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Introspections   |    
Insight
Richard G. Druss, M.D.
Am J Psychiatry 2003;160:1749-1750. doi:10.1176/appi.ajp.160.10.1749
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Lenny Cohen (the names in this essay have been disguised) was 35 years old, married, and had two little children when he began to see me for psychotherapy. He was an account executive ("a fancy name for a stockbroker") at Schreibeck, Gillini, & Olandorff, one of the first discount brokerage houses in New York City. Lenny had attended the firm’s training program but had received no formal education beyond a bachelor’s degree at Columbia University. He had majored in humanities and had hoped to earn an advanced degree in English and eventually to teach the subject. Upon hearing this, his father had recited his mantra, "Gelt is de Welt" ("Money is everything"), and told Lenny, "No one makes money from being a professor." Hence, Schreibeck, Gillini, & Olandorff.

Lenny spoke extensively about his work situation. I heard in exquisite detail about Mr. Gershon, the office manager, and about the four co-workers who were Lenny’s rivals for promotion. Only one of the four would be promoted. Lenny told me about his agony in choosing a holiday gift for Mr. Gershon. Was it expensive enough? Was it too showy? What were Parnell and Levy giving him? Inviting Mr. Gershon to his home for dinner was the subject of many, many therapy sessions. Should little Cathy, 4, and Arthur, 6, sit at the dining table?—a nice family man’s touch. However, Lenny decided that their presence was too unpredictable and settled for having his children greet Mr. Gershon at the door, after which they would be scouped up by Thelma, the babysitter, and taken to their rooms. Should his wife, Helen, a fine cook, do her veal scaloppini, or should she bring in a professional so that Helen could work her charms on Mr. Gershon? The latter scenario was selected, but then Lenny had to coach Helen on topics of conversation to avoid with Mr. Gershon. What should he wear? A tie? A turtleneck?

The dinner went well, but I heard a rehash of the entire evening mouthful by mouthful for the next 2 weeks. Lenny spoke without emotion, thinking aloud in a tedious monologue. I usually felt irrelevant to and excluded from his speeches.

Lenny had always arrived promptly for his appointments and had never missed a session, regardless of the state of his health, the weather, or world events. He was my only patient who did not even mention the final days of the Nixon impeachment proceedings or Nixon’s dramatic resignation.

One day Lenny came in and began the session by telling me, in an offhand manner, that Helen was undergoing evaluation for possible heart surgery. She had had serious rheumatic fever as a child and had recently developed a heart murmur that seemed to be due to scarring of the mitral valve (mitral stenosis). She might well need surgery on her mitral valve. He said that at 8:00 a.m. the next Tuesday she was scheduled to have a cardiac catheterization, which is common these days but was quite risky at the time. The cardiologist would know at once if major surgery would be necessary.

The next Tuesday, I expected to have a free hour during Lenny’s usual time and had already unfolded the New York Times when the doorbell rang. I quickly put the Times under my chair and buzzed Lenny in. He lay down on the couch as usual and began to tell me about the latest doings at S., G., & O. Mr. Gershon had given Levy a compliment accompanied by a big smile that had "Partner" written all over it.

He was droning on when I interrupted, "Pardon me. Wasn’t today the day of Helen’s procedure? Did they cancel it or what?"

Lenny stopped stone cold. He sat up on the couch bolt upright, looked at me, red-faced, and said, "What the fuck am I doing here?"

I replied, "What are you doing here?"

He grabbed his coat, ran out of the office, and took a taxi to the hospital to be at his wife’s side.

During his next session the next day, there were tears in his eyes as he entered, and he cried the entire hour. "What have I let myself become? What has happened to me? Helen and the kids are what really count. I’ve neglected them in favor of some goal I’m not sure I really want anyway."

At the end of the session, he said, "Thank heavens they were late starting the catheterization, so I got there on time. She won’t need heart surgery. She won’t need any surgery at all."

He spent the next 6 months talking to me about Helen and the kids and what they meant to him. He brought in photographs of his attractive wife and his adorable children. He began to question whether money was really everything after all and whether, just maybe, taking a few more courses in English wouldn’t be such a terrible idea.

Address reprint requests to Dr. Druss, 180 East End Ave., New York, NY 10128.

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