Yale Psychiatry Grand Rounds: May 21, 2021

Transcript

• 00:00I'm John Crystal, chair of the
• 00:02Department of Psychiatry at Yale.
• 00:03I'm very pleased to welcome you
• 00:05to the inaugural T Byram Karasu.
• 00:09Psychosocial studies lecture
• 00:11which will be an annual lecture
• 00:13that has been established through
• 00:15the generosity and support
• 00:17of honor. One of our department's
• 00:19most distinguished alumni. Doctor
• 00:21T Byram. Karasu.
• 00:23He is the distinguished Professor
• 00:26Emeritus Dorothean Marty Silverman,
• 00:28professor emeritus in
• 00:30university chairman emeritus.
• 00:32For the Department of Psychiatry
• 00:34and Behavioral Sciences at the
• 00:36Albert Einstein College of Medicine.
• 00:38A post that he held for 23 years.
• 00:43The karasu psychosocial studies lecture
• 00:46will identify leading speakers from
• 00:47around the world to address a wide
• 00:50variety of research and practice
• 00:52subjects such as psychotherapies,
• 00:55social issues,
• 00:56including addictions and biases,
• 00:59literature, philosophy, and humanities.
• 01:03I'd like to say a few words about our friend.
• 01:05An alumnus, doctor Karasu.
• 01:09After graduating from the Yale
• 01:11Psychiatry Residency in 1969,
• 01:13Doctor Karasu emerged as a leading
• 01:15expert on the practice of psychiatry.
• 01:18He chaired the Apas Commission
• 01:20on Psychiatric Therapies,
• 01:21which produced a monograph called
• 01:24the Psychiatric Therapies and Shared
• 01:26another task for National Task Force,
• 01:29comprised of over 400 scholars,
• 01:31researchers and clinicians seeking
• 01:33to produce a Seminole document
• 01:36on each psychiatric disorders.
• 01:39This four volume report,
• 01:41called the Treatments of
• 01:43Psychiatric Disorders.
• 01:44Was praised as being in its time 25 years
• 01:48ahead of its time by Atlantic Monthly.
• 01:51And the best psychiatric book
• 01:54ever by contemporary psychiatry.
• 01:56Doctor Karas,
• 01:57who also chaired the AP a task force in
• 02:00producing the practice guideline for
• 02:03major depressive disorders in adults.
• 02:05He wrote a total of 21 books including
• 02:08psychotherapy for depression,
• 02:10deconstruction of psychotherapy,
• 02:12the art of Serenity, of God and Madness.
• 02:16Gotham chronicles the culture of sociopathy,
• 02:20maxims, minimas,
• 02:21reflections and microstyle and life.
• 02:24Witness evolution of the psychotherapist.
• 02:28We're very proud to have Electra that
• 02:30celebrates both the contributions of
• 02:32Doctor Karasu to the field of psychiatry,
• 02:35in which also celebrates the humanistic.
• 02:38Aspects of the practice of psychiatry
• 02:41and mental health treatment.
• 02:43Doctor David Ross will now introduce
• 02:46our inaugural carouso psychosocial
• 02:48studies lecture Doctor Irvin Yalom
• 02:54It is my distinct pleasure and
• 02:56honor to introduce our inaugural
• 02:58recipient of the Karasu Lectureship,
• 02:59Doctor Irvine Yellow.
• 03:01Doctor Allen graduated from Boston
• 03:03University School of Medicine and
• 03:05then completed his internship at the
• 03:06Mount Sinai Hospital and his residency
• 03:09in psychiatry at Johns Hopkins.
• 03:10After two years of service in the army,
• 03:12he moved to Palo Alto to join
• 03:13the faculty at Stanford,
• 03:15where he's remained ever since.
• 03:16He's the author of the Seminole Textbooks,
• 03:19the theory and practice of group
• 03:20psychotherapy, now in its 6th edition
• 03:23and existential psychotherapy.
• 03:24He's perhaps even better
• 03:25known for his fiction,
• 03:27including several collections of short
• 03:28stories about therapy encounters,
• 03:30including loves executioner and Mama,
• 03:32in the meaning of life and
• 03:34three teaching novels,
• 03:35when Nietzsche wept.
• 03:36Lying on the couch and the Schopenhauer cure,
• 03:39each is designed to bring core
• 03:41clinical concepts to life.
• 03:42For trainees who are learning
• 03:44how to conduct psychotherapy as
• 03:46well As for a broader audience.
• 03:48His most recent book,
• 03:49A Matter of Death and Life,
• 03:50combines his lifelong interests
• 03:52in writing an existential ISM
• 03:54in a uniquely personal way.
• 03:56The book is Co written with
• 03:57his wife Marilyn Yalom,
• 03:58who was herself an author, Anna Scholar.
• 04:00She was a professor of French and
• 04:02comparative literature and the
• 04:03director of an Institute on Women.
• 04:05The book begins from the time of
• 04:07Maryland's diagnosis of terminal
• 04:08cancer and consists of alternating
• 04:10chapters by Earth and Marilyn as they
• 04:12move through the process of her dying
• 04:14and what it means to die a good death.
• 04:16The last portion of the book document
• 04:19serves process of continuing on without her.
• 04:21This intimate and courageous
• 04:22account of their journey creates a
• 04:24powerful experience for the reader,
• 04:26one that,
• 04:27in the spirit of Doctor Yalom's work,
• 04:29instills clarity about what
• 04:30truly matters and how we can
• 04:33all experience life more fully.
• 04:35Will now share excerpts of a
• 04:36conversation that I had last week
• 04:38with Doctor Yalam following which
• 04:39will join us for a live Q&A session.
• 04:41So if you have any questions,
• 04:42please chat them directly to me via zoom.
• 04:51As a reader, the beauty of your
• 04:54fiction has has been that it.
• 04:56It allows the reader to feel
• 04:58like they are in the room
• 05:00while therapy is happening.
• 05:02And that it brings to life
• 05:04some of these core.
• 05:05Conceptual frameworks for
• 05:07existential psychotherapy and
• 05:08makes them alive for the reader.
• 05:14Yeah, I I don't quite know
• 05:16how I accomplished that.
• 05:17I never had a course in writing.
• 05:19I've always asked to do that.
• 05:22I had no electives in pre Med school,
• 05:26so I read all my life,
• 05:28but I I've never approached it in
• 05:31some sort of a student fashion.
• 05:33Learn how to write novels.
• 05:34I just I just plunged into it myself.
• 05:38Sometimes I feel sorry for myself
• 05:40for not having had that education.
• 05:42Sometimes I feel proud of.
• 05:44Not having not having done it,
• 05:46then going about it on my own,
• 05:48I really didn't know how I was doing this,
• 05:51but it just just flowed.
• 05:53Yeah, and I wonder if you could
• 05:55just set up 'cause as much of your
• 05:59work describes these central.
• 06:01Tensions and struggles with death anxiety an.
• 06:05Both how individuals struggle with it and
• 06:08a path forward that can be therapeutic,
• 06:10and I wonder if you could just
• 06:12sort of describe how that plays
• 06:14out for some individuals.
• 06:17Well, I I've accompanied a great
• 06:20many people to to their death.
• 06:24Working with them is
• 06:25always part of my practice.
• 06:28And tried to overcome my own fear as
• 06:32I worked with them and I still see
• 06:34people with with a lot of death anxiety.
• 06:37Even in these single consultations
• 06:39and a large number of them were
• 06:42dealing with death anxiety.
• 06:44And in the last couple of years.
• 06:48And in dealing with patients
• 06:49who present with their things,
• 06:50and that's what they want to work on,
• 06:52I began to fashion a kind of
• 06:54formula that I don't think it's
• 06:57really totally original.
• 06:58But it's been working for me.
• 07:01It seems to me that that that
• 07:03people who have a great deal of
• 07:07concerns or feeling that they
• 07:09haven't fully live their life,
• 07:11that they're full of regrets about about
• 07:14the way they about the way they've lived,
• 07:17their life,
• 07:17and what they haven't done in life.
• 07:19I think these are the individuals who
• 07:21have the most anxiety about about dying.
• 07:24I can say that personally for
• 07:27myself that I as I've I'm growing
• 07:30old now I'm I'm I've outgrown.
• 07:34I'm all my friends had died who I went
• 07:38to medical school at George Washington.
• 07:42At that time there was a
• 07:44shortage of that year.
• 07:45There was a shortage of cadavers
• 07:47that we had six of us dissecting.
• 07:49They could never, rather than four,
• 07:51and they have only recently.
