[An excerpt from The Patient Who Cured His Therapist: And Other Stories of Unconventional Therapy by Psychology Tomorrow’s Editor-in-Chief Stanley Siegel]
What could be more relative than the notions of success or failure? We read newspaper accounts every year about retired professional athletes “failing” to gain election to their respective halls of fame, following decades wherein they achieved one herculean success after another. Olympians “fail” to win a gold medal, while winning a bronze instead. Exactly who is kidding whom here?
But in systems as intricate and beautiful as families, if we all adhere to reasonably measurable standards of behavior and accomplishment, we certainly can fail to achieve them, in which case I like to ask the question, “Well, what did we achieve, then?”
In this section, the longest, most complex story concerns a family that achieves multiple layers of however misdirected success directly as a result of the failure of their children to achieve conventional successes. In many families where one or more members fail to measure up to the family’s standards, the failure itself is achieving a hidden goal: drawing attention away from a potentially cancerous disruption; serving as a diversion, to allow another family member to break into the light of success; permitting family members to remain loyal to the messages of their own pasts. So often, as in the story entitled “Holocaused,” the failure is borne of generosity and self-sacrifice, and wholly within the failing family member’s control, despite appearances to the contrary.
The paradox of failure is that you can succeed at it.
Sarah Steinmetz was nineteen years old and a symptomatic smorgasbord by 1982, when her family appeared at the Family Institute. Although Sarah’s symptoms had shifted and changed over the years, she had been consistently agoraphobic for seven years and suffered severe and evidently physically painful anxiety over even the thought of leaving her house alone. She barely had finished high school through a home-study course tailored for her by an office of the New York City public school system, and she had made a few abortive attempts at work and college. At home, Sarah suffered severe, medically untraceable stomach pains and refused to be left home alone. Miriam, her mother, sometimes stayed in the room with Sarah at night and recently had taken a leave of absence from her super market job to remain at home with her sick child.
Sarah’s eldest sibling, Ari, the eldest of Miriam’s three children, was married by this time, living in Hartford and working as an accomplished family therapist. Dedicated as Ari was to helping her family, she had not succeeded in resolving any of the conflicts about Sarah; nor had any therapist or agency Ari recommended to them helped the family at all. Having read in her professional literature of a three therapist team-treatment method (originated by three senior family therapists, Olga Silverstein, Peggy Papp, and myself), Ari had placed a desperate call to the Family Institute. The family then had agreed to treatment – to the joint sessions, to the videotaping, to the full participation the program required – in order to reassure Ari that they would make whatever sacrifices necessary to help Sarah overcome some of her obvious suffering and her consistent failure to recover or construct a life of her own.
It is unusual for a family with one so obviously symptomatic member to participate in family therapy. More often such families try to “get some therapy” for the troubled soul, as if a failing member of a family owes his fate to himself alone. The Steinmetz family was manifestly different. Not only were they tightly knitted, they were so well aware of the strength of this weave that family therapy seemed the only remaining logical approach even to them.
The program – requiring as it did the efforts and presence of three senior therapists during each therapeutic session, as well as strategy meetings before and after each session – was reserved for the most difficult cases only. Intake material on the Stemmetzes did indicate that they had tried a number of therapeutic approaches and had been unsuccessful for years, and prior failure in therapy was a prerequisite for acceptance into our program; but Sarah Steinmetz’s behavior in the very first session convinced all three of us that this case presented a serious challenge indeed.
The treatment team, consisting of Alice Tripp, Ruth Goldman, and myself, conducted at least four sessions devoted to learning the family stories and identifying the characters. During each, Sarah seated between her brother, Ira, and her father, Karl, alternately writhed, grimaced, moaned, grasped, and clutched in apparent agony at her father’s and brother’s hands, and then abruptly interrupted her anguish occasionally to sip, childishly, from a can of soda, as family members described their history, their feelings about her troubles, and how they dealt with them.
Sarah spoke in contradictory voices, sometimes with the lazy, whiny squeak of a petulant little girl, sometimes with the labored, softened consonants and sloppily extended vowels of a drunk. She openly described herself as the center of the family, the problem around which everyone’s lives pivoted. There was neither arrogance nor pride about her self-designation; it sounded more like a simple declaration of her role. She also declared herself incurable. “I’ll always be like this, she said. I know I’ll never get better. I just have to learn to accept it.“
Moreover, if you closed your eyes and listened to Sarah’s moans – and we noticed this only when the video failed once during playback – they sounded weirdly orgasmic, intensifying and relaxing in waves, as the offending family member continued to elaborate or backed off.
Her face grew taut with pain, it seemed, at certain testimony more than others. She writhed when her mother mentioned the possibility of returning to work. She slapped her brother’s hand punitively and snatched it back when he – handsome young man of twenty-six, who still lived at home and still was struggling to “find himself – suggested he might someday want to be freed of her clutching.
Sarah’s convulsive contractions could have interrupted all discourse – as they were meant to – but intertwined with world-changing events and involving characters from three generations, the following family history nonetheless emerged:
Miriam had been eight years old when German soldiers stripped her family of their land and all their possessions during the 1938 occupation of Austria. They seized Miriam’s father and took him to Dachau, where he was imprisoned for years.
