What Happens When the Analyst Dies

Unexpected Terminations in Psychoanalysis

Claudia Heilbrunn

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9780367261061
• eBook ISBN: 9781000022421
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

What Happens When the Analyst Dies explores the stories of patients who have experienced the death of their analyst. The book prioritizes the voices of patients, letting them articulate for themselves the challenges and heartache that occur when grappling with such a devastating loss. It also addresses the challenges faced by analysts who work with grieving patients and/or experience serious illness while treating patients.

Claudia Heilbrunn brings together contributors who discuss their personal experiences with bereavement and/or serious illness within the psychoanalytic encounter. Chapters include memoirs written by patients who describe not only the aftermath of an analyst's death, but also how the analyst's ability or inability to deal with his or her own illness and impending death within the treatment setting impacted the patient's own capacity to cope with their loss. Other chapters broach the challenges that arise (1) in 'second analyses', (2) for the ill analyst, and (3) for those who face the death of an analyst or mentor while in training.

Aiming to give prominence to the often neglected and unmediated voices of patients, as well as analysts who have dealt with grieving patients and serious illness, What Happens When the Analyst Dies strives to highlight and encourage discussion about the impact of an analyst's death on patients and the ways in which institutes and therapists could do more to protect those in their care. It will be of interest to psychoanalysts, psychotherapists, counselors, gerontologists, trainees, and patients who are currently in treatment or whose therapist has passed away.

Part I

Patients

Sub-part I.I

Illness and death within the context of long-term treatments

Chapter 1

Disappearing shrinks

Claudia Heilbrunn

My two therapies mirrored each other in duration and ending: both therapists died before the natural termination of my treatment. My treatments were diametrically opposed in the ways in which each doctor handled letting go not only of life, but also of the patient each treated. Their different ways of saying or of neglecting to say goodbye have greatly impacted my life; their ability or inability to face their own deaths was critical to my own capacity to cope with the greatest losses of my life.

Dr. Cecil Smit

I first met Dr. Smit when I was fourteen years old. I was a depressed and empty teenager struggling with anorexia, which was soon to become bulimia. Dr. Smit became my god and stayed my god until I was compelled, after his death, to look at the disturbingly destructive methods he used in his treatment of me. Dr. Smit laughingly told me and the rest of my family – who were also in treatment with him – to call him Dr. Shit in order to remind us that he was not a god. And yet he knew that he was and enjoyed his position. Dr. Smit was arrogant and “above.” I loved and worshipped him more than anything in the world. He was the first person who told me that I was smart; he was the first person who made me feel loved and valued; he stood up to my mother, and then made fun of her “inanities” behind her back; and he obviously hated my mean older sister and favored me. He told me that I could be like him, one of the elite few. I could enjoy literature, music, and art. I could be happy and not waste my time with the neurotic mental shenanigans and behaviors that controlled the peons of the world. He told me that he could cure me, and I believed him. I wanted more than anything to be cured.

Dr. Smit gave me orders, and I followed all of his commands. When I failed to make sufficient progress, he threatened to kick me out of treatment. When I sobbed and sobbed because I couldn’t stop throwing up, he laughed and told me of the unconscious pleasure I derived from my pain: “For every ounce of conscious misery, there is a pound of unconscious pleasure,” he would say. He told me it was my fault that I couldn’t stop throwing up. That if I really wanted to, I would be able to. I could do it at any time. When I asked him how, he was silent. And yet I knew he was right. Something was wrong with me. I had to work harder, I had to be better, so that I could be loved by – and exactly like – him. I wanted to breathe freely, to be one of the up and above.

Dr. Smit had many orders and dictums that impacted the ways in which I thought and the ways I ran my life. At various times I broke off relations with my family members because he told me I had to do so in order to be healthy. I was not allowed to discuss even a word about my treatment with anybody. In the end, I was a devotee worshipping her savior, and working towards the day when I could be good enough to join him in a life free of neurosis and pain.

His other dictums included telling me, when I was fifteen and during the height of the AIDS epidemic, that I never had to use a condom when having sex. Dr. Smit said that I could not get AIDS because AIDS was psychological, and I did not have the psychological make-up of an AIDS victim. Homosexuals and other people who got it were playing the role of scapegoats for mass anger. Their own self-perceptions caused them to be sick. “Condoms are for sissies,” he would say in his usual arrogant way. At one point he told me that I was getting healthier because I was not friendly with as many gay people as I had once been.

