Psychiatry and Literature: A Relational Perspective

^Psychiatry and Literature: A Relational Perspective Samuel Shem Recently I was asked to see a patient for a psychiatrist colleague of mine while he was on vacation. This young man—let's call him "Harold" — was a cocaine and opiate addict who had been drug-free for the past year and a half. The note from my colleague said that Harold "recently has gotten a little paranoid, and he's been using call girls again, which makes him feel ashamed and guilty." Harold was a meticulous, guarded man in his thirties. Our first session proceeded in a courteous but empty manner. He told me some of his history, not only of drug use but about losing a sister to a drug overdose, and about the abusive upper-middle-class Jewish family in Chicago in which he'd grown up. And yet this history was told without making real contact with me, told as if to a tape recorder. His relationship with me had the qualities of falsity, suspicion, and veiled threat. He would not look me in the eye. Harold spoke of his latest compulsion, using call girls. I asked how I could help him not to indulge while his therapist was away. AU this, so far, was familiar: the standard fare of psychopathology and dynamic formulation. But dull fare, for he was not engaging in any kind of authentic relationship with me. He spoke about the call girls in the same dull way. My boredom told me that here was a man who had difficulty making real contact with others, who, like most addicts and alcoholics, was dealing with his isolation by withdrawal, suspicion, and falsity, that is, by breaking the relational context, condemning himself to an even worse and more destructive isolation. We were getting nowhere. In twenty years as a psychiatrist I've learned how important it is to speak to a client's strength, and I asked him what he enjoyed doing. With a shy and flickering glance at me, he said he liked to read. I asked what he liked to read. His eyes twinkled, and he smiled, and he told me that for the first time in his life he was reading novels, one after the other, great novels that he'd never allowed himself to "waste time on" before. He was just finishing Dickens's David Copperfield—much to his chagrin, for, in his words, "I don't want it to end! I've been crying my eyes out Literature and Medicine 10 (1991) 42-65 © 1991 by The Johns Hopkins University Press Samuel Shem 43 at the last few chapters, like I never cried before!" Telling me about crying, his face lit up with joy. Suddenly Harold had come to life, his whole being now vibrating with that excitement we know as children, when we discover a piece of the world so terrific that it makes us feel that we are with the world, together, in all its majesty. Harold had connected with Copperfield ; that relationship, which had enlivened Harold in private, now was enlivening his relationship with me. Here was a small miracle, a connection between connections, each mirroring and magnifying each. Here was a complex junction between literature and psychiatry. Novels mostly are read in silence, in twentyminute segments before turning off the night-light. Psychiatry is mostly done with words, in forty-five-minute segments, with another person, in relationship. Here was a nexus of shared purpose between literature and psychiatry: to ignite the vital, growth-enhancing energy of relationship, in a wounded, hardened heart. When therapy is alive, it is because it is a mutual process, and I too woke up, not only relieved to be making contact, but also enjoying the chance to talk novels. Harold soon picked up my excitement, and, now seeing me as an ally in the struggle against deadness, asked what I might recommend he read next; I suggested (thinking of his history) Henry Roth's Call It Sleep, and then, because it is for me the memorable novel of my past fifteen years, Gabriel GarcÃ-a Márquez's Love in the Time of Cholera. I refrained from adding a final connection...