WRITING SHORT: 29/50

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[Come summer heat, much of my blogging momentum melts away. Hence an experiment until Labor Day: fifty minimalist posts about whatever.]

I belong to the talk therapy generation – when you could disgorge a Portnoy-length complaint about you you you to a willing, patient, selfless listener for as many fifty-minute segments as needed. I’m not just talking Freudian psychotherapy here. Whatever the therapist’s orientation, he was always there for you – on time, attentive, with no needs of his own, except to be paid.

Yes, it was expensive. You had to work for it. (If only your parents wrote the checks, it might go on forever.) But many therapists had a sliding scale. And if you found the right one, opening up about your troubles to such a knowledgeable, caring listener could change your life, and sometimes actually save it.

After two false starts, I talked my way through twenty-four non-consecutive years of trouble – eight years for three “hours” a week with one man, who may have kept me from going crazy, and later once a week for sixteen more years with another. They were both older and wiser than I was. I paid for all of it with my own earned money and used to say, jokingly, that I couldn’t leave a husband till I had a shrink, and couldn’t leave a shrink till I had a husband. It wasn’t entirely a joke.

Now that insurance companies demand quicker (cheaper) results, psychiatrists mostly medicate; psychologists and social workers, who’ve taken over the talking trade, tend towards the quick fix and goodbye. There may still be some few psychiatrists who believe in talking it out, but it’s highly unlikely they take insurance or Medicare, which has made real talk therapy, if you can find it, a luxury.

I do wish I could ensure Bill and I live on and on together, but the prospect of one of us dying before the other is hard to disregard, and I sometimes ask myself: To whom will I then turn? Have I outlived all the talk therapists still in practice? If not, how long can I afford to keep talking? Being a crotchety aging person, I don’t  much trust the guidance of younger “professionals” reimbursed for rapid turnover as I enter the uncharted emotional wilderness of old old age. That must be the ultimate hard place, where you must stand all alone till the end.

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IN DEFENSE OF TALK THERAPY

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I save things that seem important: old photographs, records of the past I might want to revisit, writing that speaks to me.  Sometimes I forget about these saved things for years and then come upon them by happenstance while looking for something else.

As was the case yesterday when I was rummaging around in the front drawer of my father’s French Provincial desk (a North Carolina copy, not an 18th century original), which is practically useless for real work but decorative enough to keep in the living room to put a lamp and framed family photographs on.  (Also one of the cats likes napping on it in the evening.)  Its thin middle drawer contains, among a few other folders and envelopes, a binder of articles that at one time or another I thought keepers — including a review by Joan Acocella of several books about psychiatry that appeared fourteen years ago in The New Yorker. (May 8, 2000 issue.)  It was called “The Empty Couch: What is lost when psychiatry turns to drugs?” I had to drop everything I was doing and re-read it at once because, like Acocella, I am a member of the talk therapy generation.

I have at times made fun of my years on the couch, or on an expensive chair — expensive in terms of hours sat on, not initial cost. Called myself the Queen of Therapy.  (Woody Allen is King.) Have even dropped at least one light-hearted reference in this very blog to “the Hungarian,” the first of the two shrinks who you could say — not quite literally but not exactly metaphorically either — saved my life. He was the one who called me “honeybunch,” which may not have been quite in keeping with the ethics of the profession, but was what I then certainly needed to hear from somebody.

In fact, I probably owe the existence of my two children to this ebullient representative of the “paprikash of Europe” (his own term for Hungarian men). It’s also an accurate summary of my emotional life to say I haven’t been able leave a husband until I had a shrink, and haven’t been able to leave a shrink until I had a husband.  (You figure that one out: Bill is both.)

Like many things in my life, and in the lives of others who have lived as long as I have, talk therapy seems to be on the way out. It is time-consuming, expensive, participatory — and to those who haven’t experienced it (or haven’t paid for it out of pocket, as most of us in the old days did, going without other things to afford it), it may seem self-indulgent and too self-referential.  Medication, by contrast, is a quick fix for symptoms, once the doc figures out the formula that works.  Moreover, insurance companies love the biomedical approach: one, two, three and skidoo — out into the world again, seemingly good as new.  And what insurance companies love (and pay for) is what insureds get.

Acocella’s review considers how we reached this point, and the merits for certain kinds of patients of each approach.  But she, like me, clearly tips in favor of talking oneself back into balance, unless one is seriously ill. And because I feel I should atone somewhat for my occasional levity about what has helped me get through some very rough times, and also because she is eloquent, I am now going to turn the lectern over to her. She states the case for an approach to life’s problems that I hope will not entirely disappear:

For many people of my generation, especially women, psychotherapy is not so much an issue as a history, a language in which they learned to speak of themselves, and of life. This fact has been widely deplored. Psychotherapy, people say, has taught women to think of themselves as victims. It has made them narcissistic, turned them in on their own minds rather than out into the world, where the men seem to be living. True enough, of some therapies. In others women — and men — have learned to stop being victims and to act in the world…..