I was utterly dependent on Dr. Smit and would do anything for him. I became for him what he wanted me to be. Dr. Smit told me what to study, which art exhibits to attend, and what was unacceptable for me to do. He also told me what I felt and why I felt it, where I was at fault and what I had done well. My mind worked like a computer ticking off all the things I did that were “healthy” or “neurotic”: if I was tired, I was repressing a feeling; if I sat on my hands, I was angry; if I ate a carrot, I wanted to bite a penis; if I ate a low calorie muffin, I was identifying with my mother, a chronic dieter; if I had a headache, it was murderous rage; and when I sprained my ankle badly before a trip to France, I did it on purpose because I could not allow myself to have anything good. I remember how he laughed and laughed at the sorry spectacle of me crying because of what I had done – me, now a peon again.

I loved Dr. Smit with everything I had. Every thought that I thought and every rule that I followed was because of him. The life that I built was a life dedicated to living the image he envisioned. At the time of his death, I was a straight A student at Columbia University. As he prescribed, I studied Latin, classical literature, and ancient Greece. My future studies were to include the Renaissance, Wagner, and art. Anything less was unacceptable. Any grade below an A meant I was doing myself a disservice. Not meeting his standards meant that I would be nothing again.

And then one day, eleven years into my treatment and seven months into my college career, he announced that he was going away for six weeks. He was leaving the very next day. He also reported to me that I was ready to end therapy. I was fine. And with that statement, Dr. Smit broke the one and only promise that he ever made to me. Years earlier, after he kicked me out of treatment because I was not changing enough, I collapsed in tears outside his front door. He came out of his office, saw me, and brought me back into his treatment room. I was sobbing with anguish, begging him to take me back, pleading with him, “You’re all I have. I have nothing else. I have nobody but you.” He took me back, and at that moment I asked him to promise me that he would never kick me out of therapy again. He promised. And yet, he was now telling me that I was fine and had to leave treatment. I realized that he had lied, but I said nothing. What can you say to protest against God?

Dr. Smit returned six weeks later and, although we had plenty of time to discuss the termination of my treatment, nothing was said. The only comment he made when I asked him why I had to leave was, “You have everything it takes. All you lack is the conviction.” Since everything he said was true, I imagined he was right. “The conviction,” I would repeat to myself after my therapy was done, “All I lack is the conviction, the conviction.”

I don’t remember when I realized that Dr. Smit was sick. It started with a cold and weight loss. It progressed to a white film covering his eyes, a cough which produced a lot of phlegm, and emaciation. “I have a pneumonia,” he said when I asked what was wrong. Most of my questions about his sickness were met either with the answer of silence – as if it was therapeutic to let my questions hang in the air – or with a rhetorical comment that took the spotlight off him and focused it on me: “You are concerned I am sick,” he would say. I had no answer. I was concerned – the truth was that he was right. So I stayed silent. I am a good student. I stopped asking and noticing as I watched him disappear.

I do not remember for how many months I watched. As I think back, I realize it started before he told me he was ending my treatment. The act of watching and remaining silent about what I saw put a fog over me, as if the white film that covered his eyes were now covering mine too. He never told me not to ask him questions, but his answers of silence made his orders clear. Three times a week, I would enter his office and follow the rules. I no longer remember what I talked about; I only remember what was not discussed: the imminent termination of my treatment, his worsening health, and my terror about what was to come.

Weeks before the date set to end my therapy, I sat in Dr. Smit’s waiting room as usual. When the time of my appointment came and left, I began to panic. Not because I was worried, but because if he was not there, I knew I had somehow made a mistake: Had he told me to come at another time? Was something wrong with what I was doing – with my watch? I decided to sit there a few more minutes. Dr. Smit appeared a few moments later. He walked out of his kitchen and into the corridor in front of me. He stood there, obviously in a confused state – as if he were not quite sure of where he was. He was naked, except for a pair of white jockey underwear – the same ones I had seen my father wear when I was young. I stared, shocked at the thinness of his body, the drooping skin that no longer stuck to his muscles and bones. I sat breathless.

As his mind cleared, Dr. Smit looked around quizzically, turned his head in my direction, and suddenly realized what was going on. “Oh my goodness,” he said, and then he disappeared behind the kitchen door. Minutes later he reappeared, in his regular attire, his calm and arrogant self. “You may come in,” he said. I followed him into his office and sat down. The session began. Nothing was said.

