Transcending Illusions: The Two Spaghetti Stories

[An excerpt from The Patient Who Cured His Therapist: And Other Stories of Unconventional Therapy by Psychology Tomorrow’s Editor-in-Chief Stanley Siegel]

TRANSCENDING ILLUSIONS

Illusions, subconscious spasms of creativity, arise from a desperate need to transform the details of reality and make them more pleasant, satisfying, exciting, or challenging than their creator considers them at the moment. People organize illusions to help them deal with acute or serious anxiety caused by situations or circumstances, as a mother of four does with the help of the Reader’s Digest in the story entitled “Sin’s Syndrome.” Sometimes the illusion passes with the crisis, but sometimes, as in the mother’s case, it becomes fixed over time because it functions to balance an attempt to reconcile the past and future, or to postpone a confron­ tation between past deeds and future consequences, mainly by avoiding the unpleasant details of the reality.

In “Father Knows Best,” one member of the family in the service of another, and with the assistance of still other fam­ily members in a collaborative effort, assumes a burden of tremendous anxiety in order to love and protect the more hurting member. All of them believe that the hurting family member is not yet able to handle her problem. The illusion that the strong member is fraught with anxiety gives the weak one both the protection she requires and whatever time she needs to prepare to face her own worst fears.

The two “Spaghetti Stories” suggest  that some illusions become sacred and permanent  in themselves, and for rea­sons that will forever remain a mystery; while others drift in and out of accepted reality as the need arises for them, and require only better management. Like failures, illusions work, perform a function, achieve a goal. The therapist’s challenge is to discover the purpose of the illusion and de­ fine it, perhaps to appreciate it when he cannot.

THE TWO SPAGHETTI STORIES

New  York, 1974

At the beginning and the end of the first year of my training, I encountered two patients, Florence and Grace, each of whom had created a separate reality for herself that challenged my own and raised questions about the very nature of what reality was.

I met Florence first, at a dreary clinic on the grounds of an even drearier state-operated psychiatric hospital. I was the equivalent of  an intern, working under the supervision of professionals who were as dedicated to the traditional psychoanalytical approach to the behavioral studies as I was sorely tempted, but not yet ready, to rebel from it.

I was young. I had a plan to change the world, and I was eager to get started, knowing, as I did, that the work was going to take months at the very least.

I spotted Florence at an orientation briefing. I and my student colleagues were invited to shuffle into a small, musty gymnasium, whose brown-painted heating pipes seemed to be kicking each other awake whenever the oil burner yawned to life, sounding as if someone in a nearby anteroom were tuning the radiators with a nightstick. Mo­ments after we gathered at mid-court, a handful of obvi­ously skeptical attendants herded in a mini-busload of patients so forlorn in their appearance that I’m certain several of us immediately flirted in our imaginations with the notion of alternative vocations, like driving a cab, or cleaning graffiti off subway trains.

Our job, and the patients’ job, was to select each other, quite randomly, as potential partners in education and ther­apy. By mingling with them, we might get an idea of just how difficult and/or challenging this work might be. By mingling with us, each of them might finally encounter the one unjaded, undefeated genius who could answer such prayers as they might have been praying had they been administered lesser dosages of medication.

Florence was last to enter the room, seconds after an observant and, I guess, kind attendant had told me she would be. He said she always was last, as she was also the last to leave the bus, or to enter it, or to queue tip to eat, or to sit down to string beads.

She wore a nondescript housedress with a pale argyle sweater draped over her shoulders. Some synthetic hor­ monal ingredient in her daily medication had seeded her upper lip with a spare but unattractively dark mustache, which she apparently never considered removing or bleach­ing. She wore yellow terrycloth slippers and sweat socks whose elastic had grown as fatigued  and apathetic as the hands that declined to pull them up.

