Therapy on the High Seas: A Search for Self

H. drank for thirty years, so much and so frequently that his heart, swimming continuously in alcohol was failing. He was still drinking when he came to see me.

Long ago H. had discovered that no one heard him. Not his parents who were wrapped up in their own worlds, not his siblings, not his friends. Of course they all thought they did, but they didn't. When he turned sixteen, he decided to change his last name to the name of his maternal grandmother. He remembered a few warm times they had spent together.

He had seen many psychiatrists and psychologists in the past. None of them had heard him either. They had all fit him into the their frameworks: he was an alcoholic, a manic-depressive, paranoid, one personality disorder or another, and treated him accordingly. He had tried A.A. but found that too mechanical and regimented for his taste.

When he showed up in my office at Mass. General, I wondered whether I would be able to help him. So many highly credentialed psychiatrists and psychologists had tried and failed. And I wondered how much longer he was going to live. But his story was compelling: he was exceptionally bright, he had a Ph.D. in Anthropology from Princeton, and had taught at a variety of colleges before his emotional problems and drinking had become too severe. So, I decided to give it a try.

In between teaching jobs, H. told me he had bought a sailboat and for a number of years sailed all over the world. He loved long ocean voyages. On the boat he made personal, intimate contact with friends and crew that he had always longed for but could never find elsewhere. There was none of the phoniness of day to day life--people were genuine; on the open ocean game playing quickly disappeared, people relied upon each other for survival.

So, how was I going to help him? From his stories and the way his life had proceeded, I knew he was telling the truth about his family. They had never heard a word he said; not from his earliest days on. And because of his sensitivity to their deafness, his life was tortured. He wanted so much for someone to hear and yet no one would or could. I told him I knew this was true, and that he did not need to convince me any further. The other thing I told him was that because no one had heard him for all of these years, I was certain he had thousands of stories to tell about his life, his disappointments, his wishes, his successes, and I wanted to hear them all. I knew that this would be like a long ocean voyage; that my office was our boat; he was going to tell me everything.

And so he did. He told me about his family, his friends, his ex-wife, his working in some of the fancy restaurants around town as a chef's helper, his drinking, his theories about the world. He gave me books by the Nobel physicist, Richard Feynman, video tapes on chaos theory, anthropology books, scientific papers he had written; I listened, thought, read. Week after week, month after month, he talked and talked and talked. One year into therapy he stopped drinking. He merely said that he didn't feel the need any more. We hardly spent any time talking about it: there were more important things to talk about.

Like his heart. He spent much time in the university libraries research medical journals. He liked to say that he knew as much about his condition, cardiomyopathy, as the leading experts in the field. When he met with his doctor, one of the premier cardiologists in the country, he would discuss all of the latest research. He enjoyed this. Still, the results of his tests were never good. His "ejection fraction" (essentially a measure of the heart's pumping effectiveness) continued to slip. His only hope was a heart transplant.

Two and a half years into therapy, he knew that he was not going to be able to tolerate another Boston winter. As his heart progressively failed he had become fatigued and much more sensitive to the cold. Besides there was a hospital in Florida that had a relatively high success rate with heart transplants, and he thought it would be helpful to live nearby just in case the opportunity arose. The downside, of course, was going to be ending the ocean voyage with me, but he figured we could have contact by telephone if need be. The one thing he asked was that if he did have a transplant that I be in the recovery room when he awoke from surgery. It was not that he wouldn't know where he was (he knew everyone had this experience) it was that he wouldn't know who he was until he saw me. This thought terrified him.

After he moved, we had occasional contact by phone, and when he twice came to Boston he stopped in to see me. By this time I had quit Mass. General and was working out of my home office. The first time he came in he gave me a hug and then moved his chair to within three or four feet of mine. He joked about this: I can hardly see you from there, he said, pointing to where the chair used to be. The second time he came in, I moved the chair closer for him, before he arrived. Each time I saw him he looked a little worse--pasty and weak. He was waiting for a transplant, but there was so much bureaucracy and such a long list of people in need. But he was still hopeful.

A couple months after I last saw H., I got a call from a friend of his. H. was in the hospital in a coma. A neighbor had found him on the floor of his apartment. A day later I received a call that H. had died.

Some of H.'s friends held a memorial service for him down in Florida. A long time friend sent me a sweet note and a photograph of H. at his best: skippering his sailboat. About a month later I received a call from one of H.'s brothers. The family was going to have a memorial service for H. at one of the local hospital chapels. Did I want to come?

At 10:45 I arrived at the hospital and strolled around the grounds for fifteen minutes thinking about H.. Then I went to the chapel. Oddly, when I arrived, a small group of people were filing out the door.

"Is this where the memorial service for H. is?" I asked one of the men who was leaving.

"It just ended."

"I don't understand," I said. "It was supposed to be at 11:00."

"10:30" he said. "Are you Dr. Grossman?" he asked. "I'm Joel, H.'s brother. H. thought very highly of you."

I felt crazy. Could I have gotten the time wrong? I slipped the post-it out of my pocket on which I had written the time Joel had told me. 11:00. "I'm sorry to be late," I said, "But you told me 11:00."

"I don't understand how that could have happened," he said. "Would you like to join us for lunch?"

Suddenly, in my mind, I could picture H. laughing and drawing his chair so close that he could reach out and touch me. "See!" I heard him say. "Didn't I tell you?"

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: Dreams, Imagined Dreams: Failed Therapy