Torn between the anguish she felt over the loss of her husband and the terror she felt about the safety of her two daughters, Miriam’s mother made a heart-wrenching decision during the weeks following the storm troopers’ raid. She decided she would remain in Austria, for fear she otherwise might never see her husband again. Secretly she would send away her girls, Miriam and Fredda, to what she believed as the safety of Sweden, to live under the protection of sympathetic families there.
By the age of eight, then, Miriam felt desperately abandoned by her family. Though she lived safely in Sweden until 1946, she was separated from everyone, including her sister, who lived with another family in another Swedish city, too far away even for infrequent visitation.
Intellectually, Miriam always understood the logic of her mother’s decision; it may well have saved her life. But emotionally, Miriam could not help but feel that, faced with the choice of staying by her husband or remaining with her children, her mother had chosen to be a wife first and a mother second. It was a hard slight to forgive, and Miriam never did.
By 1946, Miriam’s parents managed to escape Austria and settled in Palestine. With the help of the Swedish government, Miriam and her sister also traveled to Palestine and were reunited with their parents. The family had barely had time to readjust, however, when sixteen-year-old Miriam was conscripted into the army, as the emerging nation struggled for its independence.
While serving in the army, Miriam met Karl Steinmetz. His family had fled Germany during Hitler’s early rise to power. After a brief courtship, during which – consciously or otherwise – Miriam learned of a fundamental difference between her family and Karl’s, Karl and Miriam married. Within a few years they had two of their three children, Ari and Ira.
In 1958, Miriam and Karl faced a dilemma not unlike that of Miriam’s mother twenty years before. The parents of two children, they were living in a perilous place at a perilous time. Karl surely would be required to serve in the army again, and Miriam thus worried about her children growing up fatherless. However, leaving Israel to save her new family required Miriam’s re-separating from the family the war already had rendered near strangers. So before the Steinmetzes emigrated to the United States, Miriam extracted from her parents a promise that they would follow in five years.
Five years passed, during which time Karl’s family did emigrate to the United States. Miriam and Karl meanwhile had a third child, Sarah. Miriam then received word from her parents that her father’s business commitments precluded his moving out of the country. He and Miriam’s mother would remain in Israel, they said. Crushed, feeling once again abandoned by her family, Miriam formed an especially powerful bond with the infant Sarah.
Sarah responded tenfold.
In the early sessions of therapy we detected and discussed possible impediments to the process and tried to overcome them by temporarily adding to the cast of characters from whom we learned more than we expected, any way. For instance, it occurred to us while reviewing the videotapes that if we were to succeed in helping the family, we would tacitly be declaring Ari a failure as therapist to her own family. So we invited her husband, Marvin, to the next session to redefine Ari as more separate, part of a different unit now, than the troubled family we hoped she would turn over to us. However, we found out in that next session that Ari was afraid to become less intensely connected to her parents’ problems for fear she then would expect greater emotional contact with Marvin, for fear that Marvin ultimately would disappoint her the way she believed her father had disappointed her mother.
A subplot – a demanding-wife-vs.-withdrawing-husband pattern – was beginning to emerge in two generations, at least. We already knew that Miriam was disappointed in Karl, also a supermarket employee, for his apathetic ambition his marginal success as a provider; we knew that since Karl’s mother had died two years before, leaving Poppa to Karl and Miriam’s care, Miriam felt imprisoned by Karl’s family as well as abandoned by and estranged from her own.
We invited Karl’s father, Poppa, to another session. Poppa declared himself the senior of the clan and accused his son of being “too lazy to change, too lazy to stand on his feet against his family. ·
“That’s something I really don’t like in him,” Poppa said of the fifty-five-year-old Karl. “He gave too much over to his wife and she is a demanding one. She is not only a demanding one; she is a commanding one!”
Ruth had been acting as the principal interviewer of the team, a deliberate choice based on her age and ethnicity. We had antic1pated that this Holocaust-surviving family might believe, deep down, that their history made them different to the point of uniqueness, and that therapists consequently would never understand them. We hoped that by leading off with Ruth – Jewish and about sixty years old we would implicitly counteract this kind of inherent road block.
Ruth asked Poppa how life had been with his wife. Poppa first answered that they had had a love affair for fifty years. Ruth pressed: “But you more or less followed your wife for fifty years, right? I mean, that’s something Karl learned from you, how to be a devoted husband.”
“I don’t know,” he answered in a thick German accent. ”Because he is devoted, she got him so far that she is the man in the house. What I understood later on in my life is that the brain, or the nature, of a woman in feeling love is different from a man’s feeling of love. A man can love one woman very much. The woman has no time for so much love, because she has children, she has her homework, and he has her part-time work, like the stitchery, which she likes very much.”
”A woman loves her children more than she loves her husband. Is that what you’re saying?” Ruth asked.
“Yes,” he said, nodding briskly for punctuation. “You see, for me, my wife came first in life. For her, the children came first.”
There we found a profound difference between Miriam’s parental family and Karl’s. Somehow in the messages of courtship, Miriam had discovered in Karl an honored family tradition that demanded that, given the awful choice, a woman always would stay with her children rather than her husband.
