In our downtime, Marilyn and I explored the island. We adored the graceful Balinese and admired their art, dancing, puppetry, carving, and painting, and we marveled at the religious parades. The beach-walking and snorkeling were heavenly. One day our driver took us, along with two bicycles, to one of Bali’s highest points, and we coasted several miles downhill through villages, passing stands selling slices of jackfruit and durian. To my surprise, chess was popular in Bali, and I found games everywhere. I often went early to a nearby restaurant to play chess with the waiter.
My agreement with Marilyn was to spend the second half of the sabbatical year in Europe. I love tropical islands, and Marilyn loves France, and throughout our marriage we have compromised. Marilyn had just officially left her administrative position at Stanford (though she has stayed on until this day as a senior scholar), and she still had some professional duties that took her back to Palo Alto on our way to Europe. I stopped in Hawaii for a writing retreat on Oahu at our Japanese host’s lovely condo, where I wrote two more stories. Finally, after five weeks, Marilyn rang the bell, informing me it was time to resume our trip.
Next stop, Bellagio, Italy. A year earlier we had each applied and been accepted for residence at the Rockefeller Foundation Center in Bellagio, she to work on her women’s memoirs of the French Revolution, and I to work on my book of psychotherapy tales.
A residency at Bellagio must be one of the greatest perks of academia. Only a short walk from Lake Como, the Rockefeller compound has beautiful gardens, a superb chef, who hand-made the pasta and served a different variety every night, and a handsome central villa that houses the thirty scholars and provides a separate study for each. The scholars met together at mealtimes and for evening seminars, where we each presented our work. Marilyn and I wrote each morning and in the afternoons we often took the ferryboat to one of the small, charming villages on Lake Como. I spent a great deal of time with one of the other scholars, Stanley Elkins, a marvelous comic novelist. Stanley had been invalided by polio and used a wheelchair. Every night he regularly trolled for plots and characters by listening to talk radio.
After Bellagio we spent the remaining four months of our sabbatical in Paris, renting an apartment on the Boulevard Port Royal. Marilyn wrote at home and I in an outdoor café near the Panthéon, where I finished the last four stories. Once again, I took my daily French lessons—alas, as always, to no avail—and late afternoons and evenings we strolled through the city and had dinner with her Parisian friends.
Writing in an outdoor café agreed with me and I wrote with unusual efficiency. Later, when I returned home, I found an outdoor café in San Francisco in North Beach (Café Malvino) with good writing vibes, where I continued the practice. Since I meant this to be a collection of teaching tales for young therapists, I set out to write a few paragraphs at the end of each story that elaborated upon the theoretical points illustrated within. That idea proved unwieldy, and instead I spent several weeks writing a sixty-page teaching epilogue to appear at the end of the book. Then I mailed the manuscript to my publisher with a sense of great satisfaction.
Two or three weeks later, Phoebe Hoss, the Basic Books editor assigned to the book, contacted me. Phoebe was an editor from hell (but also from heaven) and we were destined for an epic battle. As I recall, Phoebe did only minor editing of the stories except at one point to insert a phrase, “an avalanche of flesh,” into the fat lady story. That phrase sticks in my mind because it is the only gratuitous phrase any editor has ever added (even though I often wished for more). But then, when Phoebe read my long epilogue, she went berserk and insisted I ditch it entirely. She was absolutely sure that no final theoretical explanation was needed and that the stories would speak for themselves. Phoebe and I had a major war, battling for months. I submitted one version of the epilogue after another, and each was returned to me cruelly shortened until, after several months, she had reduced my sixty pages to ten and insisted it be moved to the front of the book. As I reread the book today, beginning with the succinct prologue, I am chagrined by memories of my fierce resistance: Phoebe, a blessed editor, whose like I would never again encounter, was absolutely right.
When the book was to be released Marilyn and I flew to New York for the publisher’s publication party—such events, now rare, were common in that era. The party was scheduled for a Monday evening, but a negative review in the Sunday New York Times put a damper on everyone’s spirits. The format of the book had very few precedents: only some of Freud’s case histories and Robert Lindner’s The Fifty-Minute Hour, about patients in hypnotherapy, came close. The New York Times reviewer, a child psychiatrist, was affronted by the format and ended her sour review saying that she would prefer to read her case histories in professional journals.
A few minutes after midnight on Sunday night, however, I was awakened by a phone call from my overjoyed publisher saying that the Wednesday New York Times would publish a rave review by Eva Hoffman, a well-known writer and reviewer. To this day I am grateful to Eva Hoffman, whom I had the pleasure of meeting years later. I did readings of the book in New York and at bookstores in a dozen cities. Those national book tours are now largely a thing of the past, along with the profession of book tour guides, who met authors at the airport and transported them to speaking engagements. At almost every bookstore, Oliver Sacks had just preceded me, promoting his recently published book The Man Who Mistook His Wife for a Hat. Our paths crossed so much that I felt I knew him, but unfortunately we never met. I much admired his work, and after reading his moving final book, On the Move, I wrote him a fan letter shortly before he died.