• 07:53Just several months ago
• 07:54it began to dawn on me.
• 07:56That was thinking as I thought about this.
• 07:59This unforgettable year,
• 08:01I said thing that could ever.
• 08:04That all the other five had died.
• 08:06I was the only only one left
• 08:08alive is rather frightening.
• 08:10Kind of feeling that you see
• 08:11all your all your companions,
• 08:13all the people who are with you
• 08:15during your education who are dead.
• 08:17So I am experiencing that now.
• 08:19And I'm also I can tell you this,
• 08:22that as I think about death and
• 08:24I think about my own death,
• 08:27which is approaching.
• 08:28I'll be 90 in in a few weeks,
• 08:31but I have very very little
• 08:33death anxiety and I do believe.
• 08:35That is closely related to my sense of
• 08:39having few regrets about how I live my life.
• 08:42I lived my life since I was
• 08:4514 with with with Marilyn,
• 08:47my wife,
• 08:48who's extraordinary woman and
• 08:51felt fortunate to be with her.
• 08:54And almost all times,
• 08:57and as I as I look back on my life,
• 09:00I have so few regrets.
• 09:02One thing that I was doing after
• 09:05after she died and I was in
• 09:08deep grief and lying in bed.
• 09:10Just feeling very numb and my eyes caught.
• 09:13This row of books that I had
• 09:15written and I thought for the and
• 09:17then for the first time I started
• 09:19to reread my my own books and it
• 09:21was quite an experience.
• 09:23It was extremely good therapy for me.
• 09:26I was more or less pleased with the books.
• 09:31I was also very startled.
• 09:33I came to
• 09:33a book called Momma and the Meaning of Life.
• 09:37It was the early book and one of the
• 09:40stories I just almost fainted when I
• 09:42saw this with about the third story in
• 09:44there was something like 8 advanced
• 09:46lessons in the therapy of grief here.
• 09:49I was mired in grief and I see I wrote
• 09:51a striper totally forgotten this story
• 09:53and I read it from Mendis interest.
• 09:57It was a story of a professor at Stanford,
• 10:00a woman who had just lost her husband and.
• 10:02Couple years before that had lost
• 10:05her beloved brother and therapy was
• 10:08difficult with her, she was angry.
• 10:11Angry at Fate, but got angry with me too,
• 10:14saying she should say things like, oh,
• 10:16you sit there in that nice try pink shirt.
• 10:20Nothing's ever happened to you.
• 10:21Nothing bad is ever happened to you.
• 10:24You don't know how I feel and I
• 10:26would start to argue with her.
• 10:28We get into arguments, I'd say, oh,
• 10:30I have to be depressive, period.
• 10:32Depressed patient.
• 10:32I have to be schizophrenic,
• 10:34the treated schizophrenic.
• 10:35Should be shouting back at me,
• 10:37but a gradually oh maybe,
• 10:39maybe over the course of a year and a
• 10:42half she gradually began began to improve.
• 10:45But now as I think of her,
• 10:49I think I realized that she was really right,
• 10:52that that I I could work with her
• 10:54much better now than I did then.
• 10:56Having experienced what,
• 10:58it's like to feel this numbness
• 11:01of Greek of grief.
• 11:03This inability to kind of
• 11:05forget your your less.
• 11:07Images of the person who you've lost,
• 11:09so I think I'd be there a
• 11:12better therapist for grief
• 11:13now than I was at that point.
• 11:16OK,
• 11:16well maybe we
• 11:17can talk about the new book
• 11:18a Matter of Death and Life,
• 11:20and from the beginning of the book we
• 11:23know How It's going to end that that.
• 11:26That Marilyn is is dying of a
• 11:29terminal illness an and it's a
• 11:31story that's about the journey and
• 11:34about how you get there and how you
• 11:37how you move through that process.
• 11:40And maybe you can start by telling us
• 11:42what was the was the initial impetus,
• 11:44like like what was the moment that
• 11:46said that the book came to be that
• 11:48you said we should write about this.
• 11:50Oh I can, I can tell you answer that
• 11:52just precisely Myrtle and I are just a
• 11:56block for nice park away, often walking.
• 12:00That park and one day Melon said
• 12:03to me she had multiple myeloma,
• 12:06and as you as you know, treatment of
• 12:10that sometimes be pretty successful.
• 12:12People can be kept alive for 10-15 years.
• 12:15Some people can't, and she was one
• 12:16of those who fell into that category.
• 12:18All the medications that were that were
• 12:21that were tried were not helpful to her,
• 12:24and so we were walking along and she was
• 12:27saying to me, you know, I've been thinking I.
• 12:29I think we should.
• 12:30We should write a book about what's
• 12:32going on here in our lives.
• 12:34You and me already chapter.
• 12:35Then you write. A chapter.
• 12:37Will alternate chapters.
• 12:40And I said to her, you know very well.
• 12:42That's really a wonderful idea.
• 12:43I think it's a book you should write.
• 12:45As you know, I'm just I've already started
• 12:47in her book of stories that I'm writing,
• 12:49and she says,
• 12:50and she was a very powerful woman.
• 12:53She was all about 98 pounds,
• 12:56rarely over 100, and not quite.
• 12:59She called herself 5 foot,
• 13:01but she was about four feet 11,
• 13:03so she was tiny.
• 13:04But she was very tough and very powerful.
• 13:06And she said, Oh no, you're not writing.
• 13:09You're not ready.
• 13:10That book is going to be
• 13:11writing this book with me,
• 13:13and sure enough,
• 13:14we started writing that book,
• 13:15and so the book is is really a
• 13:19book about about her death and we
• 13:23call it a matter of death and life.
• 13:25That reason I call it that I called
• 13:27it that because it's a book about her
• 13:29death and then about my life afterwards.
• 13:32The second half of the book,
• 13:33which I of course wrote by myself.
• 13:35So our life really ended with are working
• 13:38on a book I've often thought of the fact.
• 13:41That her life began and ended
• 13:44with books I met, Marilyn.
• 13:47I wrote about this in a memoir that I
• 13:49wrote called Becoming becoming myself.
• 13:51I I met Marilyn when I was 14.
• 13:54I just moved out the out of this very
• 13:57rough neighborhood into a nicer part of town.
• 14:00And I just I just as the school
• 14:03year was starting.
• 14:04I,
• 14:04I heard from somebody that I knew he
• 14:06came to me and so you know there's
• 14:08there's a party at Maryland Codex House.
• 14:10Let's let's go on over there.
• 14:12I said what I didn't get invited, he
• 14:15thought was not necessary so they came over.
• 14:17There was a big.
• 14:20Mob of students right outside the
• 14:22house trying to get in the house
• 14:23is totally full and he said to me,
• 14:25let's climb through the window so
• 14:28I did and I saw her at the other
• 14:31end of the room.
• 14:32I immediately just this thought
• 14:34so well of her and I hardly ever
• 14:37talked to a woman before.
• 14:39But anyway, I got up my nerve.
• 14:41I went over to her and said, I'm Irv Young.
• 14:44I just crawled through your window.
• 14:48That's the kind of social
• 14:49skills I had at that point, but gradually,
• 14:52we talked for a few minutes.
• 14:54He was very busy then,
• 14:55but I got her phone number and
• 14:58called her back and we had a date.
• 15:00My first date with a woman and a day
• 15:03or two later and she told me the fact
• 15:06that she had skipped school that day,
• 15:08and I wish astounded by that.
• 15:11Skip school that day, why?
• 15:13Well, she had skip school because she had
• 15:15stayed up the night before reading all night.
• 15:18Long gone with the wind.
• 15:20And so as soon as I heard
• 15:23that I was astounded,
• 15:26here's someone who loves books,
• 15:27is as much as I do so.
• 15:30In a sense,
• 15:31our relationship really started
• 15:32with with books and hearing it
• 15:35and ended with books and books
• 15:36have been so important to us over
• 15:38like she was a wonderful writer
• 15:40and always my first editor.
• 15:44And through the first third of the book,
• 15:46there's some degree of optimism that
• 15:49she's getting new treatments and,
• 15:51and there's hope that things
• 15:53may may turn around and,
• 15:54and you also convey the struggles of
• 15:58that time period and what it was like to
• 16:00have death feels so close for you both.
• 16:02And I wonder if you can talk
• 16:04a little bit about that.
• 16:05Well, we went to the went to hospital
• 16:08one day a week where she get infusions
• 16:12with the various treatments for.
• 16:14Alphapoint myeloma, or as I mentioned before,
• 16:18they they all failed,
• 16:19but she would often have to
• 16:21be infused for several hours.