During my last session with Dr. Smit, I sat on the floor. It was the second time I actually spoke about the fact that I was never coming back. The first time, I wondered what the last session would be like, and now it was here. On that final day, I told him that he broke his promise to me. He said he had not. “We made an agreement that the treatment would end.” And then for the first and only time in my life I stood up to him. I said that that was a lie. I did not make any agreement: “You made an agreement and told me what it was.” His answer was silence again. I told him that I did not feel ready to end therapy. He said, “If you weren’t ready, you would have started to purge again.” I was amazed: You mean all I had to do was throw up? If I had only thrown up, you would have kept me? I didn’t say it out loud, but not returning to my bulimia became the biggest regret of my treatment. Dr. Smit then told me that I was fine, that I should never seek treatment with another therapist, and that I was never allowed to call him again. I needed no contact. I had everything – all I lacked was the conviction. I wondered for months, while sitting on my bed, not knowing what to do or how to get through the day, how I could get the conviction. And then, after twelve years of seeing him three times a week, it was suddenly done. “Well, goodbye,” I said, and I walked out of his office for the very last time.

I held myself together after Dr. Smit kicked me out of treatment by following all of his rules. I knew people who were still seeing him: my parents had periodic appointments and my friend, Lynne, was still in treatment. I lived for the moments when my mother would return from one of her appointments with Dr. Smit and tell me how his eyes lit up when she mentioned my name. It meant that he still loved me – that he still cared. Dr. Smit’s god-like power was strong enough to keep me on track, albeit internally insane. Outwardly I was fine: I still got my As at Columbia, I still held down my job, and I went on with my life. Inwardly I was falling apart. I sat on my hands when I wanted to binge and purge: “All you lack is the conviction, the conviction,” I repeatedly said. All of his rules ticked off in my head like an internal, pre-programmed computer that kept me on track and kept me from failing at life. I analyzed every feeling and thought that I had, as he had trained me to do. I tried to understand everything that was happening to me. Every thought, every feeling had a reason. It was my job to figure them out. When I was tired, hungry, anxious, out of my skin, or physically ill, I was failing. I was supposed to feel everything in its “authentic” form and then be done with the feeling. I was supposed to come out the other side. Fatigue was my biggest problem because it meant that I was repressing a feeling. The search for what I repressed and the analysis of what I was doing wrong were endless.

A few months after my treatment ended, my friend, Lynne, called me in hysterics. She was downstairs in Dr. Smit’s building. “Claudia, something’s wrong with Dr. Smit. He was taken away in an ambulance. What if he dies?” “Dies!” I responded, “He’s not going to die. He’s still young.” And I believed it. After all, God can’t die. After that, Dr. Smit disappeared. I began calling his answering machine to hear his voice and to make sure that he was okay. I found out a month later that he was in St. Vincent’s hospital. Three weeks after that I called the hospital to see if he was still a patient. They said he was not. I imagined he went home. One week later, my friend, Bob, told me that Dr. Smit was dead. My parents had known for days, but did not have the courage to tell me themselves. They thought I would be “too” upset. Upset does not quite describe how I felt. In fact, nothing can describe it. I did not understand. How could a force that strong be dead? How was it possible that he was not in the world? The only force that kept me standing had vanished.

The pain I felt when Dr. Smit died was beyond any pain that I had ever felt. Even after he kicked me out of treatment, knowing that his force was still in the world, and that he was out there rooting for my wellbeing, kept me afloat. Now, there was nothing for me to hold on to, except for his rules, which were getting harder and harder to follow. After I heard of his death, I spent every minute that I was not at work in bed, listening over and over to a song that somehow reminded me of him. I listened to Dr. Smit’s voice on his answering machine until the “hello” message disappeared. I held my own “goodbye” ceremony during which I read Ezra Pound’s Canto #3, a poem Dr. Smit read to me one day to demonstrate the musicality of its lines. Standing, poem in hand, looking out at the ocean and at sunrise, I said goodbye and waited to feel something, anything, that would make me feel okay. Yet I was spinning out of control and coming closer and closer to bingeing and purging. So for the first time in my life, I disobeyed Dr. Smit. I went to seek help from my sister’s therapist, who gave me a prescription for Prozac and told me that Dr. Smit was abusive. “Do you know how long you’ve suffered for no reason?” she said. “You could have been helped years ago. He was a sadist, a fraud.” She sent me away with a prescription and a recommendation that I read The Drama of the Gifted Child.

