Open Heart (32 page)

“But if not an M.D., why a psychologist, right?—and this had to
do with my wanting to understand
myself
better. I started out in Yale Law School, you know, and made a decision after three days there to get out—that being in an adversary profession was not for me. Probably because it would have put me in touch with my anger, which I was afraid of, though I didn't realize it then. Law school—and being a lawyer—that seemed like a life where I'd be fighting under the boards for rebounds again and again, and I didn't want to do that.

“Now in my home I never heard, ‘You should make a lot of money—go out and become rich.' And I never heard it in my friends' homes. Once, when somebody asked me what I was going to do when I grew up, thinking I was very clever, I said I was going to make a lot of money. And my mother got upset, and my father spoke to me and said this wasn't the way one should move toward a vocation. So it was my assumption always that I would do something that would be of service, would save me from mediocrity—that enormous fear of being
‘average'
—and make me into a professional: a teacher, doctor, lawyer, engineer—and that the money would follow, and it would be enough for me to be able to live a good and decent life.

“But from a psychoanalytic point of view, since as a young person I was very competitive and ambitious, I think I was also ashamed of the competitiveness, and when I got into Yale and realized I was entering into a profession where I would be making a living from the competitiveness, I said ‘Stop!'—and then I thought about how much I loved being involved with people, and recalled that in my second year of college I took a psychology course I loved, and that I had decided then to go into psychology, and it was like ‘Whoa—I can play basketball and get paid for it!' and so, at twenty-one, I left Yale—I measure my time there in hours and not days—went back to Columbia, and to CCNY, and took the necessary undergrad courses.

“After that, I went to Clark University, in Worcester—the place where Freud gave his lectures when he was in America—but I didn't like the way they looked at psychology there, so I came back and went to Columbia for my doctorate, and I never looked back or
second-guessed myself again. If I had to make a decision today for a new life, I can't imagine doing anything else.

“And this was always connected to the idea of being a
professional
—and my idea of a professional was a guy who was a .320 batter year after year, a regular sixteen-to-nineteen game winner, a man who routinely pulled down fifteen rebounds a game. One of the things I took enormous pride in during my years as a shrink was that I almost never did
not
get to my office and do my day's work. It's like Ripkin and Lou Gehrig being out there, game after game—something about consistency, the doing of the work and not letting minor colds or sore throats interfere.

“Now I was blessed with good health, I didn't have horrific accidents—though I once did a whole day of therapy with cotton swabs sticking out of my nose after it was cauterized for a nosebleed—nothing that compromised me in terms of getting to the office. Because the notion of consistency and reliability is something I associate with the idea of a professional, and this is bound up with a certain measured, thoughtful way of going about one's life—of a consistent availability to the people one serves. When people are exploring and risking themselves, consistency is very, very important.”

I say that Phil says Arthur is really just doing the same thing in his sixties that he was doing when we were teenagers—being on call to his friends, listening to our problems, talking with us, giving advice, getting us through.

When, for example, after my move to New York, I am upset about the deterioration of a relationship, Arthur assures me I have given the relationship every chance, that I have been generous and open—a
mensch
—and that there are no issues I am blind to in the situation, or in myself. It is his judgment—both personal
and
professional—that I should get out. He also speculates, briefly, about what he thinks may be going on in the woman, in terms of what psychologists call “projective identification.” “But look,” he says then. “Let me put it another way: if we were walking along Flatbush Avenue and you told the guys what you were going through, they would say to you, ‘Neugie, she's busting your balls.'”

When I remind Arthur about how helpful he's been to me, he
shrugs off my gratitude, says he is a lot less sure of things—of what he truly
knows—
than I might think, and he talks about his clinical experience and its relation to the education of therapists.

“My most energizing experience—my highest level of gratification—comes from my involvement with people,” he says. “Now, in my field there are three variables in the treatment process. There's a patient, there's a therapist, and there's a treatment modality. If one of the three isn't appropriate—wrong patient for the right modality and the right therapist, right patient for the wrong therapist, et cetera, psychotherapy will not be a success. And in my field we have done far too little scientific investigation of the match—of the integration of proper therapist—by age, life experience, psychotherapeutic skills—with patient. And the failures in my field—what you and Robert have experienced in spades—or a high percentage of them certainly, are a function of our inability to put together the three variables in a way that's synergistic.

“My sense of things is that it's different in medicine—for Rich, let's say—and that in your prototypical heart arrhythmia situation you're pretty sure you're as good as the next guy in town. But I don't know if people in psychology or psychiatry can feel the same way. Or maybe this is just my fantasy about doctors—that here is somebody who's sure of things, and that there
are
answers, and that if only I studied harder, had been smarter, I would have gotten it.” Arthur smiles. “It's like believing WASPs don't sweat.”

Like our physician friends, Arthur laments the premium that has been put on speed. “At least since the mid-eighties,” he says, “more and more people were saying to me, ‘Look, I really don't want to spend four years here, Doc. Listen less, tell me what to do, and help me make things okay' And on top of the pressure coming from the patient, managed-care people are saying, ‘You get six sessions for a buck-and-a-half and then you gotta pay the guy's regular fee,' so they want it even faster. Maybe in a medical situation there's a quick resolution, but not always in my work.

“Because the work I do is very private, and depends upon confidentiality—a place where people can talk about their most private thoughts, feelings, fears, experiences—and it seems to me that in a cultural way, unfortunately, there are almost no sacred private areas
anymore. Everything—like those ads for doctors and hospitals—is for public consumption, and I don't really know what that means. It is what it is, I guess, but it certainly is not good for the doctor-patient relationship.”