From all of this, Ruth, Alice, and I constructed a hypothesis describing the relationship between Sarah’s symptoms – and to an extent, Ira’s less obvious inability to tear himself away from the family – and the family’s various connections and disconnections: the children’s failures were functional.
In her children’s failure to succeed outside the house, and especially in Sarah’s exaggerated inability to live without Miriam always by her side, Miriam was protected from further familial separation. The conventional role of children Ira’s and Sarah’s age was to leave home and become independent, or at least to be preparing to leave home. However, if Miriam’s children were to make those moves toward separating successfully, they would be abandoning their mother, as they knew her own mother had abandoned her. Also, they were members of a family whose paternal side had a strong tradition of the mother – child relationship being more important than any other, and whose maternal side held to a tradition of reading child – parent separation as abandonment. Miriam felt tremendous pain for having been abandoned by her mother as a child, as well as tremendous guilt for having left her mother behind as an adult. The message to the children, particularly Sarah, was: “Never leave your mother, and never allow her to leave you.” Karl was to support that. And fidelity to the message required the children’s failure.
Ira remained faithful to his mother by failing to become independent and leave. Ari remained faithful by failing to serve the family professionally and thus free her siblings to leave. Sarah had transmogrified into a rock of fidelity, supporting her mother’s needs almost single-handedly, by failing with theatrical heroism at life in general.
Olga Silverstein, Peggy Papp, and I had developed a strategy for helping families with such multilayered dilemmas to reveal and define their choices. So Alice, Ruth, and I set about to use it, first persuading Ari to hand over her family to us without damaging herself in the process. We would debate the consequences of change for the family, while the family sat and listened to us. They would have to listen to their own dilemmas and choices being played out in front of them.
Our first debate would center around the possible consequences of Ari’s turning them over to us. Each of us would argue from a pre-planned position. We had decided that Ruth, who was most identified with the parents by age and ethnicity, would surprise everyone by championing change, urging the children toward independence and therefore, she postulated, health.
Outrageous as it might have sounded to anyone who knew my normally positive view of change, I would represent the opposite view, the conservative approach, constantly suggesting that change would be costly to the stability of the family, that the current arrangement served everyone, that the risks of change would be too high (and the risks were high, especially to the fragile marriage of Miriam and Karl).
Alice would assume a third position – one of compromise, rounding out what we had determined were the family’s dilemmas about change. In our debate we would voice and dramatize all of the elements we recognized that supported or negated change and its consequences. Alice would “see” the merit in both Ruth’s exhortations and my trepidations, but she would be the advocate of marital happiness, and she would say that she believed that the family’s problems could be worked out, whatever the risks involved. None of these debating stances were invalid; we could have changed places and argued with equal combinations of reason and passion for each. We were presenting the family with a more clearly defined version of their true dilemma. They could remain faithful to their family messages and stay the same, or they could change and risk the consequences.
I said I had some serious concerns about Ari turning the family over to us, because I thought that if we were to begin to help Sarah and Ira grow up, both marriages would be placed in jeopardy. “Without the constant problems of Ira and Sarah,” I said, “the link between the women in the family might weaken, and you, Miriam, might turn to Karl and expect more of him. Then Ari might turn more to Marvin. And both you women might be disappointed. On that basis, I would recommend that for the time being, you two, Sarah and Ira, continue to have your problems. They provide a very important link for the women in the family, and they protect the two husbands.”
Thus I planted the suggestion that Sarah and Ira were more in control of their failure than anyone might have imagined. I hoped that describing their unconscious motives as deliberate would force them to be conscious of their function. That, in turn, would place their failure under their control.
“Wait a minute!” said Ruth, picking up the debate but continuing to work within my control suggestion. “What ever the consequences, Sarah and Ira have a right to grow up. I don’t think that they should have to worry about their parents. Young people have to take care of themselves, not their parents.”
Alice then addressed herself to the two married couples, saying, “I feel that it might stir up trouble in your marriages if Ari were to tum the family over to us for change, but I believe you can handle it. Miriam, it might be good if you did make more demands. It’s important to concentrate on the issues between you and Karl, whatever they are. It might strengthen both marriages rather than hurt them. And I don’t think the husbands need protection from that.” “Well, it’s of no concern to the children at any rate,” Ruth said. “They have to tend to their own business. However, let’s leave the final decision up to the family, all right?
We all agree there would be risks; we disagree on whether you should take them. You’re the family; you decide.”
The Steinmetzes showed up for the next session without Ari and Marvin. Watching them arrive, we determined that Ari’s absence meant they had rejected my position in the debate, which held that Ari’s remaining involved in therapy would be an open admission that neither marriage could withstand the consequences of change. We were on a way to a new challenge, the family effectively saying, “Go ahead, cure Sarah.” Sarah, of course, continued to insist that she would never be cured.