What do we think about psychotherapy? I don’t mean for inpatients. (They clearly need it; their lives are wrecked.) I mean for outpatients, the walking wounded — us. For some, it’s damaging. Even when it’s good, it’s very expensive, but compared with the church and family of yesteryear, whose loss it is trying to make up for, it’s a bargain. (In the church, you tithed, gave ten percent of your income. As for the family, it kept women at home. What was the cost of that?)

And when it is good, it is something hard to find in life, a moral dialogue.  [One of the writers reviewed says of one of her therapists that with him talk] “was not only the means to a therapeutic end, but … the central source of moral meaning itself.” …. [T]he truth is that a talk about moral meaning cannot not be therapeutic, if by therapy we mean not just symptom relief but a chance for a serious life.

The matters that people discuss in psychotherapy — whether they are really answerable for their lives, whether they should place their own welfare over another’s — are the things that people in the Bible were trying to decide.  They are the big questions, right? For patients in serious distress, pills are useful, but they cannot provide, don’t aim to provide, what psychodynamic therapy has at its core:…“a sense of human complexity, of depth, an exigent demand to struggle against one’s own refusals, and a respect for the difficulty of human life.”

The italics at the end are mine.  I like to laugh as much as the next person, but I have never wanted to be numbed into accepting what was, when what was was of my own making. You can choose to swallow something someone gives you, not feel the pain, and giggle. Or you can demand the right to struggle against your own refusals. Life is difficult, but if you choose not to experience it, not to work your way through the difficulties — can you say you’ve really lived?

MY FIRST TIME

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I am a firm believer in talk therapy — the old-fashioned kind that used to take time, cost money, and almost doesn’t exist any more because pharmaceuticals produce quicker “fixes” and insurance companies therefore like them better.  To hear aging psychiatrists tell it, medical school psychiatry these days is accordingly mainly about prescription drugs for the psychotic, which means that M.D.’s are no longer properly trained to hear out the merely neurotic, on couch or chair, for as long as it takes.  They leave that to the social workers, a different category of “service provider” entirely.

But in the old days, the right therapist, M.D. or no, could save your life. In some instances literally save it, more often save it metaphorically –by asking the right questions and steering you gently in the right direction, without saying too much, if anything, but devoting all his or her attention to you.  That was key — it was always all about you.  The other person in the room had no needs, no agenda, for the fifty minutes you spent together.  But you did have to find the right one — the one who could listen to you.  It took me a while to find that right therapist, the one where the transference took.

******

In March 1953, I was 21 and knee-deep in several unsatisfactory situations:

(1)  First serious boyfriend and I had broken up.

(2)  I had allowed my parents to move me out West with them after college because I had no idea of how to look for a job that would support me back East.

(c)  After several abortive tries, I had finally found employment, paying $140 a month, in the typing pool at ABC television in Los Angeles.  Here I typed sit-com scripts, written by better-paid people, on purple stencils until 4:30 in the afternoon and then joined other pool members in assembling the pages  — leaving at the end of each day with purple fingers and thumbs that required a lot of soap to come clean again.  Me, the college graduate!  A young woman in Personnel not much older than I  had promised when something better opened up, it would be mine.  I soon realized she had lied.

(d) As for the new man in the West who had somewhat replaced first serious boyfriend in my affections — he was nine years older, had four small children by a previous marriage, was paying alimony as well as child support and, as a university instructor, earned what my father scornfully termed “bubkes.”  He was also not Jewish, which didn’t go down so well at home, either.  Not that we were observant, or that he ever went to church.  It was the principle of the thing.

In short, I was not a happy camper.  One morning, as I was about to pass reluctantly through the ABC front gates, I found I just couldn’t.  Spinning around, I went back to the ’37 Plymouth coupe the divorced man had helped me buy,  drove to his studio apartment, knowing he would be at work, and used the key he had given me.  I needed help.  First serious boyfriend  — still on my mind — had found it with a therapist. (For which his parents had paid through the nose.)  Maybe I should try a therapist too, even though my parents thought therapy was for “crazies.”    I looked up the number of the L.A. Free Clinic for Mental Health in the divorced man’s phone book, used his black rotary phone to call, and obtained a clinic appointment.

I had to wait three weeks. Stoically, I endured life until then.

The address I’d been given over the phone was near Chinatown.  The lobby of the clinic was a stew of sour unhappiness:  crippled and misshapen people, troubled-looking people, in some cases malodorous — all milling about and obstructing the way to the front desk.  Children cried. A mongrel dog with scabrous ears had lost its owner and trailed a broken leash around unfamiliar feet, whimpering.

