Insider: Irvin D. Yalom

I intend to reflect on several books by and about Irvin Yalom, one of the best known and still living psychotherapists in the U.S. In some ways, Yalom has influenced more people inside and outside of psychotherapy than any other contemporary psychotherapist because he is not only the originator in the U.S. of both existential psychotherapy and group psychotherapy approaches, but he has also published a series of fictional accounts of psychoanalysis and other types of psychotherapy, as well as several volumes of case stories.

Irvin Yalom published “Becoming Myself: A Psychiatrist’s Memoir” in 2017 at the age of 85. I will review some of this book, along with Ruthellen Josselson’s biography of Yalom, titled: “Irvin Yalom: On Psychotherapy and the Human Condition”(2008), and comment on several Yalom’s fictional works.

Yalom’s “Becoming Myself” provides background and insights into his various career shifts and accomplishments. It is too infected with name-dropping for my tastes, but because I have read so many of his books and intersected with many of the same people he mentions, I appreciated making connections between why he pursued existential psychotherapy, group psychotherapy, then used his psychotherapy and philosophy interests to write novels, and why he continued to practice psychotherapy and teach.

Josselson’s book about Yalom includes an interview with him and excellent summaries of his philosophical approaches to existential and group psychotherapy, as well as insights into most of his clinical stories and novels. The best summary statement of Yalom’s position regarding existential therapy is one Josselson provides from Yalom’s book, “Staring at the Sun” (2008):

“Psychological distress issues not only from our biological substrate (a psychopharmacological model), not only from our struggle with suppressed instinctual strivings ( a Freudian position), not only from our internalized significant adults who may be uncaring, unloving, neurotic (an object relations position), not only from disordered forms of thinking (a cognitive-behavioral position), not only from shards or forgotten traumatic memories, nor from current life crises involving one’s career and relationship with significant others, but also- but also- from a confrontation with our existence.” (p. 66-67)

Yalom was able to engage with patients from multiple perspectives, yet he did not prescribe medication, though he was an M.D. psychiatrist, and he focused on the existential givens: coming to terms with our eventual death, with our aloneness in the universe, with finding meaning in life and with recognizing our freedom and taking responsibility for the lives we lead.

Yalom stated that he “never intended to create a new field of therapy. My interest was to increase all therapists’ awareness of existential issues in their patients’ lives. (p.199). Existential psychotherapy has become an approach and field of psychotherapy nevertheless. The existential givens, which most existential psychotherapists employ to frame their approach to therapeutic insights and healing, are informed by the ideas of a number of significant philosophers. Yalom was particularly influenced by the philosophy of Nietzsche. Because of his interest in Nietzsche, Yalom found that using fiction as a means of exploring the ideas of psychoanalysis and those of Nietzsche would be a fine way to share his understandings with a large public. He published the novel, “When Nietzsche Wept” in 1992. He had originally hoped to fictionalize an encounter between Nietzsche and Freud in 1882, but Freud was still in medical school when Nietzsche had need of a therapist, so Yalom blended fact and fiction for an encounter between Nietzsche and Josef Breuer, who was Freud’s professor, and likely the originator of “talk therapy”- later psychoanalysis. Yalom said “fiction is history that might have happened” (p.239). Brought together by Lou Salome, who appealed to Breuer to help Nietzsche with his suicidal despair, Breuer and Nietzsche end up assisting each other. Each of them had been struggling with romantic obsessions. “Yalom saw in Nietzsche’s philosophy a movement toward an interior, self-actualizing process, toward the possibility of realizing one’s own potential. Nietzsche’s instruction for the necessary inner work was, ‘Become who you are’. What could be a more succinct statement of the goal of existential psychotherapy” (Josselson, p.81). “When Nietzsche Wept” sold well over 2 million copies worldwide and established Yalom as a fiction writer.

Another philosopher who influenced Yalom was Arthur Schopenhauer. While Nietzsche’s philosophy gave Yalom an opportunity to explore particular life affirming existential issues in psychotherapy, Schopenhauer’s philosophy presented an opportunity to postulate a life-denying, life is suffering position and in his novel, “The Schopenhauer Cure” (2006), these two positions are interposed within a fictional group psychotherapy process. This gave Yalom a way to probe the dynamics of group psychotherapy and draw upon his vast experience as a group therapist.

A former patient of psychotherapist, Julius Hertzfeld, is invited to join a therapy group that Dr. Hertzfeld runs. This former patient, Philip Slate, is a sex addict and claims to have been cured by Schopenhauer’s philosophy and now has his own therapy practice using as his therapeutic framework Schopenhauer’s notion that life is an endless cycle of wanting, satisfaction, boredom, then wanting again, desires endlessly plague us and cannot be fulfilled. Dr Hertzfeld is facing his own mortality and invites Philip to join his therapy group to persuade him, with the help of the group, of the importance of human relationships to meaning in life. Josselson (2008) says that “The Schopenhauer Cure” “is the one volume in which Yalom combined his existential and group therapy interests. It was Yalom’s intention that “The Schopenhauer Cure” also serve as a companion volume to his group therapy textbook and the fifth edition of “The Theory and Practice of Group Psychotherapy” is studded with cross references to pages of “The Schopenhauer Cure” that provide illustrations of a number of group therapy principles.”