Florence carried a Styrofoam cup of coffee in one hand and a lit cigarette in the other, always. Frank, the attendant, told me that she chain-smoked-literally. He had never seen her touch a match to the end of a cigarette and guessed that she required only one match each day, obviously first thing in the morning. He correctly predicted her every move, up to and including the move that rendered her thereafter mo­tionless. He said she would shuffle over to a seat next to the piano bench, and she did. He said she would then stare straight ahead, and she did that. He said she would not flick but more or less allow her cigarette ashes to fall off, forming a little gray island around her, and she did that. When any­ one needed access to the piano, he said, one or two of the attendants would lift Florence, chair and all, and move her aside, and she would not flinch during portage. By that time I had no reason to doubt Frank’s word. Finally, he said that she would not talk to anyone, not ever, that she never had, and that if I thought for a moment that I could get through to her, I would be wasting my time. I glanced at Frank as the question “What makes you say that?” crossed my mind, and he answered it before I got the chance to edit my thoughts.

“You have that look,” he said.

I had to laugh.

“I get the feeling that you’ve seen student therapists once or twice before,” I said.

He had to laugh.

But he was right. I already was tempted to begin changing

the world by introducing its promise to Florence. She was irresistible. Her withdrawal created a gravitational pull that seemed directed right at me.

Her history: she was in her mid-thirties, though she looked fifteen years older. Born into a psychiatric ward, the daughter of a full-time patient and a part-time rapist, Flor­ence had grown to junior high school age in three different foster homes, and upon reaching puberty she was diag­nosed – or maybe denounced, I thought-as “catatonic hebephrenic,” severely regressed, hallucinatory, and ”de­luded” by life.

I watched her intently for what seemed like (but was not) fifteen minutes or so, when I thought I noticed her lips, then her head, move forward and back ever so slightly. Why, she was conducting a conversation! All right, maybe only half a conversation. Her counterpart in the discus ion may well have been hallucinatory, but she was clearly talking. Already I had made a discovery that had gone undetected by the rest of the profession.

“I thought you said she didn’t talk,” I whispered excit­edly to Frank. “Look at her now. Look at her!”

“No,” Frank said without looking up. “Listen to her. Slide over there quietly and listen to her.”

I walked nearer. She stopped, I thought because of my approach. But then she sipped her coffee, puffed on her cigarette, and resumed the monologue. I drew closer. She stared ahead, talking. Finally I was within earshot. I strained to hear what she was saying. When I heard it, I strained harder to decipher it.

“Stallbig. Fraymore ball duff mon ling doo. Desimore. Banadore lymink shraboleen. Dorf.”

Not one of her phonetic concoctions amounted to a word, not even mistakenly. She had created a language specific to her isolation, and so specifically for her isolation that she had assiduously avoided even an accidental swipe at any combination of vowel and consonants someone else might understand. I listened for more, and I got more. It was re­ markable. She could talk paragraphs of what anybody else would  consider  nonsense  syllables.  I didn’t  think  there could be that many nonsense syllables.

I pulled up a chair in front of her and sat down, facing her. I said, “Hello, Florence. I’m Stanley Siegel, an intern here.  It’s nice to meet you.”

She stopped talking, or whatever  it was she had been doing with her sounds. I was encouraged by the cessation and continued my conversation. She stared straight ahead, occasionally sipping, occasionally puffing.

“I’ve only been here a short time,” I said. “I’m not at all familiar with the place, although I bet you are. Perhaps one of these days you could show me around. I mean, if you want, if it would be all right with you.” She stared ahead. I talked on, complimenting her sweater and yellow slippers, avoiding looking at her mustache, making small talk about the weather, droning on insufferably, I suppose, until I be­ gan to suspect that she was patiently ignoring me, waiting for me to stop, or to finish, or to grow old and die. After a while I thanked her for her time. I rose and walked  away, whereupon she sipped and puffed and resumed her sylla­bles.

I repeated  the exercise every day for weeks, conducting one-sided  conversations  in English, wherein I reported toher as much news as I could remember about the other pa­tients and the staff and the bus drivers and the weather and whatever entered my mind. She stared ahead, sipping and puffing. Whenever I finished, she launched into her  phonetic mysteries.                                               .

What a wonder she was, I thought. If her life was so awful had she not managed to create a private, peaceful, and presumably interesting life inside her imagination and. outside the institution, outside all institutions, even the institution of language?

