Rafael Yglesias - Dr. Neruda's Cure for Evil

“A perfect description of psychotherapy,” Harry said.

“Do something bad?” Susan asked wonderingly.

“I remember thinking at one point that he was worried I would hit him.”

“Possible abuse came up, didn’t it?” Susan asked. “About the father. When the mother made that—”

“That came from me. I said the law wouldn’t allow her to skip getting the father’s permission unless she was alleging abuse.”

“What?” Harry said. “Where did you get that gobbledy-gook?”

“The mother was trying to get Rafe to agree to keep the therapy secret from the boy’s father,” Susan explained.

“I needed to invoke the law or she would have kept after me forever.”

“We do require the parents’ permission,” Susan said. “That was appropriate.”

“A little hyperbolic,” Harry said.

“I can’t become part of whatever neurotic dynamic the mother has going with the father. And, besides, treating him in secret could easily become a legal issue,” I said. “You can’t treat minors without the knowledge of parents and I assume that means both parents.”

“Absolutely,” Harry said. “But it’s medical ethics. Why drag in the law?”

“You didn’t assert yourself,” Susan said.

Harry turned off the whistling kettle and shook his fist at me with mock outrage. “Be more phallic. You’re a goddamn M.D. You can sic the AMA on her.”

I covered my face. Despair, fatigue, disappointment in myself, the feeling that everything I had learned and worked for had been wasted overwhelmed me — and the knowledge that these reactions were excessive only made them worse.

“Rafe.” Susan said my name quietly, but it was a prompt. “Come on. Keep using your brain. Don’t indulge.”

These were key phrases from my therapy with her, Pavlovian in their effect. I uncovered, looked into her eyes and listed the reasons aloud. “I was angry at her, convinced I couldn’t stand up to her, so I grabbed for you first as a defense.”

“Help, Mommy,” Harry said.

“Shh,” Susan said.

“He’s right. Then I reached for the law—”

“Help, Daddy,” Harry said.

“And I was scared that if I was her only obstacle, she would talk me out of it and, typically irrational, I was scared if I stood my ground, she would use that as an excuse not to bring Gene in for therapy.”

“But that’s what you wanted, not to have him as a patient.”

“Me. I didn’t want to treat him. But I didn’t want to give her a way out of giving him treatment.”

“Sure is irrational,” Harry said. He put a cup of coffee in front of me. “She brought him in. She wanted him to be treated—”

Susan cut him off. “You didn’t believe her?”

“The school forced her to bring him in. No, I believe she wants her son to think of himself as sick. I don’t believe she wants him well.”

“Huh?” Harry said. “That’s quite a leap.”

“I know. I said I was out of control. Anyway, he needs treatment. I wasn’t confident that refusing to keep the therapy secret from his father was correct.”

“You were worried it was something you reached for to get out of being his doctor,” Susan said.

“Right,” I said. “So I wanted to leave the decision to you.”

“Bullshit,” Harry said mildly. “You were just being chicken.”

“No,” Susan said, equally mildly. “You let Felicia see you without telling her parents.”

I nodded.

“Felicia?” Harry asked.

Susan explained to Harry while he brought her a cup of coffee. “Felicia came in eight months ago. All by herself. She’s twelve. Her mother was a prostitute—”

“I remember,” Harry interrupted. “Your miracle cure. Twelve-year-old heroin addict turned into a ballerina. My wife, unfortunately, is right. You could have gotten into a shitload of trouble for seeing Felicia on the sly.”

“That’s the point. Why wasn’t I willing to take a very modest chance for Gene? It was a disgusting impulse.”

“No!” Susan slapped my hand, lightly, but it was still a slap. “Use your head. You were using it in the session. You’re not now.”

“I had a reason? A good reason?”

“Yes!”