• 16:23I would sit by her bed,
• 16:25read it was with her during all
• 16:27that time and never left her side.
• 16:30And so we went there one day a week
• 16:35until the time came when it was
• 16:39apparent that it wasn't working.
• 16:41She began having pain in her back should.
• 16:44Begin to weaken.
• 16:46It was my sport by alarm,
• 16:48as as you know is a is a cancer of the
• 16:51blood cells and plasma blood cells,
• 16:54white blood cells and she became
• 16:56weaker and weaker and soon became so
• 16:58weak that she really couldn't even
• 17:01walk out the house to the mailbox,
• 17:03which is about 150 feet away until
• 17:08finally she and she talked to the
• 17:12people at Stanford and ask them.
• 17:15If they would help her die,
• 17:17and California is one of the states
• 17:20in which physician assisted death
• 17:23is is possible with required is 2
• 17:26physicians who will attest to the
• 17:28fact that she has a fatal illness and
• 17:32they're allowed to to help her face death.
• 17:36It varies from state to state as
• 17:38it varies from country to country.
• 17:40Many people go to Switzerland to
• 17:42go through the Netherlands for
• 17:45physician assisted suicide.
• 17:47So she went first to A to a Hospice,
• 17:51or which,
• 17:52which is a quite a wonderful help
• 17:54for her with a physician who it is
• 17:58cystid so many patients who are dying.
• 18:00And when she got to the point she's
• 18:02saying this is not worth living anymore,
• 18:05the pain is too much.
• 18:06She she asked the physician to to help
• 18:10her die and she said that he came
• 18:14over with with. With medications.
• 18:17There's a.
• 18:18Assortment of medications including digits,
• 18:21****** Alice drugs,
• 18:23as well as a lot of working and
• 18:26grounded up into a liquid that
• 18:29she could suck through a straw.
• 18:32Patients must administer.
• 18:33This must be awake enough to take the
• 18:36to suck it up rather than getting an Ivy,
• 18:38which is is not permitted,
• 18:40and so and so.
• 18:42I was by her side,
• 18:45or four children were by her side
• 18:49and watched her.
• 18:51I take this medication I all I could
• 18:53do is stand next to her and hold
• 18:56her hand and I counted her breaths.
• 18:59I counted 17 breaths and then she stopped.
• 19:05I leaned over and kissed her
• 19:07forehead and she was already called.
• 19:11Strongest sentence in the book
• 19:13for me is is that that I'll never
• 19:17forget that AC kiss and that's true.
• 19:19I I don't forget it. I don't forget that.
• 19:22Seen it just it stays in my says
• 19:24my head it was it.
• 19:25Was it a good thing is there's
• 19:27certainly a good thing for her that
• 19:29I was there not so sure it was a
• 19:31good thing for me because like I
• 19:33can't get it out of my mind even now.
• 19:35Even all all these months have passed.
• 19:41And what was it like in in
• 19:43in the wake of this for you?
• 19:47After she died.
• 19:51Is a horrible time. I'm not.
• 19:54I'm not through it yet.
• 19:55I knew that when Maryland died,
• 19:59my prognosis was not going to be good
• 20:02because I've worked with a lot of
• 20:05people whose spouses had had died,
• 20:07but I've never encountered anyone
• 20:09who's had as long as deeper
• 20:11relationship that I had with her.
• 20:13I mean, since we're 14,
• 20:15and when she died as 89, you know that's it.
• 20:19A long time to be with someone.
• 20:22I married when I was still in medical school.
• 20:26In fact, she she went to Wellesley and I was
• 20:30accepted to to George Washington University.
• 20:33I grew up in Washington DC and
• 20:37there was a quota at that point.
• 20:41Very public quote of 5% for Jewish students,
• 20:45and so I felt I had to is
• 20:49only one way I could.
• 20:51I could handle this, which is that
• 20:54I'll just once GW undergraduate.
• 20:57Get all A's and they have
• 20:59to accept the and that was.
• 21:01That was what happened.
• 21:02So I I came in after three years of
• 21:04school rather than their other than four.
• 21:07And after my first year at George Washington,
• 21:10I Maryland was up at Wellesley.
• 21:12At that point she just started
• 21:15undergraduate school Wellesley I and I.
• 21:18I learned that there was a
• 21:20place open at Boston University,
• 21:23so I transferred there just to be with her.
• 21:25And then the third year medical
• 21:27school we married.
• 21:34Yeah, what's helped you get
• 21:37through this this period.
• 21:41Writing. Writing has helped enormously.
• 21:45It's all that I'm really doing now. I
• 21:49I I my schedule for
• 21:52the last. My professional schedule
• 21:54for the last year or so has been.
• 21:57I see one patient, one consultation today
• 22:00and the rest of the time I'm writing.
• 22:02I wrote the last of the end of that book. Of
• 22:07the book that I wrote with
• 22:09with Marilyn, and then after
• 22:11that I've been writing a book of
• 22:12stories that have emanated from
• 22:15some of the consultations. I
• 22:17mean this to be a book of rather
• 22:20short stories that will be used for
• 22:23teaching therapists in training.
• 22:25So the writing is is tremendously
• 22:29engaging to me. And you know,
• 22:32I'll come to this office sometimes,
• 22:34and suddenly I sit down at
• 22:378:00 o'clock in the morning.
• 22:39And next thing I know it's noon already
• 22:41haven't even got out of my chair
• 22:42that I'm zooms by the Book of stories
• 22:46that I'm doing is almost book length,
• 22:49and I'm I'm a little frightened.
• 22:52You know, I do not want this book to end.
• 22:54I don't know what I'll do
• 22:55with myself after that.
• 22:56I just have to have this this, this,
• 22:59this work that I'm doing
• 23:02and I loved. I love doing this so
• 23:04I'll be this will be a long book
• 23:06I think is I'm not about to stop
• 23:08into this side to stop doing it.
• 23:10But that's that's my schedule.
• 23:11I'm writing all day long and
• 23:13you talk about that creative
• 23:14process of of how you
• 23:17approach writing a story.
• 23:19Oh, that's really a hard question.
• 23:22It's very difficult for me to to
• 23:25think about that, but you know?
• 23:30The stories emerged from the consultations,
• 23:33maybe one out of every used to be
• 23:35about one out of every 10 I saw.
• 23:38Now it's about 1:00 every 20 or 30 I see,
• 23:41but suddenly it feels like there's a.
• 23:43There's a, you know,
• 23:45there's there's an interesting story
• 23:47in here that I begin to think. I.
• 23:49Then I gradually begin to shape it.
• 23:51I mean, I'll give you an example I wrote.
• 23:57I saw a patient.
• 23:59On zone and I I simply could not reach her I.
• 24:05I I every time I see a
• 24:07patient in consultation,
• 24:08I'll spend part of that section,
• 24:10maybe half the session,
• 24:11even dealing with the here and now.
• 24:13What's happening here between you and me?
• 24:15What are you feeling about,
• 24:16how how we're talking?
• 24:17What are my questions make you feel
• 24:19what questions you have of me?
• 24:21So I'll work very much in here I
• 24:23could not reach her she simply
• 24:25would not engage at all.
• 24:26So after the session I I dictated
• 24:29into my phone would you can dictate?
• 24:33Of course,
• 24:34since your iPhone I dictate into my phone.
• 24:36And talked about that and then
• 24:39start off by saying this is the.
• 24:41This is the least successful
• 24:43consultation I've ever done.
• 24:45It it,
• 24:46I just couldn't reach this woman
• 24:48and I wrote this.
• 24:49You know,
• 24:49it's a page or two I'm writing
• 24:51to myself because what I do then
• 24:52is I I emailed to myself so it
• 24:54appears on my computer.
• 24:55OK,
• 24:56well I get a letter from her a day
• 24:59or two later saying to her that I
• 25:03mailed this to her rather than to myself.
• 25:07So there's a story here.
• 25:08Of course,
• 25:09she tells me she's never been so upset
• 25:12you couldn't sleep all night long.
• 25:14IAM modified I I'm so I'm so anxious
• 25:17about that I asked her if we could
• 25:20meet again and she she said she'd
• 25:23like to do that so we we met again
• 25:26and we talked about that and then
• 25:31gradually it ended up being a very
• 25:35interesting story for one thing.
• 25:37I had totally forgotten that was
• 25:40my memory leaking away already,
• 25:42but I've totally forgotten that letter.
• 25:44She had written me saying that
• 25:46she was in training in social
• 25:49work school by not in person,
• 25:52but but just just zoom.