At first I stubbornly determined to wear her down with my kindness. For years afterward, I thought of my efforts as wasted time, but I no longer feel that way. I learned a great deal from the weeks and weeks spent trying to talk Florence into talking to me. At the time, however, I got absolutely nowhere.

I talked to her, or at her, for thirty minutes each day, and the entire time she stared ahead, puffing and sipping, puff­ing and sipping. I read newspaper stories to her. I told her about the traffic outside the hospitals in the morning and in the evening. I recited sports scores to her and tried to incite a reaction by insulting otherwise sacrosanct heroes of Amer­ican baseball, football, basketball, and Olympic teams. I talked of recipes, painting schemes, party favors, wedding gifts, automobile styles, weather patterns, fabric preferences, contemporary decor, architecture, the comparative characteristics of different woods, the mysterious lives of eccentric artists, the intellectual difficulties presented by organized religions, the miasma of global politics, and the in­furiating qualities of various inventions designed to hang a heavy painting on a plaster wall.

Nothing. No reaction. Sip and puff. Sip and puff…

One night I awoke with what I thought was an original idea, a potential key. Later, I learned it and used it as a tactic. I also learned that it was not an original idea at all, and that I probably had heard or read of it before, under the category of “joining” a patient’s “universe.” But in the middle of the night, during a period of protracted frustration, it felt like a world-altering discovery, and I remember the joy it brought me the way old men remember the joys of Christmas mornings when they still believed in Santa Claus.

I would talk to Florence in her language. I would join her.

I would invent nonsense syllables similar to hers. If they meant nothing, she would hear the same nonsense she heard when I spoke English to her. If I stumbled onto sounds that she understood, she might recognize me and try to reciprocate. If she was really talking nonsense syllables as a device for escaping, my joining her might cause her to see the futility and downright silliness of her tactic, and she would recognize it and talk to me.

God, I hope nobody eavesdropped on my one-sided conversations.

“Brendeel wain bathenloom,” I said as Florence stared ahead, making no eye contact, sipping and puffing, waiting for me to finish. “Lornell foppin dooz. Manya frandish. Via mastindike sheem. Drolin thab rol mickindelle fut manda­ loon. Ord? Foy maindee! Rame dell stadlerbem chardav­ enborg…”

I did that for another week at least, for a half hour every day.

Once she interrupted me and barked a syllable I thought I recognized as one of my own inventions. She continued staring straight ahead, sipping and puffing, but I convinced myself that I had seen the flicker of a major breakthrough.

I was encouraged  in a fashion so exaggerated,  I felt compelled to continue babbling to Florence for a daily half hour right up to the last morning of my internship.

About a week before the year’s end, I was working at a desk in an office I borrowed from nine to ten every morning, mainly to fill out admission and insurance forms and coordinate appointments. Someone knocked on the door. I had told those patients considered mine that I would be borrowing that office for the same hours every day, should they ever feel the need to talk on days that we did not have a formal appointment. I did have patients other than Flor­ence, and I did experience some success with them. But as the year’s end grew nearer, I felt increasing frustration about only one patient, my dear, intractable Florence, who, as I opened the office door, appeared before me, holding her ever present props in either hand.

“Florence!” I exclaimed. She sipped her coffee.

“Florence, come in, please. How nice to see you! Have a seat.”

“I have something on my mind,” she said, staring past me, then puffing on her cigarette.

I could barely hold myself together. She spoke! I think my heart rate set off alarms in another part of the hospital. For all I knew, it was the first English-language sentence Flor­ence had said to anyone in years. I had broken through!

Florence was going to talk to me, perhaps even rejoin my world after years in her own. Which was the key? Did she trust me because of my patience? Was it that I had joined her in the nonsense syllables? Had I shown her the respect that she deserved for creating her own functioning, private universe, or had I revealed to her the frivolity of her lin­guistic escape? Where were the doubting Thomases now? Where were my supervisors? Where was the media? I thought I would burst.

“Florence!” I stammered. “Something on your mind! Well, please, come in. Come in! On your mind. Of course, on your mind. What else would it be on? Tell me. What’s on your mind, Florence? Yes, yes. What is on your mind? What is on your mind?”

And she answered: “Spaghetti.”

