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Nicole's Story
Four months before she came to see me, Nicole, 46, would have said her life was very nearly perfect. She had been married nineteen years and had a healthy daughter, 17, and son, 14. She worked part-time as the office coordinator for her husband Grant, a successful realtor. She was in close touch with her sister, 40, and both her parents. She had friends, a dog, two cats, and a Volvo SUV.
Sure, she sometimes wondered whether drinking a glass of wine or two to get to sleep could be a problem, but plenty of people didn't sleep well and plenty of people enjoyed their wine. There was also the way she went on shopping sprees to lift her mood when she felt down for more than a day or two, but a few extra dresses or pairs of shoes didn't seem like the end of the world. Even the fact that she didn't have much interest in sex anymore didn't seem so weird. After all, she'd lived and worked with the same man for nearly two decades--not exactly the ultimate recipe for passion.
Then, shortly after her daughter Kelley was accepted to a nationally recognized design school, Nicole's mood really started slipping. She was thrilled to see Kelley pursuing her dream, so she couldn't understand why she wasn't on Cloud Nine with her. She remembered feeling the same way after her wedding, when the ceremony and celebration and honeymoon were over.
However, her mood continued to slip. Despite Kelley's growing excitement about going to college, Nicole found herself tearful at times. She felt exhausted and couldn't concentrate at work. She began arguing more with her husband, especially when he bothered her about her drinking. She was up to three glasses of wine at bedtime. She had no sexual desire, whatsoever. In dark moments after midnight, she even doubted whether life was worth living.
She began to wonder whether her real problem might be her marriage. She certainly didn't feel anything like romantic love, anymore. She probably hadn't for many years. But she didn't want to think about it.
By avoiding the pain in her life, Nicole was no different from most of us. Human beings have a reflex reaction to psychological pain no different from our reaction to physical pain. We withdraw from it. We try to avoid thinking not only about the painful aspects of our lives today, but those in the past, all the way back to childhood.
We accept the notion that the mind uses many "defense mechanisms" to distance us from bitter realities. Chief among these mechanisms is denial. Denial can make us "look the other way" in the face of evidence that our spouses are unfaithful or our children have turned to drugs. It can make us immune to feedback from friends and loved ones who warn us about our addictions or other self-defeating behaviors.
Nicole might never have come to see me, in fact, were it not for her fourteen-year-old son Nathan. Nate was a high school football player and all-around jock, not one to talk about his feelings, so when he got choked up and told Nicole he felt like he had "lost his mother," she decided it was high time she tried to "find herself."
The first time we met I could see Nicole wasn't just well-put-together; she was perfectly-put-together. Everything was in its place--her designer clothes, her jewelry, her makeup, her hair. She was physically fit and looked younger than 46. But she also looked worried. She avoided eye contact. And more than once, she clenched and unclenched her fists, as though to wring the tension from her hands.
I nodded at them. "You're having a hard time," I said.
She looked down at her hands and let out a long breath. "I never thought I'd be saying this," she told me, "but I think I may need something."
"You mean, a medicine?"
"My sister's on Zoloft. She says it helps her."
I knew why Nicole was asking for Zoloft right off the bat: Part of her was still searching for some way to cover up the trouble in her life, instead of getting to the bottom of it.
"Zoloft might be part of the answer," I told her, "but I'd have to understand much more about you and your life to know."
She clenched her fists, again.
I leaned toward her. "Tell me what's wrong," I said.
That was enough to make her eyes fill up. "Nothing," she said. She twisted her engagement ring back and forth. "My marriage. The way I am around my kids . . . losing my temper. I'm a complete mess."
"You're a person," I said, "That's always messy."
She looked directly at me for the first time.
"What's happening in your marriage?" I asked.
She smiled at the same time as a tear escaped her eye. She wiped it away. "Not a lot--which is kind of the problem. We're . . . existing." She shook her head, as though trying to stop herself from saying more. The impulse to keep one's truth--especially one's pain--secret is among the most common, powerful, and toxic elements of human nature. "Grant is a wonderful person," she said. "He's been a great provider for almost twenty years. He's never hurt me."