Dr. Smit had forbidden me to take anti-depressants. He prescribed them for other people whom I knew, but I was different: I had to become healthy in the same way I became sick – naturally. Taking drugs was somehow impure. The up and above do not use drugs to feel well. Although my parents wanted me to take the medication – they thought that my grief was too intense – I did not. I ripped up the prescription, threw it in the garbage, and celebrated my feat. I could withstand my feelings. I could live my life as Dr. Smit intended me to live. And yet I knew I needed help.

After consulting with a few therapists, I finally came upon Belinda, a lovely social worker who felt safe. Although I did not think she was very smart (after all, whose intellectual ability could match Dr. Smit’s?), she gave me what I needed: a place to go each week and cry. And that is what I did. I cried and cried and cried. I did not understand how the world had not stopped moving, and I needed, somehow, to make sense of how Dr. Smit could disappear. With Dr. Smit dead, the point of life seemed unclear; I was like a religious person who realized that God is dead – or that God never existed at all.

I felt like I could not live until I understood why I was here and he was not, so I went on an active search to figure it out. It was in Seattle, at Mount St. Helens, that I got my first glimmer of understanding. Seeing a little green shoot of grass sprout up amidst what seemed like absolute destruction made me think about the cycle of nature and life, of utter death and destruction and the possibility of rebirth. My next clue as to my reason for staying alive was found at a children’s museum in Vancouver. I saw a short film on evolution and decided that my purpose in life was to take as big a psychological step forward as I could in order to help to give birth to a healthier next generation. I dedicated my life to living out this purpose, of becoming as psychologically healthy as I could.

The process of mourning for Dr. Smit was complicated by my recognition of all the falsehoods he told, for with his death came a harsh reality that I in no way wanted to know. Over the next several years, I slowly awakened to the truth of what had happened during my treatment. When I could finally see it all, that insight ripped to shreds all the rules and dictums on which I based my life: Dr. Smit was gay and he had died of AIDS. All of his anti-homosexual statements were feelings he had about himself. Dr. Smit was not a happy man who lived loftily above the peons of the world. In fact, I eventually realized that, for him, I was a kind of Pygmalion figure; he was trying to make me into the person he could never be. My therapy was a farce. The interpretations that I thought were biblical truths, truths on which I based my life, were all, seemingly, false. The life I created was created for him: I had become a straight A/A+ student at Columbia University who majored in Classical Studies, and who eventually married the “Smitian” ideal: a brilliant and intellectual professor at Columbia.

As I faced the truth of my relationship with Dr. Smit, the foundation of my life crumbled. I recognized, bit by bit, all the lies that he had told. And then the recognition of the harm he did made me completely lose my footing. He made my sister wear a phallus during family therapy so that she would deal with her wish to be a boy – my father’s son; he ordered me to throw up on my parents after they force-fed me, since my bulimia was about my taking in, and then throwing out, their feelings. He told me everything I felt and analyzed everything I did without ever asking about or hearing thoughts and feelings that organically came from me. He dictated the “me” that I was allowed to be and pushed into me all of his own feelings and thoughts. After his death, I did not know which thoughts were mine and which were his. My own and Dr. Smit’s beliefs, points of view, values, and goals were inextricably linked. Was it my brain or his? Tangled, it took years to know.

I knew I was supposed to hate Dr. Smit for all of the damage he did, but the truth was that I still loved and missed him. No longer ...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of contributors
• Preface: introductory reflections
• Acknowledgements
• Introduction
• PART I: Patients
• SUB-PART I.I: Illness and death within the context of long-term treatments
• 1. Disappearing shrinks
• 2. Unfinished business: the impact of denial on the grieving process
• SUB-PART I.II: Sudden death
• 3. The art of grief
• 4. Monumental losses, monumental gifts: analysand and analyst mourn the death of an analyst and friend
• SUB-PART I.III: Inconsolable grief and recovery following the death of a young analyst
• 5. Birth interrupted
• 6. Re-finding a way
• SUB-PART I.IV: Making room for death within the treatment setting
• 7. After the first death, there is no other
• 8. The gift of goodbye and the invisible mourner
• PART II: Practitioners
• SUB-PART II.I: The post-death analyst
• 9. Defenses, transferences, and symbolism after an analyst’s death
• 10. A patient’s and analyst’s self-experiences with shared loss
• SUB-PART II.II: The ill analyst: coping with illness and picking up pieces
• 11. The analyst’s illness from the perspectives of analyst and patient
• 12. Experiences of a bereaved and suffering second therapist: replacing a beloved student therapist and a gay psychoanalyst
• SUB-PART II.III: Psychoanalytic institutes and training
• 13. Death begets growth
• 14. Hidden illness
• Epilogue
• Index