• 25:54So she was in training in social work
• 25:57school and they use my textbook and
• 25:59group therapy and the teachers revered
• 26:02me so much and gradually it became.
• 26:05I became aware she's talking to me.
• 26:07That this woman is terrified of me and
• 26:10and that was really what was responsible.
• 26:13So we worked that out,
• 26:14and it came up in interesting fashion.
• 26:18Towards the end of the session is
• 26:20where someone said you have any
• 26:21last questions you want to ask me.
• 26:23She says yes I do.
• 26:24I wanna know about this.
• 26:27Emailing this to yourself.
• 26:28Tell me about that.
• 26:30Why are you doing that?
• 26:31And I said,
• 26:31well I I all I do is
• 26:33dictating the phone and
• 26:34then I emailed to myself.
• 26:36Problem solved is right on my computer
• 26:38so she said well listen let's get off
• 26:40the zoom and let's go to the telephone.
• 26:43We went to the phone and then she
• 26:46guided me through to my computer.
• 26:48And she says she she,
• 26:50she wanted me to go to notes on
• 26:52my computer and I went to notes,
• 26:54and I suddenly realized that
• 26:56all the dictation,
• 26:57the hundreds of device was
• 27:00already on my computer.
• 27:01So we had a good time talking to me about.
• 27:05She's so frightening me.
• 27:06And here I am a real bonehead
• 27:08thinking I had made this wonderful
• 27:10discovery about email you to myself.
• 27:12So it was amusing story to me.
• 27:14That's that's one of the stories.
• 27:17Buddy, you gravitate immediately to a story
• 27:20of failure rather than a story of triumph.
• 27:24Well, it's a. It's the failures of
• 27:26probably the most interesting one.
• 27:29Well, I turned out to be not a failure.
• 27:32It turned out to be it
• 27:33always for the best we had.
• 27:35We had a a wonderful another
• 27:38session that was quite interesting.
• 27:40Yeah, I don't. I don't mean that in any
• 27:42way to reflect on the therapy itself,
• 27:43but if your personal experience of Oh my God,
• 27:46I I wasn't connecting with this
• 27:47patient in the way I wanted to
• 27:49and then I send this email.
• 27:50I think it's one of the things that's
• 27:52so lovely about your work is is the
• 27:55openness with the entire T of the process.
• 27:59Yeah, I I tend to be quite open if
• 28:01you're gonna work in the here and now
• 28:03as I think every therapist should do it.
• 28:06It's always wear.
• 28:07The paydirt is but you you have to be.
• 28:09You have to be open to yourself and I
• 28:12tend to be pretty self revelatory in
• 28:15my writing as well as my therapy work.
• 28:18I know that's it's.
• 28:21Shonda doubted by a lot of
• 28:24experiencing practicing therapists,
• 28:26but I feel pretty strongly about that.
• 28:31But my first when I started
• 28:33my residency at Hopkins,
• 28:34I was told that you know it's good
• 28:37idea for the residents being analysis.
• 28:40I entered analysis with a.
• 28:43An analyst who was a senior
• 28:46analyst in Baltimore.
• 28:47She was in an office of six other
• 28:50analysts had analyzed the other five and
• 28:53she was an older woman and of course,
• 28:56I never really couldn't see
• 28:57her during the session.
• 28:59Once I strained my neck issues
• 29:00behind the couch,
• 29:01there's no relationship really between
• 29:03the tools that we could talk about.
• 29:06She was very distant and very non
• 29:09disclosing an I had them four times a
• 29:12week with her for three years and 600 hours.
• 29:14It was a hard an expensive lesson
• 29:17for me about how not to do therapy.
• 29:19It was,
• 29:20I felt was a wrong approach to
• 29:22therapy and gradually I got
• 29:24into a position where I was,
• 29:27especially perhaps helped by my
• 29:29work with group therapy that it
• 29:32was much more self self revelatory.
• 29:34That's how long course.
• 29:35When I when I started working
• 29:37at teaching it at Stanford,
• 29:41I was teaching group therapy just as
• 29:43had been taught to me with my residence.
• 29:46And some house medical students.
• 29:47So behind this two way mirror they could
• 29:50look in patients just so a mirror.
• 29:52But of course the group had to
• 29:54know their students behind there.
• 29:55I had to tell them that of course,
• 29:57and so they, the patients,
• 30:00all knew that there were students
• 30:02behind the mirror.
• 30:03But they still were a little
• 30:04uncomfortable with these people that
• 30:06they couldn't see watching them.
• 30:08And I I just decided to try a
• 30:11bold experiment.
• 30:11I say, well, listen,
• 30:13I'm I'm going to suggest another.
• 30:16But alas,
• 30:16that after the group the residents
• 30:18come into this room and we
• 30:20talk about the group meetings.
• 30:21But I'm going to suggest now that
• 30:23you all the group members you can
• 30:25go in the observation room and
• 30:27watch our discussion.
• 30:28So just as we watched you, you can.
• 30:31You can watch us discuss this.
• 30:32Freaked out the residents for
• 30:34for half hour or so,
• 30:36but they gradually got used to it.
• 30:37It was a wonderful experience for
• 30:41the patients and they talked about
• 30:43the residents and some of them who
• 30:45are way off base and why they're all facing.
• 30:47So it got to be quite a quite
• 30:49a good experience,
• 30:50so that was my first real
• 30:53attempt with self disclosure.
• 30:54I don't know why I how I did this.
• 30:57It was not because I felt so self assured I
• 31:01was always a doubting myself and I've
• 31:03had a rough 14 early years in my life.
• 31:07Then yeah, so there.
• 31:08So that was one of the first
• 31:10experience that I had with
• 31:12that sort of self revelation,
• 31:14and I've done that ever since then.
• 31:16I probably even, especially in Group therapy.
• 31:19I think, yeah, coming coming
• 31:21back you started talking about
• 31:22the process of how you write these
• 31:25stories and from an encounter that
• 31:27strikes you in a particular way
• 31:29and then can you walk me through
• 31:31the process so you see a patient,
• 31:33you take these notes and what happens?
• 31:37Come. How does that?
• 31:40What are the next steps by
• 31:41which that finally becomes the
• 31:43polished product in a book?
• 31:46Well. Maybe that's most evident
• 31:50in some of the books of stories
• 31:52that I've written, 'cause they're
• 31:53they're shorter pieces, so
• 31:55you know, I will.
• 31:57I will agitate, I may invent
• 31:59a couple of things to make
• 32:01the story more interesting.
• 32:02I always, always send
• 32:04it to the patient for permission.
• 32:06I absolutely cannot publish anything
• 32:09without without that happening,
• 32:12and I do that to this day.
• 32:14All the consultations I've done,
• 32:18if I write a story about that, I.
• 32:21I do everything I can to disguise
• 32:23the patient if I'm if I'm seeing a patient
• 32:26who may be in the UK and Ireland.
• 32:30Let's say I put her into New Zealand or
• 32:33some other place disguised,
• 32:35identity changed, identity survival,
• 32:37change the gender if it if it's possible.
• 32:39So I disguised them extremely well
• 32:41so no one could recognize them and
• 32:43then send this story to the patient
• 32:45and and get their permission.
• 32:48Because those are the two biggest
• 32:50questions I had about that
• 32:51is is is to what extent
• 32:52the details are changed,
• 32:53which it sounds like as much as
• 32:55possible to preserve the core
• 32:56and then that you do communicate
• 32:59with the individual. Always
• 33:01I couldn't. I couldn't possibly
• 33:02write his story with that.
• 33:04Yeah, and I wonder what those
• 33:06conversations are like when you reach
• 33:08out to somebody to say I'm thinking about
• 33:10writing a piece based on our encounter.
• 33:12Does that come before you start writing?
• 33:14Just come once you've written.
• 33:15I don't say that to them
• 33:17before I right afterwards.
• 33:18Actually write the story,
• 33:20and then I send it to them and ask
• 33:23him about how they how they feel about this.
• 33:26You know, it's amazing to me how
• 33:28many patients I sent this to.
• 33:29Who say you disguise me too much.
• 33:32You know, I'd rather you use my real
• 33:34or my real name or something like
• 33:36that of the of the many, many that
• 33:38I've sent out of these consultations.
• 33:40Only one has refused and I understand
• 33:44her point no matter how much this Kaiser,
• 33:46it's still a point where
• 33:47she was having an
• 33:49extramarital affair. Anan, she
• 33:50had too much concern,
• 33:52fears that their husband met
• 33:54somehow somehow find find that out,
• 33:57and I understood that perfectly.