While interviewing Sarah and Ira – the rest of us, therapists and family, watching from behind the glass – Ruth discovered a powerful alliance between them, in which they revealed that they cooperated to protect their parents, a form of loyalty pact we had seen before, especially in the families of Holocaust survivors. Ruth then tried to separate the two children over the issue of independence, cleverly suggest ing that since Sarah practically had vowed by her protesta tions to remain ill forever and thereby provide her mother with a lifetime child, why shouldn’t Ira leave the protecting entirely up to Sarah and move more comfortably toward his own independence? “Why should both of you take on this responsibility when one can handle it quite well?” Ruth asked boldly, once again asserting that Sarah reigned over her problems.
Sarah squeezed Ira’s hand at this suggestion and writhed in a spasm of pain. But neither Sarah nor Ira protested Ruth’s suggestion that their respective failures were serving to protect their parents. So the session ended with their troubles placed in a context new for them and for their parents, observing from behind the glass. Ruth’s parting, incendiary, recommendation to Ira was to encourage Sarah to have more problems and free him from the responsibility a little.
The family had to carry Sarah up the stairs to the next session (though during it, she again interrupted her agonized writhing to sip Coke).
This session was devoted to an attempt to formally structure a new context for the whole family, one that viewed the children’s failures as a means of protecting the parents.
Having seen hints of that restructuring in the last session, everyone in the family seemed to know what was going on, and they were eager to evade, avoid, or deny it.
As if trying to show their doctors a miraculously healed wound in order to avoid more surgery, Karl and Miriam said that their lives had changed for the better in the intervening week. We had connected Sarah’s symptoms to them and their marriage, and they were trying to disconnect them – and quickly. Miriam even had awakened Karl in the middle of the night to make love, an event so unusual as to suggest a total cure, thank you; so there really was no need to proceed further along the course we had only yet just begun. Miriam also had decided to return to work, she declared, as further evidence of a case closed, a job done, needs satisfied.
Sarah, however, had deteriorated, beginning the night they had returned home from therapy. We were not surprised. If Sarah was helping her mother avoid the marriage and choose her children instead, Miriam certainly would need a needy child to serve. Sarah’s recovery would deprive her of that convenience. ·
Ruth began the session by asking Ira if he had done what she’d prescribed, encouraged Sarah to get worse, to fail, in effect, even more demonstrably. Ira equivocated, but finally said that he had not been in the house much that week. During the conversation Sarah moved from writhing and clutching to crying. Ruth, with laser-beam precision, addressed Sarah directly:
“Sarah, when you decided you were going to take this whole thing on yourself, did you decide about how far you were going to go with it? Or is this open-ended?”
Sarah leaned her head to the left, crying, but at the same time trying to hide or withhold a grin, which I took to be a smile of recognition, maybe even release. If our persistent suggestion had any merit at all, Sarah did have control over her failures. Sarah’s smile revealed that she either suspected or knew that she did. Ruth continued, again questioning the logic of having both children fail to help the family when one failure would surely suffice.
As Sarah continued to writhe and cry, Ruth said to the rest of us, “You know, it’s a very tough spot she’s picked for herself. It’s really one that we can empathize with. But, Ira, I suppose maybe it would help if you showed a little gratitude.”
“Well,” Ira said hesitantly as Sarah gripped his hand, “I don’t think I’ve been entirely willing to do that, because I don’t think I’ve been willing to let her take all that on….”
“I was afraid of that,” Ruth said.
“I predicted that,” I said.
“I don’t know what it is,” said Ira. “I notice that now I’m getting angry. I feel like saying, ‘Damn! Let go of my hand today!’ But I have all these pictures in my head of what it’s supposed to look like, if Sarah takes it all on. One is that she won’t need to hold my hand anymore, and I’ll be able to sit over here like this-”
“Nooo! Nooo!” Sarah whined, writhing in apparent pain.
“Sarah,” I said softly but firmly, “I want to begin by complimenting you on your sound understanding for what happens in this family.”
Sarah rocked, clutched her head and whined, “I don’t understand at all!” – but still with a slight trace of a smile.
“Well, let me explain what I mean. I think that you must have understood this week that your parents were getting closer, and that in fact they may even have started some love affair. In the most profound way you understood that, and you particularly understood the danger in that.” Sara looked at me, ostensibly perplexed. ”What I mean is that if your mother continued to invite Karl to enter into a love affair with her, she would be choosing thereby to be a wife first and a mother second. And I think that you understand that she would feel enormous guilt about that. She might even worry that you and Ira might never forgive her, in the way she has not forgiven her own parents.”
“You really bug me, Stanley!” Sarah cried. “I mean, some of the things you say! I am not out to save my family! I don’t believe this!”
“Now, just listen to me a minute,” Ruth interrupted. “You are caught in a very tight spot, and the dilemma is fairly clear to me that you are on the one hand really anxious to get on with your life, that you really want to leave. I think seeing Ira make some moves in that direction exaggerates that same desire of your own – to get a little freer, to live on your own, to do what you want to do with your life to succeed. No? There is some of that drive, is there not? But, on the other hand, there is the other place – that were you to do that, you would be abandoning your mother.” Sarah held her ears and shook her head.
The next session began with Ruth asking matter-of-factly, “Anything new since we last saw you?” and Sarah just as matter-of-factly answering, “I went to Boston for the weekend.” It was very difficult, she said, but it was with that same childlike ambivalence that looks for approval in shocking the adult she is trying to please or impress – in this case me, the conservative one, because I “opposed” her breaking out and changing. The relationship with me was becoming beautifully dual, as if I were a demanding but loving grandparent. She wanted to revel against me, be she wanted my approval, too.
