H
EALING THE
S
PLIT
The really valuable method of thought to arrive at a logically coherent system is intuition.
—A
LBERT
E
INSTEIN
The view from the eighteenth floor of the Century City Medical Plaza was spectacular. In the distance I could see the sun setting over a deep blue strip of ocean lining the horizon, cradled by the rugged Santa Monica Mountains in the north. Now thirty-two, I felt I had arrived.
I was beginning my own private psychotherapy practice in one of the most prestigious areas of the city: Four blocks south on Pico was the Fox studio lot, the offices of ABC television were five minutes away, and directly across the street on Century Park East were the twin tower buildings, identical forty-eight-story triangular metallic and glass obelisks packed with the densest concentration of high-powered attorneys in Los Angeles.
With financial help from my parents, I had leased an elegant penthouse suite in a top medical building, and I was determined that everything be first class. My mother hired a decorator to pick out the finest fabrics, wallpapers, and paints to color-coordinate the office. The wall beside my desk was covered with my laminated degrees from college, USC medical school, Wadsworth VA internship, and psychiatric residency at UCLA—proof that I was now a full-fledged M.D. The stage was set. The external trappings were perfect.
But opening a private practice was a risky business. The Westside was already overrun with therapists: Entire office buildings were packed with them, and there were probably more therapists per square foot in Beverly Hills, Century City, and West L.A. than anywhere else in the country except Manhattan. It was also true that I had never been very good at selling myself. With such stiff competition, the odds against my practice succeeding were high. But I tried hard to look the role, to project a professional image to the world.
Sparing no expense, my mother bought me an entire new wardrobe and a car. On a resident's salary there was no way I could have afforded this. Each morning I would dress in a tailored two-piece business suit, a pressed linen or silk blouse, and a pair of one-inch Ferragamo heels and drive to work in my beige ‘77 Mercedes sedan.
Ushering me into their world, my parents were offering me all the advantages. Medicine was a comfortable language that they understood, and we now had a common bond. When I talked to them about patients or doctors we both knew, they could relate. Our relationship grew closer: They were proud of me and I was proud of myself.
But I wasn't doing this just to please them. I relished my authority and responsibilities, the respect of nurses and staff, the power to help people. I was getting an enormous amount of positive reinforcement from teachers and patients alike. Still, in my quiet moments, I knew something was missing. I had left a part of me behind, though in no conscious way had I intended it. To survive the manic pace of my medical training, a kind of protective amnesia had taken over. It was similar to what happens when the body goes into shock, closing down sensation and memory, cutting off my psychic experiences, nor did I have the energy or desire to backtrack to find them. Though I wasn't oblivious to what had happened, it was easiest not to look back. I became programmed to think more than to feel, and this became habit as I resigned myself to the loss and focused on the present. But there was a price: vague melancholy, a sense of absence, nagging emptiness—all covered up by the incessant pressure and motion of my practice.
Also, twelve years had passed since I'd worked in Thelma's lab. During most of that period I had been a teenager, with part-time jobs, often financially dependent on my parents, without a sense of calling. Now, at last, I had one. Finding medicine, I had been indoctrinated into the scientific method. Compared to the rigors of conventional psychiatry, the psychic research I had done seemed vague, less exhaustive than I was currently comfortable with. I'd come to value what could be systematically proven and gave little attention to anything else.
I intended to open a traditional psychiatric practice. I would see patients all day in my office and then in the evenings make hospital rounds, a typical routine for many psychiatrists. Since I would be on call twenty-four hours a day and weekends, my life would revolve around work. I subscribed to the system I had learned, matching symptoms to treatments, using medication and psychotherapy as my primary tools.
At UCLA, despite an emphasis on the biochemical components of psychiatric illness, we were also given supervisors, physicians from the community, to teach us psychotherapy. In my case, the supervisors were classical Freudian psychoanalysts. For them, it was essential to be caring, but to convey as little as possible about themselves. The goal was to remain a blank screen on which patients projected their own behavior. The theory is that removed from personal interaction, therapists are better able to help. Thus some psychoanalysts would seldom speak during a session, giving only occasional interpretations, mostly taking notes, sometimes not even sitting where the patient could see them. Generally, psychoanalysts also made a point of dressing conservatively, accentuating a neutral professionalism.
