Don't miss the third installment of Last Analysis in Marienbad!
It was now the second month of the analysis, conducted 3 days a week. With Fräulein S. now “on the couch,” Kessler felt a bit less exposed to the young woman’s scrutiny—a bit more, as he put it to Otto, “in his element.” Of course, there is a critical interval between the time the analysand arrives at the analyst’s office and the time he or she assumes the classical analytic posture. Fräulein S. invariably used those precious minutes to take in her analyst from head to toe, as if with the sweep of her gaze, she might strip off the protective layer that seemed to envelop the old man. Perhaps she might even garner some clue as to the pain that was etched in Kessler’s face.
From Kessler’s perspective, the analysis had not gone well. While he had grown more comfortable with his own intense reaction to Lotte, he found himself stymied by the young woman’s insistence that, prior to her depressive bout, her life had been “wonderful”—even, as she put it in a recent session, “nearly perfect!” Looking through the records of her 2 previous psychiatric evaluations, Kessler found scattered references to “the patient’s blasé attitude”—"bordering on la belle indifference”—and her “resistance to talking about possible precipitants of the depressive bout.” Both psychiatrists had used a cognitive-behavioral approach to Lotte’s problem, combined with 1 of the standard antidepressants. Though a good deal of evidence supported this approach, it had done little to dislodge the incubus that lay upon the young woman’s breast. Then, at last—in a single session—there was progress.
It began on a day when the pain in Kessler’s finger was especially intense—and this, despite a very large dose of ibuprofen. The ever-vigilant Lotte, trained as a physical therapist, did not fail to pounce, late in the session, even as she lay compliantly on the couch.
“Herr Doktor, I could not help noticing the expression on your face as I entered the office. I can see you are in pain. No one deserves such pain, and perhaps I can help! I often see you rubbing your finger, and…”
Kessler could not help himself. Breaking one of the cardinal rules of psychoanalysis, he interrupted his patient’s train of thought.
“Yes, yes, Fräulein, I have some pain in my finger. I assure you, I am dealing with it, and I thank you very much for your concern. Now, if we may resume…”
At this, the young woman became agitated, and her voice suddenly changed in timbre, sounding more like a child who had just fallen and bruised her knee.
“You know, Opa,” she said choking back tears, “you know that I would do anything—anything!—to stop your pain!” She had used the German word for “grandpa.”
Kessler nearly dropped his notepad. “Fräulein,” he said softly, “you just called me ‘Grandpa.’”
“No, no—you are wrong! I said, ‘Herr Doktor.’ I am quite sure of it!”
“Fräulein, please. I would very much like to hear about your Opa. I know that he was ill and that you were in charge of his care. Please tell me about that.”
She began to weep softly, and Kessler had to restrain his impulse to comfort her, perhaps even to put his hand on her shoulder and tell her, “It will be alright, my love, I promise you!” Instead, he allowed Lotte to tell the story of Opa’s death and her “filthy abandonment,” as she described it.
Her maternal grandfather, at age 84, was in the final stages of metastatic prostate cancer, which had spread to his bones. The doctors had done all they could do, and the goal was simply to keep the old man comfortable and at home. Hospice had been discussed with the family, but vehemently rejected by Opa. A visiting nurse came in twice a week to check on him, but when Lotte’s parents were away, Opa’s care fell to her. Her chief tasks were to make sure her grandfather had sufficient food and drink, and to ensure that his pain medication, a strong narcotic, was administered properly.
“I loved Opa!” Lotte said with a certain vehemence. “The last thing on earth I would wish for him was pain! But that night—the night before he died—I had arranged a date with Lukas. Lukas was…he was my first, you see. I mean, with respect to intimacy. My parents were away on a short visit to some cousins in Prague, and I had intended to slip out of the house for a few hours, but…” She paused to take some tissue from her purse and blew her nose.
“But, well, Lukas’ parents were also away, and we wound up in bed. I found myself spending the night with him and waking with a terrible feeling, almost a premonition. I knew, somehow, that I had sinned against God and my family. We come from good, Lutheran stock, you see, and Opa had very strong views on matters of…well, sensuality.”
“Please go on, Fräulein.”
