[An excerpt from The Patient Who Cured His Therapist: And Other Stories of Unconventional Therapy by Psychology Tomorrow’s Editor-in-Chief Stanley Siegel]
Buffalo, New York, Winter 1986
Myrna Novik was described to me as an overweight, quite crazy thirty-four-year-old woman who had been under regular treatment for more than half her life. At a combination seminar and consultation in her native Buffalo, where I was lecturing and consulting once a month at a church-affiliated counseling center, a participating psychologist told me: “She’s the senior member here. She has more seniority than the staff. They come and go; she remains.”
I asked for a brief outline of her background and got a litany of bleak facts in return. The daughter of a man who had spent vast portions of his life in psychiatric institutions, and who in fact was in one at that very moment, Myrna had been molested by an uncle when she was barely pubescent and raped again by a stranger when she was fifteen years old.
The second rape produced her first child, who had Down’s syndrome. Doctors and county officials advised that she institutionalize the baby, and Myrna declined. They insisted; she refused. In the ensuing years, Myrna had married three times, her selections crossing racial lines for her second and third husbands. Her third husband, with whom she lived when I met her, was unemployed and collecting a small monthly disability allowance from Social Security Supplemental Security Income. All three children were of mixed racial ancestry, inasmuch as the assailant who had sired her first child was of African descent also.
The psychologists at the center considered Myrna “impossibly irresponsible,” partly for insisting from the outset that she maintain custody of the Down’s syndrome child, partly because she had an apparently uncontrollable penchant for shoplifting, and probably also because she had twice broken unspoken taboos against miscegenation.
Her shoplifting was the most often stated reason, though. She had been caught at it numerous times and once had even gotten herself sentenced to weekends in the city jail. Therapists complained year after year that they could not seem to make her understand that her risking further incarceration by continuing to indulge in compulsive thievery was effectively equivalent to abandoning her children. She was therefore openly abdicating her responsibility as a mother. ”Irresponsible and crazy,” they called her.
Accidentally, I caught sight of Myrna before our formal introduction, while another staff member was tactfully ad vising her of my arrival and my intended advisory role in her therapy. I was quite surprised at Myrna’s demeanor, particularly her woefully drawn facial expression. I had half expected to see someone flighty and frivolous, perhaps overly adorned in fake jewelry and excessive makeup, or someone disheveled and reeking of self-neglect.
Myrna’s round face was framed in long straight brown hair, not unkempt but not ostensibly attended to. She wore a polyester blue blouse, its shirttail draped outside the waistline of her black slacks. She wore black canvas slip-on sneakers, shoes that were comfortable, functional, inexpensive, and unostentatious – very practical. She was overweight, but in her face was the faint suggestion that she might once have been a beautiful child, if not a beautiful young woman. Her facial muscles seemed taut and strained, as if they were weighted down by a gravitational pull stronger than that affecting most other people. I watched through the one-way glass as she sat in a metal-backed chair and waited for me with her feet crossed and her hands in her lap.
I studied the face.
Myrna’s head leaned over to the right in the manner of a dazed prizefighter’s. Her ready frown reflected the drawn shape of her cheeks above and her brow above them, forming chevrons of burdened sadness. She did not look crazy and irresponsible. She looked worn, exhausted, and peril ously close to defeated.
I introduced myself and said I had heard a lot about her. She snorted, as if to say that whatever I had heard, it probably was all bad. The reaction was like that of a child in the principal’s office for the fifteenth time, only this time with a new principal. When I said that I’d heard a lot about her, Myrna “knew” the deck already was stacked against her. I felt instantly that I had taken a step backward.
So, I thought I would surprise her. Instead of asking questions, I began the session by telling her what I knew about her – that she had three children, one of them with Down’s syndrome; that she was taking care of her husband and her sick mother as well; and that she had been caring for her mother since she was a teenager. I said I knew that she was not getting any child support from her ex-husbands and had to rely on Social Services and her wits to keep everybody for whom she was responsible clothed, fed, and reasonably well cared for.
She nodded slowly as I spoke. Finally I said, “I don’t understand how you manage to do all that. It seems like a great deal of work and responsibility.”
An observing therapist later remarked on how I had be gun the process of reversing Myrna’s self-perception by manipulating the information she had given me. I may have beg n this process, but there was no clever, manipulative tactic to my approach. My admiration and sympathy were real.
“It’s just real hard,” she responded, weakened by the unexpected understanding. “Life is just real hard. I think I was really… I was not prepared for it. I was just not prepared for how hard it was.”
I learned later that the experienced observers in the anteroom were surprised at both her statement and the tone of resignation with which she had delivered it. It was as if they were seeing her tired for the first time. When she said life was hard, she closed her eyes with an emphasis laden with difficulty and pain.
