Thankfully most of life‘s relationships are familiar, defined by some conventional guidelines, and therefore carried on with some sense that one knows what one should be doing. Right from the cradle we fall into family relationships quite naturally, as easily as we later learn how to converse with friends, spouses, coworkers, lawyers, doctors, etc. Whatever the degree of intimacy or harmony, we can depend on certain basic ground rules of the relationship.
There are also certain relationships for which neither God, nor parents, nor Emily Post has prepared us. One of these, and perhaps it even heads the list, is that totally unique relationship between patient and psychiatrist. Here you are truly on your own.
As an example, let’s look at an early interview with an old-school Viennese analyst. You arrive, perhaps 30 minutes early, since you’re still uncertain of the directions to his office. Even your GPS had trouble with this winding route! The dry run you took before appointment Number One doesn’t count because you were so nervous you didn’t think to time the trip until you were almost there, and once again, time on the GPS can’t be trusted.
Upon arriving, you note the sign PLEASE RING BELL at the office entrance of his opulent home, and you do so, rather proud that it’s old hat by now, and you know the ropes well enough to know that the bell will not summon a secretary, a family member, or God forbid the analyst – interrupted by your jarring buzz during his previous hour, which he had to rudely disrupt on the chance that it was someone important. Oh no – you give the bell a solid, unhesitating push and saunter right into the waiting room, knowing everything you’ve done up to this point is perfectly normal. Then comes the selection of the chair. Would the comfortable one over in the corner you used in your first visit get you pegged as a shy, withdrawn type? If you take the loveseat directly opposite the treatment room door, would there be an embarrassing confrontation when the door opens and you’re eyeball to eyeball with the previous patient, AND, perchance, the analyst? You finally slump down in the comfortable chair in the corner and, after a brief moment of calm and attempted relaxation, you commence 28 minutes of near frenzy. Thoughts dart and race through your mind. What will he think about your being 30 minutes early – does it show insecurity, eagerness, dependency – the other patient inside is probably a seasoned, almost-cured type who has just joined in the analyst’s bemused chuckle over the early arrival.
Why don’t you pick up a magazine? You can’t be found just sitting there, empty-handed with NEUROSIS written all over you. But now, how can you get up and get a magazine? If they come out early, they’ll come upon you standing up instead of sitting down like you should be. You look at your watch again – amazingly only one minute has elapsed. Impulsively you bolt over to the magazine table, heart pounding, and force yourself to not just pick up any magazine, which would be phony and dishonest, but pore over them for a panic-filled minute until you find one you prefer. That done, you sink back in the chair for another moment of utter relief and tranquility. You’ve gotten a magazine and safely reached that chair before the Door opened. Once again the bliss is short-lived. Rehearsals now begin on what pose to affect at the time the door does open and the patient emerges. Should you fix your eyes rigidly on the magazine as if you’re so absorbed that you’re not even aware that another body has entered the room? But this almost-cured patient would recognize that as the inept gambit of a very green and seriously NEUROTIC patient. All right then, but if you look up, what if the patient is crying; what if he or she has just achieved some dramatic new insight and needs privacy? The decision’s made – the only viable option is staring at the magazine, which is what you’ve been doing all this time anyway. Your appointment is now seven minutes away, and it is now truly within the realm of possibility that the door could open any moment, since the analyst takes a short break between patients.
Your eyes alternately seize on the Door, the magazine, the plant, your watch, the little gold clock which is disconcertingly two minutes behind your watch, the other door (which could be a bathroom, a closet, another analyst’s office, God knows, so better not to ever open it,) the plant again, which has a dead leaf that more and more commands your attention, the Door, the magazine, etc. until finally, you hear footsteps and the Door, as your heart stops utterly, opens. The carnal version of your fantasies appears in the form of a semi-attractive middle-aged woman dressed in more professional than fashionable clothes. The grim reality closes in – you know she’s not a patient at all – she’s another analyst, either in training or, at her age, more likely a colleague dropping by to discuss a patient. Her non-patient status is confirmed by the fact that she discreetly lowers her eyes in order not to embarrass the 30-minute-early NEUROTIC and briskly walks out into the cold late afternoon, obviously on the way to teach some seminar or see a few more patients of her own in some other office with a PLEASE RING BELL sign. You are crushed.
Suddenly you are seized with the urgent need to check your face in the mirror while a few seconds yet remain. Perhaps there’s still some hamburger caught between your teeth or some soot has landed on your chin, which, if inadvertently rubbed, could cause a glaring black streak. The magazine-selection was child’s-play compared to this maneuver – if he opens that door and catches you red-handed with mirror in mid-air, there’s no explaining your way out of that. (“Hi – just checking to see if I have my regular glasses on or my sunglasses?”) (No-horrendous!) There you are, he thinks, primping for your analytic session, thereby revealing seductiveness, exhibitionism, or gross insecurity.