Yalom’s “Lying on the Couch” (1996) turns the tables by investigating therapists rather than patients. His characters represent types which explore a number of issues that contemporary therapists have dealt with, such as transference-countertransference, the boundaries of sexual propriety, the role of money in relationships with patients, personal woundedness, such as obsessive-compulsive behavior, and the politics within a psychotherapeutic community. While this is fiction, Yalom probes much of the same territory as Gottlieb did in her “Maybe You Should Talk with Someone” (2019).

It is difficult to fully assess the impact that Yalom has had within and beyond the field of psychotherapy, because his fiction, non-fiction, teaching, and therapy practice have all influenced a wide variety of people. He has claimed that his autobiography will be the last book he writes, yet because of the meaning writing has provided him, one wonders if he may have even more material to explore. There are two quotes from his “Becoming Myself”(2017) which I believe represent the core of Yalom’s existential philosophic principles.

“The greater the sense of unlived life, the greater the terror of death” (p.294).

“I take very seriously the idea that, if one lives well and has no deep regrets, then one faces death with more serenity”(p.295).

Insider: Barbara O’Brien

There are two themes from Perceval’s Narrative which I wish to explore: Bateson’s idea of the double bind (to be discussed in my next post) and the unusual circumstance of an apparent “spontaneous recovery” from schizophrenia, which I will discuss here. Barbara O’Brien’s “Operators and Things”(1976) is the most vivid account of a schizophrenic journey during her six months riding on Greyhound buses across the U.S. while being controlled by “Operators” – her hallucinated voices. O’Brien explains what she knows about schizophrenia (in 1958 when the book was first published) in the opening section of her book. She then explains how she developed schizophrenia and how the operators first came to her:

“I developed schizophrenia abruptly, in the way which is now considered most fortunate for an optimistic prognosis. I awoke one morning, during a time of great personal tension and self conflict, to find three grey and somewhat wispy figures standing at my bedside. I was, as might be imagined, completely taken up by them. Within a few minutes they had banished my own sordid problem from my mind and replaced it with another and more intriguing one. They were not Men From Mars, but the Operators, a group in some ways stranger than Martians could be. I listed to what the Operators had to say, weighed the facts which they presented to me , and decided that there was wisdom in following their directions. I packed some clothes and mounted a Greyhound bus, as they directed, and followed them. Riding off in the bus, I left safely behind me a mess of reality with which I was totally incapable of coping.” (p.9-10)

O’Brien narrates the specific personalities and characters of each of her Operators along her six -month long Greyhound schizophrenic journey. At one point she queries Hinton, one of her chief Operators, about the relationship between Operators and Things:

” Hinton sighed. ‘Things. Yes, of course. think of the word with a capital initial, if you like. It may help your ego a bit. All people like you are Things to us – Things whose minds can be read and whose thoughts can be initiated and whose actions can be motivated. Does that surprise you? It goes on all the time. There is some, but far less, free will than you imagine. A Thing does what some Operator wants it to do, only it remains under the impression that its thoughts originate in its own mind. Actually, you have more free will at this moment than most of your kind ever have.'” (p.39)

Another Operator, Bert, explains, “the one great difference between an Operator and a thing is the construction and ability of the mind. Operators are born with special brain cells known as the battlement. With these cells, and Operator can extend and probe into the mind of a Thing. He can tap the thing’s mind and discover what is going on there, and even feed thoughts to the Thing’s mind in order to motivate it. The mental difference is one of ability, not one of quality. Operators, like things, may be stupid or intelligent. But that one difference permits the Operators to rule the Things.” (p.42).

O’Brien was “directed” or “guided” by Operators to buy Greyhound bus tickets to various cities and towns, to seek treatment for some ailments, and to continue to maintain her daily life for six months on the road. She wrote “Operators andThings” three years after she stopped having the hallucinations and delusions, which she has discussed as products of her her unconscious mind – Operators are the unconscious and Things are the conscious. She reflects on her “spontaneous recovery”:

“If I were having a slow time tracking down the cause of my schizophrenia, it was clear that once I had unconsciously understood the cause very well. I could cite a spontaneous recovery after six months of continuous hallucinations and delusions, a certificate of sorts, proof that my mind had found the road out of insanity, a feat that is never accidental. If the guideposts that remained in my memory appeared very often to be too much mumbo-jumbo, it seemed at least possible that the appearance of mumbo-jumbo existed because I could not read the strange language. According the the psychoanalyst who treated me, spontaneous recoveries are rare and weird events in advanced schizophrenia and when they occur they present mysterious spectacle- that of a mind walking out of a fourth dimension into which it had been propelled. No matter how many times I went over the story of the Operators and told myself that it represented only well-organized fantasy without guidance or planning, the clear indications of guidance and planning persisted in standing out.” (p.145)

Both O’Brien and Perceval claimed to have recovered “spontaneously” from their schizophrenia, though both had spent time in mental hospitals. They both are critical of mental hospital treatments and the psychotherapists or psychoanalysts who worked with them. Approaches to treating psychotic conditions were obviously quite different for Perceval in the 19th century and O’Brien in the 1950s, and they would be considerably different now from what they were for O’Brien. Still, there is no known “cure” for schizophrenia and from current accounts by insiders, such as Elyn Saks and Esme Weijun Wang, there are not likely any single approaches , medications, or other treatments which seem to be effective for all cases.