After a ten-minute wait sandwiched between other people’s thick thighs on a crowded bench, my last name was called and I was assigned a seat in a small glassed-in cubicle off the lobby, equipped with rickety plywood desk and Underwood typewriter.

Another ten minutes went by.  At last, a blank-faced older woman in a tight rayon print dress sat down heavily opposite me and proceeded to ask a seemingly endless series of tedious questions, the answers to which she laboriously block-printed on the form in front of her:  First name, middle name, family name (that one she asked how to spell), address, telephone if any, schools attended, years of school attendance, highest year of education completed.  The “middle name” part of the questionnaire gave trouble.  I didn’t have one.

“I have to put one down,” said the woman.

“There isn’t one on my birth certificate,” I said.

“That doesn’t mean you haven’t got one.  I need a middle name.”

We stared at each other.  Impasse.   “If I had been born in Russia,” I finally said, “it would have been ‘Mikhailovna.'”  This was true.

“Were you born in Russia?” she asked.

“No.”

“I can’t leave a blank. Can I put it anyway?”

I sighed.  No one had ever called me “Nina Mikhailovna.” But she was chewing up precious time.  [I still assumed I would be speaking with a professional after these preliminaries.]  Besides, does anyone really look at these things?

“Put it anyway.”  I spelled it for her.

Then we continued:  current place of employment, position, how long there, salary, previous place of employment, position, how long there, salary, reason for leaving, nearest relative, relative’s name address phone if any…  God, she was slow!  What good was the Underwood if she wasn’t going to use it?

“Problem?” the woman asked.

“Pardon?”

“Your problem.  Why are you here?”

“I’ll tell the doctor when I see him.”

“I have to put something.”

“Put ‘personal.’ ”

“‘Personal’ what?

“Personal problem!”

The woman looked at me impassively.

“Family issues, all right?”

The woman carefully printed “Behav. Hlth — Fam. Iss”  on the last line of the form.  Done at last!  She consulted another paper under her pad of forms, her finger running down a column of figures.  “$5 a visit.”  I nodded, thinking of the $45 first serious boyfriend’s parents had paid his therapist.

“Sign here,” said the woman.

I signed.

“Next Tuesday, 5:30. Room 110,” said the woman, getting up.

“But what about today?” I cried.  “I have a crisis.  I came for help!”

“No help today.  You don’t want to come Tuesday, 5:30?”

I capitulated.  “I’ll come.”

Room 110, when I reached it the following Tuesday, looked like my eighth grade classroom at P.S. 99 Queens.  I squeezed myself into one of the little pupil seats with an arm on which to write, and waited.  After a while, a young woman wearing a green sweater came in with another typed questionnaire;  this one had blanks after some of the questions and boxes to check off for the questions that were multiple choice.  The first page was headed, “Los Angeles Free Clinic: Behavioral Health Division.”

I had to use my own pen. The young woman sat with crossed legs on a stool at the front of the room and began to read a book. No one else was there.  Why did I need a proctor?  Did they think I was going to cheat on the answers?  I peeked at the bottom of the last page; there were 203 questions.  “Don’t jump around,” directed the young woman, looking up.  “Start at the beginning and keep going.  If you don’t finish, that’s all right.”

It was now a month since my desperate phone call.  I worked my way impatiently through the first couple of pages — inquiries into full name (all three again), nickname, date of birth, names of family members, pets, friends.  Then medical history, educational history, work history.  (Come on already.)  Did I believe in hell?  Heaven?  God?  Best thing about myself? Worst thing? Favorite food?  Favorite activity?  Vindictively, I wrote, “Fucking.” (The divorced man’s word.  I myself always thought of it as “making love.”)  What would I do if I found out my best friend was lying to me? Stealing from me? Having an affair with my husband/wife [choose one]?

“Why am I filling this out?” I asked the young woman in the green sweater.  “I just want to talk to somebody.  Why can’t I talk to somebody?”

The young woman looked up from her book, annoyed.  “It’s diagnostic,” she said.  “You don’t get to talk to anyone till you’ve completed the diagnostic.”

I’ll give you diagnostic, I thought.  I drew a diagonal through the rest of the questions.  “Done!” I announced.  “Now can I see someone?”

“Next time,” said the young woman. “Make an appointment at the front desk for next time.”

“Next time” was not for another two weeks.  “But I’m in crisis,” I pleaded at the front desk, without conviction.  My month of waiting was inuring me to dull misery.

“Are you suicidal?” asked the man at the desk.  “Are you a cutter?”