If all my years as a practicing psychiatrist have taught me one thing, it's this: Listen for what people do not say. All Nicole could say at the moment about Grant was that he made money and wasn't abusive. That left out a lot of other desirable qualities.
I knew Nicole needed permission to tell me what she was really feeling. And since she had already hinted at her reality, I gave her an opening. "He's wonderful, but...," I said.
"But I'm bored to tears," she said flatly.
"And have been for how long?"
"Honestly?"
I waited.
"Probably since I've known him."
Nicole had come in asking for a prescription, maybe thinking that she had slid into a depression over the course of a few months, and we were already journeying back twenty-three years, to when she first met Grant. "What did you think of him when you met him?" I asked.
"That he was a real gentleman," she said. "That he would make a good husband and father--even if he was pretty, well, predictable. I'd been through a really bad breakup just before I met him," she said. "I wanted someone stable."
"Who had you broken up with?" I asked.
"Oh, God." She laughed and actually blushed--over twenty years later. So much for those who would deny the power of the past. "He was a complete mess."
A complete mess. Those were the same words Nicole had used to describe herself just moments before. And that was no coincidence: Listening carefully to Nicole had led me to my questions, which had led directly to the unconscious connection she now felt with her lover from decades before. "What kind of mess?" I asked.
"The worst kind," she said. Her expression brightened, and she suddenly looked ten years younger. "A troubled artist. Your typical bad boy."
"'Bad,' meaning ...?"
"You know: Wine, women. Not to mention the fact he was broke."
"You weren't about to go there," I said.
She chuckled, shook her head. "I'd already been there."
"How so?"
"With my dad."
Nicole had come in for what she thought would be a quick fix--Zoloft--and come face-to-face with unresolved feelings about her father. We had traveled thirty or more years in about thirty minutes.
"Your dad?" I asked.
"Ancient history," she said. She looked away, again.
"Doesn't sound like it," I said. "Here we are talking about him."
"What can I say? He was a lot more interested in his scotch, the track, and other women than he was in my mother, my sister or me."
Nicole told me the rest during a few more sessions. Her father would disappear for days at a time. Other women would call the house, setting the stage for screaming matches and occasionally even physical fights between her parents. Sometimes, her dad gambled away everything he made as a laborer, leaving the family without food.
Once I knew that "ancient history," I knew why it seemed so important to Nicole to look perfect. She felt anything but perfect inside. Part of her was still the little girl whose father might be sober one night, drunk the next, smiling and generous when he came home from the track a winner, violent when he had lost everything. No wonder Nicole would have traded passion with a troubled artist for the predictability and stability Grant offered. And that's one reason she would have felt somber after exchanging marriage vows; those vows were motivated partly by fear. They were partly about living life and partly about avoiding it.
"It doesn't help anything," Nicole said, "that I work with Grant and live with him. We're together twenty-four, seven."
"Why did it turn out that way?" I asked.
She shrugged. "He needed the help, and I didn't have much of a plan," she said. "I mean, I had fantasies about interior design or whatever, but I had no training or anything." She laughed. "I figured I'd at least know where he was all the time."
"Unlike your father," I said.
She stopped laughing. "I suppose," she said.
"Did you ever pursue your love of design?" I asked.
"Just stuff in our house," she said. "I'll leave the rest to Kelley."
My skin turned to goose flesh, as it does whenever the past becomes palpable in the present. It was clear to me now why Kelley leaving for design school had triggered Nicole's depression. Kelley was living out dreams that Nicole had once had for herself, dreams she had buried in order to create the safe family life she craved. Now, with her daughter off to design school, where she might even fall head over heels for an artistic, romantic, unpredictable man, Nicole was feeling the loss of what she had given up in exchange for stability--pieces of herself.