I took advantage of her gaze by starting our debate anew, saying that she had me even more worried than before. My job, after all, was to argue strenuously for the status quo.
“Stanley!” Sarah cried. “You really are amazing!”
Well, let me tell you why I am worried,” I began. “Obviously, you you did make an independent move, and although it was painful, it was somewhat successful. But I am worried about your mother now, for all the reasons that I have given before. With Sarah successfully making such independent moves, I fear that Miriam will be in jeopardy. I therefore want to make a recommendation to Karl. I think, Karl, that you should follow the tradition of men in this family, of protecting the important ties that their wives have to their children. Therefore, I think you should make every effort to stop Sarah from making any more independent moves.” Sarah wailed in disbelief.
“I don’t think I can oblige you,” Karl said as Sarah shook her head, as if to shake my obvious insanity out of her ears.
Alice declared my recommendation unjustified, as was her prepared position, because she felt my fears were not legitimate. Ruth said that when Sarah made up her mind to be independent, nobody would be able to stop her. I pressed the debate further. “I know that we have disagreed all along,” I said to Alice, “but I feel that as the most cautious one among us, I have a responsibility to make this recommendation I feel strongly about it. I think, Karl, that you really must protect the ties in his family. And if you need help in that, you may try consulting your father on it.”
Poppa, who was present for this session, quipped, “That’s the nicest joke I have heard in two years.”
The next session began with Sarah announcing that “… immediately after therapy today, I am leaving for Israel.” Smiling widely, she looked directly at me for a reaction. Miriam laughed, saying, “She didn’t want to call and tell you because she wanted to see your reaction!”
Our expressions must have asked the question “How did this happen?” because Sarah animatedly jumped to answer it.
“Oh, I know what happened!” she yelled. “I know what happened. Oh, please, Stanley! My mother said, ‘This is it! Stanley was right! Stanley is absolutely right!’ And she starts crying, and I’m like ‘Ma!’ And she says, “I can’t talk to your father, and I can’t talk to your brother! I’m not allowed to call you sister. You’re the only one I can talk to, and I’m going to keep holding on,’ and ‘How can I do this to you? I am going to destroy both our lives!’ and ‘Stanley is right!’ and ‘What are we going to do?’ and ‘Oh, my God!'”
When Sarah became calm, Ruth asked her what she planned to do in Israel, but before she could answer, Ruth moved right to the question “Are you going to visit your mother’s family?”
“Oh, my mother already has instructed me firmly on that…” Sarah said.
I shook my head, as if on the verge of commenting sadly.
“…that I have to do this also for her,” Sarah continued, glancing furtively at me. .
Miriam interrupted: “Yes. I told her to be with them, because they need her. Two weeks ago, I called and told them: ‘I have a surprise for you. I am sending you my daughter. My mother said, ‘I don’t believe it!’ She’s been very depressed, my mother. Losing a lot of weight. I told her, ‘Sarah is coming. so you’ll get well.'”
I shook my head again. Sarah looked at me as if to invite my judgment. I took the cue, saying, “Sara , I was very shocked by your telling us that you were gomg to Israel, because initially I thought it was an independent move. Now as we talked about it more, I am more reassured-.”
“It’s dependent,” she said with fatigue,” she said with fatigue.
“Yes, exactly. I realize now that you are making this trip for your mother, because she needs you to. For some reason at this moment your mother needs to be reunited with her family, and you are her emissary.”
“Karl,” Alice said, moving in another suggestion aimed at nurturing the marriage, “I think you are the only one who can bring Miriam together with her parents. I don’t think Sarah can do that. That is not going to even the score between you and Miriam, and you know we have a score to even here. You had your parents all these years, and she left hers behind.”
We previously had determined this to be a long-standing issue that had helped keep Miriam and Karl apart. After all, it was for Karl’s safety that Miriam emigrated and left her family behmd. He owed her a reunion, though every time the subject had come up, he had protested the prohibitive cost and said he worried about how he would get along without her while she was gone.
“Never mind,” Ruth said, picking up her part as the hampion of change. “I think the trip is just fine. I think it is a independent move, whether Stanley thinks so or not. I thmk it s a great opportunity for you, Sarah, to make whatever decision you have to make, when you are there, to make the tnp work or you. It’s a great opportunity, though I am aware that it presents a great dilemma, too. If you really were to work on your own behalf and use this opportunity to gain some independence and have a good time, you might decide to stay in Israel a little longer, and there’s probably some danger, at least in your head, that if you were to do something like that, you would be putting yourself in the same position in your family that your mother is in hers: going abroad and leaving your family behind.”
“We thought of that,” Sarah said. “I talked to my mother all night about that. But this is the most independent thing I’ve ever done m my whole life! C’mon, Stanley, give me credit!”
“I’m afraid I can’t.”
“Stanley, you’re such a damned pessimist!”
“As a matter of fact, Sarah,” I said, “I think that your mother needs you very much right now, and I think that if you have to go to extremes to reunite your mother with her family, you should do just that-”
“But what about me? Maybe this is for me!”