“It makes me mad,” she said, “because I’m learning that I could have done things differently. But yet, when I think about what I could do, when I think about what I can do now, it just freezes me in place.” She clenched her hands together. “So therefore, I’m just content to be in the con fines of my home. Like other stuff isn’t there.” She waved her hands, as if waving other things away.
A smoker in those days, I reached for a cigarette.
“You may be thinking about the wrong things to do,” I said. “It sounds like you’re trying harder to be more responsible.”
I was thinking about the phrase “Irresponsible and crazy,” her label, and how supremely responsible she appeared to me, practically from childhood; and then how she seemed never to have had enough time or freedom to relax, or even to go a little crazy.
“So, how would it be if you went crazy?” I asked. “It sounds like great fun to me.”
Sadly, turning away to the right, she said, “It does.”
The sadness convinced me that I was on the right track. Not only did she need to go crazy, she knew she needed. it. Anyone else might have chuckled at such a suggestion, thinking it was a joke, coming from a therapist. For Myrna, “great fun” was no joke. It was the Impossible Dream. She then added, “Well, my sister, underneath me, and a lot of other people, say that it’s a cheap way out. It’s a coward’s way out, and maybe that’s what keeps me from not doing it. It was my father’s way out.”
The statement startled me for its perception. Her father was institutionalized. Who would think of institutionalization as a way out of anything? Someone who was stuck with the leftover responsibilities, no doubt.
“How did he do it?” I asked. “What did he pick?”
“He just went berserk on religion,” she said. “He just brought religion as the main focus to take care of some guilt that he had as a child. It played into his whole life.”
“Was your mother the responsible one?”
“Yeah. Well… she was more responsible than my father. She wasn’t as responsible as I would have liked.”
“But you were more like her than like your father. You were closer to her?” I was challenging the perception that she was following in her father’s “crazy” footsteps.
“Well, I was closer because she was the one that was there more of the time. He would have to go to the hospital and stay there a lot of times. And then when he was there, he was working.”
Thinking of her father’s periodic hospitalization, I said, ”You mean he was allowed vacation time.”
“He allowed himself vacation. That’s for sure!” she said. “He sounds like a wise man,” I said, having just figured out exactly what I was going to do and to recommend. “Now, when was the last time you had a vacation?” I asked. “The last time you remember letting go?”
“I guess I let myself go when I go and steal,” she said. She tilted her head left, toward me, and looked up at me in a shy, childlike manner. “They told you about my steal ing?” she asked with lips pursed like Shirley Temple.
“Yeah,” she said, returning to her sadness. “That… to me that’s a kick. To me that makes me feel good, something that I feel I do for myself, but… I guess what I have to learn is how to channel doing things for myself in a better way, so that it doesn’t end up making me feel worse or something.” She looked up at me for approval. She had put no feeling into the last statement; it just sounded like a statement a therapist would want to hear. She knew a lot about therapists.
“Are you good at it? Stealing?”
“Real good!” she said with a slight laugh. “Too good.” “Tell me how do you do it. Maybe I could learn a lesson or two.”
“You could. I wish… I have a sister trying to tell me I should turn it around and use it to make money by trying to teach stores how to make their security better. It sounded good at the time. It sounded like something that someday could probably be really real. But I’ve never – I’ve never acted on it.”
“But you’re an expert.”
“I’m not an expert, but I’m among the best. I’m not an expert, and I have been caught, many times.”
“Have you been to jail? Have you managed to stay out of jail?”
“I had to do a month of weekends one time. That was the only incarceration I had, other than just being there un til you get to court.”
“Well, that’s one way of taking a vacation, isn’t it? On the other hand, you’re such an extremely responsible person! How does someone who is so responsible, and so concerned about her children, her mother, her husband, how do you ever get the opportunity to let go unless you find someone to help you achieve that?”
I excused myself, saying I wanted to talk with my colleagues. In the room, I told them how diametrically opposite she looked to me from what I had heard about her. I also suggested, carefully, that I had a different view of Myrna’s refusing to institutionalize her Down’s syndrome baby. Their contention was that institutionalization would have been a more responsible act. “Just from the way she looks and the amount of work she has to do,” I said, “I think Myrna saw abandoning the baby as an escape from responsibility. Where did we get the idea that this woman was irresponsible?”
“What about the shoplifting?” an observer asked. “I mean, she doesn’t just steal things; she steals according to a list.”
“What do you mean, a list?” I asked.
“She goes shoplifting with a list of items to steal. She doesn’t just pick a necklace here and a gold watch there. She’s not merely out of control for a moment or for ten minutes; she goes in specifically to steal specific things, things other people have ordered.”