I hesitated.  Was I about to destroy myself because of the divorced man or the job?  What was a cutter?  “I guess not,” I said.

“Two weeks,” said the man.

On the first of May, I paid five dollars at the front desk and finally saw a doctor.  “Nina Mikhailovna?” asked a tall thin young man in a white coat with a look of determined cheer on his face.  He had said “Mikhailovna” correctly.  He must have studied up on me for for this meeting, perhaps consulted a Russian speaker on fine points of Russian pronunciation. Then he strode confidently into the small room where I had been told to wait. “I’m Dr. Frug, Jonathan Frug. Your treatment supervisor.”  He held out one hand for me to shake; I could see he had my so-called “diagnostic” in the other.  He looked no older than first serious boyfriend.  Was I supposed to bare my soul to someone only a few years older than I was?  He must be an intern.  Or a resident.

“Nina,” I said.  “My name’s Nina.”  I waited until he had seated himself at another of the Los Angeles Free Clinic’s plywood desks.  “You see, I have this boyfriend.  He’s divorced?  With four children?  And I seem to be stuck.  So I need help.”

“Well, we’ll get to that,” said young Dr. Frug kindly.  “But first tell me, Nina Mikhailovna…. You have such a lovely name.  Why don’t you like it?”

“I don’t have anything against it.  It’s just not my name.  Everyone’s always called me Nina.  All my life.”

“But you put down that Nina Mikhailovna is your name.  Here, on the first line of your questionnaire.  And again on your diagnostic.  Now you tell me it’s not?”

I sighed.  “Dr. Frug.  The intake woman insisted that I had to have a middle name.”

“So you made one up?  To please her?”

“Not exactly.  If I had been born in Russia?  Everyone there has a patronymic?  You know, a middle name based on the father’s first name?  And that woman was so insistent?”

Why was he putting me on the defensive before we began?  Why was my every sentence turning into a question?

Dr. Frug took careful notes.

I continued, consciously declarative: “Mikhailovna is not on my birth certificate.  Or social security card.  Honestly, Dr. Frug, you’re making too much of this.”

Dr. Frug shook his head indulgently.  “We’ll see,” he said.  “What do you think of when you hear the name Nina Mikhailovna?”

“I think of an unhappy late nineteenth-century Russian woman.  In a Chekhov play. They all had those double names.”

He looked at me sympathetically.

“She’s probably not the heroine,” I babbled on in the silence.  “She has braids.”  More silence.  “My mother always liked Chekhov. He’s a Russian playwright.”

At last he spoke: “And is that your heritage?  Are your people Russian?”

My “people?”  My mother and father were non-observant Jews.  “Not really,” I said.  “My parents are naturalized Americans.”

Dr. Frug took more notes.  “And how do you see yourself?” he asked presently.

“Me?  I was born here,” I said.  “In New York.  After they escaped from the Soviet Union.”

Dr. Frug sat back and looked at me in a friendly manner.  “So. How does it make you feel to say your name isn’t really Nina Mikhailovna, a name so rich in cultural signifiers?”

“Do you really want to know?

“Yes, I do,” said Dr. Frug.

“It make me feel very annoyed with you, Dr. Frug, for frittering away my time this way.”

“I suggest you’re rejecting your identity and that annoys you?”

“That’s a ‘how often do you beat your wife’ question, Dr. Frug.  But yes, yes it does.”

He didn’t miss a beat.  “How does it feel to say you feel annoyed?” he asked.

Trapped.  I was trapped in a parallel universe with young Dr. Frug.

We never reached the “favorite activity” part of the questionnaire. Dr. Frug had just come to the “Do you believe in God?” question when we ran out of time.

I never went back. The next week, the divorced man found me a better job as a trainee copywriter in the advertising department of The Broadway Department Store. The hours were 9:00 to 6:00 (with an hour for lunch), and I couldn’t easily work Dr. Frug into that schedule even if I had wanted to, which I didn’t.  In fact, I wouldn’t have gone back under any circumstances.

However, I did receive a letter from him nearly three years later, when I was about to marry the divorced man.  The letter expressed concern for my well-being and an invitation to call the clinic to resume “treatment.”  Young Dr. Frug didn’t fool me, though.  If he had really felt concern, I would have heard from him long before. He was probably closing his files at the end of his internship.  Or residency.

Perhaps it goes without saying that the marriage was a mistake.  Although I doubt Dr. Frug would have known that, even if we had continued together. But of course we didn’t.

It would be another five years before I found the right therapist.  Actually my husband (the previously divorced man) found him for me.  By then, I had misspent most of my twenties in turmoil and angst.  But I now had another job, with an okay salary, and the therapist was generous in adjusting his sliding scale quite far down for me.

With his help, I at last began to turn my life around for the better.