Peter D. Kramer - Should You Leave?

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FOR SARAH, JACOB,
AND MATTHEW
AND, AS ALWAYS,
RACHEL

A LL YOU want is a simple piece of advice.

There is a decision you must makestay or leave. It is a decision in a matter of the heart. You do not want psychotherapy. You have had psychotherapy, enough and more than enough. Or you mistrust psychotherapy. It is not a question of wanting to change or grow or understand, but of needing to make a choice. Psychiatrists must be familiar with dilemmas of intimacyhave seen them many times, know how they turn out. Nowadays, there is professional help for everything. In this matter that concerns you, psychiatrists are experts. You want an expert opinion.

It is a hazy New England summer afternoon, and I am talking over glasses of iced tea, rivulets of condensation running down the glasses, with a senior psychiatrist, Lou Adler. We are sitting alone in my small urban backyard, sweating politely, and I ask Lou, whom I consider my mentor, should I or should I not write a book of advice? I have written a best-seller, and when a psychiatrist writes a best-seller, he is next urged to write a book of advice.

The question is provocative and, I fear, even hurtful. Lou, a maverick when first we met, has become rigid, a staunch defender of psychoanalysis. But even in the early years, Lou taught that we consistently underestimate the otherness of others. We do not know what is best for the stranger before us. That I, who value this legacy, should consider a book of advice may strike Lou as a betrayal.

I broach the idea in a cautious way, through raising technical concerns about books of advice. I am suspicious of the formthe chain of illustrative vignettes, too convenient to be fact, too predictable to be decent fiction. I have trouble imagining writing in the second person, the way advice books are written: You have this problem, you have that. I have more trouble yet deciding what it is I might know.

Still, for some time (here I begin making my case) I have been fascinated with the question of advice. Fifteen years ago, when I moved to this town, I was solicited for a charity auction to donate an item from my business. Those were still the days when the better therapists, the ones people went to if they were au courant, were largely silent and withholding. I assumed that among the participants in a charity auction there might be some who would have so had it with psychotherapy that they would bid on a special item from my business: a piece of advice from a psychotherapist. There it was, when I arrived at the auction, a folded beige rectangle of tagboard, standing on its edges like a tent, offering a piece of adviceThis is not medical treatment for mental illness, the tagboard specifiedin the silent auction, and it was contested by a number of bidders, though I never gave the advice.

The high bidder said her husband would contact me, it was about his relationship with their son. The husband is a colleague of sorts, a surgeon. I doubted he would phone; doctors dont call strange doctors for advice in family matters. It was unsettling to catch a glimpse of a family problemto have the woman open the door a crack. The exercise lost whatever whimsy it might have had, and I was left wondering whether I could in fact have been of use. Can we help in any straightforward way? The point is, I was already thinking about advice. And not long after, I had occasion to give advice in a quite serious context.

Comfortable now, sinking into the heat of the day, I begin to tell Lou about the time I was wakened on a summer nightthe night of a day much like this, steamy and closewakened by a phone call from a neighbor who said his wife had died suddenly, and could I answer a question. To my half-alert mind, the news seemed an element of a nightmare. Im so sorry, I must have said, and, Ill be right over. This was the question: Should he bring their young children to the funeral?

I threw on clothes and set off around the block. I remember feeling perturbed, as we do in these moments, by the contrast between the orderliness, the optimism of the physical world we have constructed for ourselvesstreets, houses, lawnsand the arbitrariness of so much else we live amidst.

When I arrived, the house was filled with neighbors and relatives. There is such a bustle about death: negotiations with the hospital and funeral home, plans for the religious service and the reception. At the center of the hubbub was the poor man, colorless and slack-skinned, in a state of shock and exhaustion. I did not know him well, but evidently he had reached past all the ready help that surrounded him to contact me, as an expert who might answer this one preoccupying question.

He took me aside and shook off my condolences. He was insistent, he needed to know: Should the children attend the funeral? I wanted to do the right and helpful thing. I said: Either will be wrong. It is not good or bad to go to the funeral. It is bad to have your mother die when you are young.

I knew the literature, the old accounts of children traumatized by funerals, the newer studies that find children do okay, should go if they want to. But I was moved to say what I said and nothing more. The man seemed grateful, and in later days he made it a point to thank me, not insistently but warmly, in a way that seemed to confirm that I had struck a right note.

As I walked homemy clothes were sticking to me, the city felt oppressive now and dirtyI tried to understand why I had replied in the way I did. Not to say however you choose will be fine, but to cast the uncertainty in the negative. I realized that to say you cant get it right makes the decision an ordinary act of parenting, binds it to what people are always saying, that you cant win when it comes to pleasing kids. And absolves the man in advance for any blame he might later receive from his children. Having assuaged unspoken guilt, I was able to say what mattered more: It is understandable that this decision should seem weighty; what has happened is more serious than the bustle about you suggests. He knew as much, and the acknowledgment calmed him. It occurred to me that we rarely respond in so helpful a way, perhaps precisely because we are trained, as psychotherapists, not to reply immediately and directly to the questions posed us.

And ever since, I tell Lou, I have been thinking about advice, which may be why I am willing to entertain this project.

Few things so harrowing... Lou mumbles, sotto voce.

I know the passage, have used it when teaching psychotherapy. Harry Stack Sullivan, perhaps the greatest American psychiatrist, warns against the expression of opinion: There are few things that I think are so harrowing as the occasional psychiatrist who knows a great deal about right and wrong....

And then I catch the flicker of an ironic smileperhaps recognition of the advice contained in the proscription against advising, perhaps understanding that we do not find our tasks so much as they find us. Lou asks whether I offer much advice to patients, and I am able to say that I do not. I hew mostly to the old conventionsstaying out of peoples way when possible, hoping to catalyze their own discovery of what they want and how to get it. But patients so often know our opinions anyway. Opinion has a way of bleeding through into the therapy. Lou used to teach about this process, how for all that a therapist may aim to be unobtrusive, he or she becomes known to the patient with as much intimacy and exactness as the patient is known to the therapist. Or rather, on both sides there is a tension between the precision with which the other is known and the invisibility and isolation that remain.