“And she gives the things to these people?” I asked. “Worse. They pay her for them.”
“And what does she do with the money?”
“What difference does it make what she does with the money?”
“Do you know what she does with it?”
“Well, she doesn’t go to Las Vegas with it, if that’s what you’re suggesting.”
“I’m sorry. I didn’t mean to suggest anything. My feeling is that her stealing in this fashion might be consistent with her responsible behavior.”
“Stealing as responsible behavior?”
“The way you describe it,” I said, “she does it as a business. How irresponsible was Dickens’s Fagin? His boys went to work every day picking pockets. It was a skill, and in an economy where they had no other work. They rehearsed their moves, went through mock drills. For that, they all got fed and housed, and they survived. Unless there’s some evidence to the contrary, I suspect that the proceeds of Myrna’s excursions go to augment the cost of supporting her mother and her family. That’s pretty responsible behavior, it seems to me. It’s risky, certainly, because it’s against the law. She’s risking jail. We’re learning a lot here. Myrna is no classic kleptomaniac. She evidently isn’t impulsive; she’s purposeful. She doesn’t need to be more responsible. If anything, she needs a break. Maybe that’s it. Maybe what she needs is a day off. Time when she is not responsible for all these people. So far, weekends in jail are the only vacation she’s had.”
I returned to the room.
“Have a fantasy,” I said, “about what you would do if you were to go crazy with me today. What would you do if we were to make this our vacation, free from all responsibilities?”
“Talking,” she said quietly. “Maybe going somewhere. Sightseeing in the city or something, some points of interest. And still have communication going. I think that’s a way of- ”
“That’s so responsible! You’re going to show me Buffalo?”
She thought about it for two seconds and seemed to determine that sightseeing in Buffalo was not that crazy after all. She would have to come up with something really wild. “I’d probably end up going all the way,” she said, employing a phrase from another era. To make herself clear, she added, and this time very demurely, “I’d probably… we’d end up sexually involved.”
Of course, I thought. Still responsible. The perfect tour guide. If you were to go absolutely crazy and be totally irresponsible; if you were to let go completely and have the wildest time of your life, you might do it by showing a man around Buffalo and then making lave to him.
I excused myself again.
“I don’t know if you noticed,” I told those watching, “but earlier in our session, Myrna gave me the tool that I was looking for to use as my intervention in this case, as my way of moving her to look at herself in a different way, to look at her life in a different way and maybe handle it differently as a result. She told it to me almost as if she knew it all along. And in a profound way I believe that she did know it all along, but needed someone to encourage her. I find that frequently. The patient knows better than anybody what he needs to do for himself and is merely searching for someone to encourage him to do it. I plan to do that in the next few moments. I’m going to give Myrna Novik an assignment, and when I do, for those of you who haven’t already figured out what my plan is, I want you to think about the degree of honor and respect that inspires it, because honor and respect are fundamental to what we are trying to do.”
I returned to the conference room with Myrna.
“It is rare,” I said, “that I meet somebody as responsible as you are, somebody who tries so hard to keep things in order. If you continue to steal, although you’re an expert at it- ”
“Not an expert,” she interrupted humbly. ·
“Well, good at it: a good one. But now that you mention it, if your unconscious longing is to let go, you will never become an expert, and you will get caught. If you have an unconscious longing, as I’m sure you do… ”
“To take a holiday’.” she guessed correctly.
“…to take a holiday,” I agreed, “you will get caught and be forced to take a holiday. So, I think you need lessons in how to let go. And I think there is only one teacher in the world for you…”
“…and that is your father,” I said. “He seems to be a master at it.”
Myrna closed her eyes. The corners of her mouth rose slightly, forming a resigned, relaxed grin, as if she not only agreed but was genuinely relieved and gladdened to hear the suggestion.
“So my advice to you is to make a visit to your father and to ask him to teach you how to let go. ‘Dad, you have some thing that I have not allowed myself to have, and something that m ybe I aven’t appreciated about you. You have a gift for taking holidays. You have an ability to let go, to unburden yourself.'”
“He does,” she said.
“‘And I want you to teach me this,'” I continued, pausing again.
Her eyes moistened. I thought that she might have been moved by the mere possibility of momentary relief – from the burdens of her daily life, from whatever burden she felt about her relationship with her father, from the burden of clinic staff members telling her over and over that she was irresponsible when she knew she was the opposite.
I waited a moment.
“So, Myrna, could I trust that you will visit him and take from his wisdom those lessons, and use them in a way that would give you the opportunity to unburden yourself just a bit? Can you do that?”
