If all Medicine be considered a religion, well, then, the psychiatrist is the cloistered nun, a contemplative whose pale hands are unused save for the telling of beads.
When, years later, I found a copy of a memoir he published after leaving practice, it was not his face that I remembered as I gazed at the dust jacket photo, it was the sapphire stickpin that always speared the same blue and black striped tie, week after week. Our meetings, when I was fourteen, were a brief ritual that we shared, in his effort to mend my family. I always imagined that we drove him from practice, and that, however much he believed himself to be a failure, he never knew how much he contributed to my own entry into the field.
My mother’s psychiatrist, H. Allen Appleman, MD, a clinician and a teacher at the university medical center, had his office in a tall, Victorian-era limestone building in downtown Kansas City. The waiting room was gloomy, except for the yellow light of two brass lamps, which made bright ovals on the dark paneling and on the single door that led to the inner sanctum of his office. Magazines were scattered about a coffee table. Usually, I leafed through Boy’s Life while I waited. My father always drove me to my appointments with Appleman, and he waited in the outer room while Appleman and I talked.
“If I can’t help your mother,” Appleman said to me, the face I barely remember perched above his steepled fingers, “then I’ll help you build some armor against her rages.”
My father told me that after the second visit Appleman had said of me: “He’s a nice boy. A good boy. And if you were a wealthy man, I’d say you should send him away, too.”
Soon after, my sister left home for residential treatment, gone for years. And Appleman dismissed my mother from treatment, my father would later tell me, because he did not believe that she would benefit from his therapy.
I had been curious about Appleman’s felt presence in my life for another reason. For months before my first visit with him, I’d found three-by-five cards scattered mysteriously about the house, each bearing cryptic acronyms in blue-inked capital letters, and each, I later discovered, strategically placed: near the kitchen phone; on top of the counter in my parents’ bathroom; between the drinking glasses on the lower shelf of a kitchen cabinet; nestled between canisters on the kitchen work bench. The cards said ‘DHS.’
My father spilled the beans before my first visit with Appleman. DHS stood for ‘Don’t Harangue Scott.’ The cards were reminders from Appleman to my mother, to curb the fury of her volatile and mercurial moods.
In those days before lithium and depakote, Appleman’s cue cards were Don Quixote’s shield against the fury of manic-depressive illness. But once I understood the meaning of the acronym on those cards, they also became my weapons when my mother’s restraint failed her, not that her quiver lacked for arrows, even without provocation.
One afternoon she stood in the kitchen as I came in from school, a cue card visible to me between the flour cannister and the sugar.
“What are we having for dinner?”
“Am I the fucking maid here?” A pan clattered across the tiled floor.
“He thinks you’re nuts,” I yelled, scared, but standing my ground. “And he’s right; you are.”
I watched rage fly like lightning bolts across her face, and listened to her scream until she retreated to the bedroom, leaving me to make my own dinner.
And when, five years later, my parents divorced, I asked my father if I might visit with Appleman again.
“He retired,” my father told me.
“Really? He isn’t an old man yet.”
“I saw him downtown. I was leaving Talman’s Restaurant, and he was on his way in. He said he was through, that it was getting unbearable for him.”
“He said that?”
“That’s what he said.”
Psychotherapy loomed in my mind like a mountain range, and I the climber, as if the Himalayas rose in the dazzling slopes of my dreams, something brilliant, something dangerous. And so it is.
When she was young, and first hospitalized, I am told that my mother wore a leaf atop her head and chanted that her father was dead, though my grandfather was fit and well at the time. She was sixteen, and the only treatment for mania was voltage – hot, searing, frightening voltage. She would never talk about her ‘summer trip’ away.
Weeks earlier, in pictures taken at her sweet-sixteen party, she is dazzlingly frail, shy and precious in her dusky beauty. Only after she died of an autoimmune disease, alone and broke in a county hospital out in Arizona, did my one surviving great-uncle tell me what Appleman must have known and been powerless to stem; although she was not always manic, she was always unhappy, desperately and irrevocably unhappy.
“Don’t psychoanalyze me,” she said during a visit the summer I entered practice. I had recommended a good psychiatrist to her. “Save that shit for your patients.”
My tongue was anaesthetized.
“Maybe I’ll just kill myself,” she screamed.
The veins across her temples were alive with heat, and my wife fled the apartment in tears.
“Then why the hell don’t you just finally do it and get it over with,” I said, my tongue finally shaking off its immobility.
I never said I was sorry. Instead, I returned to my home on the opposite coast, where that shit that she believed I save for my patients usually helps, but sometimes misses the mark. And when I miss the mark, especially with depressed female patients, I am prone to despondency and self-recrimination, even after twenty years as a clinical psychologist.
Not long after I began my career, I dreamed of Appleman, though he never directly appeared in that night journey. I had seen a patient earlier that day, a woman who awoke from a suicide attempt after three days on a ventilator, disappointed that she was still alive.
“Just give me a reason to live,” she had said, “or let me die in peace.”
In the dream, I am standing in an empty cathedral, its vaulted ceilings rising high, dust motes floating in slanted shafts of brilliant light. The light pours through a single stained glass window, its panes of sapphire blue, crimson, and gold separated by lead strips. There are no pews in this cathedral or synagogue, just hospital beds, old ones, like those one might find in jails. On each bed, there lays a broken strand of shackles, the manacles open. The inmates are gone. Gone, too, are the doctors. All have fled.
In the center of the room, between the rows of empty beds, there is a slight depression in the concrete floor, and a single drain. Water runs in streaks, from the walls, the legs of the beds, across the floor toward the drain. Someone has washed the entire cathedral, then left it.
