Ирвин Ялом - The Schopenhauer Cure

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years, he yearned to be out of the classrooms and onto the wards as a clinical clerk, with

white jacket and stethoscope hanging out of pocket or slung casually about his neck like a

steel–and–rubber shawl. Not in the clerkships of his third and fourth medical school years,

when he finally took his place on the wards. There he yearned for more authority—to be

important, to make vital clinical decisions, to save lives, to dress in blue scrubs and

careen a patient on a gurney down the corridor to the OR to perform emergency trauma

surgery. Not even when he became chief resident in psychiatry, peeked behind the curtain

of shamanism, and was stunned at the limits and uncertainty of his chosen profession.

Without doubt Julius`s chronic and persistent unwillingness to grasp the present

had played havoc with his marriage. Though he had loved Miriam from the moment he

laid eyes on her in the tenth grade, he simultaneously resented her as an obstacle blocking

him from the multitude of women he felt entitled to enjoy. He had never completely

acknowledged that his mate–search was over or that his freedom to follow his lust was in

the slightest way curtailed. When his internship began he found that the house staff

sleeping quarters were immediately adjacent to the nursing school dorm brimming with

nubile young nurses who adored doctors. It was a veritable candy store, and he stuffed

himself with a rainbow of flavors.

It was only after Miriam`s death that the reversal must have occurred. In the ten

years since the car crash took her from him, he had cherished her more than while she

was alive. Julius sometimes heaved with despair when he thought of how his lush

contentment with Miriam, the true idyllic soaring moments of life, had come and gone

without his fully grasping them. Even now, after a decade, he could not speak her name

quickly but had to pause after each syllable. He knew also that no other woman would

ever really matter to him. Several women temporarily dispelled his loneliness, but it

didn`t take long for him, and for them, to realize they would never replace Miriam. More

recently, his loneliness was attenuated by a large circle of male friends, several of whom

belonged to his psychiatric support group, and by his two children. For the past few years

he had taken all his vacationsen famille with his two children and five grandchildren.

But all these thoughts and reminiscences had been only nocturnal trailers and short

subjects—the main feature of the night`s mentation had been a rehearsal of the speech he

would deliver to the therapy group later that afternoon.

He had already gone public about his cancer to many of his friends and his

individual therapy patients, yet, curiously, he was painfully preoccupied with his «coming

out» in the group. Julius thought it had something to do with his being in love with his

therapy group. For twenty–five years he had looked forward eagerly to every meeting.

The group was more than a clump of people; it had a life of its own, an enduring

personality. Though none of the original members (except, of course, he himself) was

still in the group, it had a stable persisting self, a core culture (in the jargon, a unique set

of «norms»—unwritten rules) that seemed immortal. No one member could recite the

group norms, but everyone could agree whether a certain piece of behavior was

appropriate or inappropriate.

The group demanded more energy than any other event of his week, and Julius had

labored mightily to keep it afloat. A venerable mercy ship, it had transported a horde of

tormented people into safer, happier harbors. How many? Well, since the average stay

was between two and three years, Julius figured at least a hundred passengers. From time

to time, memories of departed members wafted through his mind, snippets of an

interchange, a fleeting visual image of a face or incident. Sad to think that these wisps of

memory were all that remained of rich vibrant times, of events bursting with so much

life, meaning, and poignancy.

Many years ago Julius had experimented with videotaping the group and playing

back some particularly problematic interchanges at the next meeting. These old tapes

were in an archaic format no longer compatible with contemporary video playback

equipment. Sometimes he fancied retrieving them from his basement storage room,

having them converted, and bringing departed patients back to life again. But he never

did; he couldn`t bear exposing himself to proof of the illusory nature of life, how it was

warehoused on shiny tape and how quickly the present moment and every moment to

come will fade into the nothingness of electromagnetic wavelets.

Groups require time to develop stability and trust. Often a new group will spin off

members who are unable, for reasons of either motivation or ability, to engage in the

group task (that is, interacting with other members and analyzing that interaction). Then

it may go through weeks of uneasy conflict as members jockey for position of power,

centrality, and influence, but eventually, as trust develops, the healing atmosphere grows

in strength. His colleague, Scott, had once likened a therapy group to a bridge built in

battle. Many casualties (that is, dropouts) had to be taken during the early formative

stage, but once the bridge was built it conveyed many people—the remaining original

members and all those who subsequently joined the group—to a better place.

Julius had written professional articles about the various ways that therapy groups

helped patients, but he always had difficulty in finding the language to describe the truly

crucial ingredient: the group`s healing ambience. In one article he likened it to

dermatological treatments of severe skin lesions in which the patient was immersed into

soothing oatmeal baths.

