Tales from the Couch

Seeing the patient from psychiatry’s perspective

All In the Family

When a patient reveals too much

In June 1979, I received a call from a young man. When John and I met, he talked about his father. His dad was a rough-hewn man who belittled and humiliated John, whose self-esteem was crumbling steadily. 

Though he was in his mid-thirties, John still lived with his parents. I soon realized John was dependent on his father. He even worked for him. It was quite clear: despite his protestations, John’s wish was to remain a “boy.”

We established a good working relationship. John opened up, and I could tell he trusted me. He said his father was a mob underboss in a Brooklyn crime family. I took this information in stride, thinking it scarcely mattered. After all, John was trying to grow up and leave the nest.

John told one anecdote after another about his relationship with his father; and we were making progress. John realized that despite resenting his dad, he fostered the situation with his father. 

One evening in mid-July, John entered the consultation room with a knowing smile spreading across his face. 

Find a Therapist

Search for a mental health professional near you.

I waited, thinking something important—perhaps some kernel of insight—might emerge. 

“You wanna know who clipped Carmine Galante…?”

John was referring to a mob rubout of a few days earlier. On July 12, 1979, Carmine “Cigar” Galante, an acting boss in the Bonanno crime family, was dining on the patio at Joe and Mary’s Restaurant in Brooklyn. Suddenly, three ski-masked mobsters burst onto the patio and opened fire, killing Galante instantly. One bullet penetrated his eye.

Everyone in New York knew about the hit, since Galante’s photo had been plastered all over the daily rags: it showed Galante—dead as a doornail—sprawled on the pavement with his head resting against a low brick wall. Stuck in his mouth was his still smoking cigar.

John waited for my response. 

I realized I was in a terrible situation. Did John’s father know he was visiting me? If so, what did he think John told me about the family business? After all, patients tell their psychiatrists many secrets. I suddenly realized no matter what was—or wasn’t said in our sessions—someone in the family could conclude I knew too much…about anything.

“We have to talk,” I began.

John looked questioningly at me.

“I can’t treat you anymore…”

“Why not, Doc?” John looked surprised and disappointed.

“Because I don’t know what your father or any of his associates think you tell me.”

“It’s just between you and me,” he protested.

“True. But other people know you come here, right?”

“Yeah…”

“And we don’t know what they think we discuss.”

John got the point.

That was the last session we ever had.

For some time afterwards, I looked over my shoulder. 

Mark Rubinstein, M.D., is a former professor of psychiatry at Cornell. His most recent book is the novel Mad Dog House.

more...

Subscribe to Tales from the Couch

Current Issue

Just Say It

When and how should we open up to loved ones?