Vietnam was for Arthur what Nigeria was for Jerry. “It changed my life forever,” he says. “And it changed it forever even before I got there. Because I was a young man who did everything the way his mother and father wanted him to: I wore a white shirt to school, I went to the right college, I was a doctor, I married a Jewish girl, I had a piano and a nice house, I had a lovely daughter, things were all working out terrifically, and all of a sudden I was one of two people chosen in the entire U.S.A. in my specialty to be sent to Vietnam.

“So this was the first time I fully understood that life was neither good nor fair—that you can do everything right and the way you're supposed to, and still get fucked. Now that's a big thing to take in at any point in your life, and I should have been weaned from it earlier, but I was twenty-eight years old and it hit me like a ton. I mean, if being a good boy was not going to pay off, why should I marry a Jewish girl? Why should I be polite to my Aunt Sophie?

“I did my clinical internship at Walter Reed General Hospital—this was just before I was chief of psychology at Fort Monmouth—and the head of psychology at Walter Reed became the head psychologist in the army. Now, for reasons I absolutely to this day cannot fathom, he said to himself, ‘This guy Rudy, out of the two hundred fifty or three hundred psychologists in the army, will be somebody who I think will do a good job in Vietnam.'

“And I know this, because I said to him, ‘Why'd you pick me? You have a lot of psychologists who want to go there and get medals and ribbons so they can build up a career in the army' And he said, ‘Because I believe in this war and I believe in you.' So I became one of only two people who did my work in Vietnam, and it was truly transformative—and traumatic.

“I was with a Mobile Army Surgical Hospital—the 98th Medical Detachment, 8th Field Hospital—and I was chief of the Psychology Section, and even on the boat going over there I knew that I was alone in a way I had never understood aloneness before. I couldn't
be bailed out by people who loved me. I was an interchangeable number, replaceable by some guy who was at that moment sitting down to dinner with his wife in Topeka or Des Moines.

“The other thing I realized was how provincial my vision of America had been. I'd grown up in an insulated parochial convent of middle-class Jewish kids, and most Americans viewed the world differently from the way I did. From that point on—in Vietnam, and for the next six or seven years—I began to realize that no matter how much you are loved or cared for, and no matter how much people want for you, you are ultimately alone—whether in your dying, in a serious illness, in childbirth, in the pain that comes from failure with your child.

“I saw the kinds of things I never wanted to see—ghastly stuff: people burned up, people being carried out of helicopters with pieces of metal sticking out of them, and it's one thing to see that in an ER, but another thing when you know the metal was put there on purpose. You go down to the psychiatric unit and on one side there are American boys who've lost limbs and on the other side there are Vietnamese prisoners who've lost limbs. And they look at each other across the unit, and it's okay. Now that they've been mutilated for the rest of their lives, no one's killing anyone.

“Not only did I experience feelings about the potential for my
own
mutilation, but my feeling of insecurity—of being separated from everything that made me feel safe—was very intense because I also knew that the doctor
I
saw was as scared as I was, and was running from his own diarrhea, and that we could all be dead in the next millisecond. And I don't know if I have ever felt secure since. But maybe security was an illusion. Maybe it was
always
an illusion.

“Vietnam is the one year of my life I can remember in complete detail because it was
alien
, and in an infinite number of ways, and I think the core of my experience there would ultimately translate into some of what I've been talking about—that life isn't fair, that you can die in the next minute even if you'd done everything right, and that you've got to live in the present and not postpone or defer gratification the way we were trained to do.

“When I came back home after a year, I found myself having symptoms of the sort I was seeing in patients. They were coming out
of nowhere, and they were frightening to me, and they were confusing. They made me feel that I really had to get my own stuff cleared up if I was ever going to be of use to anyone else, and this led to my analysis.

“I found myself intensely concerned about my health, and I had never thought about my health before. And when you begin thinking about your health, you find parts of your body you never knew existed. It's like when you go through a terrible experience and you do fine, but then afterward you tremble and shake, you know?”

Arthur talks very quickly now—when he talks about his experiences in Vietnam, I have noticed, his words come faster than at any other time in our conversations—and says that the nature of his defensive structures was such—compartmentalized—that he had no clue for a year or two as to what was going on, or that the symptoms he was suffering from—with his health, with bodily obsessions, with driving a car—came under the heading of what we now know as post-traumatic stress disorder.

“I just thought I was probably screwed up and that I never realized just how neurotic I was, but that maybe I should speak with someone about it. Now we all have the same body parts, but the configurations make each of us different, and I began to see that there were few things that came to my doorstep as a therapist that I hadn't experienced in my own way. Because I have felt sexual longing, fear, despair, helplessness, anger—because there were things I was frightened of and ashamed of, I could tap into that fear, anxiety, and depression for the people I worked with.

“So that the changes I worked through in myself came to help me in my work with others. No one was going to come to my office, especially if they came with issues relating to shame, embarrassment, vulnerability, or self-esteem, tell me something, and not have my internal reflexes not work for them. I understood. ‘Poor baby,' I'd think, though I wouldn't say that to them, of course. I'd maybe look poker-faced, but I believe that what I understood from my own life was informing the process with my patients
all
the time. At some level they knew they were not being judged—because I had been there, and worse, and in my chosen profession that was a gift to me.

“And there's this too: that the reason I made a living was because
the former custodians of these things—of healing—were representatives of the ministry. And ministry is informed by ‘oughts' and ‘shoulds' and the Ten Commandments, and my Bible is different from their Bible and I didn't judge, and I really tried to understand, and to give compassion, and with empathy, and with the best I could intelligently give to people to help them cope with the parts of themselves they were ashamed of, and had difficulty with—because I had been there too.”