I shared my office on 57th Street with Dr Jacob Ecstein, young (thirty-three), dynamic (two books published), intelligent (he and I usually agreed), personable (everyone liked him), unattractive (no one loved him), anal (he plays the stock market compulsively), oral (he smokes heavily), non-genital (doesn't seem to notice women), and Jewish (he knows two Yiddish slang words). Our mutual secretary was a Miss Reingold. Mary Jane Reingold, old (thirty-six), undynamic (she worked for us), unintelligent (she prefers Ecstein to me), personable (everyone felt sorry for her), unattractive (tall, skinny, glasses, no one loved her), anal (obsessively neat), oral (always eating), genital (trying hard), and non-Jewish (finds use of two Yiddish slang words very intellectual). Miss Reingold greeted me efficiently.
'Mr Jenkins is waiting in your office, Dr Rhinehart.'
'Thank you, Miss Reingold. Any calls for me yesterday?'
'Dr Mann wanted to check about lunch this afternoon. I said "yes".'
'Good.'
Before I moved off to my patient, Jake Ecstein came briskly out of his office, shot off a cheerful 'Hi, Luke baby, how's the book?' the way most men might ask about a friend's wife, and asked Miss Reingold for a couple of case records. I've described Jake's character; his body was short, rotund, chubby: his visage was round, alert, cheerful, with horn-rimmed glasses and a piercing, I-am-able-to-see-through-you stare; his social front was used-car salesman, and he kept his shoes shined with a finish so bright that I sometimes suspected he cheated with a phosphorescent shoe polish.
'My book's moribund,' I answered as Jake accepted a fistful of papers from a somewhat flustered Miss Reingold. 'Great,' he said. 'Just got a review of my Analysis: End and Means from the AP Journal. They say it's great.' He began glancing slowly through the papers, placing one of them every now and then back onto his secretary's desk. 'I'm glad to hear it, Jake. You seem to be hitting the jackpot with this one.'
'People are seeing the light – '
'Er... Dr Ecstein,' Miss Reingold said.
'They'll like it – I may convert a few analysts.'
'Are you going to be able to make lunch today?' I asked. 'When are you leaving for Philadelphia?'
'Damn right. Want to show Mann my review. Plane leaves at two. I'll miss your poker party tonight.'
'Er... Dr Ecstein.'
'You read any more of my book?' Jake went on and gave me one of his piercing, squinting glances, which, had I been a patient, would have led me to repress for a decade all that was on my mind at that instant.
'No. No, I haven't. I must still have a psychological block: professional jealousy and all that.'
'Er... Dr Ecstein?'
'Hmmm. Yeah. In Philly I'm gonna see that anal optometrist I've been telling you about. Think we're about at a breakthrough. Cured of his voyeurism, but still has visual blackouts. It's only been three months though. I'll bust him. Bust him right back to twenty-twenty.' He grinned.
'Dr Ecstein, sir,' said Miss Reingold, now standing.
'Seeya, Luke. Send in Mr Klopper, Miss R.'
As Jake, still carrying a handful of forms, exited briskly into his inner office, I asked Miss Reingold to check with Queensborough State Hospital about my afternoon appointments.
'Yes, Dr Rhinehart,' she said.
'And what did you wish to communicate to Dr Ecstein?'
'Oh, Doctor,' she smiled doubtfully. 'Dr Ecstein asked for the case notes on Miss Riffe and Mr Klopper and I gave him by mistake the record sheets of our last year's budget.'
'Don't worry, Miss Reingold,' I replied firmly. 'This may mean another breakthrough.'
It was 9.07 when I finally settled into my chair behind the outstretched form of Reginald Jenkins on my couch. Normally nothing upsets a patient more than a late analyst, but Jenkins was a masochist: I could count on him assuming that he deserved it.
'I'm sorry about being here,' he said, 'but your secretary insisted I come in and lie down.'
'That's quite all right, Mr Jenkins. I'm sorry I'm late. Let's both relax and you can go right ahead.'
Now the curious reader will want to know what kind of an analyst I was. It so happens that I practiced non-directive therapy. For those not familiar with it, the analyst is passive, compassionate, non-interpretive, non-directing. More precisely, he resembles a redundant moron. For example, a session with a patient like Jenkins might go like this:
JENKINS: 'I feel that no matter how hard I try I'm always going to fail; that some kind of internal mechanism always acts to screw up what I'm trying to do.'
[Pause]
ANALYST: 'You feel that some part of you always forces you to fail.'
JENKINS: 'Yes. For example, that time when I had that date with that nice woman, really attractive – the librarian, you remember – and all I talked about at dinner and all evening was the New York Jets and what a great defensive secondary they have. I knew I should be talking books or asking her questions but I couldn't stop myself.'