I wanted to bring Nicole face-to-face with the truth she had run from her whole life. Only that kind of reckoning with the early chapters in her life story could leave her free to imagine, and then live, wonderful chapters in the future. "So what do you think your dad loved more," I asked her, "the gambling, girls and booze . . . or you?"
She sat in silence for several seconds. Her eyes filled with tears, again. "Not me," she said finally. "I guess I never really wanted to admit that. I mean, I was the one by his bedside every day for six months after he was diagnosed with cancer. I think I just wanted to hear him say ..." She stopped herself.
"...that he loved you," I said.
Tears ran down her cheeks.
"Had he ever told you that?" I asked.
She swallowed hard. "No," she said. "And he never did." She looked down, as though ashamed.
I let several seconds pass. "You know the worst part?" I asked Nicole.
She looked at me.
"Part of you still thinks he was right--that you're not lovable. That's what part of any little girl would think growing up with a father incapable of caring about her. And that's the same part of you, by the way, that tells you that you have to keep tabs on your husband to keep him honest, instead of challenging him to grow if he wants to keep you around. It's the same part of you that won't express your passion for design. There's always that little voice at the back of your head saying maybe you're not worthy of love--not even your own."
"So how do I get that voice to stop?" she asked.
I smiled. "By listening to absolutely everything it has to say."
Only by hearing out the little girl inside her saying that she was never worthy of her father's devotion could Nicole, now an adult and a mother, nurture herself as she might a child--by finally focusing on the truth that she was born to a man who never made her feel worthy. And only by truly grieving that misfortune could she stop blaming herself for it. Back to top
Linda's Story
Living the Truth can help defeat psychological disorders, including major depression and panic disorder. Linda's story makes that plain.
Linda was a slight, redheaded, 42-year-old woman who came to see me with symptoms of major depression, including low mood, insomnia, difficulty concentrating, and decreased self-esteem. She had tolerated emotional abuse from her husband for several years and said she felt like she had "nothing left to give." She had three sons—4, 7, and 10—whom she was always trying to protect from her husband, literally standing between him and the boys, trying to deflect or absorb his scathing criticisms of them.
"He calls them every name in the book, even in front of people," she said. "He says horrible things like, 'You should never have been born.' And it doesn't have to be for anything major. Even little things set him off, like not taking their plates to the sink, not being friendly when we have people over the house, not wearing the 'right' clothes. But, the thing is, I know he doesn't mean it."
"Why do you say that?" I asked.
"He's just burnt out a lot of the time. He works so hard. He's under a lot of pressure. And now, I'm out of commission, crying all the time. And that just makes it even harder for him--and the kids."
Linda was actually blaming herself for her husband being abusive. "What does he do for work?" I asked her.
"He's an EMT. He has to deal with horrible things. Car accidents. Heart attacks. You name it."
Among my friends are surgeons, emergency room doctors, combat veterans, and police officers. They have to deal with plenty of ugliness, too. But I've never seen them lash out at their kids in any serious or sustained way. "He says his job makes it impossible to control himself at home and in public?" I asked.
She shook her head. "He doesn't make excuses for himself. I can just tell that's what's going on for him."
Linda's husband didn't have to make excuses for himself. Linda was doing it for him. "You can tell by the fact that he loses his temper?" I asked her.
"That and other stuff. He gets to a point where he just shuts down. I know he's thinking about everything he's seen. And he drinks a lot more than he should."
We weren't fifteen minutes into our time together, and Linda had already mentioned a second reason her husband might be losing his temper--his drinking. The fact that she was letting him off the hook by blaming his stressful job made me wonder whether she was predisposed to do so by her earlier life experience. "You're very understanding," I said.
She shrugged. "My dad was a firefighter," she said. "He retired five years ago."
"He was under a lot of stress while you were growing up?" I led.
"To say the least."
"How did he deal with it?"
"Not so well."
"Meaning?"
"Let's just say he makes my husband look tame, by comparison," she said.