“Yes,” she said. “I can do that.”
“I think your father might be honored.”
“That I would ask him? He probably would be.”
“And you might even feel less guilty about having been so oppositional with him, so rebellious.”
She nodded, unable to speak.
Later, I discussed Myrna Novik’s case in a seminar. My recognition of and respect for her sense of responsibility in the face of years of accusations of irresponsibility – had rattled certain of the observers’ prejudices. Some no doubt would cling to their former notions (responsible shoplifting, indeed!). I wouldn’t say that the concept overwhelmed them, but it turned their dial to a different channel for a while. I had the sense, though, that whereas they had seemed competitively threatened by my approach, they now were more intellectually curious. Some even seemed emotionally excited by what had been accomplished and, moreover, by their participation in it.
Described as a failure, as her father was similarly described, Myrna had viewed herself as a failure and her family as a family of failures. Our encounter structured a different view, that of a woman who was successful at assuming and meeting responsibilities. Moreover, Myrna had rejected her father for what she viewed as his failures, but the intervention placed him in a position success, too-: as an expert at letting go, as someone quite in charge of his so-called irresponsibility, even to the point of getting him self incarcerated when he felt the world was too much for him. In way, he had the better idea for letting go, because he was in control of his incarcerations. She was risking a forced rest that might come at an inconvenient time. At any rate, the intervention was intended to repair Myrna’s view of herself, and it repaired her view of her father as well. A bonus, in my book.
One observing therapist wondered aloud what would happen next. The answer was anyone’s guess, but I presented this possible scenario: if Myrna consulted her father as prescribed, there existed a chance that she could repair her relatio ship with him. First, she would be honoring him, thus changing the past and providing a different foundation for a different future. Then? Perhaps he might offer her an alternative to the idea of incarceration. He might have good advice for her. He might feel freed to offer her help. I couldn’t know that. I knew only that she had left the premises with a different view of herself and of him, and there fore with new options and new hope.
Surprise creates a momentary rupture in the thought process. The mind, momentarily confused, is thrown off balance, and in that rare moment, the opportunity arises to introduce a new thought. As a therapist, I use surprise as a technique a means of disrupting a pattern of thinking and creating a moment of attention in which I can introduce a new idea. In the case of Myrna Novik, not only did I use it with the patient but with an entire agency which was watching me, confident in the ascription of hopelessness they had made.
As luck would have it, well-meaning guardians of tradition had so completely misunderstood Myrna Novik that the shoplifter.
As a therapist, I had the incalculable satisfaction of giving a surprisingly new view and new hope to a deeply conflicted but fundamentally fine person. As a performer, I had the thrill of pleasing all segments of an audience to one degree or another. As a representative of a school of thought that challenged tradition, I won some converts as a teacher, I had offered a perspective on behavior opposite from tradition in tandem with presenting the possibility that a patient might not have a problem at all but a solution to a problem.
Myrna’s case provided me with a living, breathing illustration of my point, and then some. Her demeanor told me she was burdened by some responsibility long before her words did. And wasn’t it enough that she had suffered abuse abandonment, and emotional and economic poverty – did she also merit society’s condemnation for its own betrayal of her? How criminal of us to call irresponsible someone who in a very calculated way systematically accepted daily responsibility for all the people around her.
Because Myrna’s calculated way of coping was criminal, though, I was walking on eggs, so to speak, when I suggested its value to her. I had to be ever careful t onvey respect for her responsible motivations for her activity but not for the activity itself. I never suggested that she engage in it, though I tried to bring it under her control. And, in offering as a possible explanation for her taking such chances that she was always risking a forced vacation from responsibility, I posed the notion of taking a rest from responsibility without the risk of incarceration.
I don’t know that this would have been a one-shot intervention had I not been a visiting teacher-therapist on a show-and-tell mission to a distant city. I might have wanted at least another session with Myrna, if only to support her altered perspective and her I hope changed relationship with her father, whose tradition she genuinely followed – though ironically with less control than he.
Assuming I would not see Myrna again, I took comfort in the wider impact that the session had on the agency, wherein everyone’s definition of a problem got turned in side out. Everyone, including Myrna, was forced to rethink moral issues and psychological issues and to reexamine their own patterns of thought regarding problems and solutions. Myrna had bought the family’s definition of her father as crazy just as the agency had bought society’s definition of Myrna as crazy. The intervention offered the agency a different way of thinking about her; it offered Myrna a different way of thinking about herself and her father, a way that permitted her to short-circuit her rebellion from him and lessen her overidentification with her mother. Moreover, the case raised the question of craziness in general, and irresponsibility. Who was crazy, after all? The father? Myrna? The agency? Her last three therapists?