ANALYST: 'You feel that some part of you consciously ruined the potential relationship with that girl.'
JENKINS: 'And that job with Wessen, Wessen and Woof. I could have had it. But I took a monthly vacation in Jamaica when I knew they'd be wanting an interview.'
'I see.'
'What do you make of it all, Doctor? I suppose it's masochistic.'
'You think it might be masochistic.'
'I don't know. What do you think?'
'You aren't certain if it's masochistic but you do know that you often do things which are self-destructive.'
'That's right. That's right. And yet I don't have any suicidal tendencies. Except in those dreams. Throwing myself under a herd of hippopotamuses. Or 'potami. Setting myself on fire in front of Wessen, Wessen and Woof. But I keep goofing up real opportunities.'
'Although you never consciously think of suicide you have dreamed about it.'
'Yes. But that's normal. Everybody does crazy things in dreams.'
'You feel that your dreaming of self-destructive acts is normal because...'
The intelligent reader gets the picture. The effect of non-directive therapy is to encourage the patient to speak more and more frankly, to gain total confidence in the non-threatening, totally accepting clod who's curing him, and eventually to diagnose and resolve his own conflicts, with old thirty-five-dollars-an-hour echoing away through it all behind the couch.
And it works. It works precisely as well as every other tested form of psychotherapy. It works sometimes and fails at others, and its success and failures are identical with other analysts' successes and failures. Of course at times the dialogue resembles a comedy routine. My patient the second hour that morning was a hulking heir to a small fortune who had the build of a professional wrestler and the mentality of a professional wrestler.
Frank Osterflood was the most depressing case I'd had in five years of practice. In the first two months of analysis he had seemed a rather nice empty socialite, worried half-heartedly about his inability to concentrate on anything. He tended to drift from job to job averaging two or three a year. He talked a great deal about his jobs and about a mousy father and two disgusting brothers with families, but all with such cocktail-party patter that I knew we must be a long way from what was really bothering him. If anything was bothering him. The only clue I had to indicate that he was anything but a vacuous muscle was his occasional spitting hissing remarks – usually of a general nature – about women. When I asked one morning about his relations with women he hesitated and then said he found them boring. When I asked him how he found fulfillment for his sexual needs, he answered neutrally, 'Prostitutes.'
Two or three times in later sessions he described in detail how he liked to humiliate the call girls he hired, but he would never make any effort to analyze his behavior; he seemed to feel in his casual man-of-the-world way that humiliating women was good, normal, all-American behavior. He found it more interesting to analyze why he left his last job; the office he worked in 'smelled funny.'
About halfway through the session that August day he interrupted his seemingly pleasant recollections of having single-handedly destroyed an East Side bar by sitting up on the couch and looking intensely but, in my professional opinion, dumbly, at the floor. Even his face seemed bulging with muscles. He sat there in the same position for several minutes, grunting quietly to himself with a sound like a noisy refrigerator. Finally he said:
'I get so tied up inside I just have to... to do something or I'll explode,' he said.
'I understand.'
[Pause]
'Do something... sexually or I'll explode.'
'You get so tense you feel you must express yourself sexually.'
'Yes.'
[Pause]
'Don't you want to know how?' he asked.
'If you'd like to tell me.'
'Do you want to know? Don't you need to know to help me?'
'I want you to tell me only what you feel like telling me.'
'Well, I know you'd like to know, but I'm not going to tell you. I've told you about the fuckin' women I've fucked and how they make me want to puke with their snaky wet orgasms, but I guess I'll keep this to myself.'
[Pause]
'You feel that although I'd like to know, you've already told me about your relations with women and so you won't tell me.'
'Actually, it's sodomy. When I get tense – it might be right after I've fucked some white-satin slut, I get... I need... I want to ram the Goddam insides out of some woman... some girl... young... the younger the better.'
'When you're very keyed up you want to ram the insides out of some woman.'
'The Goddam insides. I want to sink my prick up that intestine into that belly through the esophagus up that throat and come right out the Goddam top of her head.'
[Pause]
'You'd like to penetrate through her whole body.'
'Yeah, but up her ass. I want her to scream, to bleed, to be horrified.'
[Pause. Long pause]
'You'd like to penetrate her anus and make her bleed, scream and be horrified.'
'Yeah, but the whores I tried it with chewed gum and picked their nose.'
[Pause]
'The whores you tried it with were neither hurt nor horrified.'
'Shit, they took their seventy-five bucks, shot their ass into the air and chewed gum or read a comic book. If I tried to get rough some guy six inches taller than me would appear in the doorway with a sledgehammer or something. [Pause] I found sodomy, per se [he smiled awkwardly], didn't end my tenseness.'
