By Irvin Yalom
Discovering the Third Way
I entered psychiatry as many people did in the 1950s, seeing a traditional, Freudian psychoanalyst four times a week. She was older and had a suite of five offices, all of them rented by therapists she’d once analyzed. She was like a grandmother analyst, and I guess you could say I spent 700 hours being psychoanalyzed by my grandmother.
Looking back, it’s clear it wasn’t 700 hours well spent. In fact, it offered a good instruction on how not to do psychotherapy. Despite all the time and expense, we never dealt with any of the issues that came to seem to me more and more the central concerns of life in later years: mortality, freedom, the search for meaning, and our ultimate existential isolation.
Then in 1958, psychologist Rollo May came out with his book Existence and, suddenly, I saw there was a third way for psychotherapy—something that wasn’t biological or psychoanalytic, but a way of grappling with the great existential challenges of life. I decided to write a textbook to further explore this new, alternative pathway for therapists. To do that, I felt I needed to do something bold that nobody else was doing at that time: I needed to talk to people facing their own mortality close up.
My ordinary patients weren’t prepared to do that, so I asked the other professors at Stanford and the faculty in the medical department to send me their dying patients so I could talk with them. By then, I had quite a bit of group experience, so I started seeing these patients in groups.
That experience was extremely anxiety provoking, for me and my students. It was so poignant and moving to listen to people trying to cope with the idea that they were going to die shortly that I actually developed night terrors, and many of my students watching these group sessions from behind a one-way mirror often ran out of the room in tears.
Psychotherapy’s Biggest Challenge
The thing that’s most troubling to me about our field is the demise of training in the kind of psychotherapy that I’m familiar with. These days, I feel that I’m a bit of a dinosaur. I’m in a group of 11 other therapists, a bunch of white-haired therapists, all with full practices who have more patients than we can see. But there aren’t going to be people like us in the future. If somebody wants a referral to a good psychotherapist now, I’ve got to really strain to find one. I find myself thinking, “They’ve got to see someone with gray hair, because the young psychiatrists aren’t being trained to do depth psychotherapy—or really any kind of psychotherapy.” Cognitive-behavioral therapy has taken over.
Recently, I met with a bunch of group therapists who each led, on the average, five or six groups. That meant there are about 80 therapy groups represented in our little seminar, almost all of them short-term, behaviorally oriented. The emphasis was on imparting knowledge, teaching people about subjects like panic attacks or other anxiety symptoms, giving them exercises to work on, and doing manualized treatment. None of them was interested in helping people focus on how they came across interpersonally or how to solve other interpersonal issues. That’s sad to me.
I’m a little bit mellower about facing my own mortality at this point. I don’t have the uprising terror and anxiety that I used to feel. The other day, somebody sent me a picture of the Stanford faculty in 1963. It was wonderful seeing all my old friends. I thought, “Oh, I’ll e-mail this to some other people.” Then I realized that almost everybody else in the photo was dead. That was a sad moment for me.
At this stage of my life, I’m finding that once you get your mind around the idea that death isn’t so far off, you can actually learn to live a little bit differently. My wife, Marilyn, is slightly younger—a half-year younger than I—and we’re enjoying our times together very much. Recently it’s been warm weather, and Marilyn doesn’t want to do anything but sit outside in the sun and read the newspapers with me. It feels so good. We keep making jokes saying, “I guess these are the Golden Years,” and they really are.
I learned a long time ago from my group of cancer patients that there are many people, even in the midst of this awful illness, who actually start to change in a positive way. They grasp that they’re going to die and begin to say, “Why am I spending time doing what I don’t want to do? Why am I seeing people I don’t want to see?” They begin to reexamine what’s really meaningful and what’s trivial in their lives; they start saying no to things they don’t want to do.
Once you fully realize that you really are mortal and that you’re going to die, you can come to appreciate life more fully. You don’t waste quite so much time striving for material goods. As German philosopher Arthur Schopenhauer said, if you strive for objects all the time, eventually, you don’t have them: they have you.
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