• 33:59So I've not published in that story,
• 34:01of course. Yeah, I always honor
• 34:04the patient's wishes in that.
• 34:11You know I have moved
• 34:12far away from the medical
• 34:14side of psychiatry.
• 34:15I haven't prescribed medications
• 34:17for a long, long, long time.
• 34:19I'm really a psychotherapist now.
• 34:23I work with people
• 34:25coming with many different kinds
• 34:27of kinds of degrees, so that's
• 34:30been my position now.
• 34:32But I still have a group of my
• 34:34ex students that I still meet with.
• 34:37You know, there are two groups that I
• 34:40attended for a long time.
• 34:41I mean for decades.
• 34:42One is a group of people of
• 34:46psychiatrist that I had worked with.
• 34:49Got together and we decided
• 34:51to form a therapy group for us
• 34:54with a leaderless therapy group.
• 34:56So I met with this group of about
• 34:58eight students, a ex students
• 35:01of mine and we met for oh
• 35:04maybe close to 40 years meeting
• 35:08meeting meeting once every every other week.
• 35:12And we met for an hour and a half.
• 35:13There was no leader to the group
• 35:15and it was an absolutely wonderful
• 35:18experience. I finally stopped it after.
• 35:20At the time my wife was very ill and I
• 35:22just couldn't continue. At that point,
• 35:24the group still going on though.
• 35:27And there's another group I met when Eric
• 35:29Lindemann from Harvard had came come out to
• 35:33the West Coast and it was was
• 35:36teaching at Stanford a little bit.
• 35:38During that time, we formed
• 35:39a Lindaman group,
• 35:40which is a case presentation group
• 35:42there about 8:00 or nine of us,
• 35:44and we presented turns presenting cases.
• 35:46I still go to that group. I mean at least
• 35:4840 years of past and we meet once a month.
• 35:52And these are all close
• 35:53colleagues and friends of mine.
• 35:55They were all once once students.
• 35:58It take turns presenting cases.
• 36:01Now when I present a case,
• 36:03I'll read a story that I'm working on.
• 36:06Something like that,
• 36:07and so they're close together and I
• 36:10feel very close to this. This group
• 36:12of people I've worked with
• 36:13all these all these years.
• 36:15It's been very moving experience for me.
• 36:19You wrote a book, The gift of therapy
• 36:22that was a collection of pearls to pass
• 36:26on to next generations of therapists.
• 36:29And it's lovely and practical and accessible.
• 36:32And I wonder if there any particular
• 36:34elements of that or themes that stand
• 36:37out that you think is as most central
• 36:39to the identity of a therapist.
• 36:43Here, that's one of the
• 36:45books I haven't reread.
• 36:47But I think I edited a couple of
• 36:49times and added more and more.
• 36:51I've always thought it was a very.
• 36:52I've got a lot of feedback over
• 36:54the years that it's a valuable
• 36:56book for three therapists.
• 36:57I was going to call it, you know,
• 36:59100 tips for therapist,
• 37:00but somebody else had that name and
• 37:02there was a book published by that.
• 37:04So we settled for gift to therapy.
• 37:07But I I think probably that I've
• 37:09always felt that it's one of the more
• 37:11effective teaching books that I read,
• 37:13and it's used in a lot of
• 37:16different professions, I mean.
• 37:17Not only psychiatrist but psychologists
• 37:18and social work schools, but it's it's a.
• 37:21It's a widely read book.
• 37:23If I had to say that assumes
• 37:25anyone book of mine to read,
• 37:27I think it would be that one.
• 37:30I've I haven't re edited for
• 37:32the last 10 or 15 years,
• 37:34but each time I re edited I added a few
• 37:37more that I thought were essential.
• 37:39If maybe that's a book I can go back
• 37:41to and see if there's anything new.
• 37:43I want to add something.
• 37:44Thanks for reminding
• 37:45me of that one
• 37:46is well worth the read.
• 37:54Yeah. Yes, you described through the book.
• 38:00Your own. Coming to terms with with.
• 38:06Your your health and an.
• 38:09Illness and starting with the
• 38:12arrhythmia in the pacemaker
• 38:14and then feeling progressively
• 38:15physically disabled and talking
• 38:17about struggling with your memory
• 38:18as well and and and the challenges.
• 38:21And I was curious if you could
• 38:22reflect on that a little bit
• 38:23what it's been like for you.
• 38:25Well I sometimes I feel like I could
• 38:29write a book about someone who's still
• 38:30got his mind intact and and write about
• 38:34what's happening to me in this world,
• 38:35what it's like growing old
• 38:37it's it's quite remarkable.
• 38:39As I watched my memory fade away,
• 38:41you know I get a letter from
• 38:43someone I said who is this?
• 38:45I know this person and sometimes
• 38:46have to guess my daughter.
• 38:48You know who this is or looking up on Google.
• 38:51So I see these things like away are
• 38:55forgetting losing things in the House
• 38:58so that's that's the shocking to me.
• 39:02Curry. Curiously enough though,
• 39:05I one thing I'm not experiencing
• 39:07as well is a lot of death anxiety.
• 39:10Well, 11 phenomenon I've been noticing
• 39:13lately is that sometimes I will
• 39:16think about and I think about death,
• 39:19and then I will say then I'll think
• 39:22about the fact that I'll be joining
• 39:26Maryland and I suddenly feel a
• 39:29wave of a comfort sweep over me.
• 39:32And that's that's a fascinating event for me,
• 39:38because the rational part of my mind.
• 39:41Is that this is pure nonsense?
• 39:44You know.
• 39:45I've been a pretty developed atheist
• 39:47since I was very early in life.
• 39:50And I'm saying Brown is not here anymore.
• 39:54She doesn't exist any longer.
• 39:56She's she's just bones at this point,
• 39:59but nonetheless, you know,
• 40:01I still get this comfort is.
• 40:04I think I'll be joining Maryland.
• 40:05It gives me much,
• 40:08much more clear idea of what religion has
• 40:12offered to us since the beginning of time.
• 40:15It offers that kind of come.
• 40:17You know the idea that the
• 40:18death won't be the end,
• 40:19that somehow will be rejoining it.
• 40:22So the idea of my joining Maryland
• 40:25still I feel some some wave
• 40:27of comfort come over me.
• 40:29It's a fascinating phenomenon as I,
• 40:32as I observed,
• 40:33that.
• 40:35Carolyn described in. Well, her.
• 40:44Our own comfort at the imminence
• 40:46of death towards the end,
• 40:49where she describes having.
• 40:52Feeling like she lived a full,
• 40:54rich, meaningful life with wonderful
• 40:56relationships and having accomplished
• 40:58the things and that she wanted to
• 41:00do and not having any regrets.
• 41:01And as as the time came close
• 41:04that she says I'm she's,
• 41:07she's clearly grateful to pass in the way
• 41:09and at the time that she was ready to.
• 41:13Yes, yes she was living in in a lot
• 41:15of pain and then and said to me,
• 41:18you know I it's not worth going on.
• 41:21I'm the days are too awful for
• 41:23me and you know. And I had to.
• 41:25I had to agree with her.
• 41:27I I could see what she was going
• 41:29through and I would have made I would
• 41:30have made the same choice myself.
• 41:35Well, I think one of the comments that
• 41:38I was talking about earlier.
• 41:40I just want
• 41:41maybe press only trainees that
• 41:43when I talk about the here and now,
• 41:45I know that many of you don't
• 41:47quite know what I mean,
• 41:49but but what I mean is that I want
• 41:52you to explore the relationship
• 41:54that you have with your patient.
• 41:57You know what, what?
• 42:01It can be so helpful.
• 42:02This is the richest and most alive part
• 42:05of what's happening between the two links.
• 42:08The same in what's what's happening,
• 42:10and it it can give you inroads to so
• 42:12many different different kinds of issues.
• 42:15I saw a lovely woman who was
• 42:19a physician and she was doing
• 42:22research and she was coming to me.
• 42:25I saw
• 42:26her in zoom. She was
• 42:27in another continent,
• 42:29but she had come to this
• 42:30place and she told me that.
• 42:32She's a researcher and her first,
• 42:36maybe eight or nine years
• 42:38out of medical school.
• 42:40And she was saying to me, contact her.
• 42:43She simply would not would not talk.
• 42:46So after a while,
• 42:47you know I began to express this to
• 42:50her and I began to and she didn't
• 42:52know quite what I was talking about.
• 42:54Why was I doing this for me?
• 42:55Like talking about her and
• 42:57me and I kept saying to her,
• 42:59you know what's happening
• 43:00here between you and me?