Within a few weeks after publication, to my total astonishment, Love’s Executioner found its way to the New York Times bestseller list, where it remained for several weeks. I was soon overwhelmed with interviews and speaking requests, and remember complaining about my fatigue and stress in a lunch conversation with Phillip Lopate, a fine essayist who had been one of my instructors at a writing workshop at Bennington College. His advice to me: “Chill out and enjoy the attention—bestsellers are rare and, who knows, you might never have another.” And, oh, how right he was.
Twenty-three years later, the publisher decided to reissue Love’s Executioner with a different cover and asked me to write a new afterword. I reread the book—the first time in a great many years—and had strong reactions: pride coupled with chagrin at my aging and envy of my younger self. I couldn’t help feeling this guy writes a lot better than I can. It was a pleasure to revisit all my dear old patients, many of them no longer alive. But there was one exception: the story “Fat Lady.” I remember writing that story in a Paris café and spending hours constructing the opening paragraph, which introduces the concept of countertransference, the therapist’s unbidden emotional reactions to a patient.
The day Betty entered my office, the instant I saw her steering her ponderous two-hundred-fifty-pound, five-foot-two-inch frame toward my trim, high-tech office chair, I knew that a great trial of countertransference was in store for me.
The story is meant to be a teaching tale for therapists, and I, even more than the patient, am the main character. It is a story about those irrational, sometimes abhorrent feelings a therapist may feel toward a patient that may constitute a formidable obstacle in therapy. A therapist may have extremely strong feelings of attraction toward a patient, or may have a powerful negative reaction flowing from unconscious sources, perhaps from encounters with negative figures in the therapist’s past. Though I wasn’t in touch with all the reasons for my negative feelings toward obese women, I felt certain that my relationship to my mother played some role, and I knew I had to struggle hard to overcome my unruly feelings and relate to the patient in a human, positive fashion. That was the story I meant to tell, and to do it I magnified the extent of my countertransference. Thus the conflict between my negative countertransference toward Betty and my desire to help her provided the central drama.
One i
ncident, in particular, evoked strong empathy in me. Betty had set up a date from the personal ads in a local newspaper (the common practice in those pre-Match.com days) and wore a rose in her hair to be identified. The man never appeared. This was not the first time Betty had experienced something similar, and she surmised that he had taken a look at her from a distance and disappeared. My heart went out to her and I had to hold back my tears as she described herself struggling to keep her composure and drinking in solitude at the crowded bar.
I took pride in the denouement expressed in the final words in the story when she asked for a farewell hug: “When we embraced, I was surprised to find that I could get my arms all the way around her.”
I opted to write the story with brutal revelation of my shameful thoughts about obesity. No, it went much further than that: for the sake of literary power, I greatly magnified my repugnance and crafted the story into a duel between my role as a healer and the onslaught of bedeviling thoughts in the background.
It was with some trepidation that I handed Betty the story to read and asked her permission. I had, of course, altered all identifying details, and I asked if there were other changes she desired. I told her how I had exaggerated my feelings in the service of teaching more effectively. Betty said she understood and gave me written permission to publish the story.
The response to this particular story was vigorous and loud. “Fat Lady” generated a flood of negative responses from women who were hurt and outraged. But it also resulted in an even greater outpouring of positive letters from young therapists who felt relieved as they tried to work through their own negative feelings toward some of their patients. My honesty, they said, made it easier for them to live with themselves when they harbored negative feelings and enabled them to speak openly of such feelings to a supervisor or colleague.
When Terry Gross interviewed me on Fresh Air, a popular PBS radio program, she questioned me, perhaps “excoriated” is the more accurate term, about this story. Finally, in self-defense, I exclaimed, “Didn’t you read the end of the story? Did you not understand that the story was about my journey in therapy with someone toward whom I had negative prejudices and that by the end I had changed and had matured as a therapist? I am the main character in this story, not the patient.” I was never invited back to her program.
Though she may not have been able to tell me so, I imagine the story did cause Betty pain. I had put blinders on. I was too ambitious, too reckless, too caught up in liberating my writerly impulses. I regret it to this day. Writing that story now, I would try to transform obesity into some entirely different condition and more radically fictionalize the events of therapy.
I ended my afterword to a new edition of Love’s Executioner with an observation my younger self would have found surprising: namely, that the view from eighty is better than expected. Yes, I can’t deny that life in the later years is just one damn loss after another; but, even so, I’ve found far greater tranquility and happiness in my seventh, and eighth, and ninth decades than I had ever thought possible. And there’s one additional bonus: reading your own work can be more exciting! Memory loss has some unexpected advantages. As I turned the pages of “Three Unopened Letters,” “The Wrong One Died,” and the title story, “Love’s Executioner,” I felt myself burning with curiosity. I had forgotten how the stories ended!
CHAPTER TWENTY-NINE
WHEN NIETZSCHE WEPT
In 1988, I returned to teaching and clinical work and collaborated with Sophia Vinogradov, a former Stanford psychiatric resident, on A Concise Guide to Group Psychotherapy for the American Psychiatric Press. Soon a familiar discomfort descended upon me: I missed having a literary project to work on and felt adrift. Before long I found myself drawn again to some of Nietzsche’s works. I had always loved reading Nietzsche and soon felt so intoxicated by his powerful language that I couldn’t tug my mind away from this strange nineteenth-century philosopher—a man so brilliant, but so isolated and despairing, and so much in need of help. After spending several months immersed in his early works, it dawned on me that my unconscious had already selected my next project.
