Psychiatrist Irv Yalom is 83.
I call him Irv because that’s what he asks his psychiatric patients to call him. I picture him as a sprightly firecracker of a guy, tooling around San Francisco on his bicycle, stopping into the City Lights bookstore near his office and trading deep and witty thoughts with 95-year-old poet-painter-activist Lawrence Ferlighetti.
I also have the fantasy that, at some time, somewhere, Yalom ran into and became friendly with Sherwin B. Nuland before Nuland’s death last March at the age of 83. It’s a fanciful thought. These two great souls lived across the country from each other. Yet, they seem to have shared common interests.
Nuland is best known for his 1993 book How We Die: Reflections on Life’s Final Chapter. It’s a transcendently life-affirming work that looks at the mechanics of the human body and the ways the body — our body — breaks down. Its message: Life has an end so live it to the full.
Yalom’s new book Creatures of a Day and Other Tales of Psychotherapy sends the same message but from a different perspective. Whereas Nuland looked at physical things (blood, muscles, cancer, the heart and so on), Yalom deals with the emotions, fears and terrors that human beings — his clients and himself — bring to the subject of death.
He first tackled this question in print in his 2008 book Staring at the Sun: Overcoming the Terror of Death. In many ways, he wrote, the fear of death sparks a variety of other anxieties having to do with change, such as retirement and being an empty-nester, and illustrated his point with examples from his work with clients.
Creatures of a Day is all about clients and all about death although, in the 10 case studies, the fear of the end of life is often initially hidden in seemingly unrelated behaviors and thoughts.
Yalom’s struggles with what he calls his own “death anxiety” aren’t hidden at all, however.
For instance, he’s miffed when his patient Ellie tells him she’s felt comfortable talking about him about her terminal cancer “because I sense that old persons have thought about their own death.”
Yalom responds, “I am old, quite old, and I have thought about my death. But still I’m a bit rattled by your comment…I think it’s because I just don’t want to be defined as an old person.”
Yet, as it turned out, there was more to it than simply that.
“My own fear of death”
Ellie’s cancer grew worse, and Yalom felt that their sessions together as well as email exchanges weren’t very fruitful or helpful. But then, while he was in Hawaii on sabbatical, he received an email from her that, with her body ravaged by cancer and with the assistance of her doctor, Ellie had stopped eating and drinking and would soon be dead.
Jolted, Yalom recognized that “for some reason I had withheld myself from her.” He re-read their email exchange and was shocked to realize how rich Ellie’s thoughts were and how helpful she felt he was being. (161) “Irv puts me at ease,” Ellie writes in one email, “and he’s not afraid to go into the darkness with me.”
How could Yalom have helped, though, when he felt so disengaged from Ellie? In a backward way, he explains: “For sure it was not because I had entirely overcome my own fear of death.”
Forty years earlier, Yalom had gone into a course of psychotherapy with psychologist Rollo May to deal with his fears of death, and he writes: “Gradually, over the course of several months, my death anxiety diminished, and I grew more comfortable in my work with terminally ill patients.”
That anxiety diminished but didn’t disappear. That’s why he could be present with Ellie — but still, in some way, subconsciously, keep his distance.
“As I pored over her messages, I gradually began to understand. I did get close to Ellie. But not too close! Not dangerously close. I had falsely blamed her for our lack of intimacy. But she was not the problem….I was the problem. I was protecting myself.”
“The naked therapist”
A quarter of a century ago, I wrote a review in the Chicago Tribune of Yalom’s first book for the general public, Love’s Executioner and Other Tales of Psychotherapy, a similar collection of case studies.
What struck me then and what strikes me now with his latest book is Yalom’s willingness to expose his flaws and failures. “Here is the naked therapist,” I wrote then.
And the same is true in Creatures of a Day. A key aspect of these 10 tales has to do with Yalom’s groping around to find a way to be of help to his clients. Sometimes, he tries something, and it’s a clunker.
“Hmm, it was clear that sharing my eyeglasses story had not been a great idea,” he writes in relation to a former CEO, and he repeats variations on that in several of the other tales.
Sometimes, when success is achieved, it’s evident that it’s because the client, through some alchemy of the mind, feelings and will, has found his or her own way.
In one case, Yalom works a long time with a doctor who finds it impossible to develop intimate friendships and relationships. The sessions seem a failure, but, years later, Yalom finds out that an offhand recommendation he gave to the client for someone to clean up a messy house was the catalyst for the doctor to radically reorder his life.
Therapy as poetry
In their way, each of the case studies in Creatures of a Day is a detective story. The client and Yalom are trying to solve the puzzle behind unwanted behavior and feelings.
Just as Yalom’s description of the hard-working but flawed therapist rings true, so do his descriptions of his patients and their struggles, especially their struggles with the reality of death.
More than half a century ago, Lawrence Ferlinghetti, Yalom’s neighbor in San Francisco, wrote:
“Constantly risking absurdity/and death/whenever he performs/above the heads/of his audience/the poet like an acrobat/climbs on rime/to a high wire of his own making….”
Yalom sees the therapist as a poet. He sees therapy as an art. And he sees his clients as fellow poets, working the high wire, alone and with him.
In their sessions, he and they are alive to the moment — or trying to be. And that’s what life is, isn’t it?
That, and “constantly risking absurdity.”
Patrick T. Reardon
This book review initially appeared in the Chicago Tribune’s Printer’s Row section on 2.22.15. Another review of this book appeared on this website on 2.23.15.