The Shrink Files

Shrink Love

Jen was my very first private patient and I felt green and nervous. She was not yet twenty and had just been released from a psychiatric facility where she had been hospitalized for a year. This was an era when people had a hard time getting out of mental hospitals, unlike now, when people have a hard time getting in. The reason for her hospitalization was sketchy. Basically, she was upset by the death of her father. Her level of “upset” would not indicate a long-term hospital stay today.

Jen told me that she fell “madly, totally and completely” in love with her “hot”  inpatient psychiatrist, Dr. Cohen,  and she did everything in her power to seduce him. All the patients had a crush on Dr. Cohen, and they even had a name for it — “Cohen sickness.” (The name they used was cleverer, but I’m disguising things.) Jen had a particularly bad case.  She had sessions with him four times a week and she would prepare for these by putting on perfume and make-up, blowing out her hair, and taking off her bra. Jared, another young adult patient in the facility, also saw Dr. Cohen four times a week. Hoping to make Dr. Cohen jealous, Jen deliberately had frequent wild sex with Jared so that Jared would report the interactions to Dr Cohen. Of course Jen herself made sure to tell Dr. Cohen of these erotic encounters — in detail. Many kudos to Dr. Cohen for resisting her tantalizing overtures.

Much of our year long therapy was taken up with mourning the loss of her former therapist and recounting his virtues.  He was so handsome, so charismatic, “the sun and the moon and the stars.” She wanted to go back to the hospital to be with him. Her “Cohen sickness” seemed intractable. When I pointed out that her infatuation with Dr. Cohen might have something to do with longing for her father, she dismissed the idea totally,  insisting that her love was real. He was so good looking.

I started to feel jealous, competitive with Dr. Cohen. What was I ( her new therapist) chopped liver?

Eventually Jen went back to Dr. Cohen for a planned final session. She waited eagerly this meeting. Week after week I listened to her excited fantasies about the anticipated encounter. Finally she met with him.  After her session with Dr. Cohen she said “You know, he looked old.” She had  let go!  Suddenly, no more “Cohen sickness.” But though she let go, I remained curious. Who was this guy about whom I had heard so much?

Years later I went to an APA conference, and discovered that I was giving a paper at the same time as Dr. Cohen had been assigned to give one, though my time slot was shorter. Here was my chance to scope out the object of Jen’s affection. I gave my talk and rushed off to check out Dr. Cohen. Standing in back of the conference room, I looked at him in the distance and thought….Oh, my God! Jen was right. Objectively speaking, Dr. Cohen was rather handsome. Maybe her attraction to him wasn’t all about her father. I found myself thinking about him, looking up his background, wondering about his marital status, listening for his name in professional circles…until I realized….I had caught Jen’s disease. I had “Cohen sickness”….mild case…it passed.

(The patients and doctor described are disguised)


The Swimsuit Issue

It was January, 1990. In other words, it was pre-Prozac. My patient was becoming frantic. She was convinced that her husband was scoping out other women. He was a letter carrier and he had plenty of opportunity to observe women in various states of deshabille as they collected their mail. But the first week in February posed a particular threat, a threat exceeding that of any other week of any month…..the swimsuit issue of Sports Illustrated. Her husband would be delivering the magazine to many homes. Surely he would look at it. The thought of this was unbearable to her.

Reading between the lines, as therapists are wont to do, I realized that my patient’s husband’s “looking” behavior was probably no different than any other straight man’s “looking” behavior. It was her problem, not his. Because of her worry, she held held her husband on a short leash and restricted his travel. He was not even permitted to go fishing lest he observe women in bathing suits on the shore. Interestingly, he did not seriously object to these limitations. Eventually she recognized the absurdity of her rules for him, and she came to see me.

Deconstructing her  fear of her husband’s wandering eye, my patient recollected that as an adolescent she noticed that her father spied on her when she showered. She tried to lock the bathroom door, but, somehow, the lock would never stay fixed. Her father disgusted her. He smelled of cigarettes, and when he died in his sixties of emphysema, she felt relieved. His legacy to her:  an aversion to tobacco and a fixed belief that all men relentlessly engage in  lascivious looking.