Whenever people use that phrase--let's just say --they always have much more to say. It just isn't easy to find the words, or the courage. "Your father's temper was even worse?" I asked Linda.
She nodded.
"He yelled at you? Hit you?"
She smiled for the first time since arriving at the office. "He didn't mean it. He did the best he could. He loved all of us so much."
He (or she) did the best he could is another shield of denial people routinely raise. Just because our parents did the best they could, that doesn't mean they did well enough to keep us from harm. And until we're willing to admit we suffered and didn't deserve to, we can't learn from the painful dynamics we lived through. Nor can we avoid reproducing those dynamics in the future.
I wasn't surprised Linda had somehow summoned the energy to smile as she raised her shield of denial. "Did he drink, too?" I asked.
"Only to get to sleep," she said. "He had nightmares. That's what my mom said. We all tried to make it relaxing for him when he got home, but . . ."
"But . . ."
"There's only so much you can do to settle someone down who's been running into burning buildings all day, or waiting to."
We were at the heart of the family fiction that had set the stage for Linda selecting another angry man to marry, and then forgiving his abuse of her and her children. Her mother had suggested that a man who verbally and physically abuses his family isn't to blame, that the family has the responsibility to comfort and coddle such a man, rather than confront him or flee from him, that he can have true love in his heart for his wife and children while attacking them emotionally and physically. Even the theme of alcohol abuse being a defensible way to medicate stress had been written into her life story (and that of her future family) while Linda was still a girl.
Is it any surprise that the home Linda had created was a replica of the one she had come from, where she had been valued for absorbing the rage of a man, forgiving his abuse, and trying to heal him? After all, her father supposedly really loved her, despite screaming at her and hitting her.
"Was your father an angry person before becoming a firefighter?" I asked.
She looked confused. "I have no idea."
"Did he drink before that?"
She shook her head. "I don't know. Why do you ask?"
I wanted to be forceful enough with Linda to begin to take down the shield of denial that was her birthright. "You're letting him off the hook for assaulting you and being drunk every night, because he was out all day saving lives. So I just wanted to know if he was a violent alcoholic before he started fighting fires."
"He wasn't alcoholic. He . . ."
"He drank every night."
She didn't respond.
"He screamed at you and hit you."
"But . . . "
I pushed harder. "But he was running into burning buildings. Right. I get it. Just like your husband is scraping people off the pavement, so that supposedly gives him a free pass to level you and the kids with emotional abuse. But guess what? There's no excuse for hurting your wife and kids. So why don't you go and gather some facts."
"Like what?"
"Does your father have any sisters or brothers who are still alive?" I asked.
"A sister."
"Then ask her if he had trouble with alcohol or his temper before he became a firefighter."
"What if he did?"
"If he did, you can stop giving him a free pass on hurting you just because he was helping others. Because he was just using that as an excuse. And you can start wondering whether you chose a husband a lot like him because you don't feel valuable unless you're absorbing a man's violence."
After a lot more encouragement, Linda took me up on my offer. Her aunt told her that her dad hadn't been destroyed emotionally by fighting fires. He'd been troubled as far back as his teenage years. And here's the stunning, but not surprising part (at least to me): His own father--Linda's grandfather--had been alcoholic and violent, too. And his wife had stayed by his side.
Three generations of women in Linda's family had defined their roles as wives and mothers in the same toxic way. Seeing that fact was the beginning of Linda questioning the fiction she had been taught and starting to see her reality, however painful: Neither her father nor her husband ever loved her the way she deserved to be loved--purely, without her having to volunteer for abuse as part of the bargain.