• 43:02Is a microcosm of what's typing you in
• 43:05the world between you and other people.
• 43:08And I I can see why people might
• 43:11be attracted to you because
• 43:14of your physical beauty,
• 43:17but I can also see why they weren't
• 43:18coming back because it's so hard to
• 43:20make contact with you and that was
• 43:23extremely important lesson for her.
• 43:25I don't think she'll ever forget that,
• 43:27so I feel that working on what's
• 43:29happening here in the room not only in
• 43:31Group therapy but in individual therapy.
• 43:33Is is there a most powerful message?
• 43:36I want to give to students that
• 43:37they may not get elsewhere?
• 43:41It's a fantastic tip.
• 43:43Get something that it
• 43:44isn't taught well enough.
• 43:46It's probably not learned well
• 43:47enough that it takes a long time.
• 43:49I think you have remarkable confidence
• 43:50in yourself to be able to practice,
• 43:52and in this particular way,
• 43:54well, I never had much confidence in myself,
• 43:56but I managed to do it anyway.
• 43:58It was scary at first, but you know,
• 44:02I I did manage to to do that.
• 44:06It's like very conferences.
• 44:09It takes some sort of willingness
• 44:12to put yourself out there and
• 44:15to be willing to make a mistake.
• 44:17Yeah, and you know,
• 44:18I feel comfortable talking about
• 44:20therapy talking about my therapy.
• 44:23I'm in therapy now.
• 44:24You know someone.
• 44:25I've got saying therapist who's
• 44:27who's helping me with my grief,
• 44:29and it's been very useful for me.
• 44:31And once again,
• 44:33I have so much you know, you know,
• 44:36I I see how important therapy can be.
• 44:38And I I.
• 44:39I get a lot still out of
• 44:41out of my sessions with her,
• 44:44and fortunately she's someone who will
• 44:46do the same things that I'm talking about.
• 44:49She she works the way I did,
• 44:51and so it's it's.
• 44:52It's quite important for me and I'm hearing
• 44:54all kinds of interesting things, for example.
• 44:59A couple of sessions ago we
• 45:01were talking about, you know,
• 45:03resolving, resolving grief,
• 45:05getting through grief, going passing,
• 45:08and she was saying to me something that
• 45:09should be picked up from another person.
• 45:11You know the idea that you know that
• 45:14grief is is is like an amputation.
• 45:17You know it, you've lost a part of
• 45:19something you don't get over grief.
• 45:21You know, you just learn to live with it.
• 45:24You learn to live with the with you can.
• 45:26You don't get over an amputation,
• 45:28you just learn to live with it.
• 45:29That's that's a very
• 45:31important lesson to for me.
• 45:32Yeah, because I'm.
• 45:33I'm not going to get over this.
• 45:35I mean, my every time I think of
• 45:37her I see such richness in my mind,
• 45:40says comfort in my mind.
• 45:41I'm not.
• 45:42I'm not going to get over that,
• 45:43but I I have to learn to live with.
• 45:46And gradually that that's coming to pass.
• 45:53Thank you.
• 45:56It's it's really. It's wonderful
• 45:59to speak with you and I'm
• 46:02so grateful for your work. Yeah.
• 46:06It's hard to say to describe,
• 46:08but I could tell you the the
• 46:11existential psychotherapy text
• 46:12was just foundational for me
• 46:14in my own training before,
• 46:16and all of the fiction and another
• 46:19work since we've used for teaching
• 46:22all of our trainees for many years.
• 46:26It's invaluable,
• 46:26and it's it's something that will
• 46:28ripple forward for many, many years.
• 46:30Thank you. I love hearing you say that, good.
• 46:36Alright man, I am very
• 46:38pleased to now get to welcome
• 46:40live to our group Doctor
• 46:42Yalam I see you've joined us.
• 46:45You wanna come on screen and
• 46:46we can do a quick sound check.
• 46:51Not seeing you in my current
• 46:53view, oh. Iberico hello
• 46:58good morning, good morning.
• 47:00It's good to see you again.
• 47:01Welcome you look so there have been
• 47:05lots of questions showing up in the
• 47:07chat throughout the talk this morning.
• 47:09So we will try to try to get
• 47:11through at least a couple of them.
• 47:13Starting with.
• 47:14Could you say a little bit about who
• 47:16have been your inspirations both in
• 47:19your therapy work and also as an author?
• 47:23No, those are big questions, you know.
• 47:28My therapy work. I think roller may
• 47:32was a person that I tried to emulate.
• 47:36I imagine he's wrong right where my
• 47:39real models. Yes, I tell you roll.
• 47:43In terms of people,
• 47:45I've personally come into contact with.
• 47:48Yeah, we're allowed David Hamburg,
• 47:51who's chairman of my department was,
• 47:53was a magnificent soul.
• 47:55He was very important to me,
• 47:58but the therapist and people
• 48:00that I've seen doing therapy.
• 48:02I think my work is something
• 48:04like like Rolos, and I've gotten
• 48:05a lot of inspiration from him.
• 48:09And authors who have inspired your writing.
• 48:14You know almost my entire life.
• 48:17I've been reading a book and they're
• 48:19almost every every every imaginable
• 48:22good writer I've seen I've read,
• 48:25so it's hard to choose out some right now.
• 48:29People I'm reading are David Bancroft,
• 48:33British writer. Oh, I love his work.
• 48:37I love his sentences.
• 48:37Here's a few, many characters
• 48:39in it for a man is in his 80s,
• 48:42but you'll see when you get to be 80,
• 48:45you don't want to make characters
• 48:47and sometimes you have to start
• 48:48writing him down in the book so
• 48:50you won't forget it in the queue.
• 48:51And I've been,
• 48:52I've been reading and rereading
• 48:54a lot of his material.
• 48:56I like him very much.
• 49:02So I think those are the fiction writers I
• 49:05really most admire who are writing today.
• 49:08Like Sal Bellows, he's a magnificent
• 49:11American writer and I'm just about ready to
• 49:15start rereading some of his work together.
• 49:19Currently writing Arthur's.
• 49:20There's not many that I'm
• 49:22following right now.
• 49:23And when you get to be my age,
• 49:26you will need to look for characters
• 49:27for books with relative ease.
• 49:29You characters in it.
• 49:31That you'll see for dessert, skim books
• 49:33in the 1st place is here right there.
• 49:35'cause I will get.
• 49:37I will get confused.
• 49:39Paired up, we have a couple of
• 49:40wonderful questions that are coming
• 49:42in from residents in the program.
• 49:43Right now. One of them is.
• 49:48I'm going to read it and it
• 49:50starts with reference that
• 49:51this may be overly granular,
• 49:53but do you have any practical advice
• 49:54on how to introduce the here and now
• 49:57into conversation with your patients?
• 49:58Like any like?
• 49:59Like how do you actually say it?
• 50:00How did the words come out of
• 50:02your mouth when you're going
• 50:03to move into that work well
• 50:04for the list, I feel most two years now I'm
• 50:07only doing single session consultations,
• 50:09and frankly I don't particularly
• 50:13do it skillfully or only,
• 50:16but at some point I said, you know,
• 50:18I wonder if we could take a look at
• 50:20what's going on between the tools today.
• 50:21You know what's the session felt like to you?
• 50:25What feelings got a raise?
• 50:29We're not where I said such and such
• 50:31a thing can we talk about what's
• 50:33going on right here and that's
• 50:35the whole I do and then then I'll
• 50:37follow wherever the patient goes but
• 50:40it's rather it's rather brusque.
• 50:42It's not terribly not terribly graceful,
• 50:45but I'll say how I mentioned a few minutes
• 50:48ago as I was talking about this woman who.
• 50:52Had lots of first dates and
• 50:53never any second day,
• 50:54so that was important thing for her.
• 50:56You know.
• 50:57And believe in saying to her,
• 50:59you know what's going on right here
• 51:02is is really microcosm of what's
• 51:04going on in your outside world.
• 51:06What I'm feeling toward you is what
• 51:08other people feel towards you,
• 51:09so I'll bring it into the current
• 51:12hearing now, but I will do that.
• 51:15I never let a session pass.
• 51:18Never let a session pass without
• 51:20taking like how's it tells it felt
• 51:22like you today would have been
• 51:23feeling about my questions.
• 51:24Or are there any things I've said
• 51:26to you kind of felt uneasy about?
• 51:29Can we go back and take a look at that?
• 51:31It's just that simple, yeah?
• 51:34Another poignant question
• 51:36from one of the trainees.
