Becoming Myself: A Psychiatrist's Memoir Read online

  WEDDING, 1954.

  JULY FOURTH FIREWORKS STAND, MANNED BY JAY KAPLAN AND THE AUTHOR, WASHINGTON, DC, 1954.

  Immediately after renting the Vespa, Marilyn and I took off with small packs on our back for the French countryside. For three weeks, we motored through the Loire Valley, Normandy, and Brittany exploring beautiful chateaux and churches, mesmerized by the miraculous blues of the stained-glass windows of Chartres. In Tours, we visited the lovely family that had hosted Marilyn for the initial two months of her year abroad. Every day on the road we lunched in beautiful pastures on heavenly French bread and wine and cheese. Marilyn enjoyed ham as well. Her parents were more secular and adhered to no religious dietary laws, whereas I am one of the vast army of irrational Jews who have entirely jettisoned all religious beliefs but still eat no pork (except, of course, pork buns in Chinese restaurants). After three weeks we returned to Paris, took a train to Nice, then rented a tiny Fiat Topolino to drive through Italy for a month. One vivid memory that remains of our excursion through Italy was our stay on our first night at a small inn facing the Mediterranean. For the dessert of the prix fixe dinner, a large bowl of assorted fruit was placed on the table. We were delighted: money was growing short and we stuffed our pockets with fruit for our next day’s lunch. When we paid our bill the next morning we felt like dolts, as we learned that the fruit had been carefully counted and we were charged heavily for each piece snitched.

  Though it was a divine trip, I remember often being impatient and jittery, perhaps from culture shock, perhaps from not knowing how to live without grinding and studying. This sense of not feeling comfortable in my skin plagued me during my early adulthood. From the outside I was doing splendidly: I had married the woman I loved, I had gained admission into medical school and was performing well in every way, but deep inside, I was never at ease, never confident, and never grasping the source of my anxiety. I had some unclear sense that I had been scarred deeply by my early childhood and felt that I didn’t belong, that I was not as worthy or deserving as others. How I would love to repeat that trip now with the serenity of my current self!

  Today, over sixty years later, memories of our honeymoon always bring a smile to my face. However, the details of our wedding day have faded—except for one scene: toward the end of the large wedding luncheon, Marilyn’s uncle, Sam Eig, the family’s stern and unapproachable patriarch, who had built a considerable part of Silver Spring, Maryland, and hobnobbed with the governor, named streets after his children, and never before deigned to speak to me, walked over to me, put his arm around my shoulder, and whispered in my ear as he pointed his other arm toward the entire assembly of guests, “Congratulations, my boy. You’re getting the best of the lot.”

  Uncle Sam’s words of support still ring true: rarely does a day pass that I do not feel gratitude for having been able to spend my life with Marilyn.

  CHAPTER THIRTEEN

  MY FIRST PSYCHIATRIC PATIENT

  My first practicum in psychiatry in the spring of 1955, during my third year of medical school, was in the Boston City Hospital outpatient department. Each medical student was required to see a patient weekly for twelve weeks, and we each had to present the patient at a formal case conference attended by the other clerkship students and a dozen faculty members, many of them intimidating denizens of the Boston Psychoanalytic Association. I had attended other students’ presentations and had cringed at the faculty’s brutal reactions as they competed to demonstrate expertise and erudition without a scrap of gentleness or empathy.

  My turn to present came after I had seen my patient for approximately eight sessions, and I quavered as I began. I had decided not to follow the example of other presenters, who used the formal traditional structure of presenting the patient’s chief complaint, past history, family history, education, and formal psychiatric examination. Instead, I fell back on what felt natural to me: I told a story. In straightforward language I described my eight encounters with Muriel, a young, slim, attractive woman with vibrant red hair, downcast eyes, and tremulous voice. I described our first meeting, at which I began by saying that I was a medical student just beginning my training and that I would be seeing her over the next twelve weeks. I asked her why she had sought help from our clinic, and she responded, in a soft voice, “I’m a lesbian.”

  At that moment, I hesitated, swallowed hard, and replied, “I don’t know what that means. Would you mind educating me?”

  And so she did—she told me what “lesbian” meant and what her life was like. I asked questions to help her talk and told her that I admired her courage in speaking so openly. I said that I would do all I could to be helpful to her during the next three months.

  At the start of my next session with Muriel I acknowledged how embarrassed I had been to admit my ignorance. She told me that our conversation had been a “first” for her: I was the first male to whom she had revealed her true story, and that it was exactly my honesty that made it possible for her to continue to be open.

  I told the staff that Muriel and I had become close, that I looked forward to our meetings, that we talked about her problems with her lover in the same manner as we would discuss any human relationship, that she now met my glance often, that she was returning to life again, and that she said she regretted that we had only four more sessions. At the end of my presentation I sat down, lowered my head, and braced myself for the onslaught.