Only once Linda realized this was she able to start standing up for herself and her kids. She didn't begin to hate her husband or suddenly want to leave him, but she did get angry. She gradually made it plain to him that she wasn't going to be his doormat or let him abuse her kids any longer. She told him she would indeed have to leave if he couldn't change, starting with getting help for his alcoholism. And the most wonderful part of the story is that when he did get help, he gave her some real evidence that he actually did value her. She learned that she had the power to insist on a better life for her and her children. Back to top
Richard's Story
About two years ago a forty-year-old highly successful CEO named Richard came to see me. A year before he had begun experiencing symptoms exactly like those of a heart attack. All of a sudden, he would feel nauseated and lightheaded. His chest would tighten, his pulse would race, and his skin would get clammy. Convinced he was dying, he would call 911 and be rushed from his apartment or his office to the emergency room. But each time, his EKG and lab studies would prove he hadn't suffered a heart attack at all.
When a stress test and angiogram both came back normal, Richard's cardiologist correctly diagnosed him with panic disorder--the symptoms of which can be indistinguishable from cardiac disease--and wrote him a prescription for Paxil.
Everything was fine, for about three months. Then Richard's symptoms returned. His cardiologist increased his Paxil and added some Klonopin, a tranquilizing medicine. That bought him another nine months. Then, at the leading edge of winter, his mood slipped dramatically, he lost all motivation and he began to feel like a "complete fraud." Everything he had achieved had been, he said, a fluke. He had no real intelligence and no genuine leadership ability.
Richard's cardiologist increased his Paxil yet again--but this time, to no avail. Richard's mood continued to plummet. When he broke down in tears at a business meeting, his cardiologist referred him to me.
The first time I saw Richard, he looked like a deflated super hero. His longish blonde hair, which I could imagine elegantly styled, was a mess. His suit needed pressing. His green eyes were bloodshot, with dark circles beneath them. The way he leaned forward, his shoulders hunched, made it seem like he literally needed help standing up.
I added a second antidepressant to Richard's regimen in order to help him cope with his symptoms, but I told him from the beginning that those symptoms were being fueled by earlier chapters in his life story he had been loathe to "read." Without opening them and learning what had set the stage for his suffering, no medicine would be powerful enough to keep his anxiety and depression at bay forever.
Toward the beginning of our first meeting together, I asked Richard essentially to take the Living the Truth Pledge, to assure me that he would do everything in his power to continue exploring his story, rather than run away from it. He agreed.
It wasn't until nearly the end of the hour that he mentioned that when his symptoms began two years before, he had just broken up with a woman.
"I really thought she was the one," he said. "But she threatened to throw me out, and I don't respond to that kind of thing."
Again, I noticed that Richard showed no emotion. He didn't seem sad and he didn't seem angry. "How long had you been living together?" I asked.
He shook his head. "Oh, we weren't living together. I just meant she threatened to dump me."
Odd turns of phrase often have real meaning.
Richard seemed to be saying that his girlfriend's threat to break up with him felt like being "thrown out" of his home. I kept that at the back of my mind.
He sighed. "She told me I either had to marry her or take off. She was thirty-five. That whole biological clock thing."
"How long had you been dating?"
"A little over six years."
"You weren't ready to get married?"
"I thought I was a few times," he said. "I even bought a ring once. But I couldn't go through with it."
Richard hadn't said he didn't want to get engaged. He'd said he couldn't. "Why not?" I asked.
"Who knows? Maybe I can't love anyone, or maybe I'm unlovable. I don't know anything, anymore."
That gave me hope. Not knowing was a good place to start. "Let's figure it out," I said. "Is there anyone you can say with certainty does love you?"
"My parents, that's it," Richard said immediately. "God knows where I'd be without them." He was silent a few moments, then sighed again and checked his watch. "I think we're running over."
Running, maybe. "I'm okay for time, if you are," I said.
"Sure," he said, tentatively.
"So tell me how you knew your parents loved you."
"I was an only child. They did everything for me," he said. "Best prep school in the country, best college. They always believed in me. Right after I graduated college my dad actually let me run the London office of his consulting company. Eighteen employees."
"Which prep school did you go to?" I asked.
"Andover Academy, in Massachusetts."
"Quite a school," I said. "Did you grow up nearby?"
"No, Syracuse," Richard said. "There really isn't anything like Andover anywhere near there."
