Some Kind of Peace (12 page)

It is time for Peter Carlsson’s next appointment. This will be our second assessment interview, in which I know more about him and therefore have more opportunities to get him to open up about what’s so important and what is making him look so hopelessly tormented in my Lamino chair. During the past week I had doubted whether Peter would show up for his second appointment. Sometimes it just seems too hard to come back; patients are ashamed and think they have revealed too much. Sometimes they’re simply not comfortable with the therapist. But Peter is here. He sits dutifully and waits for me to begin. I can see that he is ill at ease. His face is bright red and he avoids eye contact. When we greeted each other in the waiting room, his hand felt sweaty and I could tell that he was embarrassed that I had discovered that he could not really control his bodily functions.

After a polite exchange of pleasantries, we take a look at the scales he filled out since his last visit. Then I ask him to tell me why he is seeking help right now. What just happened that made him finally try to get help for his symptoms, since he’s had them for almost twenty years?

“Well, you see… I have a girlfriend. She is very important to me. I think this is the first time I’ve really been in love. I mean,
really
in love.”

I nod encouragingly and indicate that he should continue.

“We met a few months ago and everything was starting off well, but I was still worried. I mean, I’ve had relationships before, but I’ve always broken them off after a short time. But with this woman I don’t want… I mean I want to. I
want
something with her.”

“So you’ve had relationships before, but you’ve broken them off, and now you’ve met a woman who matters to you, and you want it to work out. Did I understand you correctly?”

Peter Carlsson nods in silence, and I can see tears welling up in his eyes.

“Can you tell me why you broke off your previous relationships, and why you are worried that you will have to break this one off as well?”

“I have thoughts,” he mumbles, “images inside my head. And they scare me.”

“Can you describe these thoughts?”

“It’s… so hard.”

He looks tormented.

“Tell me about the last time this happened.”

“Yesterday evening. It was yesterday evening. We had… something to eat and drank wine. She, my girlfriend, got tired and went to lie down. She was lying on the bed, asleep. And I could visualize how I… how I… I mean, how unbelievably easy it would be for me to put my hands around her neck… and just squeeze. I saw how vulnerable she was at that moment and how unbelievably easy it would be to…
injure
her.”

“And how did those thoughts make you feel?”

“I don’t know. At first they were almost… exciting.”

Looking embarrassed, Peter Carlsson stares down at his shiny shoes, as if that was where the solution to his problems lay.

“But then I got really scared. What if I were to hurt her
for real
? After all, I… do love her.”

He curls up in the chair and his body starts shaking. Tears are streaming down his cheeks and I make my usual gesture toward the box of Kleenex.

“And I assume that you’ve had these thoughts in previous relationships?”

He nods.

“Tell me more about it,” I encourage him.

“I almost always have thoughts that I could hurt them. Like with the car, when I thought I could run someone over. But it’s more “—he
hesitates—“more like I might lose control. You know, that I might go… crazy. What if I go crazy and do something I can’t control? Like with the car accident, which isn’t about running someone over deliberately but that I hurt someone accidentally. It is more as if I lose control, do something insane, like you see on TV, you know, like the guy who cut his girlfriend up with an ax.”

Peter is referring to a widely publicized criminal case.

“It’s always been this way… for as long as I’ve had relationships. But it’s gotten worse.”

“In what way has it gotten worse?”

“I don’t know. The thoughts have become more intrusive. They become images. Like little movies being played in my head. When I’m going to… when we’re going to… when we
try
to have sex, it’s like I see a movie in my head.”

Peter hesitates. My sense is that, whatever he’s about to tell me, it’s not something he really wants to share.

“We start kissing, for example, or… well, you know. And I get aroused. But then, then come those horrible images, and I… I do everything I can to drive them away. Start reciting song lyrics to myself or multiplication tables or… but the images come anyway. Images of how we are making love. And she’s lying there, defenseless. And trusting. She trusts me. First we make love normally and she enjoys it. She enjoys it and I enjoy it. But then… then… uhh… then something happens with the images. I see myself lifting my hands and laying them on her throat. And she looks at me and opens her mouth as if to say no, but no sound comes out. No sound at all! And I squeeze. She trembles and her back tenses but she can’t do anything. She bends, arching upward, like a bow… Her eyes are big and black and I see her surprise and her terror. I squeeze the life out of her while I am still inside her, and when she stops breathing, only then do I come.”

Peter Carlsson looks almost annihilated. He is still crying.

“How do these images make you feel, in retrospect?”

He doesn’t answer, just runs his hands repeatedly up and down his suit-covered thighs in an almost spastic motion.

I wait for his answer.

“I’m so afraid. What if I were to actually lose control and do her harm? I do love her. These thoughts make me feel
loathsome
, like a damn
sex criminal
. I really don’t want to hurt her.”

“Do you enjoy these fantasies?”

I realize that the patient could perceive this question as provocative, but it is important for me to ask in order to understand what lies behind his thoughts. Is he a sexual sadist, or are these compulsive thoughts?

“Enjoy?”

Peter looks indignant.

“No, I
don’t
enjoy them. I want to be rid of them. I wish they didn’t exist. That’s why I’m asking for help. To make them disappear. Don’t you get it?”

“What do you do, if anything, to try and make them go away?”

“I’ve stopped watching the news and reading about lunatics and people who lose control and break down and kill people.”

Peter stops himself. Silence fills the room.

“Anything else?”

“I stopped having sex. If I don’t sleep with my girlfriend, the thoughts don’t come in the same way. But… what woman wants a man who won’t have sex with her?”