I now felt split between two desires: to continue my life of research and teaching at Stanford, or to take a plunge and try to write a novel. I recall little of this internal struggle. I only know the solution that finally knit together these two disparate parts: I would write a teaching novel and attempt to transport my students in the field back in time to the Vienna of the late nineteenth century, where they could observe the birth of psychotherapy.
Why Nietzsche? Though he had lived during the era when Freud brought psychotherapy into existence, he had never been considered relevant to psychiatry. Yet many of Nietzsche’s pronouncements, sprinkled throughout his work and written before the dawn of psychotherapy, are highly germane to the education of therapists. Consider these:
“Physician help thyself; thus you help your patients too. Let this be his best help—that he, the patient, may behold with his eyes the man who heals himself.”
“You shall build over and beyond yourself. But first you must be built yourself, perpendicular in body and soul. You shall not only produce yourself, but produce something higher.”
“For that is what I am through and through: reeling in, raising up, raising, a raiser, cultivator, and disciplinarian, who once counseled himself, not for nothing: Become who you are.”
“He who has a ‘why’ in life can put up with any ‘how.’”
“Often we are more in love with desire than the desired.”
“Some cannot loosen their own chains and can nonetheless redeem their friends.”
I imagined an alternative fictional history in which Nietzsche would play a major role in the evolution of psychotherapy. I imagined him interacting with the familiar cast of characters associated with the birth of psychotherapy: Sigmund Freud, Josef Breuer (Freud’s mentor), and Breuer’s patient Anna O. (the first person treated with the psychoanalytic method). How might the face of therapy have been altered, I wondered, if Nietzsche, a philosopher, had played a key role in the birth of our field?
During this period of gestation I happened to read André Gide’s novel Lafcadio’s Adventures, and my eye fell upon this felicitous phrase: “History is fiction that did happen; whereas fiction is history that might have happened.” Those words jolted me: they described precisely what I wanted to do—to write fiction that might have happened. I wanted to write a genesis of psychotherapy that would have been entirely possible if history were rotated only slightly on its axis. I wanted the events of my novel to have had a possible existence.
As I began to write, I could sense my characters stirring as though they strained to live once again. They needed my full attention, but my duties at Stanford were demanding: I taught residents and medical students, attended departmental meetings, and met with patients in individual and group therapy. To write this novel I knew I needed freedom from all distractions, so in 1990 I arranged for a four-month sabbatical. As always, Marilyn chose the setting for one half, and I the other. I selected one of the quietest, most isolated island chains in the world—the Seychelles—and she, as always, chose Paris.
We spent our first month on Mahé, the main island of the Seychelles, and our second month on a smaller island, Praslin. Both were pristine, ringed with spectacular beaches, and almost eerily quiet—no newspapers, no Internet, no phones—the most conducive site for writing I have ever encountered. We wrote the first half of the day, I on my novel and Marilyn on Blood Sisters, an English expanded version of her French-language book about women who were eyewitnesses to the French Revolution. In the afternoons, we explored the island, walked the beaches, and snorkeled—and all the while, my characters were slowly coming to life in my mind. In the evenings we read, played Scrabble, and had dinner at the one nearby restaurant, and I mulled over plot development for the next day’s writing.
I began cautiously, stic
king close to historical facts whenever possible. My first decision was the time period. I wanted the ailing Nietzsche to have an encounter with therapy, and several considerations pointed to 1882, the year he contemplated suicide and most urgently needed help. His letters from that era describe great suffering for over three hundred days a year, including excruciating headaches, weakness, severe visual problems, and gastric distress. As a result of his poor health, he had resigned his teaching position in 1879 from the University of Basel and was rootless for the rest of his life, traveling from one guesthouse to another throughout Europe in search of atmospheric conditions that might temper his anguish.
His correspondence reveals a profound depression. A typical 1882 letter to his one good friend, Franz Overbeck, read: “ . . . at the very base, immovable black melancholy. . . . I no longer see any point at all to living even another half year, everything is full, painful, dégoutant. I forgo and suffer too much. . . . I shall do nothing good anymore, so why do anything!”
A catastrophic event for Nietzsche occurred in 1882: his passionate (though unconsummated) relationship with Lou Salomé, a lovely young Russian woman destined to infatuate other great men, among them Freud and Rainer Maria Rilke, came to an end. Nietzsche and his friend Paul Rée were both enamored of Lou Salomé, and the three made plans to live together in Paris. But the plan exploded in 1882, when Paul and Lou began a sexual relationship. Nietzsche was devastated and fell into great despair. Thus everything seemed to point to 1882 for my book: it was the nadir of Nietzsche’s life—the time when he most needed help. And it was also a heavily documented year for all my major characters: Nietzsche, Breuer, Freud (as a medical student), and Lou Salomé.