“Spaghetti,” I repeated.

Spaghetti was on her mind. Staring straight ahead, past my right ear, Florence sipped her coffee and took a short, hasty drag on her cigarette. She was done telling me what was on her mind. I had asked. She had answered: spa­ghetti.

But she had come to me, had she not? She had knocked on my door, and during the appointed  hour.  She had said a declarative sentence in English: “I have something on my mind.” And then I had asked what. And she had told me.

She turned around in three shuffling steps and walked away. She resumed her station in the chair nearest the pi­ano. She resumed her staring. She resumed her sipping and puffing. She resumed her syllabic symphony, leaving me to ponder the eternal mysteries of spaghetti and, now and then, to laugh at myself.

The reasons for her constructing this reality were inacces­ sible now, long in the past, and probably irrelevant. This new reality existed with as much validity and solidity as my own did, I thought, with its own language, ritual, and com­ forts. Here I was thinking that our reality was the better one or the right one, or that she had no control over her illusion, but in fact she proved to be a master of it, in absolute con­trol. She showed me that her reality was sacred, my med­dling blasphemous. Eventually I thought of her case as a lesson rather than a failure, and applied what she taught me. With another case – the next story – I built on the idea, not only respecting the patient’s illusions, but joining them and making them my own.

During the same intern year that I endured my humbling experience with Florence, I also began seeing Grace, who was then approaching fifty years of age. Unintentionally unemployed for the tenth or eleventh time, Grace had been a patient under every possible circumstance in a number of psychiatric institutions over the previous ten years. She had been admitted; she had admitted herself. She had been rec­ommended, remanded, required, and even sentenced to hospital stays. She represented quite a challenge for a be­ginning therapist.

Again, under the tutelage and influence of a disciple of the traditional psychoanalytic approach, I was getting no­ where, and as the year wore inexorably on, my estimation of my progress with Grace, and my concomitant frustration, threatened to rival her depression over her own apparent difficulties.

From the window of the clinic, I watched once a week as Grace parked her car in the metered lot across the street. She would get out of the car and scrutinize the distance between its wheels and the white lines bordering the space. She then would gauge the distance between the front right wheel and the line nearest it, and compare that with the distance between the rear right wheel and the same line. If the distances did not match to her satisfaction, Grace would get back into the car, put it in gear, and correct whatever she had determined to be the inexactitude. Then she would get out and review the relative distances again.

When she was satisfied on the right side, she would begin the process anew on the left, each time readjusting the mea­surements by moving the car, and therefore always spoiling the first measurements and risking having to start all over again.

Finally she would compare the distance between the fend­ers of the car and the respective white lines on either side, making sure that the car was properly centered and per­fectly parallel to the borders of the parking space.

The process often took a half hour or more, and in order to both endure and enjoy it, I adapted my schedule to ac­commodate Grace’s early arrival. I made her my first appointment of the day, or my first appoint after an hour break, so I could watch Grace without robbing another pa­tient of my attentions; and so I could ponder as well my changing approach to her, usually with an eye toward re­ directing it according to the ever changing theories that were maturing in my mind.

Grace nurtured a rather flattering view of herself in rela­tionship to the world around her. When she finally arrived at my office, she would immediately launch into extended, uninterruptible, and sometimes mysteriously cogent expla­nations of how and why she was directly responsible for the Vietnam War, the extended drought in the Sahara, the endangered-species status of the North Atlantic osprey, and the failure of manufacturers of the Mazda automobile to successfully market the Wankel, a rotary combustion en­gine. Needless to say, these treatises were as fascinating as any I had heard or read in my lifetime. If my job was to understand their origins or “cure” Grace of her propensity to conjure them, however, I was a mighty failure at it.

After two years of analytic struggle, I began to “join” her delusions, slightly after the fashion  of my “joining” Flor­ence’s linguistic fantasies, but not in so radical a way as to appear as daft myself. I decided that if Grace’s fantasies fascinated me, I would tell her so, and then probe with her what seemed to me so remarkable about them. When she repeated therefore that she had single-handedly started the war in Southeast Asia, I said, in as genuine a tone of awe as I could manage, that in my pathetic ignorance, I had not known of her titanic responsibility and never would have guessed it. Then I asked her to tell me specifically how she had started the war and what she hoped to gain by keeping it going. I exhibited passionate curiosity about every detail. I also produced examples of current literature on Vietnam and asked her to show me where it was wrong and where her name should have appeared.