That disclaimer--that Richard's parents had had no choice but to send him hundreds of miles away for his education, beginning in the ninth grade--brought me to my next question. "How did you feel going away to school?"
"Overwhelmed. It was the best."
Overwhelmed was another curious choice of words. "You didn't miss home?" I asked, as offhandedly as I could.
"I was homesick, sure," he said. "But everybody adjusts, right?"
Everybody wasn't in my office. Just Richard. "What was the adjustment like for you?" I asked.
The way Richard described feeling "homesick" sounded a lot like depression. He couldn't concentrate on his work, lost interest in the sports he loved, had trouble sleeping, dropped ten pounds, and suffered with vague physical symptoms like transient headaches and stomach aches. It went on for months. "Sounds really tough," I said. "Did you have to go back home for a while?" I asked.
He shook his head. "Not an option."
"Why's that?"
"My dad had to bail out a company in Paris for four months--until right after Christmas. My mom went over there with him. They left right after I did."
Being homesick is one thing. Being without a home is another. As I talked with Richard during our next few meetings, the latter seemed closer to the truth. Starting in ninth grade, his parents had sent him away to very prestigious schools, but they had never really welcomed him back. Even when he finished college and planned to move back to Syracuse to work in the "home office" of his father's consulting company, his dad had another plan: He sent him off to run the London office instead. His mother didn't object.
I thought of the way Richard had described his girlfriend's ultimatum that they either get engaged or end their relationship after six years. She threatened to throw me out. "Were you upset about being sent to London?" I asked him.
He shrugged. "How could I be? Talk about a kid in a candy store. There I was at twenty-two, running a company."
That didn't sound like pure fun. It sounded anxiety-provoking, too. "You were alone," I said, "thousands of miles from home."
"I was a pretty clingy kid when I was little. Its better they made a clean break of it. I probably never would have."
I felt I had a pretty clear sense why Richard's relationship with his girlfriend had ended the way it had. Unable to believe she truly loved him (because he had never truly felt loved by anyone, including his parents), he had been too frightened to give her the commitment she needed to feel secure, the love she needed to feel at home. And when she threatened to leave, he had taken that as proof that he had been right to doubt her devotion.
Trouble was, he didn't really buy that logic himself. Somewhere deep inside, Richard knew he was just using his girlfriend as a stand-in. He was blaming her for abandoning him, rather than admitting that his parents had.
My skin turned to goose flesh. The past was making itself known in the present. "Why would your parents ever want a 'clean break' from you?" I asked Richard.
"I didn't mean it that way," he said.
I kept looking at him.
He looked away.
I reminded him of the pledge he had taken to search for his truth, even if it hurt.
He sat in silence for twenty or thirty seconds, a very long time without words. Then his lip began to quiver, and his eyes filled up. It was the first gut-level emotion he had shown in my office. He was rejecting the fictional life story he had settled for decades earlier. "They had one another," he said. "I'm really not sure I ever had either one of them."
It didn't take more than a few more meetings for Richard to realize that he hadn't been able to get engaged because he hadn't trusted his girlfriend to stay with him, to create a true home with him.
"So what are you going to do now?" I asked him.
"It's not like she'd ever take me back," he said.
"How do you know that?" I asked.
"I just do."
"You think you do," I said, "because your parents never took you back. That doesn't mean it's true this time."
He called his girlfriend that very day, an act that required tremendous courage. To do it, he had to accept that his parents (not his girlfriend) had failed to give him a sense of security that they hadn't made him feel genuinely cared for. He had to admit that loving them without being convinced they loved him had left him wary of putting his heart on the line ever again. Then he had to do just that.
When you are willing to hurt in order to heal, people respond to your bravery and honesty. Your pain becomes your power. Richard's girlfriend not only took his call, she listened to what he had to say and took him back. She said she would give him the time he needed to trust her. And in doing so, she gave him the very thing his parents had failed to: the certain knowledge that he could go home again. Back to top
Mike's Story
A patient of mine named Mike, 27, shows how unexamined pain from the past can fuel conditions that might seem to have little to do with one's life story.