  But nothing happened. No one spoke. After a long silence, Dr. Malamud, the department chairman, and Dr. Bandler, an eminent analyst, concurred that my presentation spoke for itself and they had no additional comments. One by one each faculty member around the table made similar comments. I left the meeting stunned: all I had done was to tell a story that seemed so natural and easy for me. Throughout my college and medical education I had always felt invisible, but at that moment everything changed. I walked out thinking I might have something special to offer the field.

  Married life was both wonderful and stressful during my last two years of medical school. Money was tight and, for the most part, my parents supported us. Marilyn earned some money by working part-time in a dentist’s office while studying for a master of arts in teaching degree at Harvard, while I continued to earn money by selling blood to the hospital. I had applied to be a sperm donor, but the urologist told me that my sperm count was too low and advised me not to delay any attempt to have children.

  How wrong he was! Marilyn conceived instantaneously on our honeymoon. Our daughter Eve’s middle name is “Frances” to indicate “made in France,” and a year and a half later, during my fourth year of medical school, Marilyn became pregnant again.

  My clinical clerkships in my last two years of med school demanded long hours, but somehow my anxiety had calmed, replaced perhaps by honest exhaustion and the gratification of feeling that I was being helpful to my patients. I grew more committed to psychiatry and began reading extensively in the field. Certain horrific scenes from my psychiatry clerkships stay in my mind: a room of human statues at the Boston State Hospital—an entire ward of catatonic patients spending their lives in absolute stillness. The patients were mute and spent hours standing in one position, some by their beds, some by a window, some sitting, sometimes muttering but usually silent. All the staff could do was to feed them, keep them alive, and speak to them kindly.

  Such scenes were to be found in every large hospital in the mid-1950s before the advent of the first tranquilizer, Thorazine, and, soon thereafter, Stelazine, followed by a continuous stream of new, more effective major tranquilizers.

  Another scene at the Boston State Hospital stays with me: At some point in my clerkship I was able to observe Dr. Max Day, a Harvard psychiatrist, leading a group of about twelve psychiatric residents who had been asked to study their own group process. As a medical student I was permitted to attend a single meeting but not to participate, not one word. Although more than half a century has passed, I can still s
ee that room in my mind’s eye. The residents and Dr. Day sat in a circle in the center of a large room. I sat in a corner outside of the circle and recall being fascinated by the idea of a group of people discussing their feelings toward each other. What an extraordinary concept! But it fell flat. There were long silences and everyone seemed uncomfortable, while the leader, Dr. Day, just sat there. Why? I could not understand. Why didn’t he break the ice or in some way help the members open up? Later I attended one of Dr. Day’s clinical conferences and was greatly impressed by his acumen and articulateness. But that made it even more baffling. Why wouldn’t he help the floundering group? Little did I know that I would be wrestling with this question for many years of my professional life.

  CHAPTER FOURTEEN

  INTERNSHIP: THE MYSTERIOUS DR. BLACKWOOD

  After graduation, we former medical students, now Doctors of Medicine, entered a one-year internship where we had hands-on experience diagnosing and caring for patients in the hospital. In the first month of my internship at Mount Sinai Hospital in New York, I was assigned to the obstetrical service and was struck by how frequently one particular doctor, Dr. Blackwood, was paged on the hospital loudspeakers. While assisting in a delivery I asked the chief resident, “Who is this Dr. Blackwood? I hear his name all the time, but I never see him.”

  Dr. Gold smiled, and the other nearby staff members chuckled. “I’ll introduce him to you later,” Dr. Gold said. “As soon as we’re finished here.” Later that evening, Dr. Gold escorted me into the doctors’ on-call room, where a spirited poker game was in process. I couldn’t believe my eyes: I felt like a kid in a candy store.

  “And which one is Dr. Blackwood?” I asked. “And why is he always being paged?”

  Another loud guffaw from everyone. I seemed to be amusing the entire obstetrical staff. Finally the chief resident clued me in:

  “Do you play bridge?” he asked.

  I nodded.

  “You know the Blackwood convention in bridge bidding?”

  I nodded again.

  “Well, there you have it. That’s your Dr. Blackwood. He exists only as a Mount Sinai poker symbol: whenever there is a hand short in this poker game, they page Dr. Blackwood.”

  The players were mostly obstetricians in private practice whose patients were in labor. House staff and interns were allowed into the game only when they were hard up for a player. Thereafter, for the rest of the year, when I had finished my rounds and was on call and had to spend the night at the hospital, I listened for the “Dr. Blackwood” page, and whenever I was free I charged over to the obstetrics department. The stakes were high, and interns were paid only twenty-five dollars a month (plus a free all-you-can-eat dinner, from which we made lunch sandwiches the next day—we took care of breakfast by ordering extra-large breakfasts for some of our patients).

  I lost my entire salary at the poker games for the next three or four months before I got a read on the game. After that I took Marilyn to quite a few Broadway shows compliments of Dr. Blackwood.