I sensed that the tactic was starting to work when she began to laugh at the absurdity of some of my questions, and later at my notions. I told her at one point that I had been so appalled by the manner in which the U.S. military had minimized her contribution to the war effort that I had considered writing a letter on her behalf to General William C. Westmoreland. I said that friends of mine had served as officers on his public information staff in Saigon, and that through them my influence might force Westmoreland and the rest of officialdom to right the wrongs they had done her and set the record straight. The more specific I became, the more reality I began to interject into her fantasy, the clearer it became to her that my continued participation in her fantasies was becoming ridiculous. Following that, her fantasies were beginning to become ridiculous for her to hear. Once I entered and eventually took over her fantasy world, robbing her of its exclusivity, I forced her to consider surrendering it. After all, she didn’t feel so much of a need for it anymore.

After another few months, we were chatting and laughing about the imagination she had exhibited in constructing the fantasies, as if we were therapists together reviewing an old case. Then she would spend  the better part of a session telling how she had found herself wandering in one of the fantasies, how she had thought  about the fantasy in terms of our conversations, how she had imagined and even cre­ated similar conversations by herself, and how she then laughed herself out of her own fantasies in the same way we had done together in the consultation room.

Consequently, she was able to abandon the fantasies more rapidly. Not that she didn’t have them anymore. She did. But she gave them up more quickly. She didn’t wander around in them anymore; she got out.

With all the free time and energy she now had, she was able to concentrate more on the other elements of her life. She could even hold a job. She enrolled in a hairdressing academy, attended regularly for the required weeks, and started a new career as a hairdresser. She developed a fol­lowing and was satisfied with herself for the first time in many years.

Grace still was a fragile person, of course, and she called me at least once a year for ten years, alternately just to check in, to report how she felt, to make sure I was still alive and available for consultation, and now and then to permit her­ self the luxury of a relapse into an exaggerated reality.

One year she called in what sounded over the telephone like a perfect mixture of panic and euphoria, and I learned in the first half minute of her rapid-fire rambling that it was just that. She had, after years and years of preoccupation with herself, entered into somewhat of a relationship with a man, Bob, whose hair she had been cutting for six years and whose wife had died within the past six months.

I congratulated her and asked some perfectly innocuous question like, “Is he nice?” She did not appear to hear the question as she chattered on.

“It’s going well. It’s going well,” she said. “Imagine that. Me. I’m dating a man, and it’s going well, and I’m cooking him dinner. Right now. Here, in my own apartment. I decided to cook spaghetti. He likes pasta. At least I think he likes pasta. He said pasta is good for you. He worries about the fat content in meat and the cholesterol content in other things, and too much salt here, too little fiber there. But he says that pasta is very good, and I like pasta, and I’m mak­ing spaghetti. ”

“Grace!” I said. “That’s wonderful.  That’s very nice-” “No. Not yet, it’s not. I mean, it could be very nice. But I’m making the sauce, you see. And I decided to make it an authentic Italian sort of sauce: spicy. Fra diavolo. I think that means, ‘brother of the Devil,’ don’t you know; or, ‘Fa­ther Devil,’ although that would be absurd, wouldn’t it? Father Devil? You might as well say Reverend Devil or Rabbi Devil. The Most Holy Unholy Devil. Ha!

“But it means hot, whatever it is. Hot, obviously, as hell. When it’s applied to a spaghetti sauce, you see, theology has no bearing on it. We’re talking eternal flames. It means the sauce is hot. My problem is, what if it’s too hot? What if I make the sauce and he can’t stand it, because it’s so hot? And then, of course, he’ll eat it, because he’s such a good man. Polite. Doesn’t want to insult me. And then, of course, he gets sick, because of my fra diavolo sauce. If that happens, I’ve ruined the entire thing, haven’t I? I’ve singlehandedly cooked the first comforting relationship I might have had in fifteen years. Twenty years. Could it be twenty years? My God, Stanley! I won’t be able to stand it. I can’t take the responsibility of cooking sauce. Don’t you see? Look at the metaphor here. Basically, I can cook my own goose right now, today. Stan, listen to me! What if the sauce is so hot, Bob eats the spaghetti and has a heart attack? What if I kill him with spaghetti?”