Mike was an assistant district attorney. He came to see me with crippling symptoms of obsessive-compulsive disorder, or OCD. For years, he had been meticulous about keeping his home clean and his clothing and car perfect, but over the past several months he had developed much more severe symptoms. Driving to work, going to the mall, or heading out on a date, he would begin worrying (obsessive thinking) that he had left the stove on or a candle burning back at his house. He couldn't get the thought out of his mind. So he would double back home (compulsive behavior) to check that all was well. But then, after leaving the house a second time, he would be gripped by another obsessive worry--maybe he had left the coffee maker on or the toaster plugged in, or he had ignored the smell of smoke as he was walking out the door.
"It's gotten to the point," he said, "where it can take me an hour or two to get from home to work. And it should be a fifteen-minute drive. I make sure I leave the house really early, but I'm still late half the time. And even once I do get in, I can't always concentrate. I can barely resist going home again to make sure the place hasn't burned down. As far as socializing, forget about it. It doesn't take women very long to figure out there's something wrong. I'm not really with them, even when I'm with them physically. My mind is back home."
Mike's symptoms were eroding his self-esteem. "I'm the one everybody else used to rely on at work to be organized and keep things moving. I can't come close to playing that role anymore. I literally move in circles half the time."
That's why, although Mike was focused on describing his obsessions and compulsions, I was intent on going deeper. I knew I needed to search for whatever had set his obsessions and compulsions in motion--for the real source of his pain.
Obsessive thoughts and compulsive behaviors were, after all, keeping Mike's mind very busy. Distracted. And I didn't think that was an accident. I believed there was something Mike's mind was running away from.
Since Mike's obsession involved the destruction of his home, my first question related to early, sudden loss. "Did your life change suddenly in any way when you were a child?" I asked.
"Like my parents divorcing or something?"
"You tell me."
"I don't think so," he said.
"You didn't lose anyone you loved when you were a boy?"
He shook his head.
"Did your parents go through any sudden changes in their finances? Did you move from one town to another?"
"No."
"So nothing threatened to 'burn down' your life as you knew it," I said, making the metaphor plain. "It was pretty much smooth sailing."
He shrugged. "Pretty much. My sister was sick for a while, but . . . I mean, she got better and everything, so I don't think it would have been that."
This was something I felt we had to explore. Whenever someone shares a thought, then disavows it, you can almost count on it being very important.
I simply gave Mike's words back to him. "Your sister was sick for a while . . ." I said.
"Yeah," he said. "She had cancer."
I felt myself grow calmer and more centered. I was moving closer to the real source of Mike's suffering, being held by the gravity of his truth. "How old was she?"
"Seven."
"So you were, how old?"
"Ten."
"What do you remember about it?"
"I try not to think about it," he said.
Even, he could have said, if it means driving around in circles. "I can understand why," I said. "But it could be very helpful for you to get in touch with your feelings from back then."
He nodded.
"Can you tell me how you found out she was sick?" I asked.
"You mean, what her symptoms were?" Mike asked.
"No," I said. "I meant, how did you find out? Who told you?"
"My dad."
"Where and how?"
"I don't know who sounds more like a district attorney, you or me."
"He came to watch me during my basketball practice, which was weird, you know? Because it started right after school, at three o'clock. And he worked until six every day. So I remember feeling strange, just having this really bad feeling the whole time he was in the stands watching. He was smiling and stuff, but the smile didn't look real." He sighed. "Then when I got a basket and turned around to see his reaction, he was crying."
My own heart fell just from hearing that story, which testified to the kind of impact it would have had on a ten-year-old living it. Although he had denied it when asked, Mike's life had indeed changed suddenly during his childhood. And he had never forgotten the exact moment. "Do you remember what you thought when you looked at him in the stands?" I asked.
"You might not believe this," Mike said.