You are again saved. The door opens just as you’ve thrown the mirror safely into your purse and have slouched back into the chair and hastily adopted an expression combining boredom and pleasant expectancy – – admittedly one of the more difficult faces but one known to those who are well-practiced in the art of face-making. He greets you with the perfect, cordial face – not too friendly, not too cold, in short, an expression as inscrutable as the Mona Lisa. You rise, and, to your dismay, find yourself so paralyzed by fear that you lurch in with the grace of a tin man – the terror has somehow invaded every joint and muscle and you are powerless to command them to function smoothly. You dive into the patient chair, heart pounding and filled with the bitter knowledge that, despite valiant efforts in the waiting room, you are fully exposed at this moment as a flaming NEUROTIC! He is obviously used to deranged behavior so, though you search his face for clues, he is clearly experiencing nothing – – your terror is as routine to him as a hit movie is to an usher.
Mercifully, you have a moment to yourself while he performs the ritual of locating his imported European tobacco and packing and lighting his pipe. You look down and try to milk your brief moment as fully as possible to pull yourself together and gear up for the ensuing 50 minutes, but your fear has left you so weary by now that all you can do is simply wait in terror – your mind is a blank. The pipe ritual will reach an inexorable conclusion, just as surely as a time-bomb ticks away until the ultimate disaster.
The pipe is lit, your analyst settles back in his chair and disaster strikes. He looks you square in the eyes and says, “Sooo?” This, you have learned, is his habitual opening line. You smile and wait. And wait. And nothing comes into your mind. “That’s OK” you tell yourself – a minute of silence isn’t crazy – just tell him the first thing you think of like he instructed you in the first visit. He told you to pretend you were taking him to a new country and tell him anything and everything about it, just as it occurs to you. You must not arrange your thoughts in any orderly way – just think out loud.
And now the short pause is starting to lengthen into a definite silence. You are now committing the only sin that exists in analysis. You are not speaking. The panic level, which already seemed at its height, rises incredibly. You look down but then tell yourself that’s cowardly and look back up – right at him. He is totally calm and totally expressionless, except for a faint glimmer of kindness. He looks like he knows you’re breaking all the rules but he’ll forgive you if you remedy the situation fast – very fast. You feel reassured and certain that speech will emanate from your mouth. You shift your position, smile confidently at him to erase the awkward silence and open your mouth to speak. There is nothing. Nothing in the brain. “I’m not talking,” you volunteer and then blush with embarrassment as this asinine observation echoes and echoes in the ensuing new silence. He puffs on his pipe – you glance at him furtively from time to time for any sign of a reaction. Boredom? Annoyance? Fatigue? Anger? But his face reveals nothing. He is sitting there with all his years of experience, his degrees, his training in Vienna, his venerable reputation – all this is sitting waiting for you to come up with any words in the English language. And what do you give him – silence and “I’m not talking.” And in return he’s not even angry. Or bored. He looks pleasant and kind. He is an absolute Saint and you are a worm. “I feel like a worm.” “Yaaa?” Oh God. Can we make believe I never said that? But the words are hanging right out there for all to see, and he is looking expectant and pleasant and reassuring – giving you all the kindly Viennese assistance at his command. “Yeah.” You stall for time and pray that something in your brain will furnish you with an elaboration – even made up – of your statement. You look down and at the door and at him and down again, waiting in vain for those thoughts. Nothing comes. Your mouth goes dry and you’re sweating profusely. In desperation you launch into some mindless babbling about feeling wormy in many situations and feeling wormy all your life, even as a two-year-old, and feeling wormy on dates, but not with friends, but not with some dates and yes with some friends. Now what?! You have shot your wad!
Somehow you force a few more words out of your frozen mouth. “When I was a child…” “Yaaah?” comes the heavily accented encouragement. Only it doesn’t feel encouraging. In fact, you’re rapidly finding out what it must feel like to be catatonic! No speech, no movement, no thoughts issue forth. “Yaaah?” comes the second ever-so-slightly annoyed entreaty. “Vot happened when you verr a child?”
“I used to sing.” (oh God – how inane – how utterly irrelevant to the reason you’re there.) “Ho nice!! Vot did you sing?”
“I didn’t really sing – it was more like humming.” (Whoops! Caught in your first big fat lie!) “Dot’s fine too! Just say whatever comes to you!” (Oh no! He’s found you out – you’re here for the third time and still don’t care to observe the rules!”)
This halting and lame monologue somehow proceeds until finally, the end is in sight. The big brass Tiffany’s clock on the mantle says, “just a wee bit more inanity and you’ll be out of here!” You muster a few more verbalizations and… At last! He slowly stands up and beckons you to the door. You can feel blood starting to return to your veins and labored, entry-level breathing makes its way through your pursed lips. “Thank you very much,” you intone. “See you tomorrow.” And with that stab at poise, you commence your wobbly walk to the door. He opens it for you, as you decide that he can’t take anymore. You lurch through the door and march, wooden-legged, to your car. Another car door opens, and out comes another seasoned, super-confident patient, who will soon show him how it’s really done!