“Grace,” I interrupted.  “I have a great idea! Listen to me. Really. Just listen for a minute.”

“I’m listening.”

“Use my recipe for sauce. I have a recipe.”

“You do?”

“Well, sort of. It’s not a fra diavolo sauce. I mean, it’s not hot. You can’t get a heart attack from it.”

“Oh, that’s good. What’s in it?”

“Hold on one second, I’ll get it.” I ran to the pantry and grabbed an armload of small bottles from the spice shelf. I also eyeballed every benign label I could see in there, hoping to be able to memorize some of the names. I returned to the phone and told her to begin with extract of vanilla, mixing it with a can of tomato sauce and a can of cream of mushroom soup, more or less to soften the spicy edge of the tomato sauce. I recommended adding a tablespoon of brown sugar and some sesame seed oil.

“Wait,” she said. “Maybe I should write … Stanley!” she exclaimed. “Extract of vanilla? In a spaghetti sauce?”

“It sweetens the sauce.”

“Whoever heard of a sweet spaghetti sauce?”

“I also put in applesauce and sour cream, to help coat the stomach lining.”

“Stanley!”

“And a special garnish I make, by pulverizing an Alka­ Seltzer tablet and sprinkling it over each individual serving of spaghetti-”

“You are impossible! You’re doing it to me again, aren’t you! I slipped, didn’t I? Of course I did. Well, you bastard, thank you.”

I must say, I felt pretty smug. This time, however, I knew I was feeling pretty smug, and I entertained no guilt what­soever about my smugness, because I felt secure that I had deserved it. I made myself some soup. I made a pitcher of iced tea. I settled into my favorite chair with my favorite book, and I read until I could no longer hold my head up­ right. I really enjoyed myself. I retired that night feeling like a surgeon who had arrived on the scene of an accident at just the right moment.

The telephone answering machine blurted out my own voice at two-thirty or three in the morning. I was just about to doze at the drone of my own recorded message when I heard Grace’s frantic voice crying, “Stanley. Oh, Stan, please wake up! Please, please wake up. This is Grace. Something terrible has happened. I need you. Please pick up!  Please!”

I scrambled to the desk and grasped the receiver just as she was about to give up. On hearing my voice, she lapsed into sobs that did not abate until I was fully awake, which could have taken a long time, considering how soundly I had been  sleeping.

“Grace,” I cried, “what happened?”

“I made dinner!”  she howled,  as if  she were confessing to a crime of passion. ”I made dinner! I made the spaghetti. We had a lovely dinner!” she yelled, applying emphasis to words that seemed not to deserve it under any circum­stances.

“Stanley,” she shouted. “He ate! He ate, and he had a heart attack. He had a heart attack!”

Before I could stop myself, I heard the question leaking out of my mouth: “Grace, whose recipe? Was it your sauce or mine?”

“This is no time to do that to me!” she screamed, giving me credit that I did not deserve and precious time to recover from my own stupid question. “I know what you’re doing. This is no time for tactics. This happened!”

“He ate your spaghetti and had a heart attack? Is he alive?”

“Yes! Yes, he’s alive. He had the heart attack on top of me. He didn’t have it at dinner! We were in bed! We were making love! The first time since Times Square was a meadow that I had a… oh, my God!”

Grace’s illusions drifted back and forth between conven­tional reality and her private reality. I never successfully determined exactly what purpose they served, for instance, in periodically making her responsible for such global atroc­ities as the Vietnam War, but I did succeed in helping her wrest some control over their drifting, in giving her some power over the timing and frequency of the shifts from conventional reality to illusory reality. I suspect that in her private reality, she felt so responsible for events precisely because in her conventional reality, she felt so out of control regarding them. Her anxiety  over the lack of control trig­gered the erection of an illusion, as a means of escaping or containing the anxiety.