One of the major side benefits of leading a group—a fact never stated in the

professional literature—is that a potent therapy group often heals the therapist as well as

the patients. Though Julius had often experienced personal relief after a meeting, he

never was certain of the precise mechanism. Was it simply a result of forgetting himself

for ninety minutes, or of the altruistic act of therapy, or of enjoying his own expertise,

feeling proud of his abilities, and enjoying the high regard of others? All of the above?

Julius gave up trying to be precise and for the past few years accepted the folksy

explanation of simply dipping into the healing waters of the group.

Going public with his melanoma to his therapy group seemed a momentous act. It

was one thing, he thought, to be open with family, friends, and all the other folks residing

backstage, but quite another to unmask himself to his primary audience, to that select

group for whom he had been healer, doctor, priest, and shaman. It was an irreversible

step, an admission that he was superannuated, a public confession that his life no longer

spiraled upward toward a bigger, brighter future.

Julius had been thinking a good bit of the missing member, Pam, now traveling

and not due to return for a month. He regretted she would not be there today for his

disclosure. For him, she was the key member of the group, always a comforting, healing

presence for others—and for him as well. And he felt chagrined by the fact that the group

had not been able to help with her extreme rage and obsessional thinking about her

husband and an ex–lover and that Pam, in desperation, had sought help at a Buddhist

meditation retreat in India.

And so, heaving and churning with all these feelings, Julius entered the group

room at four–thirty that afternoon. The members were already seated and poring over

sheets of paper which were whisked out of sight when Julius entered.

Odd, he thought. Was he late? He took a quick look at his watch. Nope, four–thirty

on the dot. He put it out of mind and began the recitation of his prepared statement.

«Well, let`s get started. As you know, I never make a practice of starting the

meeting, but today`s an exception because there`s something I need to get off my chest,

something that`s hard for me to say. So here goes.

«About a month ago I learned that I have a serious, I`ll be frank, more than

serious—a life–threatening form of skin cancer, malignant melanoma. I thought I was in

good health; this turned up at a recent routine physical exam....»

Julius stopped. Something was off kilter: The members` facial expression and

nonverbal language weren`t right. Their posture was wrong. They should have been

turned toward him; focusing on him; instead no one fully faced him, no one met his gaze,

all eyes were averted, unfocused, except for Rebecca, who covertly studied the sheet of

paper in her lap.

«What`s happening?» asked Julius. «I feel like I`m not making contact. You all

seem preoccupied with something else today. And, Rebecca, what is it that you`re

reading?»

Rebecca immediately folded the paper, buried it in her purse, and avoided Julius`s

gaze. Everyone sat quietly until Tony broke the silence.

«Well, I gotta talk. I can`t talk for Rebecca but I`ll talk for myself. My problem

when you were speaking was that I already know what you`re going to tell us about

your...health. So it was hard to look at you and pretend I was hearing something new.

And yet I just couldn`t interrupt you to tell you that I knew it already.»

«How? What do you mean you knew what I was going to say? What in hell is

going on today?»

«Julius, I`m sorry, let me explain,” said Gill. «I mean, in a way I`m to blame. After

the last meeting I was still frazzled and not clear about when or whether to go home or

where to sleep that night. I really put pressure on everyone to come to the coffee shop,

where we continued the meeting.»

«Yeah? And?» Julius coaxed, moving his hand in a small circle as though

conducting an orchestra.

«Well, Philip told us what the score was. You know—about your health and about

the malignant myeloma—”

«Melanoma,” Philip softly interjected.

Gill glanced at the paper in his hand. «Right, melanoma. Thanks, Philip. Keep

doing that. I get mixed up.»

«Multiple myeloma is a cancer of the bone,” said Philip. «Melanoma is a cancer of

the skin, think of melanin, pigment, skin coloring—”

«So those sheets are...,” interrupted Julius, gesturing with his hands to invite Gill

or Philip to explain.

«Philip downloaded information about your medical condition and prepared a

summary, which he handed out just as we entered the room a few minutes ago.» Gill

extended his copy toward Julius, who saw the heading: Malignant Melanoma.

Staggered, Julius sat back in his chair. «I...uh...don`t know how to put it...I feel

preempted, I feel like I had a big news story to tell you and I`ve been scooped, scooped

on my own life story—or death story.» Turning and speaking directly to Philip, Julius

said, «Had you any guesses about how I`d feel about that?»

Philip remained impassive, neither replying nor looking at Julius.

«That`s not entirely fair, Julius,” said Rebecca, who removed her barrette, loosened

her long black hair, and twisted it into a coil on the top of her head. «He`s not at fault

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