Open Heart (31 page)

When, on one of our walks, a car skids to a stop in the middle of Eighth Avenue, near Columbus Circle, bringing five lanes of traffic to a horn-blaring halt, Arthur, without hesitating, walks straight into traffic, talks to the two women in the stalled car, its hazard lights now blinking, and begins to help. When a truck, coming around the corner, bears down on us—I've followed Arthur into
the street—Arthur turns and, like a traffic cop, puts up a hand to stop the truck. To me, in a smiling aside, even as he turns back to the two women: “I don't want anyone killing my friend Neugie before he finishes his book.”

Arthur and his wife Paulette, senior partner in a New York City law firm, live in a two-bedroom apartment on Fifth Avenue, directly across from Central Park. The apartment is handsomely furnished—uncluttered, open, and airy, with bright light pouring in through high windows, and Arthur and I are sitting in his book-lined study, and talking about friendship. Arthur still maintains friendships with at least a half-dozen guys he has known since about the third grade of elementary school, and, like me, he remains close with many others with whom we went to Erasmus and Columbia.

“Maybe it's because I need these friendships,” he says, “but who knows why I do? I'll tell you this, though—it gives me
great
pleasure. The pleasure you get from reading books, I get from watching you, seeing how you evolved, seeing who you've become, seeing what you're hoping to be. I get the same pleasure from Phil and from Jerry, and from all the guys I know. Because I love people—I love being with them and I always have. I'm
fascinated
by people, and getting to know people always satisfied a tremendous curiosity and craving. Even in high school, when I didn't know I was honing any professional career, I enjoyed playing with and marrying myself to the different kinds of involvements I had with different people.

“So when I went into private practice and was doing fifty to sixty hours a week of individual therapy, I was a very happy guy. I'd be seeing, on any day, six or seven different types of people—maybe there were two or three overlaps, maybe three Jewish lawyers—and I was different with each person. I was talking about different things. I was learning about the ways different minds work, and I was engaged in trying to help people deal. I'd go in at eight, I'd leave at seven or seven-thirty at night, and it went like lightning. It was a gift, a no-brainer—like Willie Mays playing center field. I did what I loved, and I made a living doing what I would have done for pleasure.”

Sitting in his study—he has shown me, earlier, his shelves of books about Buddhism, and by and about the Dalai Lama (“These
belief systems contain a much healthier approach to life, for me, than the systems I was raised in, and I resonate to them.”)—Arthur is less the outspoken, kibbitzing New Yorker, and more the relaxed, easygoing guy I've known for nearly half a century—more the man I imagine he is when he is working one-on-one with his patients, the guy I loved to take long walks with when we were teenagers, and to talk with about whatever came to mind: our friends and our family, our doubts and our dreams and our insecurities and our hopes.

He is, as ever, brilliant and canny (he graduated
cum laude
and Phi Beta Kappa from Columbia; was voted Most Likely to Succeed when we graduated, nearly thirteen hundred of us, from Erasmus), yet he is also thoughtful, direct, warm, and down-to-earth in his observations. When I ask a question, he rarely answers immediately, but will close his eyes, lean backward, and then, once he starts talking, pause frequently before he chooses words or phrases.

On this afternoon, however, he is the one who asks the questions.

“Okay,” he says. “So tell me something, Neugie. Where does medicine come in? Where does friendship fit in with medicine in this book of yours, and what do they have to do with our growing up in Brooklyn—with what we've been talking about?”

Although I have not begun the actual writing of the book, I say (it is early summer of
2000,
a week after my return from Norway), what I have begun to see—to speculate about and believe, if provisionally—seems fairly basic, and it's this: that the things people want from their doctors, and that they are, in recent years, getting less of, have much in common with what they want from friendship.

“Ah, you are a smart fellow, Neugie,” he says. Then: “Why are you smart?” he asks. “Because I agree with you!”

We laugh, after which Arthur talks about his work as a psychologist, and although I am hearing his words, my mind is floating free, and I am thinking that this—being here with him and talking in the way we do—is one of the great and unexpected dividends from my surgery. The comfort and sheer pleasure these conversations bring, and the ways the five of us have become closer with one another—this has been an unexpected and precious gift.

Rich and Phil went to elementary school, high school, and medical school together, but lost touch through the years. Now, though,
when Rich visits his children and their families in Denver, he spends time with Phil; and Phil is planning a trip to New York in September, when he, Jerry, Arthur, and I will hang out together. I say something about this—about how much more we've all been in touch with one another since my surgery, and about how much I've been enjoying our talks.

“It's our thing,” Arthur says quickly. “Sure. I call it psychological
davaning
. It's what we do, but this kind of Talmudic self-absorbed, self-reflective, looking-at-yourself-as-an-object, commenting-on-yourself stuff—this wasn't, for example, Ronald Reagan's thing. I was just reading a biography of this man—president twice, governor of California, head of a lot of organizations, well respected, yet I don't think he did as much of this in a lifetime as we do in a day. And you know what? There are lots of very smart people who don't
davan
the way we do, and his way of living is a reasonable way to live, and there's only a certain percentage of us who will do what we do and get something from it and grow from it. I talk about what's inside me. You talk about what's inside you. These are my ideas. These are yours. This kind of self-revelation and self-reflection is different from going fishing together, but I'll tell you this—it's much more fun for me to do this than to go fishing, or even to a Knicks game.