Bob pulled through. After his triple-bypass surgery he and Grace moved in together. And after a few more frantic calls, spaced about two years apart, Grace stopped calling me.

I stopped inventing recipes, too.

I have a multilayered fondness for these two cases. To me, they represent important lessons learned, or at least observed, at a deliciously early stage in my career. I am charmed by memories of my relationship with these two women, and amused but not at all embarrassed by my youthful exuberance, energy, fervor, and optimism. I still laugh aloud when I ponder the hours I spent babbling gib­berish to Florence, on the absurd notion that I might stumble across a syllabic combination that, pronounced correctly, would have a definition in her illusion’s lexicon.

I also am amazed, now and then, at what I much later took to be Florence’s fit of generosity toward me. Her taking the time and summoning the trust to utter, for the first time in years, one complete sentence for me, and then an ellip­ tical answer, in English, amounted to a generous tip for all my seemingly wasted effort.

Partly because on budgetary constraints, no doubt, and partly because of Florence’s relentlessly confounding be­havior, traditional psychotherapy had abandoned Florence to daily physical caretaking and no more. Newly graduated therapists annually had sat opposite her blank gaze. They got nowhere and ultimately gave up. But she had seen and heard my ridiculously protracted effort, and she evidently judged it worthy of a heroic kindness. By speaking, at long last, she showed me that she knew and had known the language, that she could speak it if she felt so inclined, and therefore that she was very much in control of her world and the place she took in it. Then, by returning so abruptly to her previous demeanor, to her preferred universe, she showed me quite emphatically that she was being exactly what, where, and how she wanted to be, thank you very much.

Though I was not yet convinced of it at the time, both spaghetti cases illustrate my point about the value of ther­apists moving away from the position of being the outside observer and to a position more like that of the anthropol­ogist, whose study requires that he imagine himself a par­ticipant in the daily life of a different society, the better to understand its rules and customs. Both cases also illustrate a point I later solidified as a working premise: that apparent problems are often solutions to less apparent problems.

Florence’s revelation forced me to face the jarring truth that the reality I was trying to reintroduce her to – my reality – was evidently far less desirable than the reality she had created for herself. I was in no position to judge whether Florence would be happier or better off in my world than in hers, but inadvertently I had found out which world she preferred – a startling lesson for me, and unforgettable.

If Florence was content in her illusions, Grace was not. She was suffering,  and I wanted  to relieve her of at least some of her anguish. I did not know the origins or the spe­cific functions of her illusions. It was very early in my ca­reer, and I did not yet understand that problems had functions. But with Grace, I was at least able to mfluence her control of the illusions, so that she suffered less anxiety for the. Under traditional circumstances, a psychiatrist might have given her a prescription or two and followed it up with years and years of psychoanalytic therapy designed to discover and then supplant whichever warps in her child­ hood development had led to her obsessions. But she al­ready had been through a lot of that, and it had not made her life any better.

In respecting her universe to the point of absurdity, I cre­ated bigger fantasies than she, giving her a different perspective on her own fantasies and allowing her to minimize them to a more manageable extent. On a much smaller scale, we do exactly this with our children all the time, and it almost always calms them and makes their pain easier to bear.

A child falls in the presence of his parent, skins his knee, spies the wound and screams as if he had been dis­membered. Knowing that the same child has fallen the same way in a crowded playground without so drastic a reaction, the parent responds with a form of humor – essentially joining the child’s exaggerated illusion and thus reducing the child’s panic over the comparatively benign reality. ”Let me see” says the parent. “Is the leg still attached? Yes. Thats good. Is it broken? No, not broken. Good. If we fix this fast enough, you may live to play another day. What about the street? Is the street all right? Just a dent in the street. Good. The policeman won’t notice. Maybe a bandage would help, what do you think? Or should we see the doctor?”

Case closed. The child resumes play.

Do we know all the reasons for the child’s behavior – why he dusts hrmself off and returns to his fellows in the play­ground but reacts differently when his parent is around? No. Do we even know why we instinctively join his illusion and then stretch it until it snaps back?

No, but we do it, and it works.

 

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