Jerry M. Lewis, MD

Patients’ stories (both content and structure) contain more therapeutically useful information than merely identifying and counting symptoms.

I offer all of this as a way of describing how I became involved in intensive psychotherapeutic efforts with several adolescents who I then continued to see, often for many years following their inpatient experiences.

My parents lived in 2 different worlds together. One, the outside world, was where they sparkled. Their business was so successful, and they were urbane, sophisticated, and very smooth. At home, the inside world was very different. They were competitive with each other, more critical than affectionate; there was none of the togetherness they presented to the outside world.

At 47 she was happily married with an 11-year-old daughter and expressed much satisfaction with her work as a masters-level psychotherapist. Her adolescence and young adulthood, however, were different stories, filled with chaos. She described impulsive, promiscuous behaviors beginning at age 13. Heavy drug use began in her late teens, and her parents kicked her out of the house. She fended for herself as a waitress and had a series of relationships with abusive men. As age 30 approached, she began to get herself under control, stopped using drugs, and married a musician she described as “very straight.” With his encouragement, she attended a community college, majored in psychology, and ultimately obtained a masters degree in counseling. Currently she is employed at a public agency for abused women.

Then he fell silent and moments passed. I knew, of course, about his father’s recent death and their stormy relationship. I was moved by his sadness-could feel it within. I found myself thinking about my own father’s death. The silence between us continued, and finally I said, “It is so sad.” His crying intensified; he did not look at me. I felt a teary mist in my eyes and thought, “Now what?” Should I try to stay inside where he was and reflect again on his sadness, or should I back away by offering him a more cognitive level of dialogue? This question-whether to move in or out or, perhaps more accurately, to offer him the choice of where he feels most safe-is at the heart of some forms of psychotherapy. However, as we shall see, this is not the case in all forms.

She paused for a few moments and then responded, "I don't know when children may begin to think their parents are unhappy with each other except, of course, if there are a lot of arguments and fights. My parents didn't argue or fight, but they were not openly affectionate either.

In an earlier column (Psychiatric Times, “The Road Less Traveled,” September 2002, page 14), I emphasized what can be learned from interviewing nonclinical subjects.

Over 55 years ago, I graduated from the then almost new University of Texas Southwestern Medical School in Dallas and went off to Boston and the Brigham to be a straight medical intern. I had been married for 2 years, and my wife was pregnant with our first child-neither of us knew a soul in Boston. I was on duty for 36 of each 48 hours (except for 1 weekend a month) and was of little help to my wife, who was alone in a strange city and was facing the imminent birth of our first child.

He was in his early 60s and a master carpenter who had helped build our house in the east Texas piney woods some 20 years ago. When I asked him about his cousin who had helped him with the house, he paused and then said sadly, "Doc, he just lost his spit."

The idea that there may be genetic influences on how we think about God and politics is usually greeted with disbelief, even scorn. "Ludicrous," was the intense response of a distinguished psychologist-friend upon hearing me explore this topic in a brief paper.

She was 57 years old, widowed with 2 grown children, and was being evaluated as an aspirant for the Episcopal diaconate. An open, warm, and articulate woman, she described the major turning point in her life as her husband's sudden cardiac death when he was 42 and she was 37. "It came out of the blue," she said. "One moment he was here and the next moment he was gone."

There are moments in therapy that seem to have a special, illuminative quality; something important is suddenly revealed. Such moments may come as the result of deliberate observational and interventional processes or may emerge from the therapist's unconscious.

There are occasions in which one's best psychotherapeutic efforts are not effective or help only modestly. If the effort has taken place for a relatively long period, the therapist has several options. One is to ask a colleague for consultation. A second is to reexamine one's understanding of the patient's dilemma.

He was young, schizoid, and had experienced brief periods of psychotic-like disorganization. We worked together in psychotherapy for many years. None of the then available psychotropic agents were helpful. He believed, however, that marijuana was helpful, and, if he smoked a joint in the hours preceding a session, his way of relating to me was different. He was less "there," more deeply into himself. His descriptions of the marijuana experience never varied. "I am," he would say, "at peace. I feel connected to everything. I am part of the universe, part of nature, part of God." He was, I thought, a person with significant ego boundary problems who, for the most part, maintained his basic sense of self by distancing himself from both the world and inner turmoil. Marijuana appeared to lead to the internal experience of greater connectedness and peace, although I felt he was less available to me after using it.

My teachers or supervisors never mentioned God 50 years ago when I was a resident. Psychoanalytic theory dominated the teaching program; in retrospect, the silence about God, religious beliefs and activities, and spirituality in general almost certainly reflected in part an unspoken allegiance to Freud and his negativity about religion.

Adult Growth, Internalizations, and Synaptogenesis

The topic of life's meaning is, of course, a primary issue in existential theory.

In this essay, however, I wish to use another source of data about callings my personal experience of a calling to medicine and, later, to psychiatry.

Should physicians be allowed to assist in their patients' dying, and how can physician-assisted suicide be reconciled with the physician’s role as a healer?

Differences between siblings are affected by internal representations and non-shared environmental influences such as gender, birth rank order, different peer influences, illnesses, and accidents.