“… And if you have to get sick, for example, to the point where your grandparents will have to bring you home, or your mother will have to come and rescue you, then I think you should do it, because your mother needs this reunion.”
In order to prove me wrong this time, as she so persistently had in my previous declarations, Sarah would have to succeed on the trip.
And she succeeded, though in a fashion that fell somewhere between a Shakespearean comedy and a grand Italian opera. Sarah of course did get sick at her grandmother’s house, groping and writhing and suffering tremendous abdominal pains. After a series of frantic all-night transatlantic telephone marathons and panicky trips to Stamford, Connecticut for quick passport renewals so that Miriam and Karl could rescue Sarah in Israel, Ari and Ira put pressure on their parents to resist Sarah’s lure.
A surprise turning point pivoted on Miriam’s mother. She reassured Miriam that Sarah would be all right in her care.
“Don’t come, at least not now,” Miriam’s mother told her.
“I’ll deal with Sarah. I can handle her.”
Sarah eventually settled down and enjoyed the trip. Ira remained close to home. Sarah returned from Israel on schedule, and we held a ninth session.
The family arrived looking terribly distressed. Sarah barely could sit through the hour, though we learned that she had returned home on time and full of enthusiasm, talking incessantly of making a permanent move to Israel. Miriam and Karl, meanwhile, had begun to fight about old issues; he was not as kind and as lovable as she would like. She was more critical than he would like. Sarah had become sick again during these marital battles, focusing her parents’ attention on her and temporarily putting to rest Miriam and Karl’s disagreements.
The most obvious potential consequences of change had risen up and introduced themselves to the family. With Sarah either gone or talking about being gone, Karl and Miriam had to face each other and their marriage. When Sarah saw how difficult that was, she became ill and dependent again, and thus allowed everyone to evade or postpone a confrontation.
Once again, children failing to keep their parents good parents.
We conducted several separate interviews, though everyone watched. Alice first interviewed Sarah and Ira, exploring the various ways in which Karl helped perpetuate the status quo, letting them know that they were needed at home. Alice then interviewed Karl on the same subject. He denied all of what the children had said about him. He in sisted that he wanted finally to be alone with Miriam for their long-deferred honeymoon.
Next, Alice interviewed Miriam, who began by denounc ing Karl for not being around when she needed him. “So,” she said, “I turn to my children. I go to my kids. What I don’t get from him, I get from my kids, even if it’s only that they need me. But I can give them what I have to give. With him, I will have anger.”
“What do you think he would be afraid of if the children were to leave?” Alice asked.
“I don’t know. Maybe he would be depressed. But I was very depressed, and I think it had a lot to do with my parents. I know that my mother has lived her life in depression because she didn’t have her children, or she didn’t have me, and her life has not been a good life.”
“Even when you came to this country?”
”And she never had a great relationship with my father.”
“So, the whole time you have been in this country, you have felt responsible for your mother’s depression?”
“Right,” Miriam answered, wiping an eye.
”And you feel that your father was never able to make that up to her?”
“The whole thing with me is that I left my parents. I took everything away from them. That’s the whole thing. And that comes out all the time for me.”
In this family, we concluded during a short break, another message was that children who leave their parents are responsible for their parents’ unhappiness, which made for a double-edged sword of responsibility and failure. You must stay dependent to make your parents good parents, and if ever you leave, you are to blame for their consequent misery.
We decided to have Alice tell Karl that he held the key to unlocking his family’s dilemma.
“You have said,” she began, “that you want a happy life with Miriam, the two of you alone together. Over all these years, you have given Miriam the children as a consolation prize for having left her family in Israel. She left her family to follow you to this country, and she has been grieving for them ever since. Now, what I’m going to ask you to do is going to be extremely difficult for you. I’m going to ask you to encourage Miriam to return to Israel alone to see her family and settle all the issues that have never been settled.”
Anticipating her father’s position, Sarah broke in: “I have to say I’m going to go on my father’s side in this,” she said, “because I won’t let my mother go to Israel. I’ll let her go if I know my grandparents are coming back with her, but if that’s not it, I won’t let my mother go, and I’ll make it very difficult for her to leave.”
Suddenly Sarah was taking control of her symptoms, and then threatening to employ them.
I, playing the conservative, said to Karl, “I think you do hold the key in making the difference in this situation, but I think it’s going to be very difficult for you to encourage Miriam to make this very important journey, because to do that would be unfaithful to your own father, who has clearly given you the message that you must help your wife to make the children most important. So to encourage her and to attempt even to find happiness between the two of you is a big risk to you in terms of your own father. I also think you will deeply miss Miriam. That’s another reason it will be difficult.”
“Oh, yes,” Karl said, “it will be difficult. But I will let her go.”
I turned to Sarah. “But I think, Sarah, you choose to be on your father’s side in this, despite the very strong bond you have developed with your mother, because you will do what you have always done, which is to go to what ever extreme necessary – by, say, having these problems because they will for certain keep your mother from making the trip, and your dad will therefore not have to face the difficult issues in their marriage. ”
Alice moved in to disagree with my position, arguing again in favor of the marriage: “Karl, it’s up to you to see that Miriam does something for herself and to encourage her to do that. It’s really in your best interest.” Karl nod ded.
