Tales from the Couch

Seeing the patient from psychiatry’s perspective

A Short Memory

Being on the Same Page

Joe was a private investigator who, long-divorced, lived in a posh apartment on Manhattan’s Upper East Side.

He was a streetwise guy, about 5 feet 10 inches tall, who tipped the scales at 260 pounds. He had lunchbox-sized hands and fingers as thick as rolling pins. Joe packed heat—a .38 bulged beneath his jacket.

Joe came to see me because he was involved in a troubling relationship with a woman who lived upstairs in his building.

He and Peggy were drawn to each other as iron filings are sucked to a magnet. He’d go to her apartment, and they would make love. “It’s the best sex I’ve ever had,” Joe said.

But there was a complication.

“Doc, after each time, she goes crazy. She starts screaming, scratches me, and throws stuff. She even gave me a bloody nose. I hafta run downstairs to my place. I’m afraid I’m gonna lose it—you know, hit her. And the cops’ll come, and I’ll lose my PI license. You gotta help me. I don’t wanna see her anymore. It’s just too dangerous. But I keep going back.”

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I fully understood Joe’s worries. It was clear that with one defensive swipe, Joe could really hurt her. He could be arrested for felonious assault, depending on whatever this obviously disturbed woman might claim.

After a few weeks of meetings, both Joe and I were growing frustrated. No matter what I said about using good judgment and thinking of the consequences of this self-defeating scenario, he couldn’t stay away from Peggy. His urges were just too intense. Great sex trumped his intellect every time.

His chronic mantra was “What am I doing, Doc? Why do I keep goin’ back there? I know what could happen, but I still, I go back. What’s wrong with me?”

It seemed I could do very little to stifle Joe’s testosterone-filled needs, no matter what the possible outcome might be—legal, financial, or otherwise.

Finally, by the eighth week of our sessions, Joe again asked, “Why do I keep goin’ back there? Why?”

“Because the penis has a short memory,” I said.

Joe roared with laughter. Then, barely stifling a smile, he repeated, “The penis has a short memory,” and laughed again.

When Joe returned for his next appointment,, his first words were “The penis has a short memory.” We both smiled, and laughed together.

“Doc, I stayed away the whole week.”

Over the next months, Joe continued to stay away from Peggy and eventually moved to another building. The relationship was over.

It then struck me: when trying to get someone to change, you must talk in language the patient can relate to. My man-to-man joke overrode all the stale psychiatric formulations about letting libido trample intellect and judgment. Yes, sometimes the most successful outcome depends on finding the right words.

 

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

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