Yale Psychiatry Grand Rounds: May 21, 2021

May 24, 2021

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Inaugural Toksoz Byram Karasu Lectureship in Psychosocial Studies: "A Matter of Death and Life: A Conversation With Dr. Irvin Yalom"

Irvin D. Yalom, MD, Professor Emeritus of Psychiatry, Stanford University

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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?