken you days.”
“I liked doing it. I’m good at it. People forget that we accountants have graphic skills that are never used in tax work. Here, look at the month of July: four migraines and each one preceded by either impotence or a grade-one or -two sexual performance.”
I watched Marvin’s finger point to the blips of migraine and impotence. He was right: the correlation was impressive, but I was growing edgy. My timing had been thrown off. We had only just begun our first session, and there was much more I wanted to know before I would feel ready to examine Marvin’s chart. But he pressed it before me so forcefully that I had no option other than to watch his stubby finger trace out the love leavings of last July.
Marvin at sixty-four had suddenly, six months ago, for the first time in his life, developed disabling migraine headaches. He had consulted a neurologist, who had been unsuccessful in controlling Marvin’s headaches and then referred him to me.
I had seen Marvin for the first time only a few minutes earlier when I went out to my waiting room to fetch him. He was sitting there patiently—a short, chubby, bald man with a glistening pate and owl eyes which never blinked as they peered through oversized, gleaming chrome spectacles.
I was soon to learn that Marvin was particularly interested in spectacles. After shaking hands with me, his first words, while accompanying me down the hall to my office, were to compliment me on my frames and to ask me their make. I believe I fell from grace when I confessed ignorance of the manufacturer’s name; things grew even more awkward when I removed my glasses to read the brand name on the stem and found that, without my glasses, I could not read it. It did not take me long to realize that, since my other glasses were now resting at home, there was no way that I could give Marvin the trivial information he desired, so I held out my spectacles for him to read the label. Alas, he, too, was farsighted, and more of our first minutes together were consumed by his switching to his reading glasses.
And now, a few minutes later, before I could proceed to interview him in my customary way, I found myself surrounded by Marvin’s meticulous red-and-blue-penciled chart. No, we were not off to a good start. To compound the problem, I had just had a poignant but exhausting session with an elderly, distraught widow whose purse had recently been stolen. Part of my attention was still with her, and I had to spur myself to give Marvin the attention he deserved.
Having received only a brief consultation note from the neurologist, I knew practically nothing about Marvin and began the hour, after we completed the opening eyeglass ritual, by asking “What ails?” That was when he volunteered that “you fellows” think “sex is at the root of everything.”
I rolled up the chart, told Marvin I’d like to study it in detail later, and attempted to restore some rhythm to the session by asking him to tell me the whole story of his illness from the beginning.
He told me that about six months ago he, for the first time in his life, began suffering from headaches. The symptoms were those of classical migraine: a premonitory visual aura (flashing lights) and a unilateral distribution of excruciating pain which incapacited him for hours and often necessitated bedrest in a darkened room.
“And you say you have good reason to believe that your sexual performance touches off the migraine?”
“You may think it strange—for a man of my age and position—but you can’t dispute the facts. There’s the proof!” He pointed to the scroll now resting quietly on my desk. “Every migraine of the last four months was preceded within twenty-four hours by a sexual failure.”
Marvin spoke in a deliberate, pedantic manner. Obviously he had rehearsed this material beforehand.
“For the last year I have been having violent mood swings. I pass quickly from feeling good to feeling that it’s the end of the world. Now don’t jump to conclusions.” Here he shook his finger at me for greater emphasis. “When I say I feel good, I do
not
mean I’m manic—I’ve been down that road with the neurologists who tried to treat me for manic-depressive disease with lithium—didn’t do a thing except screw up my kidneys. I can see why docs get sued. Have
you
ever seen a case of manic-depression starting at sixty-four? Do
you
think I should have gotten lithium?”
His questions jarred me. They were distracting and I didn’t know how to answer them.
Was
he suing his neurologist? I didn’t want to get involved with that. Too many things to deal with. I made an appeal to efficiency.
“I’d be glad to come back to these questions later, but we can make best use of our time today if we first hear your whole clinical story straight through.”
“Right you are! Let’s stay on track. So, as I was saying, I flip back and forth from feeling good to feeling anxious and depressed—both together—and it is
always
in the depressed states that the headaches occur. I never had one till six months ago!”
“And the link between sex and depression?”
“I was getting to that——”
Careful, I thought. My impatience is showing. It’s clear he’s going to tell it his way, not mine. For Chrissakes stop pushing him!
“Well—this is the part you’ll find hard to believe—for the last twelve months my moods have been totally controlled by sex. If I have good sex with my wife, the world seems bright. If not, bingo! Depression and headaches!”
“Tell me about your depressions. What are they like?”
“Like an ordinary depression. I’m down.”
“Say some more.”
“What’s to say? Everything looks black.”
“What do you think about in the depressions?”
“Nothing. That’s the problem. Isn’t that what depression is all about?”
“Sometimes when people get depressed, certain thoughts circle around in their mind.”
“I keep knocking myself.”
“How?”
“I start to feel that I will always fail in sex, that my life as a man is over. Once the depression sets in, I am bound to have a migraine within the next twenty-four hours. Other doctors have told me that I am in a vicious circle. Let’s see, how does it work? When I’m depressed I get impotent, and then because I’m impotent I get more depressed. Yep, that’s it. But knowing that doesn’t stop it, doesn’t break the vicious circle.”