'You were unable to release your tension by relations with prostitutes when the women seemed to experience no pain or humiliation.'
'So I knew I had to find someone who would scream.'
[Pause]
[Long pause]
'You sought other alternatives to relieve your tensions.'
'Yeah. Fact is I began raping and killing young girls.'
[Pause]
[Long pause]
[Longer pause]
'In an effort to relieve these tense feelings you began raping and killing young girls.'
'Yeah. You're not allowed to tell, are you? I mean you told me professional ethics forbid your telling anything I say, right?'
'Yes.'
[Pause]
'I find the raping and killing of girls helps relieve the tension quite a bit and makes me feel better again.'
'I see.'
'My problem is that I'm beginning to get a little nervous about getting caught. I sort of hoped maybe analysis might help me find a little more normal way to reduce my tensions.'
'You'd like to find a different way to reduce tensions other than raping and killing girls.'
'Yeah. Either that or help me to stop worrying about getting caught...'
* * *
The alert reader may now be feeling that this stuff is slightly too sensational for a typical day at the office, but Mr Osterflood really exists. Or rather existed – more of that later on. The fact is that I was writing a book entitled The Sado-Masochistic Personality in Transition, a work which was to describe cases in which the sadistic personality developed into a masochistic one and vice versa. For this reason my colleagues always sent me patients with a markedly strong sadistic or masochistic bent. Osterflood was admittedly the most professionally active sadist I'd treated, but the wards of mental hospitals have many like him.
What is remarkable, I suppose, is Osterflood's walking around loose. Although after his confession I urged him to enter an institution, he refused and I couldn't order his being committed without breaking professional confidence; moreover no one else apparently suspected that he was an 'enemy of society.' All I could do was warn my friends to keep their little girls away from Harlem playgrounds (where Osterflood obtained his victims) and try hard for a cure. Since my friends all kept their children out of Harlem playgrounds because of the danger of Negro rapists even my warnings were unnecessary.
After Osterflood left that morning I brooded a little on my helplessness with him, made a few notes, and then decided I ought to work on my book.
I dragged myself to it with the enthusiasm of a man with diarrhea moving toward the toilet: I had a compulsive need to get it out but had some months earlier come to the conclusion that all I was producing was shit.
My book had become a bore: it was a pretentious failure. I had tried a few months before to get Random House to agree to publish it when it was finished, imagining that with extensive advertising the book would achieve national and then international fame, driving Jake Ecstein to fury, women and reckless losses in the stock market. Random House had hedged, hewed, considered and reconsidered... Random House wasn't interested. This morning, as on most recent mornings, neither was I.
The flaw in the book was small but significant: it had nothing to say. The bulk of it was to be empirical descriptions of patients who had changed from primarily sadistic behavior patterns to masochistic ones. My dream had been to discover a technique to lock the behavior of the patient at that precise point when he had passed away from sadism but had not become masochistic. If there were such a point. I had much dramatic evidence of complete crossovers; none of 'frozen freedom,' a phrase describing the ideal mean state that came to me in an explosion of enlightenment one morning while echoing Mr Jenkins.
The problem was that Jake Ecstein, car-salesman front and all, had written two of the most rational and honest books about psychoanalytic therapy that I'd ever read, and their import essentially demonstrated that none of us knew or had any likelihood of knowing what we were doing. Jake cured patients as well as the next fellow and then published clear, brilliant accounts demonstrating that the key to his success was accident, that frequently it was his failure to follow his own theoretical structure which led to a 'breakthrough' and the patient's improvement. When I ended my early-morning dialogue with Miss Reingold joking that Jake's reading the 1967 budget record sheets might lead to a breakthrough I was partly serious. Jake had shown again and again the significance of chance in therapeutic development, perhaps best dramatized in his famous 'pencil-sharpening cure.'
A female patient he'd had under treatment for fifteen months with so little success in changing her neurotic aplomb that even Jake was bored, achieved total and complete transformation when Jake, absentmindedly confusing her with his secretary, ordered her to sharpen his pencils. The patient, a wealthy housewife, went into the outer office to obey and suddenly, when about to insert a pencil into the sharpener, began to shriek, tear her hair and defecate. Three weeks later, 'Mrs P.' (Jake's choice of pseudonyms is only one of his unerring talents) was cured.
I, then, was coming to feel that my elaborate writing efforts were only idle, pretentious playing with words for publication.
I thus spent the hour before lunch: (a) reading the financial section of The New York Times; (b) writing a page-and-a-half case report of Mr Osterflood in the form of a financial and budget report ('bearish outlook for prostitutes'; 'bull market in Harlem playground girls'), and (c) drawing a picture on my book manuscript of an elaborate Victorian house being bombed by motorcycle planes piloted by Hell's Angels.