• 51:38As a beginning therapist,
• 51:39I'm currently going through some
• 51:40grief of my own of my own and
• 51:42terminating with all of my clients
• 51:43at the end of our training year
• 51:45as well as around someone who I
• 51:47work with closely who came close
• 51:48to killing themselves and so,
• 51:50how do you hold some of your own human
• 51:52responses to working with people
• 51:54and becoming tide up in their lives?
• 51:59I know I just been doing it so for like
• 52:036070 years so it just it just
• 52:05feels like everyday workout.
• 52:06I don't have any problems.
• 52:09Holy what I'm hearing about
• 52:11about patience, it's it's not.
• 52:14It's not difficult for me.
• 52:16I will think about people between sessions.
• 52:19I dictate after every single session I do.
• 52:22After every session I do I will.
• 52:24I will dictate and I'll dictate
• 52:26the gutsy feelings that I have.
• 52:28Down to. Today used to be.
• 52:32You had to find dictate Dragon
• 52:35programs on your computer. Of course,
• 52:37now you just dictate into your iPhone and.
• 52:41And goes right,
• 52:42it goes right into the patients chart.
• 52:45I just learned that quite recently that you
• 52:48dictate notes into your into your iPhone.
• 52:50I then I used to email to myself and
• 52:53then I would have it in the computer
• 52:56and it happened by mistake I dictated
• 52:59a consultation summary and it was
• 53:01the worst summer Earth consultation
• 53:03I ever had and I said that in my in
• 53:06my dictation everything and then
• 53:08I tells me something about the
• 53:11difficulties he's having now with.
• 53:13With the person that she's trying,
• 53:14she's living with now and by mistake
• 53:17I mailed it to her and it was.
• 53:19It was the worst tragedy can be followed.
• 53:23Erica so, so I've written a story about that,
• 53:25so I think it's a very fun story,
• 53:27but and then eventually,
• 53:29after I gave all my apologies,
• 53:32I explained all this. She didn't hold me.
• 53:34Why were you emailing this to yourself?
• 53:36Don't you know that it's right
• 53:37or your computer?
• 53:38Anyway,
• 53:39so we talked about my my big a bit of
• 53:43a moron and how that feelings are hurt.
• 53:47How much we we someone picked up on
• 53:49one of the themes earlier and they
• 53:52were hoping you could elaborate as
• 53:54you were talking about the book and
• 53:56talking about Maryland you talked
• 53:57about the right time of death and
• 54:00could you say a little bit more about
• 54:02what you mean by the right time.
• 54:05Well, that's a that's a
• 54:07very personal question.
• 54:08I think it was nature that said,
• 54:09you know, die at the right time
• 54:12and in Maryland felt she died at
• 54:14the right time because she had the
• 54:16advantage of physician assisted dying
• 54:19at that point and a lot of people,
• 54:22many states in the United States,
• 54:24don't have that.
• 54:26I'll say something that's a
• 54:28little bit shocking to you.
• 54:29I think that I sort of feel I'm
• 54:32getting very close to the right time.
• 54:36I'm old, my memories is flaking away.
• 54:40I'm I'm alone.
• 54:41I do have wonderful children the same thing,
• 54:44but I'm not having a whole lot of fun
• 54:47in life and so I'm approaching the time
• 54:51of death and I don't have any regrets.
• 54:54And I think I know what the
• 54:57right time feels like to me.
• 55:00It's a little shocking for all of you
• 55:02know nobody in the audience is my age,
• 55:04but as I look around I'm I do have
• 55:06people in my life at the same time
• 55:09I feel lonely because all the
• 55:11people I've been close to or dead.
• 55:13You know all the close friends
• 55:15that I've had in the past.
• 55:16Another as old as I am,
• 55:18and it's always a shock to me,
• 55:21and they were always thought of
• 55:22myself as a young kid and can't
• 55:24quite get used to that image.
• 55:26But I know I'm very old now, and if it's any.
• 55:29Benefit to any of you saying
• 55:32it doesn't upset me very much,
• 55:35whereas in the past I've had
• 55:36great deal death anxiety,
• 55:38but I don't at the present time.
• 55:41Yeah, you when we spoke last week
• 55:43you actually said more about that
• 55:45theme of the things that have kept
• 55:47you hear that that in immediately
• 55:49after Maryland's death that that
• 55:50you had thoughts about about
• 55:51not wanting to be here anymore.
• 55:53And could you just say a little
• 55:55more about what what kept you
• 55:57here and what keeps you going on?
• 56:00Well, for me, the first two
• 56:02things I would say two things.
• 56:04One is my writing.
• 56:05I love the writing is something that
• 56:07gives me so much pleasure when I right.
• 56:10So that's all I'm doing it mostly.
• 56:12And the 2nd way is I love my clinical work.
• 56:15So every day of the year I
• 56:17see a patient I see a single,
• 56:19it's just a single session consultation once
• 56:21in a while patient will contact me back,
• 56:24but not doing any ongoing therapy now.
• 56:26So I see a patient that's that's
• 56:28always interesting to me.
• 56:30Without exception,
• 56:31everything that comes up I think
• 56:34about for a long time dictate keep
• 56:37the lips to myself, of course.
• 56:39But so I think that that's one of
• 56:41the things that.
• 56:43That really keeps me going.
• 56:45I know that mostly audiences
• 56:47are just are just starting out,
• 56:49but it is such a year in such
• 56:52a privileged and pleasurable
• 56:53profession because I actually look
• 56:56forward to saying every patient,
• 56:58it's always exciting to me to see
• 57:01what's going to happen and in this
• 57:03in this context that we're going
• 57:05to have today are someone that I'm
• 57:07going to be seeing in an hour.
• 57:08I'll be seeing someone else for
• 57:10a patient for today.
• 57:12It's so interesting to me.
• 57:14And by this time I have so much
• 57:16life and so much experience.
• 57:17I usually get offered something from
• 57:20them and even there's not anything specific.
• 57:22They all imbued me with so much
• 57:24wisdom 'cause they read my books
• 57:26and think I know a great deal.
• 57:27And so I will if I will say things.
• 57:29If I have a sense that that person
• 57:31is going to be a good therapist,
• 57:33you know, I I, I don't hold back,
• 57:35I'll say that you know from
• 57:37things you said like this.
• 57:39And this is never feeling.
• 57:40You're going to be a good therapist.
• 57:42That that means something to the
• 57:44people that I'm speaking to.
• 57:45Because the.
• 57:46They do read my books,
• 57:47they hold me in high esteem and they they
• 57:50may not forget that for a long time,
• 57:52yeah.
• 57:54A tough question from someone else.
• 57:59So first thank you for speaking
• 58:00so eloquently about your personal
• 58:02grief and reading from the question.
• 58:04Do you have advice for us in the
• 58:06context of the pandemic dealing
• 58:08with our own physically distant
• 58:11losses with and helping others
• 58:13cope with enormous losses?
• 58:15An ongoing grief?
• 58:17Especially while we're while we're isolated,
• 58:20I you know, I don't.
• 58:21I'm I've been sort of lock down all this
• 58:25time I've been to the grocery store.
• 58:28I think one time like children
• 58:30do the shopping for me and
• 58:31take care of me in that way,
• 58:33so I don't think I it.
• 58:36I'm so isolated as it is.
• 58:38My house is empty at this point,
• 58:40so it's for me.
• 58:42It's a bit of a double whammy.
• 58:46And in that regard,
• 58:49but I I'm I'm gradually
• 58:51getting used to the isolation.
• 58:54We have one person who's clamoring,
• 58:57do you have any plans for another novel?
• 58:59Can you tell us a little more about
• 59:01about what you are writing currently?
• 59:05But I'm ready now. Is is the stories that
• 59:09emerged from the consultations are doing
• 59:12so I see a patient every day of the year.
• 59:15That's well over 300 each year, and maybe
• 59:18I don't know if I mentioned this before,
• 59:19but maybe one out of 10 story sessions that
• 59:22I have right now is about one out of 20.
• 59:25There's some sort of a story that begins
• 59:28to emerge in my in my mind, and so I those,
• 59:31that's what I'm writing now. I write.
• 59:34I'm writing short term stories,
• 59:35each of them about 7.
• 59:37A patience and I love doing that.
• 59:42I'm going to try to sneak
• 59:43in one more question.
• 59:44We have Doctor Karasu who's
• 59:45going to be actually saying
• 59:47a couple words in a minute,
• 59:48but one more question if we can,
• 59:51can you just speak to the role of
• 59:54technology and cell phones and and
• 59:57how the role that they're playing
• 59:59now for therapy for group therapy
• 01:00:01for all these different things?