“Now remember—I come at most things from the point of view of trust, and the way we get on with one another, and the work I do when it's effective is a function of trust, and I think trust is something very, very, very hard to come by,” Arthur says. “I mean, how can you have it in today's medicine? It's my belief that it usually takes years of reliability, consistency, authenticity, maturity, and empathically resonant dialogue for patients to begin to trust therapists so that they will take some risks they wouldn't otherwise take.

“Look. At my best—in my snappiest suit and with my smartest verbiage, I could never engender trust,
real
trust,
fundamental
trust, in ten sessions. The idea that people can do that in a managed-care setting is just not comprehensible to me.

“There are times—when I was in the army, for instance—you see people six or ten times, and you do what you can do. But having seen many people for between one year and five or six years, I know
the difference. When I work with somebody over a long period of time, I get to know that person so well I can feel that person's pain—and I do, and, like that person, I find myself up late at night sometimes, trying to think and feel my way through the pain. And it's the same in medicine, though I didn't used to think so. I've seen studies saying that across the board somewhere between sixty to seventy percent of what a doctor bases his treatment on is the report from the patient. But if there's no trust, how good is the report?

“Let's say I have some funny pains in my chest and go to the physician who's been treating me for twenty years. Now he knows I've never said this before, so he'll take it more seriously than a guy who's seeing me for the first or second time, doesn't know if I'm a whiner, or if I'm just having some gas—and that's where trust comes in. You trusted the cardiologist and the surgeon because they were an extension of Jerry, and you trusted Jerry.

“But trust is also a function of time, and of age.” Arthur goes to his bookcase, and comes back with a book. “I think part of growing older,” he says, “is that we've given up illusions of control—of what we can and can't control. And that makes life easy—with our children, with everything. As certain responsibilities—raising our kids chief among them—start to slip away, we begin to use time and to think about it differently, and there is something peculiar and wonderful, I think, when time becomes our ally. But read this—it's from a speech Adlai Stevenson gave to a class of college graduates.”

I read:

Arthur and I talk about how time, age, and experience, whether in psychology, psychiatry, or medicine, relate to clinical judgment.
^*
“Let's take depression,” he says. “Somebody comes to me depressed, and what I can do is make a judgment, probably within a couple of sessions, as to whether that person is a candidate for a psychopharmacological agent that, maybe within three to six weeks, will be helpful. Secondly, I can assure him, based on my clinical experience, that virtually everyone who has been placed on antidepressants, over time—and when he gets the mixture right—will feel better. I can assure him of that because it has been my clinical experience. Third, I can tell him that if he takes the medicine, it will make it easier for him, without the pain and depression, to talk about some of the things that have led to the depressed feelings.

“So now, with that out of the way, I can begin a relationship with him where I learn about how he became the person he is—how the kind of family he grew up in, and the way he chose to deal with his childhood home, led him to feel
less
about himself—to have thoughts he's ashamed of—and I can help point out how that was happening, and is still happening, and he can begin to look at himself somewhat differently. And maybe three or four years from now he'll have a thirty to sixty percent better feeling about himself that will make the rest of his life better.”

In a World Health Organization study that covers the period from 1990 to 2020 (actual data plus projections), unipolar depression (also called major, or clinical, depression) is second, behind ischemic heart disease, in the rank order of the global burden of disease (a measure of health status that quantifies not merely the number of deaths but also the impact of premature death and disability on a population).
^*
In addition, of the ten leading causes of disability worldwide, five are psychiatric conditions (depression, alcoholism,
bipolar disorder, schizophrenia, and obsessive-compulsive disorder). Moreover, I say to Arthur, his field—psychology and psychiatry—has proven at least as effective in diagnosing and treating these conditions, and in enabling recovery from them, as medical disciplines have been in the diagnosis and treatment of, for example, neurological, infectious, and heart diseases.
^*

Arthur says that even though he knows this is so, he cannot shake the belief that psychotherapy is more of an art than a science, and less of a science than medicine is. And this belief, we agree, derives, at least in part, from the reverence with which, when we were growing up, we were taught to regard physicians.

“My first experience with a physician was, literally, with the man next door to us, who was an old-timer even then, probably in his seventies,” Arthur says. “And he would always cure me! Not hard to do given that I was getting sore throats and minor stuff. But he would also take time to affirm things—like how well I could tell time at whatever age I could tell time.

“So there he was—a safe, concerned, benign person who I thought was omniscient. And in my case he was omnipotent too—he could do things that made me
better—
and so I came into my adulthood assuming that doctors possessed all kinds of secrets, and knew everything, and this intimidated me. I think I was afraid to go into medicine, in fact, because then I'd have to see if
I
could know everything.

“But his presence also drew me, which is partly why I ended up in psychology, which is a healing field. And you know, when I was in Florida during my mother's final illness a few years ago, and I was getting into the elevator in the hospital and there was this promo poster for the head of the cardiac surgery unit, with all his credentials—he was bar mitzvahed in 1952, he played quarterback for Tulane, he did his residency at Harvard, he's done six thousand angioplasties—I said
‘Whoa!'
because this was so at odds with the model I'd had in my head, which was the
doctor-as-teacher—
a wise, caring, rabbinical practitioner, and not somebody in Nike sneakers who's on the front page of the Yearbook. All this advertising in subways and newspapers—these are not the doctors I knew.