Not surprisingly, with this in mind, though searching for a style that felt natural, I was afraid of polluting the psychotherapy process. Determined to maintain a cool therapeutic distance, I was careful never to reveal any personal information. Stiff, I conveyed little emotion, keeping the boundaries between doctor and patient well defined.
I also had the medical role models of my parents to draw on, but my father was a radiologist, having little direct contact with patients. My mother, on the other hand, socialized with patients, even vacationed with them, none of which undercut her authority as a physician. But she was a family practitioner, not a psychiatrist. The same degree of emotional objectivity and neutrality required of a therapist wasn't as critical for someone in her specialty.
My first patient, Cindy, was a young makeup artist who was going through a divorce. Cindy worked in a well-established beauty salon on Rodeo Drive in Beverly Hills. The referral had come from the salon owner, a very successful businesswoman and close personal friend of my parents. There was a great deal of pressure on me. I wanted Cindy to like me, and I wanted to show my family I could succeed. I anticipated this first appointment with the apprehensiveness of a teenager awaiting her first date.
When Cindy walked into my office, I was relieved to see that she was more anxious than I was. Redheaded and pixyish, in her midtwenties, Cindy was so distraught over the messy breakup of her marriage that she cried through the session, using up a whole box of Kleenex. I was off the hook, and barely opened my mouth: All she needed was a sympathetic listener. Fifty minutes flew by. When it was time to leave, Cindy thanked me profusely and scheduled a regular weekly appointment.
The salon where Cindy worked was the same place I went once a month to have my legs waxed. I figured it was such a busy, sprawling place that she and I were unlikely to meet, and assured her that in any case our relationship was confidential. She didn't seem concerned, however: It was my own uneasiness I had to contend with. Cindy was my first patient, and I wanted to hold on to her.
One afternoon, I was in a secluded back room of the salon getting my legs waxed when there was a knock on the door. I heard the sound of a familiar voice and then the door opened. It was Cindy, looking for a client, not knowing that the room was occupied by me. Our eyes locked and my face turned beet red. There I lay on the leather massage table, flat on my back, legs spread wide, covered with hot yellow wax, wearing only underwear from the waist down. Also embarrassed, Cindy nervously apologized for the intrusion and backed out of the room.
I was humiliated, sure that by psychoanalytic standards any hope of maintaining a professional relationship with Cindy had been compromised. But I learned that, now seeing me as more vulnerable, Cindy felt closer to me, and our therapy took off, though this was a response I certainly hadn't anticipated. I soon came to see the waxing incident as a wake-up call, a message telling me, “Lighten up. It's okay to be human.”
In any case, however hard I tried to keep a wall between my patients and me, it always seemed to get broken down. I would run into my patients everywhere: jogging on the beach, in movie lines, even at friends' parties. Since we lived in the same general vicinity, our paths naturally crossed. And though these meetings often unsettled me, it was my patients' sense of ease that gradually taught me to relax and be myself. I kept trying to play out a role, but the specifics of life were teaching me something else entirely, showing me the distance between theory and the complex reality of human lives.
Early in my practice, I began treating Eve, a ninety-year-old widow struggling with anxiety because her daughter had cancer. Some months later, when her daughter finally died in the Cedars-Sinai hospice, Eve called me to be by her side. As I came down the hall, I could hear the sound of Eve's wailing: She was making such a ruckus that the nurses were concerned. Not knowing what to expect, I braced myself as I walked into the room.
The sight of this frail, gray-haired woman pacing back and forth, moaning and crying, scared me. I was afraid she might have a heart attack or collapse. I wasn't sure what to say or how to console her. I just stood there, trying to be calm, not wanting to reveal how unprepared I felt.