I hear the drip, drip of water, and I focus on the single sapphire pane and the sky above the colored glass window.
When I wake up, I feel that Appleman has come and gone, the first time in years that I have thought of him.
At a cocktail party for members of the profession, a psychoanalyst I know approaches me, not knowing that I know of his plans to leave the field, disillusioned, and hoping to become a rabbi.
“You know,” he says, lifting a canape from a passing tray, “we all do this work because of our own disturbances. When those disturbances are gone, there’s really no reason to continue.”
“What about Cordova?” I ask, referring to the senior psychoanalyst in the city, a man revered for his rock-steady judgment and clinical wisdom. “He seems like a pretty normal fellow to me.”
“Oh, Cordova,” he says. “Well, he’s the best psychiatrist in the city, now isn’t he?”
“Don’t you think it’s possible that when our own disturbances are finally tamed, we might stay in the game because of altruism, or because we want to learn more about the creatures that lurk in the briny deeps?”
He flags down a white-jacketed server, and lifts a fluted champagne glass from a silver tray. “I’m not convinced.”
I turn away when I see an older colleague, who perhaps knew Appleman. The colleague is a leather-tough Texan, the first board-certified child psychiatrist in Kansas City. Now semi-retired, stooped by heart disease and age, he still practices in the city.
I ask gingerly, not wanting to explain why I am asking.
“Did I know Allen Appleman?” he squints and looks past me. “We shared an office. He was very bright. But he was a loner. And very private. When he left practice, he took all his charts with him. Everything. He didn’t trust his colleagues to keep them. Most unusual.”
“Where did he go?”
“Brazil? You’re kidding. Why Brazil?”
“I think his wife was from there. He just wanted to write books. He’d had it with practice. You know why, don’t you?”
I shrug, and he continues.
“He was very disheartened. He trained at Harvard, and he told me that two of the people in his residency program had died that year, one by suicide, one by heart attack. He didn’t want to join them. He was forty-one when he retired from clinical practice.”
Now it is I who teach young psychiatrists. And though I am established as a teacher and a clinician, I feel more akin to an ancient Kabbalist, as I try, year after year, to explain the secret code of the mind to young psychiatrists lost in this age of fifteen-minute medication checks.
Only a few seem to wonder what bones lie beneath the flesh of their own desires.
In the library at the university medical center, just today, I sit at a carousel, a stack of three-by-five cards fanned out before me. These are the notes for a seminar that I am teaching, for the second-year residents in the psychiatry department. The seminar is on transference and counter-transference, the unconscious geometry that connects people in intimate relationships, including psychotherapy. To understand this geometry is to understand why one does this work.
A teacher of mine had once said, “Transference and counter-transference means this: that the rocks in one person’s head fit the holes in the other’s.”
How to pique their interests, I wonder. How to show the bones, without frightening them away.
I grow restless and I roam the stacks. Two of Appleman’s books are there. I found a third, two weeks earlier, at a bookstore that specializes in out-of-print volumes, and it is in my briefcase. I take the books to the carousel where my notes lie, incomplete and waiting. His memoir was published in 1975, after he left practice, the year I saw my first psychotherapy patient. It is the memoir, not the technical books that I read this afternoon. I read until the afternoon light fades, searching for traces of what happened to Appleman, and finding his footprints between the bodies of patients and colleagues.
“My rosary of suicides has nail-studded beads,” he writes after the suicide of a patient.
When another psychiatrist dies, Appleman is called to the coroner’s office, to verify that the death is a suicide.
Why, he wonders, have so many of his colleagues died this way?
“Who knows?” he writes. “Maybe we know something the rest of you don’t know.”
“Someday, I’m going to write a book titled The Psychopathology of Kansas City Physicians and Their Families. I have plenty of case material in my files. It will be published posthumously.”
Before my mother’s funeral, just this past year, during monsoon season in Arizona, I stand alone under the canopy that houses her coffin, and I recite psalms in Hebrew. I read from a tiny Orthodox prayer book, though we were never observant Jews. The pit before me is a gash in desert sand and dirt. A simple walnut box lies across the green canvas straps. The box will soon be lowered.
The rabbi waits until I finish reading the psalms before starting the service.
“So what kind of woman was your mother?” the rabbi asks before the funeral. My sister and I were honest.
The rabbi gathers the fragments of our memories, and weaves a healing tapestry.
“We must try to understand the deeper meaning of this troubled life,” the rabbi says, “so that we can be informed by that life, and learn to open our own hearts.”
When the funeral is over, the few people there disperse into the desert heat, and I go back to my sister’s home.
The dusk fades and a glittering canopy of stars settles over Tucson. I leave my sister’s home, and wander into the desert until the lights of her home are just a speck on a distant hill. Yucca stalks rattle as I walk.
Is it the wind, or a skittering animal that kicks up wisps of desert dust at my feet? The peyote cactus is in bloom, the pinwheel-shaped, fleshy barrels looking like the cookies my mother made for us when she was well. Heat lightning shivers behind the Catalinas, the mountains visible only as a dark line beneath the edge of the stars.
I walk until I lose sight of my sister’s hill, and I begin to get younger and younger. Here, another cactus looks like the cottage cheese salads my mother made for me after school, the salad shaped like Goofy or Pluto, with olive noses, almond eyes, and thin strips of pimento turned up in a smile. The cactus smiles at me until I am so young that I yield to a space inside of me which must be the heart of what I have become.
“Momma,” I call out. “Momma. Momma.”
Stars fan out over a sapphire sky, lit by crackling spirals of lightning behind the Catalinas. I climb down the sandy channels of an arroyo. Along the floor, the air is finally cool. I keep walking, walking toward those mountains, not knowing if I am chasing her or if I am following Appleman.