My patient was able to use this insight about her past to undo her needless anxiety about her husband. She endured the the first week in February issue of S.I. without incident. She released her husband from geographic confinement. She stopped monitoring his “looking” behavior. She wanted to to party, to go into the city to the theater and restaurants, to have fun.

That’s when the real trouble in their marriage started. The more she wished to expand their horizons, the more he resisted. He was happy to stay within the boundary of his neighborhood and mail route and became anxious when he strayed. It turned out that he was suffering from agoraphobia, but had never noticed because he had never tested himself.  He simply never left town. Their neuroses perfectly balanced each other….but now that she was better, the marriage came apart. Eventually they divorced.

I wonder, in retrospect, if I did anyone any favors.


A Hates B

Patient A viscerally hated B, about whom she had murderous fantasies. Both were women in their twenties who had  met on the job, but B had moved on and up. Though B was gone from Patient A’s life, Patient A’s bitterness remained steadfastly in place. How could B have so much, when she, the truly deserving one had so little? B was rich, sophisticated, a world traveler with European parents who spoke multiple languages….and, most humiliating of all, the boss preferred B.

Patient A grew up with few advantages. Her father fled  the nest when she was about five years old, leaving her, her mom and two younger sisters to fend for themselves. Her chronically aggrieved mother did not warm to her girls, especially Patient A, and Patient A, in turn, warmed to no one — including me.

In session after session, I dutifully listened to a laundry list of grievances, notably her resentment of  the good fortune of B.  Her hostility crystallized on the other, now absent,  young woman. When I tried to empathize with her feelings of deprivation and sibling rivalry, she shot me down. She wanted me to loathe B as much as she did. She wanted me wallow in her hate-fest, to talk about B’s awfulness in elaborate detail. I wasn’t being helpful, she said. Talking to me was a waste of time.

After a few weeks, I was shocked to realize that I knew B, that she was, by coincidence, another client. Neither patient was aware that I was seeing the other. To be sure, Patient B was nothing like Patient A described her. She was timid, polite, self-deprecating, a little depressive. Far from being rich, she had grown up on welfare. It was hard for me to understand how such a mild-manner individual could ignite such passionate dislike. Of course, Patient A’s hatred of Patient B was not about B at all. It was entirely impersonal.

Though they were no longer in contact with each other, I  worried that they would cross paths in my neighborhood, or worse, in my waiting room. I felt guilty that I was harboring a secret —  that I knew and was kindly disposed toward the object of her intense hatred. I was rigorous about scheduling wide spaces between their appointments. The whole dynamic made me anxious.

Through it all, Patient B never mentioned Patient A…not a word…not even a subtle reference. Patient A was not on her radar screen. Patient A never knew about her own triviality to Patient B. She quit therapy, and, I suspect, is still nursing her grudge.

.(Note that the patient’s identity is disguised)

Smart Ass

“I’m always the smartest guy in the room,” my young highly successful entrepreneur patient said to me in his first session. “Not in this one,” I replied. In retrospect, I’m not sure it was true, but i think it was therapeutic. He needed a therapist whom he could butt up against and not destroy.

(Note that the patient’s identity is disguised)

The Wish to Get Mugged

One of the more ironic fantasies I’ve encountered among my patients is the wish to get mugged.  Ironic, because , who in their right mind wants to get beaten up and robbed? (Not that all my patients are in their right mind:  I’m a psychologist, after all). But the wish to get mugged is not really about the wish to get hurt. Rather, it is a wish for an EXCUSE to hurt someone else, anyone, (in this case, the mugger) with impunity. It is a free pass for acting out your aggressive feelings. You’re entitled to defend yourself

Beating up a mugger is not really about the mugger, who is a stand-in for a hated person, or maybe even for the patient himself. Perhaps this explains the recent spate of murders of homeless persons in California. The murderer may be killing a debased image of himself.

Maybe Nietzsche was onto something.

(Note that patient identities are disguised)