But if Eve noticed, she didn't let on. Overcome with grief, she rushed toward me, weeping, and threw her birdlike arms around my shoulders. These were not controlled, guarded tears, but sobs. Her tiny chest heaved against mine, convulsing with each breath. It all happened so fast that my body stiffened in response: I wasn't used to such an uncensored outpouring. It blasted all my circuits; for a moment everything turned black. I was threatened by Eve's intensity, overwhelmed by her need. I had an impulse to rip her away from me, to tear out of the room and never look back. I believed that patients weren't supposed to touch their therapists, much less curl up in the fetal position in their laps, as Eve was now doing. That was a job for family members. But now that her daughter was gone, Eve had no family left. I was the closest connection she had.
Craving the warmth that comes only from physical affection, Eve clung to me like a heartbroken child. A few times I attempted to shift position, to loosen Eve's grasp, but she had no intention of letting go. So there I sat, on the unmade hospital bed, cradling Eve, her daughter stone cold on a gurney less than a foot away. Once I realized there was no escape, I gave up trying so hard to be the “appropriate” psychiatrist and began to relax. There was no more pressure; I was able to feel a tenderness for Eve that my contrived notion of professionalism had blocked off. Not drawing back, I allowed myself to care for her, woman to woman. She could have been my own grandmother, the love I felt for her was so great.
For more than an hour I held Eve close. We didn't say much to each other; I just let her cry. When she was finished, we walked to the cafeteria arm-in-arm for coffee and talked. But this was no formal session; rather, it was an exchange of anecdotes about her daughter, a time of remembrance. I had known her daughter from family meetings that the three of us had had at the hospital after she became ill. Now, surrounded by clanging trays and the smell of cigarette smoke, we brought her memory alive and honored it. To do this, however, was not how I was trained to conduct therapy in school. But it was what was needed, and I knew it was right. Something essential had happened. Eve had been given the freedom to express her grief, and I had learned how vital it was to be loving and authentic.
As I continued my practice, I found that I attracted the kind of patient who insisted on intimacy. They didn't want me to sit back quietly and nod my head while they endlessly talked. It wasn't enough for me simply to ask, “What are you feeling?” and then take notes. I was called upon to react, to be engaged emotionally and to offer my opinions. My patients also wanted me to reveal more of myself, and when I did, a chemistry was established, an energetic interplay that led to change. I followed my patients' leads and learned from them. A detached style might have worked for other therapists, but I was coming to see that it was not appropriate for me.
For six months, I played the role of the traditional doctor. Friends who were physicians in the community referred patients to me. My practice filled up fast. I enjoyed the intensity of the work, the hectic schedule, and the adrenaline rush of being called into the emergency room to see suicidal patients in the middle of the night. It was a challenge to face new problems each day, a privilege to help people change and better their lives. I began to feel confident, certain I'd found my niche.
And then I met Christine. As I recounted in the Prologue, it was at this point that my experience with her—when I ignored my premonition of her suicide attempt—pulled me up short. For the first time I realized how I'd lost track of my original goal in getting medical training. Instead of working to bridge the parallel worlds of the psychic and scientific, I had become as skeptical—of even my own abilities—as my colleagues.
But keeping that long vigil by Christine's bedside made me reclaim those feelings and focus on incorporating the psychic into my practice. I would never risk endangering another patient the way I had Christine. But although this was absolutely clear to me, I still did not know what my next step should be.
Occasionally, I went back to the Neuropsychiatric Institute to visit; returning to the familiar hallways and clinics was always comforting. One afternoon, shortly after Christine came out of her coma, I fortuitously ran into Scott, who was working on a postgraduate fellowship. I hadn't seen him for over a year. Scott was the only doctor I knew who had been connected to Thelma's lab. A conventionally trained child psychiatrist, he also had an appreciation of unorthodox healing approaches and was the one person at UCLA I felt safe enough with to discuss Christine. The timing of our meeting was perfect. Drinking tea in the cafeteria, I told him what had happened.