"Try me."
"I didn't think anything. I didn't look at him the rest of the game. I just kept playing."
That was both believable and understandable. A ten-year-old boy who sees his father in tears can be excused for turning away, wishing that whatever has caused his father to leave work early and come find him, whatever is making his father break down into tears, would just disappear.
"When the game was over, I walked to the car with him," Mike went on. "We didn't say anything on the way. We got inside, but he just sat there, without starting it. Then he told me."
"What did he say?"
"He said, 'Katie is . . ." He stopped.
I waited.
"He said, 'Katie is sicker than we thought. She's going to have to stay in the hospital for a while."
A while turned out to be nearly two months, during which Katie had an abdominal tumor removed, suffered complications from the surgery, and began chemotherapy.
Mike watched as she grew more and more frail during her treatment. She lost her hair. Painful sores in her mouth made it difficult for her to eat.
Mike's parents had less time for him; they were consumed with getting Katie the care she needed. The pressure made them argue much more. Mike's father became melancholy and withdrawn.
There was nothing Mike could do about any of it. He didn't have the power to stop his sister's disease or assure himself of his parents' continuing devotion to him or bring harmony back into his home.
But something even more fundamental to his existence had changed for Mike, forever. The illusion that his family was secure, that life was predictable, and that death only happened to old people had been shattered. And no one talked to him about any of it.
Mike's obsessive-compulsive symptoms, it turned out, began around that time. He would check light switches half a dozen times to make sure he had turned them off. He felt compelled to knock twice for luck on the door jam of his house before leaving each day for school. And he developed a nervous tic--rocking back in forth in his seat at school.
As a ten-year-old, Mike wasn't prepared to face the possibility that his sister might die and that his family as he knew it might cease to exist. So he buried it under a mountain of silence and obsessive thoughts and compulsive behaviors.
The obsessions and compulsions never went away. They went through cycles, getting better and worse. Now, they were nearly unbearable.
It was certainly the case that Mike might be helped by medicine, and I prescribed one with a good track record of reducing the symptoms of OCD. But I also sat with Mike for several weeks, helping him talk about his gut-level fears from when he was ten, his terror when his sister's cancer recurred when she was thirteen, and his grief when, shortly thereafter, his beloved family pet--a dog--died suddenly.
"I couldn't even show he really mattered to me," Mike said. "It would have seemed weird, with everything my sister was going through."
"Did you love him?"
"What kid doesn't love his dog?"
"I asked about you."
He filled up and nodded. "He was great," he said. "Barney. Honestly, if it weren't for him, I don't know how I would have gotten through that time. I loved him a lot."
But here's the problem: Nothing could have protected Mike's sister from getting cancer. Nothing can imprison death. Only Mike being willing to feel his vulnerability (and that of everyone close to him) held the promise of him coming to terms with it. Only truly looking back at his father weeping in the stands at his basketball game, fresh from hearing that Mike's sister had cancer, could turn that event into something he had survived, instead of something he would keep running from for the rest of his life.
"It would be great if you could check the stove and the coffee maker and all the candles in your house to keep tragedy away from you," I told him. "But that won't work. You can drive back and forth from your house all day, every day, making sure it hasn't burned down, but that won't stop cancer. All it'll do is keep you from living your own life."
The combination of medicine and counseling helped Mike abandon his shield of obsessions and compulsions. "I figure," he told me, "that even if it costs me my house, I'm not driving back to check anything. Let it burn down, if that's what's going to happen. Because I can't let it destroy everything else I have." He looked directly at me. "Not after realizing how much I went through to get here. And you know I'm not talking about law school."
By looking directly at his pain, Mike was able to put it in the past, where it belonged. He was able to step out of the role of trying to control the future. That didn't mean he would be immune to sadness about his sister's struggle with cancer or the loss of his beloved pet or the period of discord in his parents' marriage. Much to the contrary, it meant that he would be in touch with those feelings. And that meant he would no longer remain hostage to them. Back to top