  I rotated through several services during the year at Mount Sinai: internal medicine, obstetrics, surgery, orthopedic surgery, emergency room, urology, and pediatrics. I learned how to deliver babies, how to tape sprained ankles, how to treat congestive heart failure, how to draw blood from an infant’s femoral artery, how to diagnose neurological conditions from observing the gait of a patient. In my surgery rotation I was permitted only to hold retractors for the surgeon. On a couple of occasions when I was permitted to suture the skin at the end of the procedure, the laser-eyed surgeon rapped me sharply on the knuckles with some surgical instrument and barked at me for tying “grocery-store knots.” Naturally I had the urge to respond, “Of course I’m tying grocery-store knots—I grew up in a grocery store!” But I never dared: the senior surgeons were formidable and seriously intimidating.

  By sheer chance, three of my close friends from George Washington Medical School were also accepted into the Mount Sinai internship, and the four of us stayed in two adjoining rooms—we would be on call and sleep at the hospital every other night for the entire year.

  While on my obstetrics rotation at the end of my first month of internship, Marilyn went into labor and Dr. Gutmacher, the department head, delivered by C-section our second child, Reid Samuel Yalom. It had been my turn to assist in the delivery room that day, but Dr. Gutmacher advised me to observe instead. Standing only a few feet away from Marilyn, I had the great pleasure and thrill of seeing Reid draw his first breath.

  Public transportation from our apartment to Mount Sinai was very poor, and taxis were far too expensive. For the first couple of months I drove my car to the hospital, but after accumulating a number of parking tickets, I hit upon the idea of a motor scooter. By chance I learned of an art professor at Yale who had bought a beautiful new Lambretta, but because of a severe gastric ulcer, had been advised by his physician to sell it. I phoned him, took a train one Sunday to New Haven, fell in love with the Lambretta, and drove it back to New York the same day. Thereafter the parking problem was solved: I rode the Lambretta to work, took it onto the elevator, and parked it in my room. Several times, Marilyn and I drove down Broadway, parked the Lambretta easily, and attended the theater.

  My internship offered no psychiatry rotation, but I hung around the psychiatry department and attended clinical and research presentations. One project of great interest to me involved a newly discovered compound, lysergic acid diethylamide (LSD), reputed to have psychedelic effects. Two young researchers in the department were examining whether LSD affected subliminal perception (that is, perception that occurs outside of awareness), and they asked for volunteers for a brief experiment. I volunteered. LSD had been synthesized so recently that the only known way of testing its effects was a loony Siamese fighting fish method. When squaring off for battle, the fish always assumed precise formations, and a very few drops of LSD to their water tank profoundly altered their behavior. The number of drops required to disrupt the fighting fish formation became the measure of the potency of the LSD.

  We four volunteers were given LSD-laced orange juice, and an hour later sat before a large screen upon which a tachistoscope projected images so quickly that we were unable to view them consciously. The following morning we were asked to recall all the dream images we had had that night and to sketch them. I drew two types of images: several faces featuring very long noses, and a man whose legs were missing. The following day the researchers projected the same images at normal speed for us to see. One was a popular advertisement for Life Saver candy in which a tightrope walker was precariously balancing a package of Life Savers on his nose, and the other a photo of a guard at Buckingham Palace dressed in a scarlet jacket and black trousers, with the trousers blending into the background of the black guardhouse. I was amazed at these results. I had learned firsthand what subliminal perception was: I had “seen” images without knowing that I had.

  At the end of my internship many vials of LSD remained, and the researchers gave them to me for personal experimentation. I, Marilyn (only once), and some fellow residents tried them, and I was fascinated by my sensory changes during the LSD trips: sound and vision were remarkably different. I spent an hour watching my wallpaper change colors and heard music in an entirely new way. I had a strange sense of being closer to reality or to nature, as if I were experiencing sensory data raw and direct with no wadding or filter in between me and my surroundings. I felt strongly that the drug’s effects were major and that it was no recreational toy. On a couple of occasions I grew frightened to realize that I couldn’t willfully turn off the effects, and grew alarmed that they might be irreversible. When I took my last sample on a November night, I went for a long walk outside and felt menaced by the bare November tree branches, which resembled the sinister trees in the Disney film of Snow White. I haven’t used it since, but in the following years, several publications appeared suggesting that the effects of LSD mimicked
the symptoms of schizophrenia. After I began seeing schizophrenic patients during the beginning of my residency, I wrote an essay on major differences between the LSD experience and the psychotic experience. This piece, appearing in the Maryland State Medical Journal, was my first published article.

  The internship year was transformative: by the end of twelve months I had assumed the identity of a physician and acquired some degree of comfort dealing with the great majority of medical conditions. But it was also a brutal year with long hours, little sleep, and many all-nighters.

  However, as exhausting as my 1956–1957 internship year was, Marilyn’s year was even worse. Uncommon as it was at that time for women to pursue doctorate degrees, she and I had always assumed that she would become a university professor. I knew no other married woman with such plans, but I always felt she had an exceptional mind, and her decision to pursue a PhD seemed natural to me. While I completed my last two years of medical school in Boston, she obtained her master of arts in teaching from Harvard, specializing in French and German. As soon as I was accepted for the internship at Mount Sinai in New York, she applied for the PhD program in the Columbia University French Department.