Couch is a series about psychotherapy.
Steve, my patient, fancied himself a poet, first and foremost. Brilliant, yet sadly bedeviled by schizoaffective disorder — a condition somewhere between schizophrenia and bipolar — he feared he would die before his gift was discovered. “I think I’m dying,” he said every week. His poetry reflected this preoccupation. For example:
The roses are down-petaled, so they meet their end.
Indeed, he used his writing to keep himself alive, to soothe himself when spinning out of control, and even to fuel his psychosis when he drifted into madness. Most of all, however, poetry kept him connected to others.
I first met Steve when he was referred to my psychology practice by a colleague who no longer took his insurance. I also suspect the colleague had grown tired of Steve, whose emotional pain, grandiosity and idiosyncratic ways of engaging were sometimes hard to stomach.
Steve led a difficult life. Over many years, starting when he was a promising student at an Ivy League college, he endured a series of psychiatric hospitalizations. In one of these, back in the ’60s, Steve had electroshock treatment — yet his memory remained as fresh as the latest poem he’d read or written, the latest pretty woman he’d met, the latest conversation he’d had with his brother or sister. Miraculously, he remained positive:
Though I shattered into bits and pieces
I believe in man’s unconquerable mind.
Though man is born to tears,
I believe in life’s laughter.
Now 65, Steve was large and lumbering, a “sad sack,” as he once heard someone describe him. Yet beneath this shuffling heaviness I saw a twinkle, and this — the twinkle — was all about poetry. I was intrigued.
We settled into a strange dynamic: Try as I might to get Steve off the subject (and believe me, I tried), Steve was most interested in exploring poetry. His mission was to train me to be his eager and attentive apprentice first, and then to be an admiring audience. Steve was the professor, I the student. Aware that I sometimes wrote professionally, he badgered me to write poetry while acknowledging it was no easy task:
A poet waits for the light
Waits for the night,
Waits for the night’s lights (the stars).
A poet waits for divine madness.
I declined because I knew it would further confuse our work and, also, I admit, because I knew he was a better poet than I could ever hope to be.
He lugged poetry books to his sessions and regaled me with his favorites: Shakespeare, T. S. Eliot, Emily Dickinson, Dylan Thomas, Robert Browning, Edna St. Vincent Millay, among others. As if teaching a graduate level seminar, he’d take each line and offer his perception of the poet’s intent. Then it was my turn.
We often disagreed. Steve’s analyses were usually lustier than mine, less intellectualized, always refreshing and unique — a window into his soul. We’d explore his interpretations, looking at associations, considering why certain lines spoke to him and why other lines did not. In fact, poetry quickly became the medium of his therapy, a medium I can liken only to dream analysis.
Also a frustrated actor, Steve would sometimes deliver, in stentorian voice, a Shakespearean sonnet or other poem he had memorized. More often, he’d theatrically recite his own creations, poems that could be opulent or simple, yet were often profound in message and a reflection on his struggles in living:
If life be enemy and death, a friend
Living, drudgery, till being and non-being blend
Can all we hope for is time to end
That we may be at peace.
Steve’s poems were full of his pathos, a sorrow that spilled into my office. Poetry — his own and others’ — could make him weep and, in these moments, we plunged into his internal world in depths that eluded my “healthier” patients. In time, I came to know him intimately and to treasure him.
This is not to say that Steve wasn’t difficult. For one thing, he didn’t take good care of himself. Once, I sent the police to his home after he didn’t show up for a session and didn’t call. They found Steve on the floor, dehydrated and disoriented; he spent weeks in the hospital. Shortly after his discharge, he arrived in my office wearing pajamas and spouting new, now truly alarming, poems. He hadn’t eaten for days. I called an ambulance and got him some food. It was back to the hospital for him. His family insisted he move to a group residence with more supervision.
Steve recovered from that episode, yet continued to be challenging. He often rejected my psychoanalytic interpretations and sometimes made inappropriate and unwanted romantic advances to me as well as to women half his age and even younger. He’d demand attention and pity, saying he needed a “hug.” He resisted my entreaties that he edit his often salacious remarks, especially in certain company. He passively threatened suicide just to see my reaction.
And weekly, he let me know that he thought he was at death’s very door (the roses are down-petaled, so they meet their end).
It was one of these times — that is, when he said “I think I am dying” — that I, weary of his antics, said, “Steve, we are all dying.” Although I caught myself and then backtracked, I didn’t for a moment fear that I was losing Steve. I attributed the gloom of the moment to the therapy. Our work was deep: Using poetry, we were now vividly attuning to the painful memories of loss brought on by his illness.
Except, this time, Steve was dying; I just didn’t know it. One day, Steve, who seldom missed a meeting, called. “Can we do a phone session?” he asked. This time, there was no talk of poetry. Instead we spoke of Steve’s recent dip in energy and motivation, and of how it might be tied to his disappointment in some old and new relationships. At the end of our conversation, Steve declared that he felt better and would see me the following day.
But the next day came, and there was no Steve, and no message from him. I called his group residence. “He left early this morning,” a staff member recalled. She promised to check on his whereabouts. An hour passed — and then the news: Steve had died, alone in his apartment, actually never having ventured out that day. I was stunned.
What do you do when a patient dies? For psychotherapists, relationships with patients are far more than casual; they are often intense and deeply cherished. Especially if we’ve not had time to prepare, we can feel the same as if we suddenly lost a close friend or even a family member — devastated. Worse, it’s often a lonely mourning.
So, on that day when Steve died, I sat weeping in my office, uncertain how to console myself. I thought of our work together, of the poetry we created in our connection. I thought of what I had given him, what he had given me. I conjured up his warm, sonorous voice and his poems …
With the setting sun, past the rising moon
Beyond the spinning earth, April, May, June
We are tomorrow on its way …
I wondered how to pay him tribute.
What did I do?
I wrote a poem.
Details have been altered to protect patient privacy.
Ruth H. Livingston is a co-editor of Contemporary Psychoanalysis, the journal of the William Alanson White Institute.
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