• 01:00:02And I find it striking you've
• 01:00:04been well ahead of the curve
• 01:00:05office that you've been doing.
• 01:00:07Remote consultations for quite some time.
• 01:00:09Yeah, well,
• 01:00:11I don't know if I've said this before.
• 01:00:12I kind of hate to say this,
• 01:00:15but when I see someone on the zoom,
• 01:00:18I'm not seeing a lot of difference
• 01:00:20from seeing that person one to one.
• 01:00:22I'm so accustomed to it.
• 01:00:24I do feel just as I feel right now.
• 01:00:26I'm looking right into your eyes.
• 01:00:27I think you're looking into mine.
• 01:00:29Sometimes I'll ask patient,
• 01:00:30would you mind looking straight
• 01:00:32at me so I get an idea of where
• 01:00:34we are in that so I don't see
• 01:00:35a lot of difference in in.
• 01:00:37Individual therapy and zoom.
• 01:00:39And maybe they would talk about
• 01:00:42zooms in groups before,
• 01:00:44but to do group therapy and zoom.
• 01:00:47That's a mix that's a mixed
• 01:00:49bag for me. First of all,
• 01:00:50attendance is so much better on zoom.
• 01:00:53People have town there there all
• 01:00:56the time. And also you do see unusual
• 01:00:59things you see inside of other peoples
• 01:01:01homes every once in awhile you see
• 01:01:03a child running and that things you
• 01:01:05don't ordinarily see in a group,
• 01:01:07but I have some. Feelings
• 01:01:08about negative feelings
• 01:01:10about doing a group use?
• 01:01:11I'm seeing these seven eight faces
• 01:01:13all looking straight ahead and
• 01:01:15what I don't see is who's looking
• 01:01:18at who, who sitting next to who,
• 01:01:21sometimes with the posture might be so
• 01:01:23I'm missing a lot in a in a therapy
• 01:01:25group I I would much prefer
• 01:01:27to do therapy groups first,
• 01:01:29face to face where the individual
• 01:01:32therapy is pretty close,
• 01:01:34really. I I don't think I'm at a great
• 01:01:37disadvantage and zooming with people.
• 01:01:39But as you, as you say, I've done this
• 01:01:41probably first it some years now.
• 01:01:44Yeah, thank you so much.
• 01:01:46There are way more questions
• 01:01:48than were able to fit in. Sorry
• 01:01:50we don't have more time. No
• 01:01:52thank you. I do want to turn it
• 01:01:53over now to Doctor Karasu though,
• 01:01:54who I believe wants to make
• 01:01:56a couple of remarks here.
• 01:02:01And Chris stress you probably need to unmute.
• 01:02:06Can you hear me? Yes,
• 01:02:08now I can hear you. Hi already.
• 01:02:10Hello, delighted to see you.
• 01:02:13It's been a long time.
• 01:02:14Thank you. It has been a long time.
• 01:02:18Thank you, David.
• 01:02:20First I would like to take John Crystal
• 01:02:23for your generous introduction and
• 01:02:27I appreciate an I'm honored by your
• 01:02:31disturbing upon me to distinguish
• 01:02:33Alumni Award and also establishing
• 01:02:35the lectures and this prestigious
• 01:02:38department that you made it as
• 01:02:41best department in the country.
• 01:02:44I am most grateful. Thank you.
• 01:02:49Thank you for accepting this invitation
• 01:02:52an inaugurating these lectures, but I
• 01:02:56couldn't see anyone even better to do that.
• 01:03:00Woman is one of Dave speaking to you now
• 01:03:03and you are one of my two psychotherapist
• 01:03:06in the country that I really admire.
• 01:03:09You being one of them.
• 01:03:10The other one is Aaron back and the
• 01:03:13Mother of Cognitive Therapy, both of you.
• 01:03:19Bring forth paradigm changes into
• 01:03:22theory and practice of psychotherapy.
• 01:03:28Now I can speak to the audience.
• 01:03:30Why do what do I have with
• 01:03:32these two extraordinary people?
• 01:03:34We are all three of U.S.
• 01:03:36citizens of certain times.
• 01:03:39That is, you are old.
• 01:03:46But we all still see patients give
• 01:03:50lectures and write at this age,
• 01:03:52so that is. Something common.
• 01:03:58One of the residents, urban ask
• 01:04:00you the question about the dying.
• 01:04:03The time of the dying,
• 01:04:04and as you described as
• 01:04:07painfully about your wife stats.
• 01:04:12This may not go well with the audience,
• 01:04:14but I believe that people should die
• 01:04:17at the height of their obituaries.
• 01:04:22After that it gets little
• 01:04:25too lonely in the funerals.
• 01:04:27We're getting closer that age.
• 01:04:32With today's honor, I feel like I I have
• 01:04:36reached that point of hytrel my obituary.
• 01:04:40Now that means that I want to die. No.
• 01:04:44This is the interesting part of it.
• 01:04:49It is. Philosophy is one thing,
• 01:04:51but the reality is something else.
• 01:04:53Neither know nor you,
• 01:04:55nor any human being was to delete.
• 01:04:57I even do you want to die to join Marilyn?
• 01:05:01That's a wonderful by the way.
• 01:05:04Comfort of the religion.
• 01:05:06'cause they perpetuate the sense of eternity.
• 01:05:09In fact, the.
• 01:05:11Abrahamic religions stinks.
• 01:05:13Say us as being sub species attorney.
• 01:05:17Tottus etc. Comforting idea,
• 01:05:20but eternity doesn't mean endless time.
• 01:05:25It's a, it means, timelessness.
• 01:05:28It's a succession of times
• 01:05:31and present is a is in now.
• 01:05:35Eternity is depressant, not recognizing.
• 01:05:38That creates enormous anxiety depression.
• 01:05:42Something else is actually
• 01:05:44an I'm an ambiguous unrest.
• 01:05:47I couldn't really put a symptom name to it,
• 01:05:51and unrest that I have
• 01:05:54seen with patients in him.
• 01:05:56It is did nothing.
• 01:05:58This walking into void and nothingness
• 01:06:01seems to be the most of serving.
• 01:06:04Almost everything is better than nothingness.
• 01:06:06Even the chronic most troublesome illness
• 01:06:10they would rather live with that than dying.
• 01:06:14People would rather go to hell.
• 01:06:18Then going nowhere,
• 01:06:19as only it as long it is eternal hell.
• 01:06:23Of course,
• 01:06:24he preferred to go to heaven,
• 01:06:25but whatever is available internally.
• 01:06:33One must live life. I know you did lived,
• 01:06:38lived and love your life when I know.
• 01:06:42But one must also live once death.
• 01:06:48We commonly live other people's deaths.
• 01:06:53And we sort of die other people's lives.
• 01:06:58It's very difficult to actually
• 01:07:01to even conceptualize once that,
• 01:07:04especially when you get certain age,
• 01:07:06like our age.
• 01:07:07One cannot do that, it gets, it gets it,
• 01:07:11fragments even the most stable people.
• 01:07:15So one must come to that in
• 01:07:19terms of temporality of life.
• 01:07:22In a young and healthy age.
• 01:07:26Young Mary and in fact, Socrates,
• 01:07:28as you would know at the age of 80,
• 01:07:32when teenagers ask him to give an advice,
• 01:07:35he says. Practice time.
• 01:07:39Try to practice dying.
• 01:07:45I have a little vignette.
• 01:07:46I think that you and audience may
• 01:07:49like about the temporality of life.
• 01:07:53Once a young tourist. Visits.
• 01:07:58A well known rabbi in all country.
• 01:08:03He was amazed to see that
• 01:08:06Rabbi's house was near empty.
• 01:08:10Chris asked. Where is your furniture rabbi?
• 01:08:16Rabbi replies. Where is yours?
• 01:08:22Mine. Mine says tourist. Smiling.
• 01:08:29But I'm only passing through.
• 01:08:33Rabbi says. So am I son. So am I.
• 01:08:39I think we're all passing through.
• 01:08:45Death is everyone's birthright.
• 01:08:52May I wish you very long life.
• 01:08:55Thank you very much, so lovely comment.
• 01:09:03Again, Many thanks to Doctor
• 01:09:05Karasu directly along.
• 01:09:07Many, Many thanks for joining us.
• 01:09:09Thanks everybody for the
• 01:09:10wonderful questions and dialogue,
• 01:09:12and I believe next week
• 01:09:13is the last minute word,
• 01:09:14so we'll look forward to seeing
• 01:09:15you back for that, OK?