In the final session, Miriam declared her independence and said she was preparing to leave for Israel alone. The family reported that Poppa, Karl’s father, was angered about the latest developments. “He comes out with little nothings,” said Karl, “but they mean a lot. He said, ‘What does she have to go for?’ And ‘What are you spending all your money for, anyway? When are you going to stop spending your money?’ ”
Alice repeated her encouragement to Karl, saying that when Miriam gets her problems with her parents straight ened out, there was a chance she would return to him with out the resentment and anger and perhaps rewrite their relationship in much better form. I countered, saying I still did not believe that Karl could disobey his father’s wishes by letting Miriam go. Alice said she thought he could. I said Karl had always placed his father first. Alice said she did not think he would do so any longer. “I think he can be a good son and a good husband,” Alice argued.
Finally, Karl said he was aware of both sides, but he had decided to let Miriam go, and that was that.
Sarah and Ira had transferred much of their concern to their father, and what he would be like if Miriam were away in Israel, but since articulating this concern seemed more directed at making Miriam hesitate about leaving than for any other reason, we separated the two children, and Ruth asked them about it. They were frank about their power now, very cognizant of it. They even toyed with it, knowing that Karl and Miriam were watching through the glass.
“I know this sounds like a way to keep my mother home,” Sarah began, “but it really feels like my mother could straighten out a lot of her shit with her parents right here. The other way, with her going, my father is just going to get worse. I know he’s going to get worse. There’s no doubt in my mind.”
“In other words,” Ira said with a tone of recently acquired wisdom, “It would be real easy for us to keep her home.”
“You two could start openly worrying about your father, for instance,” Ruth said.
“All she has to do is sit back there and listen,” Sarah said.
“You’re doing your number right now, aren’t you?” Ruth said.
“Right. Right,” Sarah answered. “This is taking care of it. This could do it.”
“But now, of course, you understand what a high price your parents have paid for not feeling like good children, particularly your mother. She has suffered tremendously for feeling that she was not a good daughter. And that’s been the sorrow of her life. Your father has struggled with it in his way, too. But the two of you have no debts. They had tremendous debts. You don’t have any. You’re trying to pay debts that you don’t have.” Ruth looked directly at Ira and asked, “Can you be a spectator in your parents’ life for a little while?”
“Sure,” Ira said. “Sure. I really have been a good kid.”
“That’s true,” said Ruth. “That’s absolutely true. Both of you have. Sarah, actually, if you want to put it on a scale, has been super. You have been a terrifically good kid, and she’s been a super terrific kid.”
Sarah smiled, embarrassed. They had accepted the view. They could free themselves from having to fail to spare their parents misery. They already were good kids and had proved it again and again. They could leave now and live. Miriam returned to the room, sat down, and bowed her head. “I can’t believe seven years of illness suddenly coming to an end…” she whimpered.
“Well, you watch,” said Ruth, “how quickly Sarah is go ing to get well.”
“I told my mother this morning that I’m going to apply to NYU,” Sarah said.
We told the Steinmetzes that their therapy was completed.
Both Karl and Miriam had come to therapy with bitter feelings toward their parents for having failed them. They had spent considerable energy over the years trying to show their parents how to be successful parents, mainly by dedicating themselves to their children. Their definition of the system – that good parents solve their children’s problems required a constant escalation of reciprocity. In order to be better parents, they needed increasingly troubled children. The more severe were the children’s failures, the more successful the parents could become. Conversely, in order to protect one’s parents in this system, a dutiful child would have to fail. With the intensity of this background, it would have to be a dramatic failure, and agoraphobia certainly would be an appropriate choice, given the history. It would also be inevitable for Ira that in finding himself he would find himself back in his family’s embrace.
We had turned that system around and placed the emphasis on how high a price Miriam and Karl had paid for not feeling like good children. Miriam shifted her view of herself from the good mother to the bad daughter. But there was hope in that; she could go to Israel and reconcile her role as daughter. In order to stay a good mother, in her system, she would continue to require Sarah, at least, to fail at life. And there wasn’t much hope in that.
They returned a year later with a sick and stricken Sarah, suffering this time from severe insomnia. The insomnia had overcome every known chemical combatant prescribed for it. The family had changed dramatically. Ira had left for California, where he had entered in and completed a triathlon. He had found a marginal job that he did not particularly like, but had also decided to stay in California and live there. Sarah had completed a year in NYU and was working full-time in a bookstore. Ari and Marvin had a new baby, further separating them as an independent family unit. Miriam’s parents had returned with her from Israel for a prolonged stay, during which they continued the dialogue about their relationship. Miriam also had been diagnosed with a malignant tumor and Karl was showing signs of emotional problems. Again, we were not terribly surprised at that; we actually had predicted Karl’s struggle, given the new structure in the family.