I weigh Peter’s words. The images he talks about make me feel slightly nauseous, and while I’m not certain, I think that what he is describing are compulsive thoughts and nothing more. Intrusive, unwanted thoughts and images that give rise to strong anxiety. A fear of losing control and realizing the thoughts, which often leads to avoidance of what triggers them.

Often, different kinds of rituals appear, just like they did with Peter, in order to keep the thoughts at bay. But avoidance and rituals end up keeping the problem alive; they can perhaps even make it worse. My job is to help the patient stop these behaviors and learn to directly confront the painful, anxiety-producing thoughts. The treatment principle is that discomfort and fear are reduced when you stop trying to avoid specific thoughts and situations. It sounds simple, but it is extremely hard for the
patient and demands a lot of courage as well as faith in the therapist. In this case, I still feel a certain indecision and decide I need guidance from a more experienced colleague.

I manage to calm Peter down by explaining what compulsive thoughts are, emphasizing that most likely his problem can be solved. We schedule another appointment, and when we part I think I see a light in his eyes.

Perhaps it is hope.

•  •  •

After Peter’s session I walk over to the small kitchen. I am deeply affected by the conversation we just had. His problems are in some ways uncharted territory for me, and I don’t really know how best to tackle his case. Sure, I’ve treated compulsion before, even sexual compulsion.

But this?

Does the fact that I am a woman make therapy more difficult? Perhaps I ought to refer him to Sven, but I need my patients—they’re the ones who pay my salary.

Ziggy is gone. I can no longer deny this fact. I haven’t seen his plump gray body for over a week. Of course he disappears sometimes, off on unknown adventures in the pine forest along the water, but never for this long. I’ve searched in the garden, by the pier, and in the woods between the house and the main road. I’ve inspected the treetops in case he’s gotten himself stuck up there. I’ve set out bowls of his favorite food on the lawn and waited. I felt certain he would soon return, curl his soft body next to mine in bed and, unconcerned by my fretting, carry on his usual carefree cat life.

That’s why this evening I am standing outside again, peering out over the little patch of grass in my yard that extends like a shaggy sun-bleached rug all the way to where the softly rounded, gray granite cliffs begin. Along the side of the shed, nettles grow yard-high. Every spring I tell myself I should dig them up, but of course I don’t. Sometimes I find comfort in knowing that I am incapable of change; it gives me a sense of security in a world where nothing is constant and reliable. I embrace my own passivity and think, full of self-pity, that I can’t be expected to just pick myself up and continue to live as if nothing happened, after the kind of slap in the face I received. It would be more or less like climbing out of a burning car wreck, brushing away the soot with a smile, and asking whether there’s a good restaurant nearby.

I see it often in my work: how people develop mannerisms and sometimes even outright damaging behaviors to shield themselves against life. I always force them to confront their fears. Subdue them. Dare to live in the present, for what it is. Even if it hurts. I know exactly how to do it, there are well-proven methods.

I’m just not able to do it myself.

The last rays of sun tinge the cliffs outside bright orange, and I shiver—still in my wet swimsuit after a swim—as I stand inside at the French windows, my hand on the glass.

A faint scratching noise interrupts my musings. As if a twig were scratching against my front door. A faint… scraping. As if a dozen fingernails were scratching weakly on a cloth.

My initial reaction is fear. It comes instinctively, without my consciously assessing the situation. Suddenly, all my senses are heightened: I can clearly see individual pinecones outlined against the orange sky, the faded seed heads of chervil at the edge of the lawn that resemble stylized fireworks against a backdrop of dense gray stone.

And the sound.

It’s as if a child was writing on my door with a pencil. A tentative, dry scraping that comes and goes. Rhythmically. Like sprawling words formed by a small child’s unsteady hands.

I walk slowly toward the hall, without a plan, simply trying to make my steps as quiet as possible. Halfway there it hits me: Ziggy, of course, it’s Ziggy—he’s come back! Maybe he’s injured and weak, trying to get my attention.

I cover the last few yards in two long bounds, heave myself against the worn but massive oak door, and open it to the forest on the other side. The sun has gone down and only a faint grayish-blue sheen remains between the knotty pine trunks. Ferns, blueberry branches, and moss spread out before me, but I can’t see Ziggy’s round little cat form anywhere. I step tentatively out on the wooden steps.

“Ziggy!” My voice echoes thin and toneless in the summer evening.

But except for the far-off sound of a motorboat, everything is quiet. And then there’s something else. The sound of something fragile snapping. Like twigs, small, thin twigs. I imagine Ziggy wandering confusedly among the ferns and moss-covered boulders. Injured and disoriented.

“Ziggy, come here, kitty!”

But there’s no cat coming my way.

I go back inside and get my big flashlight from the bedroom and grip it firmly in my right hand as I carefully step outside again.

“Ziiiggy!”

The evening air is damp and filled with the saturated aroma of moldering plant parts and pine trees. I turn on the flashlight and aim it at
the woods. The trunks of the pines cast irregular shadows that resemble grotesque elongated figures that fall time and again as I sweep the beam of light from left to right. A bat flies through the light with jerky movements.

“Ziggy! Come, buddy! Come to Mama!”

Slowly I walk among the pines at the edge of the forest. I am still barefoot, in my swimsuit. The pine needles stick in the soles of my feet, but it doesn’t bother me. All I want is to find Ziggy.

I reach the clothesline. The sheets that I hung out to dry this morning reflect the strong light from the flashlight and I squint involuntarily.