“In any case, when I returned home the next morning and went to Opa’s room, I…I found…he…he had taken too many of his pain pills, and…”
At this, she began sobbing spasmodically. Again, Kessler struggled to stay in his chair. “I know this is hard, Lotte, very hard,” he said. “But you are doing a very brave thing here today.”
This seemed to calm her. “I think that is the first time you have called me by my name, Herr Doktor—Lotte, the name I like! You know what else? This is the first time I have cried since Opa passed away.”
It was clear that the young woman had blamed herself, all these years, for her grandfather’s death, even though—upon meticulous dissection of the facts—it was equally clear that the number of extra pills her grandfather had swallowed could not possibly have killed him. Kessler had made this point quite forcefully, and Fräulein S. had expressed gratitude for his objective clarification of the facts.
But, of course, “facts” are one thing—the tormented soul, quite another. There was still the young woman’s sense of “filthy abandonment” to work through, and that would take time—time, it turned out, that would not be spent in treatment with Kessler. For at their very next session, which Fräulein S. insisted take place face-to-face, she announced her intention to terminate the treatment.
“I do feel much better, Herr Doktor. Better, in fact, than I have felt in years. And for that, I am grateful. But now, I need to, well, to move on with my life. And so, I must bid you goodbye.”
Kessler struggled with his own feelings about this decision. On the one hand, it would be a tremendous relief to be done with this most unorthodox and uncomfortable “analysis” and to be relieved of the feelings—hardly of a professional nature—that he had developed toward his young analysand. And, yes, even with the pain he had endured these past 5 years, it would be lovely to be back in his comfortable condo in Boston. Perhaps, after 5 years, he would even find the strength to empty Hannah’s closet and to sleep once again in the bedroom they had shared for 20 years, where the tangy scent of bergamot, orange, and lemon still clung to Hannah’s unchanged pillowcase.
On the other hand, Kessler was experienced enough to know a “flight into health” when he saw one.
“Fräulein,” he said with an unexpected huskiness in his voice, “I am very happy to see you in better spirits and feeling, as you put it, ‘like moving on’ with life. And yet, I believe there is still much work to be done: feelings about yourself that still need to be examined and worked through.”
She smiled at him—not a patronizing or ironic smile, but the smile a daughter might lovingly display to her father, or a granddaughter to her grandfather.
“Yes, I understand, Herr Doktor, and I respect your opinion. Perhaps I will take up therapy again if I need to do so. But if you will permit me…and I realize this is not, well, the role of the patient…so please forgive me, but…”
Kessler looked anxious, but spoke calmly. “Please, feel free to say what is on your mind, Fräulein.”
“Well, Herr Doktor, you know that I have been trained as a physical therapist. It is clear to me that you are in considerable pain. It is written in every line and crease on your face. I also notice that you are often rubbing the ring finger of your right hand. As you well know, in Germany, the man wears a wedding ring on that finger…and I am wondering…forgive me, I don’t wish to pry…”
At this, Kessler fought hard against the tears that were welling up, but it was a losing battle. The neurologists and rheumatologists—even the dermatologists—had assured him that there was no physical cause for the constant pain in that finger. Yet for all his psychiatric training, Kessler could not bring himself to believe them. After Hannah’s death, he had removed his gold wedding ring and locked it away, imagining—stupid, stupid old man—that this might help him forget. That it might allow him finally to move on with his life.
Lotte reached into her purse and took out some facial tissue. She rose slowly from her chair, leaned awkwardly over the big mahogany desk, and dabbed the old man’s cheek. “There,” she said softly, “there.”
Kessler, who felt a strange and sudden diminution of his pain, did not protest this most unorthodox end to his analysis.
This story began when I could not get the title out of my head, for days on end. Although I did not realize it at the time, I believe the title was an unconscious nod to the 1961 French-Italian film directed by Alain Resnais, Last Year at Marienbad, which I have never actually seen, but somehow had emotional resonance for me. I have also recently been mulling the vast and controversial issue of unresolved or prolonged grief. Perhaps the unconscious lies at the root of both my story and its inspiration.
Dr Pies is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and editor in chief emeritus of Psychiatric Times™ (2007-2010). Dr Pies is the author of several books. A collection of his works can be found on Amazon.