In Memoriam: Paul Genova, MD (1954-2008)

My friend Paul Genova’s protean life is not easy to wrap in the winding sheet of an obituary.

Paul-who died on December 13th of complications from multiple myeloma-was a man of many talents and sensibilities. Readers of Psychiatric Times will recall, with great fondness, Paul’s column, “No Shows,” which ran between 1993 and 2005. Some readers will be fortunate enough to have read Paul’s brave and prescient book, The Thaw (The Analytic Press, 2002), in which he diagnosed many of the problems besetting psychiatry in recent decades-and which seem only to have worsened since the book appeared. Paul wrote, for example, of the “progressive depersonalization-even de-personing-of the psychiatric profession,” and the urgent need to restore “simple human contact” in the American mental health care system. Neither research scientist nor grand theoretician, Paul described himself as a clinician and “psychiatric journalist.” This was characteristically modest from a man who was at home discussing D. W. Winnicott, Carl Jung, James Hillman, and Jiddu Krishnamurti.

Yet, it is true that Paul Genova always remained anchored to his down­­­-to-earth clinical roots. In his work, as in his writing, Paul stressed that the axioms of the mind must always be gentled by the songs of the heart.

We were most fortunate that in the waning days of his life Paul was able to contribute a superb valedictory piece for Psychiatric Times (“Two Stories We Tell Ourselves About Cancer,” November 2008). In this final column, Paul critiqued our tendency to shape the cancer patient’s life into 1 of 2 constricting narratives: either that of “The Fighter” who “never gives up, never says die”; or that of “The Hero,” who voyages, Ulysses-like, through a “series of drastic losses and perilous tests.” For Genova, both narratives-though well-intentioned-suffered from the same failure to confront hard realities. Both “scripts” require

. . . denial of the randomness, the disproportionate nature, and (in the God version) downright cruelty of the suffering endured, or inflicted upon, patients, even if they die in some more enlightened, loving, and forgiving state-again, the promised “riches”-which is not always the case!

Paul was too tough-minded to abide such sentimental oversimplification. His many e-mails to me (and to a stellar group of friends and loved ones) were always hard-nosed and unsparing of his own foibles, while showing generosity toward the limitations of others. Every now and then, Paul would allow himself a few good-natured complaints-and who wouldn’t complain, with more than 5 years of being poked, needled, infused, and irradiated?

It is not casting Paul in the role of Ulysses to say that throughout his ordeal, he kept his courage and maintained his faith. As he put it in his final column, “I am a person of flickering but persistent faith, a faith based not on the promise of happy endings but instead on recurrent perceptions of an underlying connectedness in things.”

In all his writings, Paul showed us the deep “connectedness” of things and persons. He also taught us about the “mysterious intersubjectivity” of working with patients-the “spontaneous willingness to take a patient in his own terms and his willingness to take me in mine.” (The Thaw, p. 47).

In one of his last e-mails, Paul moved me deeply by asking me to, “Do your best for poor old psychiatry. . . .” I am sure Paul knew that no individual in our profession could carry such a burden alone, and that his plea was meant as an exhortation to all of us, as psychiatrists. Paul ended this message with the words, “Love, Paul.” I confess that I was taken aback by this level of feeling. The truth is, in all the years we corresponded and exchanged writing, I never (to the best of my recollection) actually met Paul Genova face-to-face. Yet, over a period of more than a decade, I felt that he had become a friend-and that, in many ways, we were “kindred spirits.” In his parting message to me, Paul spoke of the importance of cherishing friends and family. And I believe that in his farewell, Paul also left us with an important lesson: love is strong-perhaps even stronger than death.