Still, they had returned to us because they wanted help for Sarah. It took only minutes with Ruth for Sarah to con cede, with an engaging smile of both discovery and relief, that by contracting severe insomnia, by getting so sick again, that her parents had to bring her back to therapy, she had in fact brought her parents to therapy. Karl still struggled with breaking from his father. He and Miriam now had a family with comparatively successful children. Their needs had changed. But still, here was Sarah, back again, being the super-good kid. Ruth asked her, “Can you turn your parents over to us now, for therapy, and go on with your own life?”
She said she could. At least this time, she hadn’t suffered for seven years to help her parents; she’d brought them for help.
As far as we know, she slept that night.
Over years of treating families of Holocaust survivors, I have discovered – and the experiences of other profession also repeatedly has affirmed for me – that the families seem to reorganize in two distinct ways as a result of this trauma: either they refuse to talk about it, or they talk about it incessantly. There are consequences that are traceable to each.
In some families, the experience, with its grief and pain, is veiled in silence and remains a great mystery to the children of the first generation, who realize early in their lives that all members of the family have tacitly agreed that any ‘attempt to define the past is dangerous and must be avoided. Consciously or subconsciously they are warned to avoid it – which, of course, makes it an ever-present gap, a looming and crucially important nonentity.
In these families, when the second and third generation members develop symptoms, the symptoms tend to relate to the lack of definition of reality. For instance, in one case, a second generation child had developed psychotic-like be havior that became extremely exacerbated whenever the therapeutic team began to probe the family’s history. The child’s behavior became bizarre at these definable junctures, so we prescribed that she do what she already was doing, but we gave it a structure where none previously had existed. We suggested that the child stay in the other room as the therapy progressed, and we asked her to bang on the observation mirror when she thought the conversation was getting dangerous. Every time the parents started to talk about the past and their guilt, disappointment, shame, and loss, the daughter went wild, banging on the mirror. Eventually and after many complicated maneuvers, the parents realized what their daughter was doing. They told her that they didn’t need her to do it anymore; they would be alright, they would talk about their past. Eventually, the daughter was reassured, and the therapy continued without her interruptions.
In the “Holocaused” case, we had a classic example of a family who refused to let go of the past. Holding on to the past becomes a central, organizing fact in such families – they think about the losses, abandonments, betrayals, separations, and mysteries, talk about them constantly, either directly or metaphorically, practically live and breathe them. In these families, we frequently see members of the older generations holding on to younger members tenaciously, refusing to let them go. The children and grandchildren develop symptoms, tending to reflect this dynamic by way of separation anxiety, agoraphobia and the sorts of psychosomatic illness that would keep a child at home. .
The Steinmetz case obviously was typical of this category Because of the extreme nature of Sarah’s psychosomatic illness and her agoraphobia, and because of the history of failure in prior therapy, we felt from the beginning that a radical approach was necessary. We three therapists reconstructed ourselves as a family, echoing the different voices in the Steinmetz family. Also, we mirrored the close involvement among family members by similarly becoming intensely involved in our own debate, allowing conflict among ourselves and showing the Steinmetzes that we could differ and still function as a family. Thus, we used their own hidden messages to show what they were doing but had been unable to recognize. .
I frankly delighted in my role in the therapeutic approach. As the only male member of the therapy team, I was to adopt the position of a family member opposed to change, a posture that would not normally be mine. Yet, we agreed that I would present that opinion and argue for it as convincingly as if it were my own, while my colleagues provided counterpoints, arguing the other facets of the dilemma. “Keep your symptoms, Sarah,” I would argue. “It’s too dangerous for you to be well. You’re actually fairly safe if everything stays this way, and so is everyone else.” So, for me, the tension and anxiety generated by the real drama of serious therapy was secretly ameliorated by an exhilarating challenge that floated somewhere between scripted stage-acting and debate-team improvisation. In overlapping ironies, I was performing as an actor in a real-life drama.
I got the clear and endearing impression-reinforced over and over again whenever I view the videotapes-that Sarah, of all people, was seeing through the tactic while simulta neously allowing it to work by suspending her disbelief just as she might in the theater. She somehow knew that I was being different from who I am; yet she went along with it. I sensed, too, that my “bad boy” routine had a seductive effect on her. She kidded about my intransigence, smiling now and then, as if she knew and appreciated that it was all part of an act of counterbalance. She seemed charmed by the knowledge that we knew that she was in control, protecting her family by staying symptomatic. She seemed proudly amused by the notion that she could prove me (or my therapeutic persona) wrong by changing and equally amused by the knowledge that my real persona favored and applauded each of her strides.
It was a very rewarding case, and I often think about that family, because while our therapy relieved much of Sarah’s terrible suffering, the pain did not disappear; it redistributed itself. Sarah had unconsciously volunteered selfsacrificially to suffer the bulk of her family’s residual burden of history. When she finally abdicated her disproportionate share of the responsibility, her parents and siblings had to pick up theirs. We ended the therapy when we were confident that Sarah was on her way to self-liberation, freed of the need to be so painfully symptomatic – though she remained available to the family, symptoms and all, for such times of crisis as they encountered a year later. When Miriam’s cancer revealed itself, for instance, Sarah stood by to absorb the family’s anxiety by returning to her symptoms, this time, consciously enough to steer them to therapy.
Once again, though, we were left with numbing realization that the waste from history’s atrocities lingers for generations.