09 Sep IRVIN YALOM: the first psychiatric publication
Toward the end of my first year, a newly published book titled Existence by the psychologist Rollo May came to my attention. It consisted of two long. excellent essays by May and a number of translated chapters by European therapists and philosophers, such as Ludwig Binswanger, Erwin Straus, and Eugene Minkowski. This book changed my life. Though many of the chapters were written in deep-sounding language that seemed designed to obfuscate rather than to illuminate, May’s essays were exceptionally lucid. He laid out the basic tenets of existential thought and introduced me to the relevant insights of Soren Kierkegaard, Friedrich Nietzsche, and other existential thinkers. As I look at my 1958 copy of Rollo May’s Existence, I see notations of approval or disagreement on almost every page. The book suggested to me that there was a third way, an alternative to psychoanalytic thought and the biological model—a way that drew from the wisdom of philosophers and writers from the past 2,500 years. As I browsed through my old copy while writing this memoir, I noted, with great surprise, that Rollo, around forty years later, had signed it and written, “For Irv, a colleague from whom I learn Existential psychotherapy.” This brought tears to my eyes.
I attended a series of lectures on the history of psychiatry. stretching from Philippe Pinel (the eighteenth-century physician who introduced a humane treatment of the insane) to Freud.
The lectures were interesting, but, to my mind, flawed in the assumption that our field began with Pinel in the eighteenth century. As I listened. I kept thinking of all the thinkers who had written on human behavior and human anguish long before—philosophers, for example, such as Epicurus, Marcus Aurelius. Montaigne, and John Locke. These thoughts, and Rollo May’s book, persuaded me that it was time to begin an education in philosophy, so during my second year of residency I enrolled in a year-long course in the history of Western philosophy at the Johns Hopkins University Homewood campus, where Marilyn studied. Our textbook was Bertrand Russell’s popular History of Western Philosophy, and, after so many years of physiological, medical, surgical, and obstetrical textbooks, these pages were ambrosia to me.
Ever since that survey course, I’ve been an autodidact in philosophy, reading widely on my own and auditing courses both at Hopkins and, later, Stanford. I had no idea, at the time, how I would apply this wisdom to my field of psychotherapy. but, at some deep level, I knew I had found my life’s work.
Later in my residency I had a three-month clerkship at the nearby Patuxent Institute, a prison housing mentally ill offenders. I saw patients in individual therapy and led a daily therapy group of sexual offenders—one of the most difficult groups I’ve ever led. The members spent far more energy trying to persuade me they were well adjusted than they did working on their problems. Since they had an indeterminate sentence—that is, they were incarcerated until psychiatrists declared them recovered—their reluctance to reveal a great deal was entirely understandable. I found my experience at Patuxent fascinating, and by the end of the year decided I had sufficient material to write two articles: one on group therapy for sexual deviants, and another on voyeurism.
The voyeurism article was one of the first psychiatric publications on that topic. I made the point that voyeurs did not simply want to view naked women: if voyeurs were to experience great pleasure, it was necessary that the viewing be forbidden and surreptitious. None of the voyeurs I had studied had sought out strip joints or prostitutes or pornography. Second. though voyeurism had always been considered an annoying, quirky, and harmless offense, I found that not to be true. Many inmates I worked with had started with voyeurism and then progressed to more serious offenses, such as breaking and entering and sexual assault.
As I was writing the article, my medical-school case presentation of Muriel came to mind, and just as I had evoked the audience’s interest by beginning that presentation with a story, I began my voyeurism article with the tale of the original Peeping Tom. My wife, while working on her doctorate, helped me retrieve early accounts of the legend of Lady Godiva, the eleventh-century noblewoman who had volunteered to ride naked through the street to save her townspeople from the excessive taxation imposed by her husband. All the townspeople, save Tom, showed their gratitude by refusing to look at her nakedness. But poor Tom could not resist a peek at naked royalty and, for his transgression, was struck blind on the spot. The article was immediately accepted for publication in the Archives of General Psychiatry.
Shortly afterward, my article on the techniques of leading therapy groups for sexual offenders was published in the Journal of Nervous and Mental Disease. Unrelated to my Patuxent work, I also published an article on the diagnosis of senile dementia. Because it was unusual for residents to author publications. the Hopkins faculty responded very positively. Their plaudits were gratifying but also a bit puzzling to me because writing came so easily.
Becoming Myself: A Psychiatrist’s Memoir
Irvin D. Yalom