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by Irvin D. Yalom
Review by Christian Perring, Ph.D. on Nov 5th 1999
It must have been nearly ten years ago when I read Irvin Yalom's earlier tales of psychotherapy, Love's Executioner, with great enjoyment. It was when I was first really getting into the whole genre of tales of psychotherapy, and I was going through them like I used to go through P.G. Wodehouse's Jeeves stories when I was a boy. Tales of psychotherapy were like mini-murder mysteries, with the therapist searching for clues to find both the nature of the underlying problem, the cause of the problem, and the solution to the problem. I especially liked The Taboo Scarf by George Weinberg, and The Patient Who Cured His Therapist by Stanley Siegel. With each tale taking no more then twenty or thirty pages, they were bite-size morsels, little parcels of pleasure. So satisfying, and educational too!
Since then, the thrill of tales of psychotherapy has diminished for me. As with any genre, this one has its limitations. I started to wonder how confident the therapist was entitled to be about his or her own view of the effectiveness of the therapy. The credibility of the author's claims is thrown into some doubt because these tales are to some extent fictionalized in order to protect the identity of the people the tale is based on. In some cases, a character bears little relation to any single person's actual life, because he or she is a combination of a number of actual patients all rolled into one. And even if the tale were a precise record of events, how sure could we be about what actually caused the changes in the patient? Most studies of therapeutic effectiveness have failed to confirm the truth of any particular theory of how therapy helps. Most studies seem consistent with the view that it is the mere process of regularly sitting with someone sympathetic and discussing one's life that is helpful, and not anything that the therapist might do or say that has therapeutic effects.
Furthermore, it is hard to not wonder about the motivation for a therapist behind writing a record of his or her cases. What determines which cases are worth writing down? How many of the therapist's blunders and embarrassing errors get included in the stories? How can the therapist avoid such a book being an exercise in smug self-congratulation? Even when a therapist writes confessionally of his or her mistakes, is that not also potentially self-serving? I started to prefer to read the stories of therapy written from the point of view of the patient.
Now Yalom has written a new set of six tales. "Long-awaited," says the blurb on the flyleaf. By the publisher, maybe. For my own part, I found Yalom's new book both smart and annoying. He is perfectly well aware of the problematic nature of this genre. In Momma and the Meaning of Life, he does more to tackle these issues in a somewhat oblique way. Three of the six stories here are listed as non-fiction; in another the story is only remotely based on a true incident. The other two chapters are fictional and even fantasy at points, yet at the same time are clearly there in the book because they have some point to make about psychotherapy. The question is, what point is he trying to make? By including fiction along with reality, Yalom seems to be acknowledging that his tales can't prove anything by themselves. Or maybe not. The recent controversy over the recent biographer of Ronald Reagan using a fictional device in Dutch to describe Reagan's early years suggests that people are unsure exactly what to make of a blend of fact and fantasy in a genre which is normally categorized as non-fiction. Similarly, I wasn't sure what to make of Yalom's unusual approach.
Yalom is well known as a practitioner and advocate of existential therapy, and he has written a number of textbooks in this area. In Love's Executioner, his tales served as illustrations of theoretical points, even if the theoretical point is that there are limits to the use of theory. In the Prologue to that earlier book, Yalom wrote, "The powerful temptation to achieve certainty through embracing an ideological school and a tight therapeutic system is treacherous: such belief may block the uncertain and spontaneous encounter necessary for effective therapy." Thus, as a good existentialist, his tales illustrate how it is important for a therapist to remain open: to conduct therapy according to a manual will inevitably get in the way of an authentic encounter between the two people talking together.
There's no indication in his writing that Yalom has changed his theoretical perspective, but in his new book, he says almost nothing about theory. There is no prologue or introduction, there is no bibliography, and there are no footnotes. He does provide a website to accompany the book, giving some references and some discussion, but even there you won't find much detailed discussion. In an Author's Note at the end of Momma, Yalom does briefly explain that in this book, he has made storytelling his top priority, so the teaching part of his mission has had to take second place.
As a good existentialist, death is a central issue for Yalom. In the short first chapter, with the same title as the book, Yalom writes about his mother and his relationship with her, during her life and after her death. She was a difficult woman to please, and rarely if ever gave her son praise. Yalom realizes that his treatment of her was not all it could be either, and through this works out some old emotional issues which were still affecting his dreams and probably his waking life. "Travels With Paula," the second chapter, focuses on a patient with breast cancer with whom Yalom had a long and complicated relationship. She moves from being a patient to being a co-worker in group therapy for people with terminal illnesses, to becoming estranged from him. In his mind, his mother's death and the resolution of his relationship with Paula are related, although the exact connection is elusive. For five years, he treats a women who lost her husband to a brain tumor in another "non-fiction" chapter, "Seven Advanced Lessons in the Therapy of Grief." His patient, Irene, is both deeply depressed and also a very smart and difficult woman, but she eventually reconstructs a life for herself.
In some ways, Yalom's touch is light in these tales. He does not hammer his point home with the use of examples in the manner of popular psychology and self-help. His references to psychoanalysis and other theoretical approaches are always brief. He is often self-deprecating and is not shy to mention his own failings. Yet when reading these tales, I am filled with the sense that Yalom is the central figure and the underlying struggle is between him and his ego. Or maybe it's between him and his modesty. Whichever way around it is, Yalom is clearly aware of this dynamic. Indeed, he himself tells us how important it is to try to gain the approval of his mother: he desperately wants to be right, and thus to be praiseworthy. Not that he seems insecure-rather what makes his style off-putting is a sense of self-satisfaction that runs though nearly all his writing. But of course we are all depth-psychologists enough today to be able to proffer the interpretation that beneath smugness resides low self-esteem.
The fictional chapters do better at avoiding this dynamic, since Yalom does not figure in their narrative, even if the therapist figure in them if of course a stand-in for him. They are as well-written as the earlier chapters, and they develop interesting themes. Yet they are more like intellectual exercises, clever but ultimately not as gripping as the non-fiction part of the book. It seems it is Yalom's grappling with his own need to be right that is the emotional engine of his writing. And in the end, it doesn't seem like such a terrible motivation, so long as he can keep his arrogance in check, which he does.
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