I recalled the provocation: Carol lowered her voice, but not enough for Gene to be excluded …

“She was driving a wedge between Gene and his father,” I announced brightly, like an obnoxious A student in class. “The loss of the father-object is his central issue. I want the father to know his son is sick and I don’t want to strengthen the mother’s grip of guilt and shame about his need.”

Susan clapped. “And what’s more — you’re right. Don’t you think, Harry?”

“Yeah, yeah. He was right in theory, but in practice he was a chicken.”

“I was,” I admitted happily. “But it wasn’t just coming from my gook, I was still making a therapeutic choice.”

“You should have taken the responsibility yourself,” Harry said. “And not laid it on Susan or the fucking law.”

“You’re right. I had to be his father.”

Susan nodded. “His loss is acute.”

“Too acute given the slight provocation. That’s why I suspected abuse. It wasn’t just projection.”

“How could it be projection?” Harry said. “Your father didn’t abuse you.”

Susan shook him off. “Shut up for a second, Harry.”

“Be happy to,” he said, sitting down.

“You have to be Gene’s doctor. It’s important for you and Gene.”

“I can’t do it,” I said.

“What do you feel?”

“Scared.”

“Of what?”

“Failing.”

“Oh, heaven forbid,” Harry said.

“You have a right to fail. Your mistakes were minor. The transference, especially for one session, was excellent. And you have real empathy for him. Your intense dislike is an inversion of empathy.”

“He’s a boring case,” I said.

“What?” Harry said. “What the fuck does that mean?”

“I’m not even sure we should be treating him. He’s having some anxiety attacks, fucking up in school a little, okay, but we’ve got much more serious cases waiting for help.”

Harry gestured to Susan, like an emcee turning over the stage to a guest.

“You’re contradicting yourself,” she said. “You said before you believe he really needs treatment.”

“I’m talking triage. We’ve turned away people on the verge of nervous breakdowns. And he’s boring. Even a mediocre therapist could help him.”

“Rafe!” Susan said, ringing Pavlov’s bell.

“Yes?” I answered dutifully.

“Do you really think his problem is boring?”

It didn’t take long to see through myself on that one. “No. Somehow he’s too close to me, to my unresolved father issues. He’s a simple case for anyone but me. You should be his doctor. You could help him.”

“Not better than you can. And what’s more,” Susan put her long-fingered hand on my arm. Her grip was both insistent and reassuring. “He can help you.”

I CANNOT RECONSTRUCT THE NEXT TWO MONTHS OF GENE’S THERAPY with the kind of exact details I’ve given of our first meeting. I took meticulous notes that night after discussing it with Susan and Harry, for one thing, and for another, my work with Gene proceeded typically for a while. Getting his history was an easy process. He was forthcoming. Even his denials and repressions were, from a therapist’s point of view, straightforward.

At first, what attracted my attention was the unusual emphasis, for those days, on the father as a caregiver. Gene’s mother was really the family’s main financial support. Perhaps this was about to change thanks to his father’s successful exhibition, but certainly during Gene’s childhood she had the steady job; his father, at least in Gene’s memory, was the comforter, the nursemaid and cook, the mother-object. Not that Carol reversed sexual or emotional roles with her husband or he with her: she was clearly feminine, he clearly masculine. Thus the Oedipal dynamic was in place: Gene vied all the more for his mother’s attention because her work made it precious. However, he didn’t have to strive hard. Once she came home, Gene’s father abandoned the field to his son, vanishing into his darkroom. This led to an emotionally incestuous intimacy between Gene and his mother, hitting the Object Relations school’s central button: improper separation from the mother. [I was already distrustful of diagnosis and treatment based on theoretical constructs. I had had success — admittedly little at that time — by keeping to the specifics of my patients’ lives. For Gene, whether Freud or Horney or Sullivan or Erikson or Mahler would have been able to fit him neatly into their systems, the drama was the rivalry both mother and son felt with the father’s photography. His problem, I believed, was that this drama was entirely performed in his unconscious, his role as thoroughly repressed as if he had been locked out of the theater before curtain.]